Medical Surgical Nursing Specialities Onila Salins
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Communicable Diseases1

 
 
 
Diseases Caused by
Virus
:
Measles, influenza, chickenpox, smallpox, mumps, viral hepatitis, poliomyelitis.
Bacterial
:
Diphtheria, whooping cough, tetanus, leprosy, typhoid, dysentery, gastroenteritis, cholera.
Zoonoses
:
Kala azar, plague, relapsing fever, rabies
Mosquito
:
Malaria, filaria, yellow fever, dengue fever.
Sexually transmitted diseases
:
Gonorrhoea, syphilis, AIDS, chancroid, lympho-granuloma venereum, granuloma inguinale.
 
TERMINOLOGY USED IN COMMUNICABLE DISEASES
 
 
Infection
Entry of an organism development or multiplication of an infectious agent in the body of a man or animal is known as Infection.
 
Infectious Agent
Infectious agents are organism, which cause diseases e.g. Bacteria, Virus, Protozoa, and Parasites.
 
Infestation
The presence of parasites on the surface of the body.
 
Infectious Disease
Disease produced in a man or animal results from an infection, is known as infectious disease.
 
Immunity
The ability of the body to recognise, destroy and eliminate antigenic foreign material to its own.2
 
Communicable Disease
Communicable disease is the one that occurs due to infectious agent or due to toxic product directly or indirectly.
 
Epidemiology
It focuses on pattern of infectious disease.
 
Immunology
Immunology is the study of body's physiological defenses.
 
Epidemiologist
Epidemiologists gather data about a particular disease.
 
Infectious Agent
Infectious agents are organisms capable of causing disease.
DISEASES CAUSED BY THE VIRUS
 
MEASLES (RUBEOLA)
Measles is an acute, highly infectious viral disease characterised by fever, rhinitis, body pain followed by a typical rash. It is a droplet infection.
 
 
Causative Organism
RNA virus belonging to the paramyxovirus group.
 
Aetiology
Commonly affect children below five years. The disease is rare in infants of 6–12 months of age.
It affects both sexes.
Life long immunity occurs with one attack of measles.
Measles is more prevalent at winter in poor environment.
Measles spreads rapidly by droplet infection, droplet nuclei, and direct contact. It is highly infectious during the pre-eruptive stage.
 
Incubation Period
1 to 2 weeks3
 
Clinical Manifestations
Three stages:
  • The catarrhal stage
  • The eruptive stage
  • The convalescent stage
 
The Catarrhal Stage
Fever, coughing, sneesing, general malaise, anorexia, conjunctivitis, photophobia, Koplik's spots appears on the buccal mucosa. It is tiny white papule. It fades away when rash appears.
 
The Eruptive Stage
Maculo popular rash appears 3–5 days from the onset of illness. The rash is bright pink or red in colour. It is first seen on the neck, face and hairline, gradually spreads to the extremities. By fifth or sixth day the rash disappears. At eruptive phase temperature increases, pruritus, hacking cough, lymphadenopathy may occur.
 
The Convalescent Stage
Rash disappears, fever is reduced.
 
Diagnosis
History of the client is taken. Signs and symptoms recorded. History of contact with measles client is taken. Presence of Koplik's spots in buccal mucosa is the sure diagnosis.
 
Investigation
During acute phase virus is identified as large multi-nucleated giant cells.
 
Differential Diagnosis
Disease is differentiated from infectious mononucleosis. Drug eruption toxic erethema, meningococcemia, CNS infection.
 
Complications
Following complications occur:
Respiratory system Pneumonia, severe bronchitis, acute laryngo-tracheo bronchitis, atelectasis.
Alimentary system Stomatitis, post-measles enteritis, abdominal pain.
Nervous system Encephalitis, acute cerebellar ataxia, sub-acute sclerosis, pan encephalitis, behavioral changes, mental retardation, motor disturbance.
 
Others
Thrombocytopenia, bacterial conjunctivitis, corneal ulceration, optic atrophy.4
 
Treatment
Symptomatic treatment is given for measles.
Analgesics, e.g. Metacin, Crocin, Calpol is given for fever.
Application of anti-pruritic agent helps to relieve itching.
Clean eyes with warm water.
To decrease cough, codein is prescribed.
In catarrhal stage give fluid diet consisting of milk, fruit juices, and later well balanced diet is given.
 
Prophylaxis
Live measles vaccine given within 72 hours of exposure provides protection.
Immunoglobulin is given within six days of exposure followed by live vaccine after three months or one year or five months gives protection.
 
Prevention
Measles vaccine…MMR is given when child is nine months old.
 
INFLUENZA
Influenza is a febrile respiratory infection caused by A, B, C virus belonging to Orthomyxo- virus and spreads by droplet, droplet nuclei. It occurs in epidemic or pandemic form.
 
 
Aetiology
It affects all ages.
It commonly occurs in summer during winter and spring.
It spreads rapidly in overcrowding environment.
Both sexes are commonly affected.
 
Incubation Period
Incubation period is 24 to 72 hours.
 
Clinical Manifestation
There is sudden onset with fever, chills and headache, body pain, coughing, generalised weakness and prostration.
 
Diagnosis
Take history, many members in the family will be affected at the same time.
 
Treatment
Symptomatic and supportive treatment is given. Maintain hydration by providing fluid such as milk, juices, and soups. Provide well-balanced diet. Analgesics is given to reduce temperature.5
 
Prophylaxis
Administer Amantadine hydrochloride in dosage of 4–9 mg/kg/day three times a day to children who are exposed to Influenza.
 
Prevention
Influenza vaccine recommended for the person suffering with chronic diseases, elderly persons, doctors, and nurses.
 
CHICKENPOX
Chickenpox is highly contagious viral infection caused by Herpes virus varicella zoster characterised by fever, pain in the back, shivering and malaise, lesion with a centripetal distribution.
 
 
Aetiology
Chickenpox is commonly seen in children under the age of 10 years.
One attack gives immunity.
It spreads by direct contact with an infected individual.
It is a droplet and droplet nucleii, spreads through the fomites, i.e. articles used by the patients.
 
Incubation Period
Incubation period is 7 to 21 days.
 
Clinical Manifestation
Onset is abrupt. The prodromal symptoms are mild fever, back pain, and shivering. General malaise occurs within 24 hours of prodromal symptoms by eruption. Lesions are superficial, polymorphic and have dew drop appearance. Lesions have centripetal distribution. It is dense over the trunk, back and few over the hands and distal parts of the body.
 
Diagnosis
Diagnosis is done by taking history of clients signs and symptoms, history of contact with infected person.
 
Treatment
Symptomatic treatment is given.
Antipyretics is given for fever.
Antihistamine for control of itching.
Antipruritic lotion is applied to relieve itching.
Antibiotics is prescribed to control secondary infection.
To prevent scratching in children apply mittens.
 
Prevention
There is no vaccination available. Protected vulnerable group by giving gammaglobulin. Follow isolation technique.6
 
Complications
The major complications are encephalitis, pneumonia, cellulites, abscess, impetigo, rare complication are hepatitis, optic neuritis.
 
SMALLPOX
Smallpox is a highly communicable disease caused by variola virus. It is characterised by hyperpyrexia, severe headache, and severe prodromal symptoms. On the third day a typical centrifugal lesion, which is dense on the face and limbs, palms and soles, is involved. It is eradicated now.
 
 
Aetiology
Very highly infectious disease from the beginning. It affects all ages and both sexes. Life long immunity occurs with one attack of smallpox. It spreads by direct contact, through fomites droplet infection. The reservoir of infection is a human case. There is no animal reservoir.
 
Incubation Period
Incubation period is 7 to 17 days.
 
Clinical Features
Clinical manifestation is seen in two stages:
  1. Pre-eruptive stage
  2. Eruptive stage.
 
Pre-eruptive Stage
Very high pyrexia 100 to 105 degree Fahrenheit severe headache, body pain, in children vomiting delirium and convulsion occurs. This stage lasts for 2–4 days.
 
Eruptive Stage
Rash appears on the 3–4 days of illness. It is dense on the face and extremities. Lesions are deep seated, circular firm. Rash in macule form within a day papule is formed. Fluid collects and lesion becomes vesicles by 7–8 days. On 14 days crust forms. Temperature falls at the appearance of the lesion and starts increasing when pustule appears.
 
Classification
It is classified as:
  • Ordinary
  • Modified
  • Flat type
  • Haemorrhagic.
 
Complications
Following complications seen: neurological complications, cutaneous complications, post-vaccinal osteomyelitis.7
 
Treatment
Treatment includes strict isolation and notification to MCH district health department. Disinfect all fomites, search for cases.
 
Prevention
Smallpox is eradicated by vaccination.
 
MUMPS
Mumps is an acute communicable disease caused by ‘a virus. It is characterised by enlargement of salivary gland.
 
 
Aetiology
It is caused by para-myxovirus.
Patients suffering from mumps are the main source of infection.
It is commonly seen in children in the age group of 5 to 15 years.
Mumps spreads by droplet infection and by fomites.
 
Incubation Period
Incubation period of mumps is 14 to 21 days.
 
Clinical Features
In prodromal phase client complains of fever, sore throat, earache, and pain on chewing and constitutional symptoms lasts for 3 to 5 days. Tenderness is felt beneath the jaw, redness and oedema of the parotid gland is present. It is painful and tender to touch.
 
Treatment
Symptomatic treatment is given. Client is isolated, bedrest is given.
Analgesic is given to control pain. Antipyretics is given to control fever.
Fomentation or application of cold compresses helps in reducing fever and relieving pain.
 
Complications
Complications such as meningoencephalitis, pancreatitis, orchitis, ovaritis, myocarditis is seen.
 
Prophylaxis
Prevent infection Gammaglobulin 2–3 ml to be given soon after the exposure to the mumps.
 
Prevention
MMR combination of measles, mumps and rubella vaccine is given when the child is nine months old.8
 
VIRAL HEPATITIS
Hepatitis is the inflammation of the liver. There are three types of viral hepatitis.
  • Hepatitis A
  • Hepatitis B
  • Hepatitis non A and non B
 
 
Causative Organism
Viral hepatitis is caused by Epstein-Barr virus, Cytomegalovirus, rubella, herpes simplex, varicella, retrovirus, Yellow fever virus, Coxsackievirus, Adenovirus or Marburg virus.
 
Hepatitis A
Hepatitis A is also known as short incubation hepatitis.
 
Causes
Hepatitis A is caused by drinking contaminated water and milk and by eating food, and shellfish.
 
Aetiology
Commonly affects under 15 years of age group. It is transmitted through feco-oral route.
 
Incubation period
Incubation period of viral hepatitis is 15 to 45 days.
Viral hepatitis spreads from person to person by close contact and through fomites. It is a low mortality disease.
 
Hepatitis B
 
Aetiology
High incidence in overcrowding places, poor hygienic environment, healthcare workers are at high risk, multiple blood transfusions in cases of dialysis, common in homosexuals, common in morticians, common in persons, who undergo tattooing, common in parenteral drug users.
 
Hepatitis Non-A and Non-B
Hepatitis non-A and non-B is caused by an unidentified virus. It is transmitted parenterally through blood, by personal contact.
 
Incubation Period
Incubation period is 7 to 8 weeks.
 
Investigation
Blood test is done for SGOPT and SGPT, protein, glucose and prothrombin. SGPT and SGOT is 9elevated. Serum protein is normal. There is hypoalbuminemia, hypoglycemia and reduced prothrombinemia occur in serious condition. Bilirubin rises above 2.5 mg/100 ml.
 
Clinical Manifestation
Symptoms of viral hepatitis include lethargy, irritability, myalgia, anorexia, nausea vomiting, abdominal pain and diarrhea, constipation. Jaundice eye, dark urine, clay colour stool, and hepatic encephalopathy liver flap occurs in serious condition. Anaemia, hypoglycaemia may occur.
 
Other Problems Includes
Gastrointestinal bleeding, disseminated intravascular coagulation, fever with leukocytosis, neutrophilia, hepatorenal problem, oliguria, oedema, ascites hypotension, respiratory failure, hypoglycemia, respiratory and urinary tract infection.
 
Treatment and Management
  • Advised bedrest, low fat and protein diet and high carbohydrate diet.
  • Antipruritic ointment is applied to reduce itching.
  • Antiemitics is prescribed to decrease vomiting.
  • No antibiotic is prescribed.
 
Prevention
Maintain personal hygiene. Food handlers must wash their hands before handling food. Treat drinking water supply. Monitor public eating-places.
Immunoglobulin is given as passive immunisation.
 
Hepatitis B is Prevented by
Hepatitis B vaccination is given. Maintain good personal hygiene. Donor's blood is screened before use. Avoid paid donors for blood requirement.
 
POLIOMYELITIS
Poliomyelitis is an acute communicable disease caused by enterovirus.
 
 
Mode of Spread
Poliomyelitis spreads by flies, sewage, contaminated milk and water.
 
Aetiology
Man is the only reservoir of infection. Virus is found in human faeces, throat swab. It affects children below 5 years. Severe fatigue predisposes the polio attack. Infant born to immune mother escapes infection. Commonly occurs in June and September month.
 
Incubation Period
Incubation period of poliomyelitis is 7 to 14 days.10
 
Clinical Manifestation
No clinical symptoms.
1. Abortive polio
Fever
2. Non-paralytic
Central nervous system is affected, head meningeal irritation, vomiting, pain in the neck, stiffness but no paralysis, child assumes tripoid position while sitting.
3. Paralytic polio
Spinal cord is involved, paralysis occurs after a 4 day fever, muscle pain, tenderness, no sensory loss, loss spinal cord, lower extremities, upper limbs are involved, abdominal muscles are also involved. Paralysis occurs temporarily, constipation is common.
4. Bulbar form
Cranial nerve is involved. Involvement of ninth and second cranial nerve results in pharyngeal and laryngeal paralysis; facial nerve also gets affected in few cases.
5. Respiratory form
Ninth and tenth cranial nerve is affected in bulbar polio. Vagus nerve is affected causing laryngeal spasm and vocal cord paralysis. In spinal polio respiratory muscle, diaphragm is involved.
6. Encephalitis form
Client will be drowsy and mental changes seen.
 
Diagnosis
Diagnosis is done on the basis of muscle pain, stiff neck, fever, nausea, vomiting, paralysis of the limb, muscle wasting and epidemic in the area which indicates polio.
 
Investigation
Blood is taken for WBC count. It is normal or elevated. CSF is examined. It is under tension, Virus is isolated.
 
Management of Poliomyelitis
 
Acute Stage
Strict bedrest advised as exertion precipitates paralysis. To relieve muscle spasms and discomfort apply hot pack, administer analgesics. Maintain body alignment. Keep wooden board under the bed. Keep footboard to prevent foot drop. Provide adequate hydration. To prevent retention of urine use nursing technique to pass urine such as hot and cold application over the bladder, keep tap open and let the water flow. It stimulates the person to pass urine.
 
Bulbar Polio
Head is kept low by raising the foot end of the bed. Place the child in prone position keep the airway clean. Tube feeding is suggested. Intravenous drip is started in serious condition. In case of respiratory failure child is put on a respirator.
 
Convalescent Stage
Advised physiotherapy, exercise is planned, rehabilitation and suggested correctional orthopaedic surgery.11
 
Prevention
Improve environmental sanitation. Oral Sabin's polio vaccination is given on mass scale. Infants are vaccinated. Contacts should be confined to bed. In epidemics febrile condition should not be neglected. Avoid tonsillectomy during epidemic of polio. Government of India has started Expanded Immunisation programme.
BACTERIAL INFECTION
Bacterial infections are diphtheria, whooping cough, tetanus, leprosy, typhoid, dysentery, gastroenteritis, and cholera.
 
DIPHTHERIA
Diphtheria is an acute communicable diseases caused by Corynebacterium diphtheria. It affects nose, face, larynx, conjunctiva, skin and trachea. It is characterised by formation of white gray patch on tonsil, general malaise, low grade fever, sore throat, signs and symptoms of toxaemia.
 
 
Aetiology
It is primarily the disease of the children below ten years. Commonly occurs in winter and autumn month. It is caused by corynebacterium diphtheria belonging to Klebs-Loeffler bacteria. It spreads by fomites such as eating and drinking utensils, handkerchief, towels, thermometer, toys, pencils, nose and throat secretions. Infant born of a mother who is immune to diphtheria. Child will be protected for few months. High incidence of diphtheria occurs in overcrowded environment.
 
Mode of Transmission
Diphtheria is transmitted through droplet infection, droplet nuclei, and fomite.
 
Types of Diphtheria
The clinical type includes nasal, facial, pharyngeal, laryngeal, laryngotracheal, conjunctival, skin, and genital type.
 
Clinical Manifestation
Diphtheria is manifested as mild fever, nasal discharge which is foul smelling, difficulty in breathing, excoriated nostril and upper lips.
 
Tonsillar and Pharyngeal Diphtheria
Tonsillar and pharyngeal diphtheria is manifested as low grade fever, sore throat, difficulty in swallowing, whitish gray patch on tonsils, enlargement of lymph gland. In serious cases, there is respiratory and circulatory failure, coma and death occurs.12
 
Laryngeal Diphtheria
In laryngeal diphtheria larynx is involved, noisy breathing, difficulty in breathing, brassy barking cough, hoarseness of voice, progressive stridor, subcostal suprasternal and supraclavicular retraction occurs, restlessness, cyanosis. Child looks very sick.
 
Treatment
Anti-diphtherial antitoxin is prescribed. Strict isolation technique is followed, client is advised to take strict bedrest. Adequate hydration is maintained. Tracheostomy is performed to relieve obstruction. Oxygen therapy is given in case of congestive cardiac failure digitalis, Guinidine and prednisolone is administered to treat myocarditis. Tube feeding is given. Intravenous drip is started. Nothing by mouth is given. It is highly infectious disease secretion is burnt. Articles used by the client is disinfected.
 
Drug of Choice
Procaine penicillin 4–6 lacs units for 7–10 days. Amoxycillin, Rifampicin, Clindamycin or Erythromycin is administered.
 
Prevention
Prevent diphtheria by administering three doses of triple vaccination. Two booster dose of DPT at 18 and 24 months and DT at five years. Carriers are treated with procaine penicillin. Contacts are examined for throat culture and positive cases are treated.
 
WHOOPING COUGH
Whooping cough is also known as pertusis. It is highly infectious communicable disease of respiratory tract. It is caused by bordetellapertusis. It is characterised by paroxysmal cough, and vomiting.
 
 
Aetiology
It is the disease of the infants and children. Male and female are affected equally.
 
Incubation Period
Incubation period is 7–14 days.
 
Mode of Transmission
It is spread by droplet, droplet nuclei and persons who are affected by the disease.
 
Clinical Manifestation
Onset of the disease is insiduous. Mild fever, anorexia, nocturnal cough, is replaced with paroxysmal cough which lasts for 4–6 weeks. Cough is triggered of by crying feeding, excitement, emotional disturbances. In serious cases, syncope, convulsion and exhaustion occurs.13
 
Complication
Complications of whooping cough are bronchitis, bronchopneumonia, bronchiectasis, subconjunctival haemorrhage, epistaxis, haemoptysis, cerebral haemorrhage.
 
Investigation
Blood is sent for WBC count. It is low during initial stage and elevated later on.
ESR is very low. X-ray shows patchy area of segmental atelectasis. B pertusis is seen in culture.
 
Differential Diagnosis
It is differentiated from leukaemia, foreign body in the respiratory tract, tuberculosis, influenza, cystic and fibrosis.
 
Treatment
Symptomatic treatment is prescribed. Cough suppressant is prescribed at nighttime to induce sleep. Drugs prescribed are Chlorpheniramine hydrochloride, Oxeladine citrate, Anti-spasmodic and sedatives prescribed. To maintain nutrition give frequent small meals between the cough. Advise bedrest. Administer antibiotics to prevent infection.
Infection is controlled by administering drugs such as ampicillin, chloramphenicol, erythromycin.
 
Prevention
To prevent whooping cough, three dose of tripple vaccine of DPT is given within one year and booster dose is given at 18 and 24 months.
 
TETANUS
Tetanus is an acute disease caused by the aerobic spore forming Clostridium tetani. Disease is characterised by painful muscular spasm which begin with trismus of the jaw muscles and spread to neck, trunk, limbs, and the respiratory muscles, pharyngeal muscles, slightest stimuli causes spasms.
 
 
Aetiology
Causative organism of tetanus is Clostridium tetani. It produces exotoxin which affects nervous system, spinal cord, brain, sympathetic nervous system. It affects 5 to 40 years, commonly seen in agricultural workers, major and minor injuries, deliveries conducted in unhygienic condition. Tetanus is higher in males than in females, poverty unhygienic customs and habits.
 
Mode of Transmission
Tetanus is transmitted by umbilical cord sepsis, middle ear infection, contaminated wounds, surgical treatment.14
 
Incubation Period
Incubation period is three to ten days.
 
Type of Tetanus
Tetanus is classified as Traumatic, Puerperal, Otogenic, Idiopathic, Tetanus neonatorum.
 
Clinical Manifestation
Generalised signs and symptoms are lockjaw, external stimuli such as touch, loud sound, bright light, strong breese stimulate spasms. Difficulty in swallowing, restlessness, irritability, headache.
Rhesus sardonicus…rigidity of back muscles, upper limb abducted and extended.
Respiratory distress and laryngeal muscle spasm. Constant muscle spasm causes fractures of vertebral column and spinal cord compression. Temperature is found to be normal to hyperpyrexia. Hypertension, sweating, tachycardia, and arrhythmia occur due to sympathetic nerve involvement.
 
Grade
1. Grade….
Incubation period less than one week.
2. Grade….
Period of onset is less than 48 hours.
3. Grade…
Lock jaw.
4. Grade….
Temperature above 40 degree C.
5. Grade….
Continuous spasms.
 
Local Tetanus
Pain and spasms are caused in particular areas only, e.g. Otitis media only facial nerve is involved. Local manifestation may become generalised.
 
Diagnosis
Diagnosis is done on the basis of history of wound and injury. Attempt is made to open the mouth. Patient keeps the mouth tightly closed.
 
Differential Diagnosis
Tetanus is differentiated from parotitis, alveolar abscess, retropharyngeal abscess.
 
Treatment
Administer Human Tetanus Immunoglobulin 3000–6000 unit. Anti-tetanus serum. Sedatives and muscle relaxant is administered to control the muscle spasms. Laryngeal spasm causes asphyxia tracheostomy is done in case of persistent respiratory distress. Provide well balanced diet. In serious condition intravenous drip is given. In mild cases tube-feeding is given. Oral hygiene is taken care to prevent parotitis, foul smell. Personal hygiene is met. Change the position. All procedures should be done at a time15
 
To Prevent Spasms
Keep client in dark room without noise. Oxygen therapy is given in case of cynosis. Treat local wounds.
 
Prevention
Below one year all children should be immunised with three doses of DPT and booster dose of DPT 18–24 months DT is given after five years at interval of six weeks. To prevent tetanus in pregnancy and post-natal period tetanus toxoid is given in two doses at six weeks interval. This also prevents tetanus in neonatal period. In case of accidental injuries tetanus toxoid is given and after six weeks repeated. In case of deep cuts and serious injury tetanus immunoglobulin is administered.
 
Health Education
Educate the people about cause prevention and treatment of tetanus.
 
LEPROSY
Leprosy is also known as Hansen's disease. It is a chronic contagious communicable disease caused by Mycobacterium leprae. It is characterised by hypopigmented patches, loss of sensation, thickness of nerve and logophthalmus.
 
 
Aetiology
Leprosy is caused by Mycobacterium leprae. Man is the only source of infection. It is commonly seen in male than female. Only few people exposed to infection develop leprosy. High incidence of leprosy found in caucasian race. It is more common in lower socioeconomic group, low standard of living, poverty, overcrowding, poor personal hygiene. Commonly occurs between 5–15 years and 25 and 30 years. High incidence of leprosy is seen in tropical climate.
 
Mode of Transmission
Leprosy is transmitted by direct contact through nasal secretion. It is spread by fomites, article used by the client. Mosquito bite and rubbing the area can spread the disease.
 
Clinical Manifestation
Leprosy is manifested as depigmentation patch, anaesthesia, loss of sweating, loss of hair, nerve involvement.
 
Classification
Leprosy is classified as:
  1. Lepromatous leprosy
  2. Non-lepromatous leprosy
    1. Tuberculoid
    2. Maculoanaesthetic
    3. Polyneurotic16
  3. Borderline leprosy
  4. Indeterminate leprosy.
 
Lepromatous Leprosy
Lepromatous leprosy is highly infectious leprosy. The lesions appear on the face ear lobe. Nodules of different sise appear and gives typical facial appearance. Peripheral nerves are involved.
 
Non-lepromatous Leprosy
Non-lepromatous leprosy the lesions are localised to skin and the nerves.
Tuberculoid leprosy Tuberculoid leprosy involves face, gluteal region of the limbs, ulnar, peroneal and greater auricular nerve. They are thickened. There is sensory loss, claw hand, foot drop seen. Logophthalmus present.
Maculoanaestheitic leprosy In maculoanaesthetic leprosy hypopigmented anaestheitic patches seen over the legs, hands, face. There is loss of sensation. It is bacteriologically negative.
Polyneurotic leprosy In polyneurotic leprosy the regional peripheral nerves are thickened. Loss of finger and toes sensation occurs.
 
Boderline Leprosy
Boderline leprosy develops from interminate phase and tuberculoid leprosy. It causes erythematous thick raised lesion which, is anaesthetic in nature. Loss of hair is present. Lepra bacilli is positive.
 
Indeterminate Leprosy
There is a presence of ill-defined pale and maculeal skin lesion with slight sensory loss. It is self healing.
 
Diagnosis
Whole body is examined for hypopigmented patch, loss of sensation and thickening of nerves. Loss of sensation is tested for heat, cold, pain, and light touch.
Bacteriological examination is done, Skin and nasal smear is taken for examination for more accurate classification skin biopsy is done. Lepromine test is performed Inject intradermally 0.1 ml of lepromine or lepra antigen. Examine the reaction at the end of 48 hours. Early reaction shows erythema enduration at the end of 48 hours. Delayed reaction at the end of 21 days shows nodules more than 5mm as positive.
 
Differential Diagnosis
Differentiate leprosy from nutritional hypopigmentation, post kala azar, sarcodosis, gyrate psoriasis, dermal leishmaniasis.17
 
Treatment
Drug of choice for leprosy is Diamine Diphenyl Sulphone or Dapsone. Multi-drug therapy prescribed. It includes Rifampicin, Clofaximine, Dapsone.
 
Prevention of Leprosy
BCG vaccination is given to all infants. Improve sanitary condition and environment. Improve socioeconomic condition of the people.
 
Leprosy Control
Leprosy control includes case finding, chemotherapy, follow-up of cases, selective isolation of cases, chemoprophylaxis to the contacts, immunoprophylaxis, prevention of disabilities, health education. Social measures, research.
 
Case Finding
Cases of leprosy is identified by house to house survey, school health programme school children are examined for cases.
 
Chemotherapy
Drugs for leprosy is prescribed.
 
Follow-up of Cases
All cases are followed-up at home. Medications are distributed. Side effects noted.
 
Isolation
Infective cases are isolated in the hospital and treated. They are kept in the hospital till they are negative.
 
Prophylaxis
Prophylaxis dose of Dapsone is administered.
 
TYPHOID
Typhoid is an acute communicable disease caused by Salmonella typhi. It is characterised by headache, malaise, prolong fever, enlarged spleen and liver.
 
 
Aetiology
Causative organism of typhoid fever is Salmonella typhi. Man is the only reservoir of infection. Typhoid may occur at any age. It commonly affects 10–30 years. More access is seen in male than female. One attack of typhoid gives fare amount of immunity. Peak incidence of typhoid is seen in the months of July, August and September. Lack of safe drinking water, poor sanitation, open defaecation low standard of personal hygiene, health practices and literacy causes typhoid.18
 
Incubation Period
Incubation period of typhoid is 0–21 days.
 
Mode of Transmission
Typhoid is transmitted through direct contact, flies, fomites faeces (stool) contaminated water, milk and vegetables.
 
Clinical Manifestation
Typhoid is manifested as insiduous onset, mild fever, headache and rigour.
 
Stages of Typhoid
There are three stages:
  1. The prodromal stage
  2. The fastigial stage
  3. The defervascent stage
 
The Prodromal Stage
During prodromal stage patient complains of headache, abdominal pain, constipation, or diarrhoea, temperature shows step ladder pattern, evening temperature is higher than the morning temperature. General malaise is seen.
 
The Fastigial Stage
Fastigial stage fever lasts for 7–10 days. It is continuous, pea sop stool person looks very ill.
 
The Defervascent Stage
Temperature reaches normal. Most of the symptoms disappears. Relapse may occur.
 
Complications
Haemorrhage, perforation, bacterial pneumonia, septicaemia, urinary tract infection furuncle bedsore occurs in malnutrition, apathy, mental depression, stupor delirium in toxic condition are seen.
 
Diagnosis
Blood urine and stool sent for examination. Isolate organism in blood, stool and urine. Widal test shows positive.
 
Differential Diagnosis
Differentiate typhoid from infective diarrhoea, pyelitis, acute malaria, tuberculosis, glandular fever and brucellosis.19
 
Treatment
Chloramphenicol is the drug of choice. Follow isolation technique. Provide well balanced diet. Maintain fluid balance. Change position every two hours to prevent bedsore. Every four hours mouthwash is given to prevent parotitis. Disinfect excreta, fomites. Complete bedrest is advised.
 
Prevention
During epidemic typhoid vaccinate with TAB vaccine. Improve environmental sanitation. Provide pottable(drinking) water. Chlorinate water. Improve food hygiene. Proper disposal of excreta and waste is planned and implemented. Educate the public regarding cause spread, treatment and prevention of typhoid.
 
DYSENTERY
Dysentery affects the large intestine. It is characterised by the passage of the blood and mucous, abdominal cramp, mild to severe fever.
 
 
Types of Dysentery
There are three types of dysentery:
  1. Shigellosis (Bacillary dysentery)
  2. Amoebiasis
  3. Giardiassis.
 
Shigellosis (Bacillary Dysentery)
Bacillary dysentery is an acute infection of the large intestine. It is characterised by abdominal colic, headache, weakness, intense diarrhoea. Prognosis is good.
 
Aetiology
Dysentery is caused by Shigella organism. It is commonly affects infants than the adults. It is very common in overcrowding, poor sanitary condition, poor personal hygienic condition.
 
Incubation Period
Incubation period of dysentery is 2–7 days.
 
Mode of Transmission
Infection is transmitted through the contaminated food, milk and water.
 
Clinical Manifestation
Dysentery is manifested as abdominal colic, headache, weakness, prostration, severe diarrhoea, mild to severe fever, greenish-yellow colour stool with blood and mucous is found.20
 
Differential Diagnosis
Differentiate dysentery from amoebiasis, food poisoning, infantile gastroenteritis.
 
Diagnosis
Diagnosis is done by sending stool for bacteriological culture.
 
Treatment
 
Drug Therapy
Broad spectrum antibiotic such as Bactrim, Septran Chloramphenicol, etc. administered for 5–7 days.
Prevent dehydration by giving milk, rice water, albumin water, apple juice, carrot juice. In severe dehydration intravenous fluid therapy administered.
 
Complications
Complication such as dehydration, acidosis, shock, electrolyte imbalance, otitis media, pneumonia, arthritis occurs.
 
AMOEBIASIS
Amoebiasis is a protozoal infection of the large intestine. It is a chronic or acute condition characterised by mild to severe form of gastric upset.
 
 
Aetiology
Amoebiasis is caused by Entamoeba histolytica. Commonly affects infants and children.
 
Mode of Transmission
Transmission is through the contaminated water, milk, food and direct contact with human carrier.
 
Types of Amoebiasis
  1. Intestinal amoebiasis
  2. Chronic amoebiasis
  3. Acute surgical amoebiasis.
 
Intestinal Amoebiasis
Intestinal amoebiasis is an acute, subacute or recurring dysentery. It presents with blood and mucous stool. Onset is sudden with vomiting and diarrhoea.21
 
Chronic Amoebiasis
In chronic dysentery recurrent attack of dysentery occurs. Blood loss causes anaemia. Amoebiasis causes dehydration and emaciation.
 
Acute Surgical Amoebiasis
In acute surgical amoebiasis intestinal obstruction perforation, rectal ulcer, prolapse occurs.
 
Complications
  1. Amoebic abscess of the liver—Onset is insiduous, fever, rigour, night sweat, weight loss, enlargement of liver.
  2. Amoebic hepatitis—Enlarged liver, pain in the right lower chest, liver enlargement, and tender.
  3. Vague recurrent abdominal pain due to amoebiasis.
 
Other Complications
Amoebic meningoencephalitis, brain abscess, pulmonary involvement.
 
Diagnosis
Stool examination shows protozoa.
 
Differential Diagnosis
Differentiate amoebiasis from ulcerative colitis, tuberculosis, Cronh's disease, sprue, malabsorption syndrome.
 
Treatment
 
Drug Therapy
Emetine hydrochloride, Emetine bismuth iodide, Chloroquine, Dehydromtine, Paramomycine sulphate, Diloxanide furate, Metronidazole.
 
Prevention
Educate the public, improve environmental and personal hygiene. In epidemic boil water, milk handled food properly. Chlorinate water.
 
DIARRHOEA (GASTROENTERITIS)
Diarrheoa is loose watery stool for more than three to four times. It causes dehydration, there may be vomiting and abdominal pain.
 
 
Causes of Diarrhoea
 
Bacterial Causes
E. coli, Salmonella, Shigella, Staphylococcus.22
 
Viral Causes
Rotavirus, Adenovirus, Arbovirus, Norwalk agent.
 
Protozoal
E. histolytica, Giardia.
 
Fungal Infection
 
Dietetics
Under feeding, overfeeding, food allergy, food poisoning.
 
Other Causes
Other causes are psychogenic causes and metabolic disorders.
 
Aetiology
Diarrhoea commonly occurs in infants and young children between 0–5 years. It is common in summer month. Artificially fed infants, contaminated food, overfeeding with excess fat and excess carbohydrate. Contaminated water, milk and food.
 
Clinical Manifestation
Loose watery stool more than three to four times a day. Vomiting, abdominal pain may or may not present.
 
Dehydration Symptoms
Sunken eyes, sunken anterior fontanelle, loss of skin turgour, rapid pulse, oliguria, increase thirst, slow shallow respiration, loss of weight, irritability, signs of circulatory failure, CNS failure.
 
Diagnosis
Examine stool for culture, blood for electrolytes.
 
Treatment
 
Acute Diarrhoea
Intravenous drip of isotonic or hypertonic solution with potassium is administered. In acute diarrhoea provide 70 KCl/kg/day.
 
Protracted Diarrhoea or Persistent Diarrhoea
Diarrhoea is beyond two weeks. Correct fluid imbalance, electrolyte imbalance. Hospitalised the child and withhold oral feeds. Nasogastric feeding 150–180 ml/kg/day is prescribed. Advised to take plenty of oral rehydration solution. It is composed of sodium chloride 3.5 gm, sodium bicarbonate 2.5 gm, potassium chloride 1.5 gm, glucose 20 gm water one liter. Continue breast milk. During convalescent period provide 120–130 KCl/kg/day.23
 
Drug Therapy
Shigella ___________________Ampicillin, Cotrimoxazole, Nalidixic acid
Vibrio cholerae _________________Doxycycline, Tetracycline
Enterovirus, E. coli ________________Erythromycin, Doxycycline, Furazolidone.
Non-typhoid Shigella ________________Ampicillin
Giardia lamblia ___________________Metronidazole
Vomiting ______________________Metaclopromide or phenothiazine
Abdominal distension _______________Potassium chloride IV
 
Complications
Complications are pre-renal failure, cortical thrombphlebitis, paralytic ileus, and convulsion.
 
Prevention
Provide clean and safe drinking water. Improve food storage facilities. Feeding practice. Continue to give breastfeeding during period of diarrhoea. Prevent contamination of food by flies, rodents, cockroaches. Improve environmental sanitation and personal hygiene. Educate the public.
 
CHOLERA
Cholera is an acute diarrhoeal disease caused by Vibrio cholerae. It is characterised by profuse watery stool, rice water stool is accompanied by vomiting without any nausea, severe dehydration occurs with symptoms of shocks.
 
 
Aetiology
Cholera is caused by Vibrio cholerae. It commonly occurs during February, March and between May and October months. It occurs in poor personal hygiene, poor enviornmental sanitary condition, in illiterate people and overcrowded places.
 
Incubation Period
Incubation period is few hours to few days.
 
Mode of Transmission
Cholera spreads through food, flies, fomites and faeces of infected person.
 
Clinical Manifestations
Clinical manifestation occurs in three stages:
  1. Stage of evacuation
  2. Stage of collapse
  3. Stage of recovery.24
 
Stage of Evacuation
Sudden onset of severe diarrhoea, vomiting, stool appears like rice water. As many as 40 evacuation occurs per day.
 
Stage of Collapse
Symptoms of dehydration occurs, sunken eyes, shallow cheek, subnormal temperature, hands and feet are cold and clamy. thready pulse, respiration is shallow, oliguria and anuria, patient is restless, intense thirst, abdominal cramps. Symptoms of acidosis present.
 
Stage of Recovery
Condition improves, temperature and blood pressure returns to normal. Urine out put increases.
 
Diagnosis
Fresh specimen of stool collected for examination. Rectal swab is taken. Water sample is collected for laboratory findings of Vibriocholerae. Food samples sent for laboratory findings.
 
Treatment
Isolate patient and follow universal precaution. Notify the disease to the health authority MCH, WHO. Intravenous drip started with Ringer's lactate, hypertonic solution. Oral rehydration is prepared by combination of sodium chloride 3.5 gm, sodium bicarbonate 2.5 gm, potassium chloride 1.5 gm, glucose 20 gm and one litre water. Encourage patient to drink plenty of fluid, if he is able to tolerate fluid. Nasogastric feed is given to those who are unable to tolerate oral fluid.
 
Drug Therapy
Chloramphenicol, Furazolidine, Sedatives are contraindicated. To control vomiting Stemetil or Largactyl is administered.
 
Disinfection
Stool and vomitus is disinfected in 5 % cresol or 30 % bleaching powder. Contaminated cloth, linen should be soaked in 2.5 % cresol for half an hour. Vessels, plates and tumbler used by the patient should be boiled in water clothing and beds used by the patients are burnt. Hand is washed with soap and water and dipped in 1% solution of cresol.
 
Prevention of Cholera
Improve environmental sanitation, personal hygiene, excreta disposal, and fly control. Provide pottable (drinking) water.
 
Vaccination
Cholera vaccination is given in two equal doses of 0.5 ml at an interval of 4 to 6 weeks. Immunity lasts for three months only. During fairs and festival vaccination is given to all.25
 
National Cholera Control Programme
National cholera control programme aims to eradicate cholera. Carry out preventive measures such as vaccination, surveillance, early detection, and treatment. Provide safe drinking water and improve sanitation.
 
KALA AZAR (Visceral Leishmaniasis)
Kala azar is a protozoal infection caused by Leishmania donovani. It is transmitted by the sand fly. It is characterised by irregular fever, enlargement of spleen liver anaemia and emaciation. It includes visceral, cutaneous, and nasooral kala azar.
 
 
Aetiology
Kala azar is caused by Leishmania donovani. High incidence of kala azar is found in adolescent. Both sexes are equally affected. Commonly occurs in rainy season and in the planes.
 
Incubation Period
Incubation period of kalaazar is between 1 to 3 months.
 
Mode of Transmission
Sand fly transmits the disease.
 
Clinical Manifestation
Continuous pyrexia, toxaemia, agranulocytosis, fever resembles like typhoid or malaria. Temperature comes down by lysis. Generalised oedema, lymph node enlargement is seen. Within two weeks of onset spleen liver is enlarged, emaciation is common. In long standing diseases, skin becomes gray with pigmentation on the abdomen, hands and feet. In older children and adult appetite is good. In older patients gingivitis, stomatitis, purpura is seen. Cancrum oris, ulceration and tuberculosis occur.
 
Diagnosis
Blood test shows reduced leukocytes. Parasites are seen.
 
Differential Diagnosis
Differentiate kalaazar from tuberculosis, brucellosis, leukaemia, amoebic abscess, Indian childhood cirrhosis, Hodgkin's disease, yaws, Lupus vulgarie.
 
Treatment
Drugs Antibiotics are prescribed; Penicillin, Tetracycline, Pentavalent, Antimonial and Aromatic diamidines, Urea stilbamine.
Diet Adequate nutrition with vitamin supplements is advised. Personal hygiene is maintained. Blood transfusion is advised in case of severe anaemia.26
 
Control of Kala azar
Spray insecticidal to reduce sand fly breeding. DDT, HCH and Dieldrin spray is done. Improve environmental sanitation eliminate breeding places of sand fly, remove shrubs, vegetation from near the residential area. Cattle shed and poultry are kept away from dwelling place. Early detection of disease and early treatment is advised
 
PLAGUE
Plague is a communicable disease caused by Yersinia pestis. It is transmitted by the bites of infected rat, flea.
 
 
Aetiology
It affects all ages. One attack of plague gives lifetime immunity. It commonly occurs between September and May months. Rodent is the reservoir of the disease.
 
Incubation Period
Incubation period of bubonic plague is 2–6 days and pneumonic plague incubation period is 1–4 days.
 
Transmission
It is spread through the bite of infected flea.
 
Types
  1. Bubonic plague
  2. Pneumonic plague
  3. Septicaemic plague.
 
Bubonic Plague
Bubonic plague is the common form of plague. Fever, prostration, lymph nodes enlargement is present at the site of flea bite. It is not spread from person to person.
 
Pneumonic Plague
Pneumonic plague is highly infectious. It is spreads by droplet. Plague bacilli are seen in the sputum.
 
Septicaemic Plague
Bubonic plague may develop into septicaemic plague. It is very fatal.
 
Clinical Manifestation
Onset is abrupt, high fever, rigour, flushed face, dry skin and tongue, tremor and muscular twitching and mental confusion present. Stupor, in bubonic plague lymph glands of groin, 27axilla or neck is enlarged and is painful with periadenitis. Petechiae and subcutaneous haemorrhage, bleeding from the mucous membrane occurs. Death occurs due to heart failure. In pneumonic plague respiratory distress occurs. Patient is toxic and brings out frothy bloody sputum. Circulatory failure and death occurs within 48 hours. In septicaemia plague person becomes comatos looks toxic. Meningeal involvement occurs. It is very fatal.
 
Diagnosis
Blood culture shows elevated WBC count. Aspirated fluid shows presence of bacilli.
 
Treatment
 
Drug Therapy
Chloramphenicol or Streptomycin injection combined with Sulphadiazine is prescribed, or broad spectrum antibiotic is used. Patient is isolated and universal precaution is followed. Tracheostomy is done in case of respiratory failure. Maintain fluid and electrolyte balance. Disinfect sputum, discharges and fomites (articles used by the patients).
 
Prevention
Early diagnosis, and treatment, prevents spread of plague. Notify international health organisation such as WHO. Treat the case without waiting for the investigation result. Educate the public about cause of spread, treatment, prevention of plague. Those who are at risk should be given oral sulphadiazine as a prophylaxis. Destroy and control rats and rodents. Quarantine all contacts.
 
RELAPSING FEVER
Relapsing fever is caused by Spirochaetes. Disease is characterised by acute fever lasting for a week, toxaemia, hepatosplenomegaly, jaundice. It is followed by apyrexia for four to six days and relapse occurs again symptoms disappears and relapse follows. It is a tick-borne and louse-borne disease.
 
 
Aetiology
Relapsing fever is caused by Spirochaetes Borrelia recurrentis or Borrelia duttoni.
 
Incubation Period
Incubation period is 2–12 days.
 
Diagnosis
Peripheral blood examination shows spirochaetes.
 
Treatment
Drug Therapy— Chloramphenicol, Tetracycline, Penicillin, Antipyretics for fever is prescribed.28
Nursing Care Cold sponging is done to reduce temperature. Well balanced diet is given. Fluid and electrolyte balance is maintained. Vital signs are monitored.
 
Prevention
Control pediculosis and ticks. Improve personal and environmental hygiene.
 
RABIES
Rabies is an acute fatal infectious disease, caused by rhabdovirus. It is characterised by fever, malaise, irritability and abnormal sensation in the region of bite. It is followed by hyperexcitability, spasm of mouth, pharynx, larynx while, trying to eat. Hydrophobia, maniacal behavior, delirium, convulsion, coma is present and death occurs.
 
 
Aetiology
Rabies is caused by rhabdovirus. Virus exists in stray dogs, foxes, jackals, wolves, mangoes. Men and children are more prone to infection.
 
Incubation Period
Incubation period of rabies is 1–2 months.
 
Mode of Transmission
Rabies is transmitted through the bite of rabies animal to man. Saliva of rabies animal is a source of infection.
 
Clinical Manifestation
Fever, malaise, irritability, hyperexcitability, spasm of the mouth, pharynx, larynx while drinking, hydrophobia, maniacal behaviour, delirium, convulsion coma, death, tingling sensation at the site of bite.
 
Diagnosis
Note history of bite by the animal, virus is present in the saliva.
 
Treatment
Symptomatic treatment is given. Maintain clear airways, administer oxygen. IV fluids and oral fluids are covered to prevent spasms. Isolate the patient and follow universal precaution. Identify all contacts and immunise them with antirabies vaccines.
 
Prevention
Vaccinate all pet animals. Control stray dogs. Wash bite of animal with soap and water or detergents immediately. Active and passive immunisation is given after the animal bite. Human rabies immunoglobulin is prescribed. Watch the animal which has beaten for ten days if there 29is any change in animal behaviour animal is killed and brain is sent for laboratory test. All those who came in contact with the animal is vaccinated.
 
MALARIA
Malaria is a communicable disease caused by the genus Plasmodium. It is transmitted to man by infected female anopheles mosquito. Disease is characterised by pyrexia, splenomegaly and anaemia.
 
 
Aetiology
Malaria is caused by four species of malarial parasite; 1. P. vivax, 2. P. falciparum, 3. P. ovale, 4. P. malariae. Malaria affects all ages. Male are more prone to malaria. They are more exposed to malaria than females. Malaria is common in low socio-economic group. It is prevalent from July to November month. Mosquito breeding places are in pot hole, burrows, pits, pools and gardens.
 
Incubation Period
Incubation period for P. falciparum is 14–15 days, P. vivax and P. ovale is one month and P. malariae is 6–9 months.
 
Life Cycle
There are two cycles. One in the man and second cycle is in the mosquito.
 
Mosquito Cycle
Mosquito ingest the gametocytes from the circulation in RBC of human host. It develops in the mosquitoes stomach into an oocyst. It bursts and releases merozoites. Merozoites reach salivary gland of the mosquito and it is transmitted to man when mosquito bites the man. Merozaites become adult worm in man.
 
Clinical Manifestations
Anorexia, headache, restlessness, irritability, mild fever rigour.
Three stages:
  1. Cold stage
  2. Hot stage
  3. Sweating stage.
 
Cold Stage
Onset is sudden, fever and rigour is present.
 
Hot Stage
High fever, severe headache occurs.30
 
Sweating Stage
Fever comes down. Profuse sweating occurs. Spleen is enlarged. Anaemia is seen.
 
Children Cycle (Man)
In children convulsion may occur, growth failure, abdominal pain, loose stool, tenderness over the spleen and liver noted.
 
Complications
Complications are cerebral malaria, gastrointestinal malaria.
 
Diagnosis
Blood is tested to detect malarial parasites. Blood test shows anaemia, leukopenia, hyper-bilirubinaemia.
 
Differential Diagnosis
Malaria is differentiated from typhoid, tuberculosis, filariasis, urinary tract infection.
 
Treatment
Drug Therapy—Quinine, mepacrine, chloroquine, pyrimethamine, primaquine phosphate, sulphamethapyrazine.
Patient is advised to rest in the bed, cold sponging is done to reduce fever well balanced diet is prescribed. Fluid and electrolyte balance is maintained. Close all breeding places of mosquito. Spray DDT, insecticides. Improve environmental sanitation. Advise to sleep under mosquito net.
 
FILARIA (ELEPHANTIASIS)
Filaria is caused by filarial nematodes. It is characterised by fever, lymphangitis, lymphadenitis in male enlargement of epididymis. It affects legs, arms, genitals, breasts, hydrocele, chyluria.
 
 
Aetiology
It affects all ages. It is common in age group 20–30 years. It affects both sexes. Causative organism of filaria is Wuchereria bancrofti and Brugia malayi.
 
Mode of Transmission
Filaria is transmitted by the bite of infected mosquitoes. Industrialisation, urbanisation and migration has helped in spreading the disease.
 
Clinical Manifestations
There are four stages of filaria
  1. Stage of invasion31
  2. Carrier stage
  3. Stage of acute manifestation
  4. Stage of chronic manifestation.
 
Stage of Invasion
Infected mosquito bites individual. Infected larvae enters the body undergoes changes. Eosinophilia and lymphadenopathy is noted.
 
Carrier Stage
Parasites are detected in the blood. There are no signs and symptoms seen at this stage.
 
Stage of Acute Manifestation
Fever, lymphangitis, lymphadenitis and in male enlargement of epididymis is seen.
 
Stage of Chronic Manifestation
Elephantitis is common in this stage. It affects legs, arms, genitals, breasts, hydrocele, chyluria is present.
 
Diagnosis
Parasites are visible in night blood.
 
Treatment
Drug Therapy—Diethylcarbamazine (Banocide Hetrazan), Corticosteroid is administered to control allergic reaction. Sulpha drugs and penicillin prescribed to control secondary infection. Anti-inflammatory and analgesic is prescribed to relieve pain and inflammation. Chyluria is treated with rest. Elevate the part, apply ichthyol glycerine to reduce swelling and bandage the part which is affected. Bladder wash is advised in acute phase. In advance condition Nodo Venous Shunt is performed.
 
Prevention
Use mosquito net, control mosquito breeding. Spray DDT. Close all pot holes.
 
YELLOW FEVER
Yellow fever is caused by flavovirus fubricus. It is characterised by sudden onset of fever, headache nausea and vomiting, tachycardia hypotension, acute hepatic and renal involvement with jaundie, albuminuria and haemorrhage.
 
 
Aetiology
Yellow fever is caused by arbovirus. Man and the monkey are the reservoir of infection. It affects all ages and both sexes. It is commonly seen in forest workers. One attack of infection gives immunity for lifetime.32
 
Clinical Manifestation
Sudden onset of fever, headache, nausea, vomiting, in severe cases tachycardia, jaundice, hypotension and delirium occurs.
 
Diagnosis
Virus is isolated in the blood.
 
Treatment
Symptomatic treatment is prescribed. Analgesic is prescribed for headache. Antipyretic is prescribed to reduce temperature.
 
Prevention
Control mosquito breeding. Advised to use mosquito net. International certificate of yellow fever vaccination is necessary if you want to travel abroad.
 
DENGUE FEVER
Dengue fever is transmitted to man by the Aedes aegypti mosquito. It is characterised by headache, rigour, high fever severe back pain, joint pain. Fever comes down by crisis. It is also known as break-bone disease.
 
 
Aetiology
Aedes aegypti is the mosquito-borne disease which transmits dengue fever. It occurs in epidemic or pandemic form.
 
Incubation Period
Incubation period is 5–10 days.
 
Clinical Manifestation
Headache, body pain, severe back pain, joint pain, fever rigour. Fever comes down with crisis.
 
Treatment
Symptomatic treatment is given. Antipyretic is prescribed for reducing fever. Analgesic is prescribed for relieving body pain, joint pain and headache. Cold compress and cold sponging is done to reduce fever. Fluid and electrolyte balance is maintained.
 
Complications
Joint pain may continue for months, Pre-arthritis persists for months, haemorrhage may occur.33
 
Prevention
Advised to use mosquito net while sleeping and control mosquito breeding.
 
SEXUALLY TRANSMITTED DISEASES
 
 
Major Conditions
Gonorrhoea, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, genital human papilloma.
 
Minor Conditions
Scabies of the genitalia, trichomoniasis, thrush (candidiasis), herpes simplex, pubic lice, warts condylomata accuminate, viral hepatitis.
 
GONORRHOEA
Gonorrhoea is also known as clap, drip, a dose, a case, strain, morning dew or gleet. Gonorrhoea is caused by the gram-negative Diplococcus Neisseria gonorrhoae. It is characterised by greenish yellow vaginal discharge in women, irritation of vulva. In men it causes painful urination, urethral discharge.
 
 
Aetiology
Gonorrhoea is caused by Neisseria (Gonococcus).
 
Incubation Period
Incubation period is 1–14 days.
 
Mode of Transmission
Gonorrhoea is transmitted by sexual intercourse with a person who has the disease. At birth infant gets infected in eyes when mother has the disease.
 
Clinical Manifestations
In women greenish yellow vaginal discharge is present. Irritation of vulva is common. In men painful micturation and urethral discharge is seen. Both men and women suffer from sore throat, swollen glands. Sometimes no symptoms are noticed. In anal gonorrhoea irritation of anus, discharge or painful defaecation is the presenting symptoms.34
 
Site for Gonococcal Infection
Potential site for gonococcal infection in women are Skene's glands, urethra, vagina, endometrium, Bartholin's glands, cervix and fallopian tube. In men, it occurs in Tyson's glands, prostate, epididymis, urethra, seminal vessicles.
 
Diagnosis
Diagnosis is based on history, physical examination. Identify organism in culture and sensitivity tests.
 
Types of Gonorrhoea
  1. Simple genital gonorrhoea.
  2. Gonococcal pharyngitis common in people who engage in fallatio (oral) stimulation of the penis.
  3. Gonococcal proctitis occurs in women with cervical gonorrhoea and people engaged in anal intercourse.
  4. Ocular gonorrhoea of the eye occurs in adult by spread of infection to the eye from other infected area.
  5. Gonococcal PID spreads from lower genital tract to upper genital tract causing gonococcal pelvic inflammation.
  6. Gonococcal haematogenous spreads via blood to distant organs in the body.
  7. Gonococcal arthritis affects wrist and knee.
  8. Gonococcal endocarditis affects heart.
  9. Gonococcal infection affects the meninges.
 
Treatment
Penicillin is the drug of choice. In case of allergy to penicillin Ampicillin, Spectinomycin, Ciprofloxacin is prescribed.
 
Complications
Sterility is noticed in women, blindness occurs in babies. Endocarditis, meningitis, septicaemia, arthritis, PID is common complication
 
Prevention
Improve moral values in public life, advise monogamy and use of condom. Educate the public about cause of spread, complications, clinical signs and symptoms, early detection and treatment and prevention of gonorrhoea. Advised to be faithful to the married partner. Medical and nursing personnel should protect them by using universal precaution. Treat contact, early detection and treatment is advised.
 
SYPHILIS
Syphilis is sexually transmitted communicable disease caused by Treponema pallidum. It is characterised by chancre which occurs in two to four weeks after sexual contact. Chancre 35develops on the scrotum, penis, glans, corona, foreskin, or pubic area, lymphadenopathy occurs.
 
 
Aetiology
Syphilis is common in homosexuals, prostitutes, multiple sexual partners. It is prevalent in large cities, ports, industrial area. Causative organism is Treponema pallidum
 
Incubation Period
Incubation period of syphilis is from 9–90 days after sexual contact.
 
Types
  1. Primary syphilis
  2. Secondary syphilis
  3. Tertiary syphilis
  4. Late clinical stage.
 
Primary Syphilis
In primary syphilis chancre or painless sore appears on the scrotum, penis, glans, corona, foreskin or pubic area. It disappears within one to five weeks without any treatment. Lymphadenopathy occurs, Asymptomatic chancre occurs on the anus, rectum or oral cavity.
 
Secondary Syphilis
Untreated syphilis heals within four to six weeks and person becomes asymptomatic.
 
Indication of Second Stage
  1. Generalised rash which is maculopapulous, nonpuritic rash appears on the palm, soles and feet.
  2. Generalised lymphadenopathy.
  3. Mucous patches occurs in the mouth and it is accompanied by sore throat.
  4. Condylomata lata a broad flat lesion occurs on the labia, anus or at the corner of the mouth. It is very infectious.
  5. General symptoms such as nausea, anorexia, constipation, headache, muscle joint and bone pain, chronic rise in temperature. Secondary stage symptoms disappear within two to six weeks time and tertiary stage begins.
 
Tertiary Syphilis
Tertiary or latent stage of syphilis is without any symptoms. Infection spreads through the blood. Granulomatous destructive lesion develops. Gummatous a painful lesion develops on the bone, skin nerves and cardiovascular tissue.
 
Late Clinical Stage
CNS involved, insanity, slurred speech, ataxia, gait, paralysis, senility, chronic bone and joint inflammation develops.36
 
Diagnosis
VDRL (Vanereal Disease Research Laboratory) test is done, history of multiple partners and health assessment is taken.
 
Treatment
Broad spectrum antibiotics is prescribed. Penicillin, erythromycin is used. Treat contacts sexual partners, women with primary and secondary syphilis should abstain from sexual contacts for one month after treatment. Proper hygiene and healthy habits are encouraged.
 
Prevention
Educate the public about STDs. Provide accurate information to women who is on treatment.
 
Complications
Complications such as abortion, stillbirth, chronic bone and joint involvement, heart and CNS are involved.
 
CHANCROID (HAEMOPHILUS DUCREYI)
Chancroid is a common STD occurs in uncircumcised men with poor hygienic practices. Chancroid occurs few days after sexual contact. In women chancroids is caused by Haemophillus ducreyi, pustular ulcer develops on vulva. It is painful and heals spontaneously.
 
 
Clinical Manifestations
One or more painful genital ulcers occur which gradually enlarges. Enlarged inguinal lymph nodes is tender and suppurates and drains spontaneously. Fever, headache, and general malaise presents. It is commonly seen in poor hygienic condition. Pustular ulcer develops on vulva. It is painful and heals spontaneoulsy.
 
Treatment
Antibiotics such as arythomycin and tetracycline are prescribed.
 
Prevention
Improve personal hygiene. Health education and counselling is given.
 
LYMPHOGRANULOMA VENEREUM (LGV)
Lymphogranuloma venereum is also known a Chlamydia trachomatis. It is characterised by painless vesicles, papules or ulcers. These lesions heal without scarring. Two to six weeks after exposure inguinal, femoral lymphadenopathy develops, rectal infection occurs.37
 
 
Diagnosis
Chlamydial isolated from lymph nodes which are affected. Serological test, culture and sensitivity is done.
 
Clinical Manifestation
Incubation period occurs between 3 to 21 days after the exposure to the organism. Painless vesicles, papules or ulcer develops on the penis or anorectal area. Lesion heals by itself. Two to six weeks later inguinal and femoral lymph adenopathy occurs. Deep iliac and hypogastric lymphadenopathy develops and it is tender.
Late signs and symptoms They are enlarged genitals, abscess around anus, narrow rectum, anal fistula, and anal strictures. General anorexia, fever, chill, arthralgia.
 
Treatment
Tetracycline, Doxycycline, Sulfonamides are prescribed. Aspiration of Buboes is done.
 
Prevention
Educate the public. Early diagnosis and treatment.
 
GRANULOMA INGUINALE (DONOVANOSIS)
It is a common sexually transmitted disease among men and women. Subcutaneous nodules develop under skin of genitalia between scrotum, thigh, labia and vagina. Ulcers is painless, it bleeds when touched.
Pus is beefy red in colour. If it is not treated it destroys genital organs.
Incubation period is 10 to 80 days.
Commonly seen in homosexuals.
 
 
Treatment
Trimethoprim, Tetracycline is prescribed.
 
Prevention
Educate the public. Early diagnosis and treatment is given.
 
GENITAL HUMAN PAPPILLOMA VIRUS (HPV)
Virus causes Genito human pappilloma. Wart near penis or vagina develops. There is no cure for this. It can predispose to malignancy.38
 
SCABIES OF THE GENITALIA
Scabies of the genitalia is caused by the Mite Sarcoptes scabiei.
 
 
Clinical Manifestation
Severe itching of genitalia anal area occurs. Papular rash appears on various parts of the body.
 
Diagnosis
History is taken and physical examination is done. Mite or the eggs seen microscopically.
 
Treatment
Improve personal hygiene. Apply Benzyl benzoate ointment. Gammexane or DDT is dusted on the clothes. Treat both the partners simultaneously.
 
TRICHOMONIASIS
Trichomoniasis is sexually transmitted disease commonly affects both male and females.
 
 
Clinical Manifestations
In women, it causes burning and itching of vagina. There is pain or burning when micturation. Foamy, green, yellow fluid discharge from vagina which, has bad smell. In men there is white, watery discharge from the penis, client complains of pain and burning micturition.
 
Treatment
Metronidazole is prescribed patient is advised to avoid alcohol. If alcohol is consumed it causes nausea and vomiting.
 
Prevention
Educate the public. Treat both the partners and contacts. Advised to be faithful to partners. Early diagnosis and treatment is essential.
 
CANDIDIASIS (THRUSH)
Candidasis is common infection of male and female which is not transmitted by sex.
 
 
Clinical Manifestations
In women, it causes itching, burning of vagina. Vaginal discharge is white in colour. In men there is itching and burning of genitalia, discharge from foreskin is white in colour.39
 
Treatment
Tablet Nystatin is introduced in vagina for 4 days. In men, Polyene cream is applied to penis for 7 days.
 
HERPES SIMPLEX VIRUS
In men, lesion appears on the glans penis or shaft, under foreskins. It causes constipation and loss of anal tone. In homosexuals, lesion occurs on the anal and perianal region. There is mucoid discharge, and rectal pain. Lesion also occurs in oral cavity.
Advised use of condom and abstinence from intercourse.
 
PUBIC LICE (PEDICULOSIS PUBIS)
Pediculosis pubis or crab line appears on the body due to close contact with an infected person or through infected clothing or bedlinen. Treatment is with gammexane application, or DDT is sprayed on the clothing. Improve personal hygiene.
 
CONDYLOMA ACUMINATUM (VENEREAL WARTS)
Venereal warts occur in genitalia, rectum of young adult. Skin creases in femoral areas. Wart predisposes to malignancy. It is treated with CO2 laser radiation, chemotherapy, immunotherapy, surgery or cryotherapy. Intrauterine warts are treated with instillation of 5-Fluorouracil.
 
HEPATITIS A AND B
RNA containing virus causes hepatitis A.
 
 
Signs and Symptoms
Anorexia, mild fever, nausea, vomiting, fatigue pain in the right upper quadrant. Spreads through anal route.
 
Treatment
Close contacts are treated with serum globulin. Follow hand washing technique and personal hygiene. DNA containing virus causes Hepatitis B. Clinical manifestations are the same as Hepatitis A. It is transmitted sexually or by kissing. Virus is found in urine, saliva, menstrual discharge.
 
NURSING INTERVENTION IN STDS
  • Maintain confidentiality.
  • Correct myths about STDs.40
  • Provide accurate, factual information to help the person avoid reinfection.
  • Advised to abstain from sex while on treatment.
  • Be faithful to partners.
  • Advised to use condom.
  • Advised to help partners to take treatment.
  • Early diagnosis and complete treatment helps the patient.
  • Advised to treat all contacts.
 
HIV/AIDS AND PREVENTION OF HIV/AIDS
The World Health Organisation (WHO) estimates 40 million people may have AIDS by the year 2000 AD. It was declared as epidemic in 1992. When a person is infected with HIV it does not mean that the person has AIDS or is ill. A person with HIV is permanently infected and he or she can transmit the disease to others. HIV infected person will not have any signs and symptoms till they reach the AIDS stage. AIDS is the end stage of HIV infection. Infected person feels and looks normal for many years. It is infectious.
 
 
History
  • First case of AIDS was discovered in USA in 1981.
  • Luc Montagnier and his colleagues from Pasteur Institute, Paris isolated virus in 1983.
  • First case of HIV was reported from Chennai in India in 1986.
  • Diagnosed case of HIV in USA died in Andhra Pradesh in 1987.
 
What is AIDS?
AIDS (Acquired Immune Deficiency Syndrome) is a condition which results from long term infection with HIV virus (Human Immune Deficiency virus).
HIV virus weakens the body's immune defense system. The immune system are damaged by the virus infection enters the body. It becomes the cause of death exact cause of AIDS is not known. Some individuals are infected but they show no signs of the disease. Some have pre-AIDS or AIDS related complex a collection of symptoms that is not quite full blown AIDS.
 
Incubation Period
Incubation period of AIDS is 8 to 10 years in adult and 18 to 24 months in children.
 
Predisposing Factors
There are three high risk groups:
  1. Male homosexuals. Those who have had sexual relation with many partners, anal intercourse among the male homosexuals.
  2. Intravenous drug users those who share needles.
  3. Blood transfusion.
 
Source of Infection
HIV is transmitted in semen, vaginal fluid and blood. Small quantity is transmitted in sputum, urine CSF, and breast milk. It is transmitted through the following routes.41
Sex—Homosexual, heterosexual
Blood—Blood and blood products.
Mother and child—Infected mother transmit infection to child. Pre-partum and post-partum period infection is transmitted.
Needle and syringes used by the drug addict, unsterilised or needles used by the health workers.
Barber's knives, tattooing and needles.
 
Factors Facilitating Sexual Transmission
  • Multiple sex partners.
  • Long-term sexual contact with infected person.
  • Genital or anal trauma, genital ulcers, anal douching, introduction of objects into vagina or anus.
  • Blood transfusion can give life or take life. Following diseases can be transmitted through blood transfusion: Hepatitis B, syphilis, malaria, AIDS and herpes infection.
 
Clinical Manifestations
  • Swollen lymph nodes.
  • Unexplained weight loss.
  • Fever or night sweats.
  • Chronic diarrhoea.
  • Unexplained or prolonged fatigue.
  • Cough and shortness of breath at rest.
  • Fungal infection in mouth (thrush or candidiasis).
  • Rash with reddish brown or bluish spot, pruritis (itching).
  • Repeated attack of herpes.
  • Kapos's sarcoma.
 
AIDS Cannot Enter Body by
  • Holding or shaking hands.
  • Living together.
  • Kissing (dry).
  • Playing sports.
  • Sharing toilet seats.
  • Dancing together.
  • Bathing together.
  • Hugging sharing clothes and food.
  • Sneesing.
  • Coughing.
  • Insect bites.
 
Testing for HIV
Blood sample is taken to test for HIV. If the person is infected the test will be positive.42
 
Prevention
There is no cure for AIDS. There is no drug for AIDS treatment.
Spread of AIDS can be prevented by providing information, education to change sexual behaviour.
  • Advise to have safe sex.
  • Use safe blood for transfusion. Take blood from the known donor who is safe.
  • Use sterilised needles and syringes.
 
Nursing Intervention
  • Main goal of treatment is to prevent infection.
  • Check the weight of the client. Note any loss in weight.
  • Check the stool note diarrhoea.
  • Inspect area vulnerable to infection such as the skin, mouth, pharynx, axilla, perineum, and rectum.
  • Note lungs for abnormal breath sounds.
  • Monitor vital signs.
  • Check fever.
  • Check secretions for alteration in colour, odour and consistency.
  • Check blood for white cell and neutrophil count.
  • Enquire if the person has sore throat or burning on urination.
  • Isolate the client.
 
Management of Asymptomatic Client
  • Counselling is done.
  • Provide well balanced diet.
  • Advise to do regular exercise.
  • Prevent stress, strain, anxiety and depression.
  • Avoid drugs and alcohol.
  • Avoid sex and use condom.
  • Provide adequate rest.
  • The diagnosis of AIDS results in psychosocial problems. There is sense of loss of health, loss of life, loss of job, loss of self esteem. Client will have severe depression and suicidal tendency and paronoia.
 
Disinfection
  • HIV virus is very fragile virus. It is destroyed by use of.
  • 10% Hydrochlorite solution. Bleaching powder 1.3%.
  • Hydrogen peroxide 3% Lysol 0.5%.
  • Ethanol 70%.
  • Boiling for 10 seconds.
 
Precaution in Care of Clients with AIDS
  • Avoid accidental wounds from sharp instruments contaminated with infected material.43
  • Avoid contact of open skin lesions with infected materials.
  • Wear gloves when handling blood specimen. Blood soiled items, body fluids, excreta and secretion.
  • Wear gown while handling client who is positive.
  • Wash hands with soap and water after caring for the client.
  • Label blood and other specimen taken from AIDS client. Special warning is written as blood precaution or AIDS precaution. If out side of the container is contaminated it should be cleaned with a disinfectant. Such as bleaching powder 1:10 dilution.
  • All articles soiled with blood should be placed in a container labelled as AIDS precaution. All items should be incinerated.
  • Needles should not be sent after use. It is disposed in a special container.
  • Use disposable syringes and needles.
  • Isolate client who is positive and very ill.
  • Observe universal precautions.
 
IMMUNISATION SCHEDULE
Immunisation Agent
Age–due
Remarks
BCG
At birth
Continue to breastfeed. It effective in TB, Leprosy and AIDS.
Oral polio vaccine
Sabin polyvalent
After the 2nd month 3–5 doss at 6 weeks interval
Virus is excreted in the stool for few days water and food gets contaminated.
DPT (Diphtheria, Pertussis & Tetanus)
10th–20th week 3 doses at 4–6 weeks interval Booster 4th dose at 2 years 5th Dose at 5 years
Pertussis vaccine is available now in japan.
TT tetanus toxoid
10 years and 16 years
Recommended, after injury Antenatal period
Rabies vaccination
Old regime 5 injection
MMR
9 months age
DT vaccine
6–12 years
 
IMMUNISATION
 
IMMUNITY
The ability of the body to recognise, destroy and eliminate antigenic material foreign to its own.
A person is said to be immune to infectious diseases when the germ causes immunity. It is prevented from multiplying in the person body.44
 
Classification
  1. Natural immunity
  2. Acquired immunity.
 
Natural Immunity
Natural immunity is inherited by genetic factor, e.g. Typhoid occurs in man but does not occur in animal.
 
Acquired Immunity
The immunity man acquires as a result of infection, administration of vaccines and antisera.
 
Types of Acquired Immunity
  1. Active immunity
  2. Passive immunity.
 
Active Acquired Immunity
Person develops infection as a result of infection by pathogenic organisms or their toxic products. To fight against the infection antibodies are produced in the body. One attack of disease result in active immunity, e.g. smallpox, administration of vaccines.
 
Passive Immunity
Body does not produce antibody. It depends on readymade antibody. Antibodies are produced in one person and this antibody is transferred to another to give protection against a disease.
Passive immunity is acquired as follows:
  • Antisera against tetanus
  • Injection gammaglobulin
  • Maternal antibodies are transferred from placenta to foetus.
  • Disease such as polio, chickenpox, diphtheria causes immunity.
 
Vaccines
Vaccines are prepared from the disease agents or toxic products. It produces antibodies when administered.
 
Types of Preparation
Vaccines are prepared from live attenuated organisms, killed organisms or combination of the both.
 
Live Vaccines
Live vaccines are BCG vaccine, oral polio, yellow fever, measles.45
 
Killed Vaccines
Killed vaccines are typhoid vaccine, cholera vaccine, whooping cough vaccine, plague, rabies and influenza vaccine.
 
Toxoid
Toxoids are diphtheria and tetanus.
 
Combined or Mixed Vaccines
Combined or mixed vaccine includes more than one immunisation agent. Combined vaccines DPT (Triple vaccine). It consists diphtheria, whooping cough and tetanus vaccine. Typhoid vaccine has type A and B combination.
 
Reasons for Immunisation
Prevent communicable diseases by giving immunisation.
  1. Every year measles kills two million children.
  2. Pertussis affects million children and kills over 60,00,00 children every year.
  3. Polio cause physical deformity and kills 30,000 children every year.
  4. Every year ten million people suffer from tuberculosis.
  5. Diphtheria cause 10–15% deaths.
 
Common Problems of Immunisation
  1. Inadequate supervision.
  2. Poor communication.
  3. Limited surveillance of disease.
  4. Poor storage facility which causes loss of potency of the vaccine.
  5. Poor electricity facility.
  6. No provision of refrigerators made if it is provided. It is not maintained properly.
  7. Careless handling of the vaccine.
 
The Expanded Programme on Immunisation
In 1974 World Health Organisation established the Expanded Programme on Immunisation.
Objectives of the programme.
  1. Reduce morbidity and mortality from six major diseases, Diphtheria, Pertussis, Tetanus, Measles, Polio and Tuberculosis by immunising all children throughout the world.
  2. Self-reliance in delivering immunisation services at the national level is promoted.
  3. Self-reliance in vaccine production and quality control is promoted.
Recommendation by WHO and UNICEF to speed up EPI are
  1. Provide immunisation, give information regarding immunisation to every contact.
  2. Reduce drop-out rates between the first and last immunisation.
  3. Priority is given to control measles, polio and neonatal tetanus.
  4. Improve immunisation services in the urban area.
  5. Special approach is planned to give immunisation.46
 
VACCINES
 
Measles Vaccines
Measles vaccine is a live attenuated virus. One dose of measles vaccine produces permanent immunity. It is given at the age of nine months.
It can cause complication encephalitis in 1 % in 10,000 vaccinated individuals. Vaccination is given even to a malnourished child. Mumps and Rubella vaccine is given along with measles vaccine.
 
Pertussis Vaccines
Pertussis vaccine is a suspension of killed Bordetella pertussis bacteria. It is given in combination with Diphtheria and tetanus toxoids. Three doses is given. It gives 70–90% protection.
 
Complications of Pertussis Vaccines
Pertussis vaccine causes pain, swelling at the site of the injection, fever occurs in few children, Neurological complication is rare. Encephalitis occurs in 1–3 in 10,000 children vaccinated.
 
Tetanus Toxoid
Tetanus toxoid can be given alone or in combination with DPT vaccine. Antenatal mother is given tetanus toxoid. It gives immunity to newborn baby up to five months. They must receive two doses of tetanus toxoid. It is given at four weeks interval. Mother is protected for three years by giving three doses of vaccination.
 
Reasons for Failure of Vaccination Programme
  1. Vaccination team did not maintain schedule timings.
  2. People to travel long distance to get vaccine.
  3. Parents feared about side effects.
  4. There is a wrong notion that vaccination prevented diseases completely.
  5. Vaccinators where unsympathetic towards parent and children, and they frightened children.
  6. Poor service was rendered.
  7. Parent had to wait for long time to receive the vaccination.
 
IMPORTANT POINTS TO REMEMBER
  1. Educate the parents and the public regarding cause spread, signs and symptoms of diseases and how many doses are necessary to protect the children? They should be informed when to bring the child for the next immunisation.
  2. Inform regarding side effects and what to do at that time? Remove fear from the parent by stating that vaccine is working and there is no cause for fear.
  3. Train field staff in sterilisation technique, storage techniques and in method of giving immunisation.47
  4. Monitor quality of vaccine, storage temperature, handling procedures.
  5. Show courtesy to mothers children and the public.
  6. Sterilise needle and syringes as per the technique.
  7. Accurate record of vaccination is maintained.
  8. Side effects are reported.
 
TUBERCULOSIS
Tuberculosis is contagious disease. It is characterised by evening rise of temperature for more than three weeks, loss of weight, continuous cough for month and above, general malaise and night sweats.
It kills one person every minute. Two people become sputum positive every minute. One sputum positive client can infect 10–15 individuals every year.
 
 
Cause
Tuberculosis is caused by Mycobacterium tuberculosis.
 
Clinical Manifestations
Any person with cough and fever of 3 week duration, not responding to antibiotic is suspected of suffering from tuberculosis. Weight loss, fatigue, anorexia, evening rise of temperature, night sweats.
 
Investigations
Examination of three smears of sputum for acid-fast bacilli is taken. Two spot on two consecutive days and one early morning specimen is taken for presence of AFB. Radiological examination is done to see the involvement of the lungs.
 
Types of Cases
 
New Cases
New case of tuberculosis who never taken antituberculosis treatment. Or client who is on antituberculosis drugs for one month period only.
 
Relapse Cases
A client who has been declared cured reports back with signs and symptoms of tuberculosis.
 
Failure Cases
Even after the treatment client is positive. Client's smear was negative at the beginning of the treatment becomes positive during the treatment and at the end of the treatment.
 
Chronic Cases
A client who remains positive after completion of the treatment48
 
Treatment
The duration of the treatment is 18 months. This treatment can be reduced to six months if PZA and RFM is included. Drugs prescribed are injection Streptomycin, tablet Rifampicin, tablet Ethambutol.
 
Category I
 
Indication
New cases, sputum positive, extra-pulmonary cases, negative smear but X-ray is positive, TB meningitis, Miliary TB with neurological signs.
 
Treatment Regime Category I
Two months of HRZE and a month of HR.
 
Indication for Category II
Relapse, failure of treatment, habitual defaulters, sputum positive cases.
 
Treatment for Category II
Two months of SHRZE and a month of intensive phase and five months HRE.
 
Indication for Category III
Smear is negative, X-ray suspects new pulmonary cases. Extra-pulmonary not serious cases.
 
Treatment
Two months of HRZ in intensive phase and four months of HR in continuation phase. Intensive phase medications to be swallowed in presence of a health workers and remaining dose to be taken by self.
 
Side Effects of Drugs
Minor side effects are anorexia, abdominal pain, joint pain, burning sensation. Urine colour will be orange or red.
Major side effect are skin rash, itching, deafness, vertigo and nystagmus, giddiness, jaundice, visual impairment red-green colour blindness, generalised purpura. Stop Streptomycin, Ethambutol and Rifampicin.
 
Chemoprophylaxis
In asymptomatic cases chemoprophylaxis is advised. INH is given to under 6–8 years. Mantoux test is done at the end of three months. If Mantoux test is negative BCG should be given.49
 
Prevention
Educate the public regarding cause of spread, clinical manifestation and treatment of tuberculosis. Treat all contacts. BCG should be given to all neonates. Prevent resistance cases by taking regular treatment.