Communicable diseases

INTRODUCTION

           Communicable diseases are more commonly seen in all the area.  Mainly factors responsible for the spread of communicable disease and the epidemiological trial i.e., Agent, Host, Environment are also seen and explained in this assignment.

DIPHTHERIA

Definition:

          Diphtheria is an acute infectious disease caused by the exotoxin of diphtheria bacilli (Corynebacterium diphtheria).  The disease attacks mainly the throat, tonsils, larynx or nose where it produces a greyish white ‘Membrane’ which spreads into air passages.

Epidemiological factors

Agent

        Corynebacterium diphtheriae is a gram positive non motile organism.  It has no invasive power but produces a powerful exotoxin.

Source of infection

          The source of infection may be (1) Patient or (2) Carrier

Most carrier are between 5 and 8 years of age.

Infective material

          Nose and throat secretions containing the diphtheria bacilli.

Host factors

Age:

          Diphtheria is primarily a disease of children between 2 to 5 year.

 

Sex:

Both the sexes are affected.

Immunity:

          Infants burn of immune mothers during the first few weeks or months of life are immune to infections.

Mode of Transmission

          The bacilli spread from person to person by (i) Droplet infection through coughing and sneezing (ii) Indirectly through formites or contaminated articles such as toys, pencils, clothes etc.

Incubation period

          2 to 6 days occasionally longer.

Clinical Features

·        The formation of a greyish or yellowish membrane commonly over the tonsils, pharynx or larynx.

·        Marked congestion, oedema or local tissue destruction.

·        Enlargement of lymphnode

·        Signs and symptoms of toxaemia.

 

Schick Test

          Schick test is an indradermal test.  The test is carried out by injecting 0.2ml of schick test toxin, indradermally into the skin of forearm, while into the opposite arm is injected as a control the same amount toxin which has been inactived by heat.  The results are read on fourth day.  If there is no reaction of any kind, the person is considered immune to diphtheria, if there is a red flush, the person is considered susceptible to diphtheria.

Treatment

·        The specific treatment is diphtheria antitoxin which must be given immediately in doses ranging from 10,000 to 80,000 units.

·        Antibiotics (Penicillin or erythromycin) help to eliminate the infection  and prevent production of further toxin.

·        Bed rest is essential to prevent heart failure

·        Tracheostomy may be needed.

Control Measures

·        Notification to the local health authority.

·        Prompt isolation and treatment of cases

·        Disinfection of all articles and clothes soiled by the patient.

·        Active immunization with DPT or APT three doses of DPT are recommended (Each dose 0.5ml) at an interval of 1 to 2 months.

 

 

TETANUS

Definition

          Tetanus is an acute disease induced by exotoxin of clostridium tetani and clinically characterized by painful muscular contractions which affects mainly masserters.

 

Epidemiological factors

Agent

          The causative agent is clostridium tetani it is present in the intestinal tract of many vertebrates including man.

Host

Age:

5 to 40 years of age

Sex:

          Higher in males than in females at all ages except 15 to 45 years.

Source of infection

          The spores are widely distributes in the environment-soil, street dust, house and cow dung.

Mode of transmission

          Cl. Tetani is usually found in the soil and faces of animals.

 

Incubation period

3 to 21 days

Signs and Symptoms

·        Difficulty in opening the mouth and swallowing owing to the spasm of masseta.

·        Spasm of respiratory muscles cause long periods of cyanosis.

·        Temperature is elevated.

·        Pulse rate increased

Diagnostic measure

·        Clinical picture

·        Microscopic examination

·        Culture

Prevention

·        The patient with tetanus should be treated in a calm, quite and dark room.

·        Adequate airway must be maintained by using endotracheal tube or tracheostomy.

·        Muscle relaxants, sedatives and anti-convulsant drugs should be administered to treat muscle rigidity and convulsion.

·        Tetanus immunoglobulin

·        Antibiotics are administered

·        Control of spasm.

·        Wound toilet

 

1. Active Immunization

          Tetanus is best prevented by active immunization with tetanus toxoid.

·        Two doses of 0.5ml each of tetanus toxoid at an interval 6 weeks given intramuscularly followed by booster doses every 10 years.

Passive Immunization

Human Immunoglobulin

          Antitetanus human immunoglobulin is the best prophylactic use.  Dose is 250 to 500 IU.

Pertussis

Definition

        A highly infectious disease of the respiratory tract caused by the whooping cough bacilli (bordetella pertussis) Pertusis is also called whooping cough.

Epidemiological factors

Agent

          The causative agent is bordetalla pertussis

Source of infection

          Nose and throat secretions of a case.  A carrier state does not exist.

Age:

Highest incidence is found below the age of 5 years.  Infants below 6 months have the highest mortality.

Sex

          More in female than male children

Mode of transmission

          Spreads directly by droplet infection or indirectly by articles soiled with discharge from infected cases.

Incubation period: 7 to 14 days

Clinical features

·        Slight fever

·        Cold and running of the nose

·        Irritating cough which gradually becomes paroxysmal within 1-2 weeks

 

Control of pertussis

a) Cases and contacts

          Early diagnosis, isolation, treatment and disinfection of discharges from nose and throat.

b) Several antibiotics are effective against B. pertussis

Erthromycin is the drug of choice

30-50 mg / kg of body weight.

 

Active Immunization

          The vaccines is the most effective way to control perturris.

          DPT is generally is given in 3 doses of 0.5ml of each intervals of 4 to 8 weeks.

          Pertussis vaccine.

Poliomyelitis

Definition

        Poliomyelitis is a virus infection.  It is an acute, systemic disease caused by RNA virus.

Epidemiological factors

Source of infection

Faeces

Pharyngeal secretions

Age

The majority of cases contract polio between 1 and 2 years

Incubation period:  7 to 21 days

Mode of Transmission

1) Farcal oral route

          This is the most common route of transmission, via contaminated water, food or flies.

2) Droplet infection

Clinical features

·        Sore throat or cough

·        Vomiting, diarrhea or constipatron

·        Fever, headache, drowsiness, restlessness irritability and sweating.

Diagnosis

·        Diagnosis can be confirmed by serological testing for polioviral antibodies.

Treatment

·        Mild analgesics and sedatives.

·        For constipation – Mild Laxatives

·        To prevent respiratory and aural complication given antibiotics – sulphonamides.

Prevention

Two types of polio vaccine are used

·        Salk inactivated polio vaccine (IPV) administered by injection.

·        Sabin oral live attenuated polio vaccine (OPV).

MEASLES

Definition

          Measles is primarily a disease of children.  It is highly infectious disease caused by virus.  It is characterized by fever coughing sneezing and running of the nose, followed by a typical rash.

 

Epidemiological factors

Agent

The causative agent is a virus

Source of infection

A case of measles

Incubation period 10 to 14 days

Age

It is a primarily disease of children

Sex

Both sexes are affected

Mode of transmission

·        Droplet infections i.e., sneezing, talking, kissing

·        Means of articles

Clinical features

a) pre-eruptive stage

·        Fever upto 39⁰c.

·        Running nose, watery and red eyes

·        Sneezing

·        Koplik’s spots

b) Eruptive stage

·        Macular rash, first on face and neck behind the neck.

·        Eruption last for about 5 to 6 days and gradually fades.

 

Prevention

a) Measles Vaccine

          A live measles vaccine is available.  The child should be immunized according the national immunization schedule.

b) Immunoglobulin

          Administration of human measles immunoglobulin in doses ranging from 250 to 750 mg.

Control

·        Isolation of the child

·        Protection of the child’s eyes from light or glak

·        Disinfection of nose and throat discharge

·        Immunization of susceptible children.

Complications

·        Bronchitis

·        Pneumonia

·        Diarrhoea

·        Encephalitis

 

MUMPS

Definition

          Mumps is an acute infectious disease caused by a virus.  It is characterized by swelling and tenderness of one or both parotid glands.

Agent

The causative agent is a paramyxo virus

Source of infection

·        Patient suffering from mumps

·        Subclinical cases

Age and sex

Common in the age group 5 to 15 years

Both sexes are affected

Mode of spread

Mumps is spread through saliva and respiratory droplets

Incubation period

2 to 3 weeks

Clinical features

·        Non suppurative swelling of the parotid gland

·        Pain and stiffness on opening the mouth.

·        Fever and headache.

 

Prevention

·        Mumps is now a preventable disease.

·        A live vaccine has been prepared against mumps

·        A single dose of the vaccine is given subcutaneously.

 

CONCLUSION

 

          Communicable disease mainly the six killer disease are explained in this presentation i.e., Diphtheria, pertussis, tetanus poliomyelitis, measles and mumps.  Its definition, epidemiological factors, clinical features and prevention are substantiated and how all these are overruling our contry.

 

BIBLIOGRAPHY

 

1.            B.T.Basavanthappa, COMMUNITY HEALTH NURSING, Second Edition, Jaypee Brothers, Medical Publishers (P) Ltd., New Delhi, page No. 661-678, 705-716.

 

2.            K.Park, ESSENTIALS OF COMMUNITY HEALTH NURSING, Fourth Edition, 149, 164.