Lasanthi Aryasinghe -1-

Vaccination &
Disease Agent Transmission Signs & Symptoms Complications
Treatment

RESPIRATORY INFECTIONS

- Case 1. Pre-eruptive Stage

- Droplet Infection (nuclei) 2. Eruptive Stage:
- Oropharangeal - Symetrical, Centripetal rash - Varicella Hemorrhagical
secretions - Rapid evolution of rash - Encephalitis - V-Z Ig
Chicken Pox -Varicella Zoster Virus
- Lesions of skin & - “Dew drops” - vesicles filled - Acute cerebellar Ataxia - Live Vaccine
(Varicella) (Human Alpha Herpes virus 3)
mucosa w/ clear fluid - Reye‟s Syndrome (OKA strain)
- Pleomorphism - Congenital varicella
POC: 2 days before rash
4-5 days after IP 14-16 days

- Case
1. Prodromal Stage:
- No carriers
- Koplik’s spots – small bluish, - Measles ass. diarrhoea
- Droplet infection (nuclei)
white spots on buccal mucosa, - Pneumonia
- Nose, throat & resp tract st nd
opp 1 & 2 upper molars - Otitis Media
secretions during
(2days before rash) - Febrile convulsions - Reconstituted
prodromal stage and
-3Cs coryza cough conjuctivitis - Encephalitis Measles Vaccine
Measles - RNA Paramyovirus early stages of rash
2. Eruptive Stage - Sub-acute sclerosing @ 9mts
(Rubeola) - Only 1 serotype (eruption time)
- Dusky red, maculo-papular panencephalitis (SSPE) - MMR
rash begins behind ears--face-- - Keratomalacia & - NHIg
POC: 4 days before rash
neck--lower limbs blindness from corneal
5 days after
3. Post-Measles Stage scarring
Isolate for 7 days after
IP 10-14 days
onset of rash

- Case
- 50–65% are asymtomatic
- Subclinical case - Arthralgia
- Short duration (3 days)
- Droplets from nose, - Encephalitis
1. Prodromal Stage
throat - Droplet nuclei - Thrombocytopenic - RA 27/3 Live
2. Lymphadenopathy
Rubella - RNA virus (aerosols) purpura vaccine
- Postauricular & postcerival
(German - Togavirus family - Max infectivity during - Congenital rubella – - MMR @ 12-18
3. Rash
Mesasles) - Only 1 Antigenic type eruption virus inhibits cell division; months giving life
- Minute, discreet, pinkish, st
1 trimester most long immunity
macular rash – spreds (and
POC: 7 days before rash dangerous= PDA +
clears) rapidly to trunk and ext.
7 days after rash cataracts + deafness
faster than measles
fades
Lasanthi Aryasinghe
- Case
- Subclinical case
- Droplet infection &
Direct contact
- RNA virus
- Max infectivity at onset
- Myxovirus parotiditis
Mumps of parotitis
- Genus; Rubulavirus
POC: 4-6 days before
6 days after illness
- Case
- Droplet infection &
- Gram negative bacilli: Direct contact
- Bordetella pertussis: - Nasopharangeal &
- Clinical disease– encapsulatd, bronchial secretions
Pertussis
Phase 1 strains - Freshly contaminated
(Whooping
- 3 major agglutinogens (1,2,3) formites
Cough)
- Max infectivity catarrhal
- B parapertussis (5% of cases) stage
POC: catarrhal and
paroxysmal stage
- Corynebacterium diphtheriea: - Case
- Toxigenic strains- powerful - Subclinical case
exotoxin- responsible for S/S - <<Carriers (temp or
Diphtheria - Biotypes: gravis,mitis and chornic, nasal or throat):
intermedius Ratio- 95carriers : 1case
- Airborne - Dust
1. Respiratory Diptheria: - Fomites
- Pharyngotonsillar - Direct inf – skin lesions
-2-
IP 2-3 weeks
- Meningoencephalitis
- Ear ache
- Orchitis
- Parotid swelling, sub-
- Epididymitis
mandibular and sublingual
- Oopheritits - Mumps Live
glands may also be involved
- Pancreatitis vaccine
- Nephritis - MMR
- Myocarditis, thyroiditis, - Rubella-Mumps
Mastitis, Arthritis, optic vaccine
neuritis, keratitis &
IP 2-3 weeks
thrombocytopenic
purpura
- Lasts for 6-8weeks
1. Catarrhal Stage (10days)
- DPT
Cough, coryza
- Pertussis – Killed
2. Paroxysmal Stage (2-4 wk)
whole cell vaccine:
Explosive cough, child is - Bronchitis
contraindicated in
chocked, anxious, unable to - Broncopnemonia
H/O epilepsy,
breathe. Bout of cough ends w/ - Bronchiectasis
convulsions,
long drawn out inspiratory - Subconjunctival hmrhgs
febrile illness
crowing sound- whoop, prod by - Epistaxis
- No maternal Ab
air gushing thru half opened - Haemoptysis
protection
glottis. Bout ends in the child - Punctate cerebral
vomiting thick tenacious hmrhgs
- Cases:
sputum. - Hernias
- Erythromycin or
3. Convalescent Stage - Rectal prolapse
ampicillin
(1-2 wks)
- Nebulization w/
Interval b/w bouts & severity 
salbutamol
IP 7-14 days
- Greyish/yellowish membrane - Myocarditis - Cases:
on pharngotonsilar area “False - Loss of visual accomod. Dipth Antitoxin +
Membrane” – cannot be wiped - Fluid regurgitation Penicillin/
away - Polyneuritis. Erythromycin
- Marked edema of - Fatality due to: - Carriers:
submandibular area + Toxeamia Erythromycin
lymphadenopathy-“Bull Neck” Laryngeal stenosis
 airway obstruction and Bronchospasm - DPT:
Lasanthi Aryasinghe -3-
- Nasal (mildest form) - Droplet – N/P secretions stridor Respiratory failure contraindicated in
- Laryngotracheal H/O epilepsy,
- Skin lesions/ulcer surrounded - Provocative reactions = convulsions,
2. Nonrespiratory Mucosal : POC: 2-4 weeks by erythema & covered with a poliomyelitis febrile illness
- Conjuntival & Genitals membrane - Schick Test:
- Presence of
3. Cutaneous Diphtheria antitoxin (immunity
IP 2-6 days status)
- Hypersensitivity to
dipth. toxin or
protiens

In children/adults: vomiting, - Tertravalent

- Nisseria Meningitides:
- Sero-types A,B,C,W135 cause
epidemics (A & C mainly)
- Gram negative diplococci
- In Neonates: E. Coli, Proteus,
Group B Streptococci
Menigitis
- In Children: H. Influenza, N
Meningitides, S Pneumoniae
- In Adults: N Meningitides, S
Pneumoniae, Lysteria, TB, H
Influenza, Cryptococcus
- Case –negligible source
fever, headache, stiff neck, light Polysaccharide
- Subclinical Cases:
aversion, drowsy, joint pain, vaccine (A,B,C, W135) :
immunity mostly
fitting, rash esp. on limbs and Revaccinate 3-5yrs
acquired by Subclinical
trunk - Rash
infection
*place glass over rash, if does - Shock - Cases:
- Carriers 80-90% in
not disappear it is menig. rash - Intravasculr coagulation - Casefatality 95%
epidemics most imp.
In babies: fever w/ cold - Renal failure - Penicillin or
source of infection
hands/feet, fretful, refusing - Peripheral gangrene Chloramphenicol
- Droplet Infection
feeds/vomiting, neck retraction - Arthritis - Dexamethazone
- N/P secretions
w/ arching back, lethargic, - Pericarditis to  edema +
pale blotchy complexion - Waterhouse neuro damage
Difficult to control b/c of
Freidichsen syndrome: - IV mannitol for
subclinal cases and
On clinical exam, hypertonia w/ adrenal insufficiency diuresis  intra
carries
neck rigid, arthritis, Brudinski’s cranial tension
sign & Kernig’s sign = +ve - Carriers:
POC: Noninfective within
- Rifampicin
24hrs of treatment
IP 3-4 days or 2-10 days - Ciprofloxacin

- Gram positive, Acid fast bacilli - Cases of Multibacillary - Face: Mask face, leonine Intensive and extensive Multidrug Therapy:
- Mycobacterium lepre leprosy- main source faceis, lagophthalmous (eye rehab centers: 1. Multibacillary
- Subclinical Cases doesn‟t close completely- leads - Prevent physical leprosy; 12months:
Types: to corneal damage), loss of deformities by early - Rifampicin
Leprosy
- Indeterminate Animal Reservoirs: eyebrows, eyelashes, corneal diagnosis and treatment - Dapsone
(Hansen’s
- Tuberculoid (Lepromin +ve) - Armadillos ulcers & opacities, perforated “Preventive rehab” - Clofazamine
Disease)
- Borderline - Mangaba monkeys nasal septum, depressed nose,
- Lepromatous (Lepromin –ve) - Chimpanzees nodules on the ear lobules and - Rehabilitation measures 2. Paucibacillary
elongated ears such as medical, surgical, leprosy; 6months:
Paucibacillary: 1-5 lesions - Direct Contact educational & vocational - Rifampicin
- Droplet Infection - Hands: Claw hand, wrist drop, - Dapsone
Lasanthi Aryasinghe
Multibacillary: >5 lesions
(Borderline & Lepromatous)
Tuberculosis - Mycobacterium Tuberculosis
- Formites
POC: Noninfective within
1 day of treatment
- Human Case
- Bovine – Infected milk
- Droplet Infection (nuclei)
- 5000 bacilli/1mL:
positive smear
- 10,000 bacilli/1mL: 95%
probability positive
- Sputum smear +ve pts
are major source of
infection in community
- Sputum smear -ve pts
responsible for 15-20% of
transmission (-ve in extra-
pulmonary TB)
POC: Pt infective as long
as he remains untreated;
infectivity 90% within
48hrs of treatment
-4-
ulcers, absorbtion of digits,
contractures, aollowing of
interosseous spaces and Lepra Reactions:
swollen hand Immunologically
mediated episodes
- Feet: Planter ulcers, foot drop, of acute and sub
inversion of foot, clawing of acute inflammation,
toes. Absorbtion of toes, if not promptly
callosities and swollen foot treated may lead to
serious deformities
- Others: Gynaecomastia and b/c peripheral
perforation of palate nerve trunks are
involved:
IP 9 months- 10 years - Type I reaction
- Type II reaction
(erythema nodosum
leprosum)
- Corticosteroids
- Clofazamine
Rifampicin - Hepatotoxity,
nephrotoxicity, gastritis,
thrombocytopenia
- Rapid & Slow multipliers
- BCG @ birth
INH - Peripheral
- Fever with night sweats DOTS strategy:
neuropathy, GI irritation,
- Weight loss -Intensive 2months:
hepatotoxicity
- Anorexia Rifampicin (BC)
- Rapid multipliers
- Malaise INH (BC)
- Chronic cough + expectoration Pyrazinamide (BC)
Streptomycin - Vestibular
- Chest pain Ethambutol (BS)
damage and nystagmus
- Blood streaked sputum to
- Rapid multipliers
frank haemoptysis -Continuation 4mts:
INH
Pyrazinamide -
IP weeks, months or years Rifampicin
Hepatotoxicity,
From exposure to +ve
hyperuricemia
Tuberculin Test takes 3-6 - Prophylaxis:
- Slow multipliers
weeks INH for 1yr or INH
(persisters)
+ Ethambutol for
9months
Ethambutol - Retrobulbar
neuritis
Thioacetazone (BS) -
Lasanthi Aryasinghe -5-
Urticaria, GI irritation,
blurring of vision

INTESTINAL INFECTIONS

Provocative poliomyelitis:
Risk factors precipitate an
IPV (Salk):
-Malaise, anorexia, abd pain, attack of polio in people
• Killed virus
nausea, vomitting, headache, who are infected by the
- Case • SC or IM
constipation, Meningeal virus:
- <<Subclinical cases • No local immunity
irritation- stiff neck and back  Trauma
- Feco-oral • Does not prevent
- Tripod Sign - sits by  Operative procedures
- Droplet Infection reinfection
supporting hands at back,  Rigorous physical
- Feaces, orophayrengeal • Not useful in
- RNA virus partially flexing hips and knees exercise
secretions epidemics
- Entero virus (Poliovirus):  Painful IM injections or
• Difficult to make
Type 1 (Brunhylde) Spinal poliomyelitis: DPT (alum containing)
Basis for eradication: • Virus content >
Type 2 (Lansing) • Anterior Horn cells affected
 Man is the only host than OPV- costlier
Type 3 (Leon) Paralysis is: Disability limitation and
 Long term carrier state • No stringent
*Outbreaks of paralytic polio • Flaccid rehabilitation:
does not exist conditions for
due to Type 1 • Patchy and asymmetrical - Pts w/ muscle paralysis
 Effective live vaccine storage
• Descending benefit from frequent
 Vaccine mimics
Polio Myelitis Types of Polio: • Proximal muscles more passive range of motion
natural route of OPV (Sabin):
- Subclinical infections: 95% involved (PROM)
infection • Live virus
- Abortive poliomyelitis: 4-8% • Deep tendon reflexes are - Splinting of joints
 Displaces the wild • Orally
- Aseptic meningitis / diminished prevent contracture &
virus in intestines • Local, humoral &
nonparalytic polio: 1% • Sensory system intact joint ankylosis.
 If vaccination is 100% Herd immunity
- Paralytic poliomyelitis: < 1% - Chest physical therapy
there is abrupt Bulbar poliomyelitis: • Prevents intestinal
 Spinal (CPT)- pts w/ bulbar polio
interruption of • Medulla affected reinfection
 Bulbar and Bulbospinal prevents any pulmonary
transmission of wild • Facial asymetry (Cranial nv.) • Effective in
 Encephalitic complication (atelectasis)
polio virus • Difficulty in swallowing epidemics
- Occupational Therapy:
• Weakness or loss of voice • Easy to produce
pts w/ paralysis of
POC: 1-2weeks before • Death  respiratory • Cheaper
extremities: hand or arm
and after the onset of insuffeciency • Store: sub 0 temp
splints, knee or trochanter
illness
rolls, footboards, or Multi-
IP 7-14 days NO secondary
Podus boots (prevent foot
prevention
drop, ulcers, etc)
- Speech Therapy

- Vibrio Cholerae: - Case 1. Evacuation: - Oral Cholera

Cholera
- Group O1: “epidemic strain” - Subclinical cases: - Sudden onset of profuse, Vaccine (OCV)
- O139: New strain maintains endemic effortless, watery diarrhorea 2 doses 10-15 days
Lasanthi Aryasinghe -6-
- Killed by Gastric pH>=5 reservoir (Exotoxin H stimulates apart mix with
- Dose-related - Large dose - Vehicle Borne: Water, adenylate cyclase  cAMP 150ml safe H2O
11
required for infection 10 food, drinks  drives fluids and ions into the - Lasts 6 months
- Direct Contact- lumen of the small intestine) Treatment:
- Biotypes of O-Group 1: contaminated fingers  “Rice water stools” • Plan A – Home
- Classical - Feces, Vomit - Vomiting therapy fluids
- El Tor – greater “endemic - Formites
• Plan B – ORS
tendancy” than Classical 2. Collapse: • Plan C – IV fluids
- 3 serotypes: Carriers: - Rapid dehydration (+ acidosis
• Ogava - Temp: maintains reservoir  Death) ORS:
• Inaba - Chronic (Gallbladder - Muscular Cramps • NaCl - 3.5 mg/L
• Hikojima affected) - Suppression of urine ( renal • NaHCO3 -2.5mg/L
- Incubatory failure Death) or Trisodium citrate
- Convalescent - Unrecordable BP - 2.9 gm/L
- Healthy: imp in spread - Intense thirst • KCl - 1.5mg/L
- Sunken eyes • Glucose - 20mg/L
POC: • Water - 1 liter
Case- 7-10 days 3. Recovery: IV Fluids:
Convals. Carrier- 2-3 wks - Increased BP, urine flow • Ringers lactate
Chronic Carrier- 1mt-10yr
sol w/ 5% dextrose
Above are S/S of the Classical • Normal saline
type (5-10%) of Cholera, El Tor (Does not correct
types causes mild & inapparent acidosis)
infection
Chemotherapy:
• Doxycycline
IP few hours- 5 days • Tetracyclin
• Flurazolidine

- Salmonella Typhi
- Gram negative, nonsporing
- Facultative anaerobic rod
- Secondary attacks may occur
- 3 main Ags- O, H & Vi:
• Widal‟s Test for O, H, Vi Ags
Typhoid &
• Ab to O Ag > in pt. w/ disease
Paratyphoid
• Ab to H Ag > in immunizd pts.
Paratyphoid fever:
• S. paratyphi A & B (rare)
• I.P. is shorter
• Clinical manifestations- Milder
• Complications – Uncommon
- Man only reservoir
- Case
- Subclinical Case
- Carriers:
• Incubatory
• Convalescent
• Chronic (>1yr) –
oraganism persists in
gallbladder & biliary tract
• Fecal >urinary carriers
(Chronic urinary carriers
are assoc. w/ urinary
tract abnormalities)
1. First stage (1 week) • Intestinal hmrrhge-
Temp  step-ladder fashion, sudden temp, shock,
severe headache, malaise, dark/fresh blood in stool
coated tongue, relative • Intestinal perforation
bradycardia, abd. pain & • Urinary retention
constipation • Thrombophlebitis
• Pychosis
2. Second stage (1-2 weeks) • Nephritis
• Fever reaches plateau • Osteomyelitis
• Abd. discomfort & distention • Cholecystitis
• Pt. exhausted and prostrated • Hepatitis
• Diarrhea- pea soup stools • Fatty liver & abscess
• Dicrotic pulse (double beat) • Bronchitis & pneumonia
• Occasionally meningismus • Myocarditis
1 Prevention:
Health education:
Domestic, personal
& environ. hygiene
Vaccines:
• Vi polysaccharide
1dose - parenteral
• Ty21a Oral live
vaccine capsule
Day 1-3-5
Booster evry 3yrs
Lasanthi Aryasinghe -7-
• Rose spots MORE • Female > Male carriers • Leukopenia • Meningitis
• Blood, urine & stools test +ve • Peritonitis 2 - Treatment:
- 1 source of infection: for salmonella • Ciprofloxacin
Feces & urine of carriers • Rose spots - 25% of white • Chloramphenicol
pts.- principally on trunk, fades • Cefexime
- 2 source of infection: on pressure • Amoxocillin
Contaminated water, • Splenomegaly & Toxemia • Cotrimoxazole
food, fingers & flies • Azithromycin
3. Third stage (over 7-10days) • Cortricosteroids –
Condition improves, temp  in  mortality in
step-ladder OR complications critically ill pts
start to appear
Chronic carriers:
4. Fourth stage: Recovery • Ampicillin plus
Relapse in 10-20% of cases Probenecid
• Cholecystectomy

IP 10-14 days; 3 days-3 weeks

IP is dose dependant
- Case
- Asymptomatic
(Anicteric) < children, Prevention:
maintains chain of trans. • NHIg -  Globulin
- Hepatitis A virus
- Feco-oral – food, water, - Given before
- Enterovirus
milk, raw / inadequetly exposure or
- Picornaviridae family
cooked shellfish Non-specific symptoms: during IP prevents
(cultivated in sewage Fever, chills, headache, fatigue, or attenuates
Serological Diagnosis:
water) , hands, eating generalised weakness, clinical illness but
• HAV particles or specific viral
utensils anorexia, nausea, vomiting, DOES NOT
Ags in feces
- Parenteral – blood & dark urine & jaundice prevent subclinal
Hepatitis A • Rise in anti-HAV titre – lifetime Primary Prevention:
blood products infection or
(infectious / persistance - Food hygiene
- Sexual – homosexuals, - Benign disease – recovery excretion of virus
epidemic • IgM appears early in illness - Supercholrination
oral-anal contact w/in a few weeks
jaundice) and persists for over 90days
• IgG appears more slowly, Vaccines:
- Fecal shedding > in • HepA Killed vacc.
persists for many years –
later part of IP and early IP 15 - 45days (usually 25- - 2doses parenteral
indicates past infection &
acute phase of illness 30days) – depends on dose - 6-18 months apart
immunity
ingested
- Feces, urine, blood, • Combined Killed
NO CHRONIC CARRIERS Hep A &
serum & other fluids are
infective during breif recombinant B
viremia - 3doses- 0-1-6 mts

POC: 2wks before – 1wk

Lasanthi Aryasinghe -8-
after onset of jaundice

- Hepatitis B virus
- Hepadna virus

3 morphological forms:
• Dane particles - 42nm
- Double shelled DNA virus
• Small spherical particles 22nm
- Antigenic, stimulate prod. of
surface Ag
- Purified 22nm particles used
to prepare Hep B vaccine
• Tubules of varying length

Serological Diagnosis: - Case Pre / Post Exp.:

HBsAg
• Appears in serum during IP
before biochemical evid. of
liver damage or jaundice
• Persists during acute illness
Hepatitis B
• Cleared during convalesence
(Serum Hep)
• Present for 4-6 months
HBeAg
• Precedes onset of disease
• Marker of virus replication,
therefore  infectivity
• Detectble 3-5days aftr HBsAg
• Persists 2-6 weeks
• Carriers - persists for yrs
• Presence of HBeAg indicates
pt. is highly infectious
- Subclinical S/S similar to Hep A • HBIg – asap w/in
- Chronic carriers: - Complicated in the carrier 6rs & not >48hrs
HbsAg > 9months state by chronic liver disease, - 2 doses – 30days
5-15% of cases; may which may follow infection apart
cause chronic active Hep - Chronic liver disease may be
- Hepatocellular cancer
& hepatocellular severe, and progress to primary • Hep B – Plasma
- Liver Cirrhosis
carcinoma liver cancer or cirrhosis derived vaccine
- 0-1-6 months
- Contaminated blood
(main source), saliva, IP 6wks – 6 months (median • Hep B vac + HBIg
vaginal secretions & IP = 100 days)
semen

HBcAg - Core Ag

Anti-HBs
• Indicates past infection &
immunity to HBV
• From HBIg or immune
response to HBV vaccine

IgM anti-HBc
Lasanthi Aryasinghe
• Indicates recent infection
• Positive for 4-6 months
- Hepatitis C virus
Hepatitis C
- Parenterally transmitted Non-
(Post
A, Non-B (PT-NANB)
Transfusion
- Single stranded RNA virus
Hepatitis)
- Similar to Flavivirus
-9-
- Clinical illness is often mild,
usually asymptomatic
- Case - Chronic carriers are at risk of
- Chronic Carriers developing liver cirrhosis and
- 50% of cases are liver cancer
NO VACCINATION
asymptomatic - Leading reason for liver
- Transfusion transplantation - Hepatocellular cancer
Treatment:
- Contaminated blood & - Liver Cirrhosis
Interferon
blood products - 50% of cases relapse when
(Very expensive)
- Maternal – neonatal, treatment is stopped
sexual transmission is - Only 25% have long-term
small remission

IP 6 - 7 weeks

- Self-limiting acute viral hep for - Food hygiene

- Hepatitis E virus
a period of several wks followed precautions
- Enterically transmitted Non-A, Intrauterine infections w/
by recovery - Supercholrination
Non-B virus Hepatitis E:
- Water borne - Induces a fulminating form of - Recovery is
Hepatitis E - RNA virus: 29-32nm • Abortions
- Feco-oral acute disease in 80% of always complete
- Calcivirus • Intrauterine Death
pregnant women
• High perinatal M&M
NO SPECIFIC
NO CHRONIC CARRIERS
TREATMENT
IP 2-9weeks
- Hepatitis D virus
- Delta virus

Serological Diagnosis:
HDAg Immunization
• Detectable in early acute - ALWAYS occurs in assoc. w/ against Hep B also
Hepatitis D *See Hep B*
infection Hep B Carrier state protects against
delta infection
Anti-HDV
• Indicates past or present
infection

Group A - Group A beta hemolytic

Streptococcal - Streptococci M type:
infections 1,3,5,6,14,18,19 and 24
Lasanthi Aryasinghe - 10 -

ARTHOPOD-BORNE / ZOONOTIC / PARASITIC - INFECTIONS

Pre-exposure:
• 3doses- cell
Furious (classic) rabies culture vaccine
- Virus spreads from site of • 80% of cases • 0-7-21-(or) 28
infection centripetally via the • Death – few days • Booster after 2yrs
peripheral nerves towards the • Hyperactivity
CNS- it “ascends” • Hydrophobia Vaccine:
• Mood swings and • HDCV or PCECV
1. Prodormal stage: aggressiveness
Fever, malaise, headache, sore • Convulsions IM- 5doses x1ml
- Lyssa virus type I, RNA virus throat, tingling at site of bite Days: 0-3-7-14-28
Reservoir:
- Family Rhabdoviridae
- Urban Rabies Paralytic (dumb) rabies
- Street virus: naturally occuring • If previously vacc:
- Wild (Slyvatic) Rabies 2. Encephalitic stage: • 20% of cases Mild bites 1ml x 0-3
cases
- Bat Rabies Sensory  Motor  • Less dramatic form of
- Fixed virus: Serial brain-to- Severe 1ml x 0-3-7
Sympathetic  Mental the disease
brain passage of street virus in
- Animal bites - Intolerance to light, noise or • Death – 1 month ID- x 0.1ml
rabits; used to prepare
- Licks air (Aerophobia)- sensory • Flaccid muscle paralysis Days: 0-3-7-28-90
Rabies antirabies vaccine
- Aerosols – in bat caves - Increased reflexes, muscle develops early-
(Acute viral 2 x 0.1ml -Day0,3,7
- Person-Person: bites or spasms- motor prominent feature of this
encephalitis) Duration of illness:
- 2-3days
organ transplantation - Pupils dilated,  perspiration, form of rabies. Post-exposure:
salivation & lacrimation- • „Dumb‟ rabies reflects I No treatment
- Dead-end disease
- Carriers: only animals sympathetic the paralysis of the II Vaccine
(organism dies along with man)
- Fear of death, anger, laryngeal muscles which III Vaccine +Ig
- Virus evades the immune
Variable qty of virus in irritability, depression- mental inhibits speech.
system before the signs of
saliva of rabid animals  - Hydrophobia- sight or sound • Mild sensory • Clean- soap +H2O
encephalitis develops
only 50% of bites result in provokes voilent spasms of disturbances • Virucidal agent
rabies pharygeal and neck muscles • Avoid suturing
Treatment: • Antibiotics
3. Coma  Death • Isolation • Tetanus
• Sedatives • Ig 20 IU/kg -
IP 3-8wks or 7 days to years • Muscle relaxants infiltrated around the
depending on site & severity of • Hydration,diuresis wounds, remains given
bite, no. of bites and amount of • Resp & cardiac support at site anatomically
distant frm vaccine
virus injected • Barrier nursing
• Antirabies vaccine

- Plasmodium vivax - Female Anopheles 1. Cold stage – ¼ to 1 hr Falciparum:

- Plasmodium falciparum Mosquito takes blood Lassitude (fatigue), severe • Hyperparasitemia Treatment:
Maleria - Plasmodium ovale mealinjects sporozoites headache, nausea, rigors, • Hyperpyrexia • Day 1
- Plasmodium malariae - Blood transfusions Temp 39-40C, vomiting, skin • Severe anaemia Chloroquine +
feels cold initially hot, pulse is • Spontaneous bleeding Primaquin
Lasanthi Aryasinghe
• Fetal Hb: supress Falciparum
• Sicklecell (AS Hb) trait:
Milder infection w/ Falciparum
• Duffy –ve: resistant to Vivax
- Protozoa: Leishmania:
L. donovani- Kala azar/Visceral
Leishmania
L. tropica/ L. major- Cutaneous
L. braziliensis- Muco cutaneous
- Carriers:
Human tht habor both
male & female sexual
forms (gametocytes) of
sufficent density to infect
a vector mosquito
- Children are more likely
carriers than adults
- Definitive Host:
Mosquito, Sexual Cycle
- Intermidiate Host:
Man, Asexual Cycle
- Bite: infected female
sandfly injects
promastigotes
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rapid & weak and coagulopathy • Day 2 & 3
• Cerebral malaria Chloroquine
2. Hot stage – 2 to 6 hrs (Convulsions, Coma)
Pt feels burning hot- removes • Acute renal failure Vivax & Ovale:
clothing, skin hot & dry, intense (black water fever) • Primaquin (5days)
headache, nausea dimishes, • Hypoglycemia
pulse full, respiration rapid • Metabolic acidosis Chloroquin resist.
• Shock Faciparum:
3. Sweating stage – 2 to 4 hrs Artesunate plus:
Fever  w/ profuse sweating, Vivax, Ovale & Malariae: • Mefloquine
temp  rapidly to normal, skin is Anaemia, Splenomegaly • Amodiaquine
cool & moist, pulse decreases Liver enlargment, Herpes, • Sulfadoxine/
Renal complications Pyrimethamine
In pregnant women: Combined antimals
• Intrauterine death • More effective
• Premature labor • Prevent resistant.
• Abortion
• Congenital maleria Chemoprophylaxis:
• Cholorquin
1wk before travel to
4wks after return
Cutaneous forms: Control of reservoir:
• Skin ulcers on exposed areas, Early diagnosis:
face, arms and legs. • Aldehyde test
• Heals within a few months • ELISA
• Leaves scars • Isolation of
parasite from
Diffuse cutaneous forms: aspirates of
• Disseminated & chronic skin spleen, liver, bone
Vector Control:
lesions similar to lepromatous marrow, lymph
• Elimination of breeding
leprosy nodes and skin.
places
• Insecticide spraying
Mucocutaneous forms: Treatment:
• Personal prophylaxis
• Lesions destroy mucous • Na stibugluconate
membranes of nose, mouth, 20days- Cutaneous
throat cavities & surrounding 28days - Visceral
tissues.
• Pentamidine
Visceral leishmaniasis: Isothionate- 10days
nd
• High fever, weight loss - 2 line drug
• Swelling of the spleen & liver
• Anaemia • Amphotericin B
Lasanthi Aryasinghe - 12 -
• Untreated fatality rate as high 7-14 days
as 100% within two years.

IP weeks-months
• Stiffness and cramps around
the area of wound
• Deep tendon hyper-reflexia
• Trismus lock jaw (masseters)
• Dysphagia
• Risus sardonicus (facial ms.)
• Opisthotonus (back and
neck)
• Painful paroxsymal spasms of
- Reservoirs: soil, dust, voluntary muscles  cyanosis
intestines of herbivorors  threatens resp.
(excreted in their feces)
- Clostridium tetani
- Contamination of Auntonomic dysfunction
- Gram +ve
wounds with tetanus (severe cases):
- Anerobic bacilli
spores - Toxin diffused to lateral horns
- Spore bearing
- Increased basal sympathetic
Types of Tetanus: tone: tachycardia, bowel &
Tetanus - Exotoxin tetanospasmin:
• Traumatic - wounds bladder dysfunction
Acts on nervous system:
• Perpeural - postabortion - Sympathetic over activity
• Motor endplates- skeletal sys
• Otogenic - foriegn body (both alpha & beta receptors):
• Spinal Cord
in ear • Labile hypertension
• Brain
• Idiopathic • Pyrexia
• Sympathetic System
• Neonatorum • Sweating
• Pallor
POC: Not transmitted • Cyanosis of digits
• Exhaustion, asphyxia or
aspiration pneumonia  Death
IP 6-10 days; depends on
character, extent and location
of the wound.
Prevention:
DPT @ 2-4-6+
3 Booster doses:
• DPT – 18 months
• DT – 5-6yrs old
• TT – every 10yrs
Post Exposure:
Introduction of spore  1. Clean wound, remove
germination & elaboration debris & dead tissues
of exotoxin  blood 2. TIG/ATS +
stream  motor nerve Benzathine Penecillin
(long-acting) OR
endings  CNS via 3. TIG/ATS + TT (in pts.
pheripheral nerves  w/ incomp. imunization)
Blocks the release of + Benzathine Penecillin
4. TIG/ATS + PTAP/APT
inhibitory (glycine)
(absorbd tetanus toxoid)
neurotransmitters across +Benzathine Penecillin +
the synaptic cleft  TT (in 6wks) + TT (in
Abolition of spinal 1yr)  in pts never been
inhibition  muscle immunized before
rigidity & spasms
Human Tetanus
HyperIg (TIG):
• Human Antitoxin
Treatment:
• 250-500IU
• Isolation
• No serum rxn
• Sedatives
• Passive immunity
• Muscle relaxants
upto 30days
• Hydration,diuresis
• Maintain adequet airway
Antitetanus Serum
(ATS):
• Equine Antitoxin
• 1500IU - SC
• Allergic reactions
• Passive immunity
only 7-10days

- Retrovirus (lentivirus family) - Direct Contact: Sexually 1. Intial Infection Tests:

- RNA virus - Parenteral route Mild illness- fever, sore throat, Treatment:
AIDS • ELISA
- HIV-1 - Transplacental/ Vertical rash. Window Period – period Nucleoside Analog
- HIV-2 in West Africa - Blood Transfusions before HIV Abs (2-12wks) • Western Blot: • Zidovudine (AZT)
Lasanthi Aryasinghe
- Occupational: needle-
stick injury
Prophylaxis (4wks):
• Zidovudine +Lamivudine
+ Nelfinavir (if source has AIDS)
• Stavudine + Didanosine
(if source failed AZT/3TC treatment)
Vertical Transmission:
• HAART during
pregnancy
• Perinatal Antiretroviral
prophylaxis
• Caesarian section
• Ziduvudine to neonate
• Avoid breast feeding
POC: Highly infectious
during „Window Period‟
and in advanced infection
- Blood Fluke/ Trematode
Urinary Schistosomiasis
• S. haematobium
- Cercariae released by
Schistosomia Intestinal Schistosomiasis
snails  penetrate skin
• S. masonii
• S. japonicum.
• S. Mekongi
• S. intercalate
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appear in blood after infection. Confirmatory Test. • Stavudine
Pt. is highly infectious due to Detects Ab to viral core • Lamivudine (3TC)
high viral conc. in his blood- pt. protien p24 & envelop • Didanosine
tests –ve on standard Ab tests. glycoprotien gp41.
Indeterminate results w/ Protease Inhibitors
2. Asymtomatic Carrier state early HIV inf, HIV-2, • Saquinavir
No overt signs- only persistent Auto-immune disease, • Ritonavir
generalised lympadenopathy pregnancy & recent TT. • Indinavir
(nodes>1cm in 2 or more sites
• CBC – In advance HIV:
besides groin area for 3months) Nonnucleoside rev.
Anemia, neutropenia,
transcriptase inhbit.
Thrombocytopenia
3. AIDS related complex • Nevirapine
1 or more of: diahorrea>1mt, • Absolute CD4 count: • Delaviridine
wt. loss>10%, fever, night AIDS – CD4<200cells/L
sweats, oral thrush, enlarged FirstLine CD4 <500
• CD4 Percentage
spleen, lympadenopathy. • 1 or 2 Nucleoside
AIDS – CD4 % <20% Analogs
4. AIDS • HIV Viral Loads:
• Opportunistic inf. + Cancers Amt. of actively Second Line
(Study table- infections related replicating virus. Relates • 1 Protease inhibit.
to falling CD4 count) to disease progression + 1 or more
• Slim disease - HIV wasting = and antiretroviral drugs. Nucleo. Analogs
Chronic diarrhoea + Wt. loss
• AIDS dementia – HIV crosses • B2 Microglobulin levels: Third Line
>3.5mg/dL ass. w/ rapid
BBB, resembles Alzheimer‟s • 1 or 2 Protease
progression of disease
inhibit. + 1 or more
Nucl. Analogs
IP Few months to 10 years • Nevirapine +
Zidovudine +
Didanosine
• Swimmer’s Itch @ site Reservoir Control:
Urinary Complications:
• Katayama fever (serum •Praziquantel
• Hydroueter
sickness like syndrome) w/ •Mass chemotherpy
• Hydronephrosis
intestinal schistosomiasis, due for highrisk
• Cancer bladder
to Ag-Ab complex children 10-15yrs
• Acute & Allergic manifestation •Artemether -
Intestinal Complications:
• Characteristic manifestations anticercarial drug
• Portal hypertension
occur after oviposition •Topical
• Liver cirrhosis
anticercarial
• Esophageal varicies
Urinary: ointment DEET
• Haematemesis
Dysuria, terminal painless insecticide
• Colorectal polyps.
haematuria. Protienuria, repellent.
• Epilepsy (S. japonicum)
ulceration, thickening and
Lasanthi Aryasinghe
- Yersinia pestis
- Gram-negative cocco bacilli
- Typical bipolar staining
- Non-motile and non-sporing.
Virulence due to:
• Exotoxin and endotoxin
• Fraction 1
• Many other Ag & toxins
Plague
Bacilli occur in:
• Buboes- Cannot spread
person-person as bacilli are
locked in buboe
• Blood
• Sputum (pneumonic)
• Spleen, liver & other viscera of
infected pts
• Natural reservoir: rodent
• Source: infected rodents
fleas & pneumonic case
• Vector: Most efficient
vector is the rat flea
X.cheopis
- Bite of infected flea
- Direct contact with
tissues of infected animal
- Bite of human flea
Pulex irritans from
plague pt. (rare)
- Droplet infection: when
primary case of bubonic
plague develops
secondary pneumonic
plague
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calcification of urinary bladder Snail control:
• Mechanical
Intestinal: method- removal
Intermittent diarrhea, abdominal of aquatic
pain, melena, intestinal vegetations &
polyposis, hepatomegaly, increase flow of
spleenomegaly and ascites. water in canals
Manifestations more severe w/ • Biological
S. japonicum b/c no. of eggs. method- snail
eaters. Ducks and
geese
IP 2- 6 weeks • Chemical method-
molluscicides
A. Bubonic Plague
• Buboes - greatly enlarged,
tender lymph nodes in groin
area w/ erythema and edema
of the overlying skin. Formalin-killed:
Comlications of Bubonic:
• Fever, suddenchills, • 2doses SC
• Secondary septicemia
• Day 0 & 14
headache, prostration, painful • Pneumonia
• Booster evry 6mts
lympadenitis • Meningitis.
• If left untreated followed by • Immunity starts 5-
• Polyarthritis
7days
disseminated infection  • Lung abscesses
• Infants <6mts not
complications  secondary • Superinfection of lymph
immunized
pneumonic plague & nodes
meningitis. Bacteremia can
Treatment: 10days
occur, some develop sepsis Septicemic Plague:
• Streptomycin
• DIC
• Tetracycline
B. Pneumonic Plague • Menigitis x4 more
• Doxycycline
• Primary  inhalation of common than in bubonic
• Chloramphenicol
organism frm other humans • Multi organ failure
• Gentamicin
• Seconday  hematogenous • Trimethoprim-
spread as a complication of sulfamethoxazole
pneumonic or bubonic plague IP
• Cough, hemoptysis, chest Bubonic 2-7 days
Prophylaxis:
pain, tachypnea and dyspnea Septicemic 2-7 days
• Tetracyclin
• Thin, watery, blood-tinged Pneumonic 1-3 days
• Sufonamide
sputum becomes frankly
bloody and mucopurulent as
the disease progresses.
C. Septicemic Plague
Lasanthi Aryasinghe
- Wild reservoir: monkey
- Urban reservoir: Man &
Aedes aegypi mosquito
- Vector- Mosquito
- Clinical cases
- Subclinal cases
- RNA virus
- Jungle (Slyvatic) Cycle
- Family Togavirus
Transmission of disease
- Flavivirus fibricus
b/w monkeys.
- group B Arbovirus
Americas: Haemagogus
- Pantropic virus- can invade &
Africa: Aedes africanus &
Yellow Fever affect different tissues of the
simpsoni
body, w/out showing affinity to
any of them
- Urban Cycle
- Shares specific Ag w/ other
Person to person
members of the genus eg. West
transmission by Aedes
Nile & Dengue
aegypti mosquito
POC:
-Man: blood of paitent
infective during first 3– 4
days of illness
- Mosquito: infective for
life
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• Primary- flea bite. S/S similar
to bubonic plague but
absence of palpable buboes.
• Secondary - complication of
pneumonic or bubonic plague.
• Some pts develop nausea,
vomiting, diarrhea & abd. pain.
1. First phase: 72 hrs
Headache, malaise, weakness,
nausea and vomiting
Vector Control:
1. Anti larval measures -
2. Remission: 24 - 48hrs
Apply larvicide to actual
17-D vaccine:
or potential breeding
3. Intoxication phase: 7-10day • Freeze-dried
places.
• Jaundice w/ hemorragic • Reconstituted w/
manifestations; mucosal cold physiological
2. Anti adult measures -
hmrhgs & GI bleeding: black saline diluent
Residual spray and space
vomit, epistaxsis and melena • Sub 0 temp
sprays with insecticides
• High fever • Immunity begins
like malathion and
• Albuminuria or anuria- acute 7th day and lasts
lindane.
renal failure >35yrs
• Shock • Revacination
3. Personal protection -
• Agitation every 10yrs
Mosquito repellants, nets,
• Stupor/ Delirium
coils and fumigation
• Seizures
mats.
• Coma
• Death within 7-10 days
IP 3-6 days