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Tetanus Malta fever

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					Brucellosis, Tetanus
         &
      Plague
           By
    Dr. Riaz Ahmed
                  Brucellosis
   Also known as undulant fever / malta fever /
    mediterranean fever.
   Bacterial zoonosis which is transmitted to man
    by direct / indirect contact with animals.
   Caused by different species of brucella- group
    of organisms and characterized by:
•   Intermittent / irregular febrile attacks
•   Arthritis / enlarged spleen etc.
                 Epidemiology
   Agent factors:
•   Brucella abortus – in bovine – abortus fever
•   B.Suis – Pigs – Swine – F or Porcine
•   B.Canis – Canines – Canine fever
•   B.Melitensis – Goats – Caprine fever
   Host factors: predominantly disease of males.
•   Farmers
•   Shepherds
•   Butchers
•   Slaughter house men
•   Veterinarians
•   Lab-workers – are at special risk because of
    occupational exposure.
 Environmental factors:
Most prevalent under conditions of advanced
  domestication in the absence of corresponding
  advanced S.O. Hygiene (+) where there is
• Overcrowding of herds

• Increased rain fall

• Lack of exposure to sunlight

• Unhygienic practice of milking/ heat
  production
 M.O.T:
• Ingestion – milk / milk products
            - meat even of camel
• Contact – absorption from skin
• Inhalation
• Inoculation 02mm – throat or oral cavity
 Source / Reservoir:
S – milk, lochial secretions, placenta, urine,
  feces & meat.
R – farm animals e.g., cattle, goats, swine etc.
 I.P: highly variable usually 1-3 weeks.
 Lab diagnosis:
• Bacteriological
• Serological / allergic test
 Control:
 in animals:
• Test / slaughter
• Vacc – B.Abortus strain – 19
• Hygienic measures
 In humans:
• At individual level
• At community level
                   Tetanus
 An acute disease caused by exotoxins of
  clostridium tetani clinically characterized by :
• Muscular rigidity
• Painful paraoxysmal spasms of voluntary
  muscles esp.
 Masseters ( trismus / lock-jaw )
 Facial (risus sardonicus)
 Back / neck (opisthotonus)
And those of lower limbs and abdomen
o Mortality : 40-80%
   Agent factors:
•   Clostridium tetani
•   Reservoir of infection
•   Source – soil / dust
•   Exotoxin
•   P.O.C – None
   Host factors:
•   Age / sex
•   Occupation
•   Rural / urban differences
•   Immunity
   Environmental factors:
•   Tetanus is a positive environmental hazard.
   M.O.T: contamination of wounds with tetanus spores.
   I.P: 6 – 10 days
   Types:
•   Traumatic
•   Puerperal
•   Otogenic
•   Idopathic
•   Tetanus Neonatorum (8th day syndrome)
   Prevention:
•   Active immunization – DPT
•   Passive – ATS
•   Both
•   Antibiotics
•   Observe tetanus schedule for pregnant women
           Plague (Black Death)
 Basically & primarily a zoonotic disease caused by
  Yersinia pestis involving rodents & fleas.
 It exists in natural foci & is transmitted by
  infected flea bites to humans living or intruding
  into the same ecological environment.
 Occurrence: many forms e.g.,

• Epizootic

• Enzootic

• Sporadic

And in epidemics of all forms including
  anthroporotic primarily pnemonic.
                       History
   Epidemics of plague are mentioned in Bible
   Association of plague with rats is known to be
    ancient.
   1st out-break – 1320 B.C.
   1st Pandemic – 542 A.D. called Justinian plague,
    which lasted for 50 years & estimated mortality was
    100 deaths.
   2nd Pandemic – 1346 B.C. lasted for 30 years &
    claimed one forth world mortality.
   In 1840 B.C. – Pandemic of pneumonic type
   In 1930 – 6 million deaths in India.
   In 1994 - out-break in India, then subsided gradually.
                        Plague
   Def: Highly fatal disease characterized by high fever,
    progressive heart failure & nervous symptoms.
o   Conjunctiva is injected with reddish appearance.
o   Skin – hemorrhage & pustular eruptions.
   Clinical forms:
•   Bubonic
•   Pnemonic
•   Septicemic
•   sylvatic
            Bubonic plague
 Onset sudden, most common type
 High temperature, prostration

 Painful buboos

 Vesicular / pustular skin lesions

 Complications:

   secondary terminal pneumonia
             Pneumonic plague
   Primary P. Plague is rare. Generally follows as
    a complication of bubonic - septicemic plague.
   Incidence decreased 1%
   Highly infectious
   Symptoms – acute bacterial infection
   Sputum – hemorrhagic
   Most deadly form of plague
 Septicemic :
• Rare

• Buboes absent

• Fever – low

• Hemorrhages into skin

 Sylvatic :

• Endemic in rodents in jungles

• Man is affected accidentally while doing
  activities like hunting etc.
 Source of infection:
 In bubonic plague : by bite of inf. Rat – fleas
      Xenophsylla cheopis
      Xenophsylla actia
      Xenophsylla braziliensis
 In pneumonic plague:
      exhaled droplets of saliva
      sputum of patients
 Reservoir : rats & wild rodents, out of 1700
  species 200 associated with plague.
 I.P:
• Bubonic : 2-7 days

• Septicemic : 2-7 days

• Pneumonic : 1-3 days

 P.O.C: pneumonic is very communicable
  from person to person, bubonic if terminal inf.
  is there.
 M.O.T:

• Bubonic plague – bite of infected rat flea

• Pneumonic plague – droplets
                    Epidemiology
   Agent factors: yersinia pestis, occur in blood,
    buboes, spleen, liver, other viscera of infected
    persons.
   Host factors:
•   Age / sex – all ages & both sexes
•   Activities of man e.g., hunting, cultivation, grazing,
    harvesting, construction etc.
•   Movements – ship, land, cargo
•   Immunity – no natural immunity
   Environmental factors:
•   Season : september – May
•   Temp : 20-25 C
•   Humidity less than 60%, Rain fall
•   Rural / urban, Human dwellings
   Population at risk:
•   Geologists, Biologists
•   Anthropologists
•   Hunters, agriculturists etc.
   Vector of plague: Pulex irritants (human fleas)
   Blocked / Partially blocked flea
   Flea Indices:
o   Total flea index
o   Specific index – if >1
o   Sp.% of fleas
o   Burrow index
          Prevention & Control
 Control of cases:
• Early diagnosis
• Notification
• Isolation
• Treatment
• Disinfection
 Control of fleas/ rodents:
Application of insecticides, rodenticides and other
  preventive measures to be adopted.
 Vaccination: 0.5-1ml SC after 7-10 days.
   Chemoprophylaxis:

   Surveillance

   Health education

				
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posted:1/11/2011
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