Download - Infectious Diseases in the Philippines
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INFECTIOUS DISEASES IN THE PHILIPPINES
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What is an Infectious Disease caused by a biological agent invasion of a host organism by a
foreign replicator, generally microorganisms, often called microbes, that are invisible to the naked eye.
requires an agent and a mode of transmission (or vector).
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HOW ARE INFECTIOUS DISEASES DIAGNOSED?
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Diagnosis• Diagnosis is initially by medical history and
physical examination, and imaging, but the principal tool in infectious disease is the microbiological culture.– Types of cultures include:• Blood culture • Sputum culture • Tissue culture • Culture of various fluids such as pleural fluid and
peritoneal fluid • Urine culture
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WATER AND FOOD BORNE DISEASE
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Water and Food Borne Diseases Food borne illnesses are defined as
diseases, usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food
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Water and Food Borne Diseases Typhoid Fever Hepatitis A Cholera Amoebic dysentery E. coli diarrheal illness Bacillary dysentery
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TYPHOID FEVER
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Typhoid Fever Etiologic agent:
• Salmonella typhosa
Source of infection:• Feces and urine of infected persons,
transient carriers
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Epidemiology Description:
A systemic infection characterized by: Continued fever Anorexia Slow pulse Enlargement of spleen Rose spots on trunk diarrhea
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TYPHOID FEVER Mode of transmission:
Direct or indirect contact with patient or carrier
Contamination by hands of carrier Flies
Incubation period: Average of 2 weeks
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TYPHOID FEVER Period of communicability:
As long as typhoid bacilli appear in excreta, usually form 1st week and throughout convalescense
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Cases of Typhoid Fever in the Philippines
0
5000
10000
15000
20000
25000
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002
Data taken from an official report done by the DOH the Republic of the Philippines: http://www2.doh.gov.ph/data_stat/html/fhsis/nd_byear.pdf
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Cases of Typhoid Fever in Philippines & Japan
0
5000
10000
15000
20000
25000
1982 1985 1988 1991 1994 1997 2000
PhilippinesJapan
•Statistics obtained from: www.WHO.int/en/
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2 PHASES OF TYPHOID FEVER 1st phase:
the patient's temperature rises gradually to 40ºC, and the general condition becomes very poor with sweating, no appetite, coughing and headache. Constipation and skin symptoms may be the clearest symptoms. Children often vomit and have diarrhea. The first phase lasts a week and towards the end the patient shows increasing listlessness and clouding of consciousness.
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2 PHASES OF TYPHOID FEVER 2nd phase:
in the second to third weeks of the disease, symptoms of intestinal infection are manifested and the fever remains very high and the pulse becomes weak and rapid. In the third week, the constipation is replaced by severe pea-soup-like diarrhea. The feces may also contain blood. It's not until the fourth or fifth week that the fever drops and the general condition slowly improves.
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DIAGNOSIS Bacilli can be isolated from the blood
early in the disease and from urine or feces after the 1st week
Agglutination reaction becomes positive during the 2nd week.
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TREATMENT For sensitive organisms, include
Chloramphenicol or IV ampicillin for 3 weeks or ceftriaxone for 5 to 10 days
For resistant organisms to initial drugs, alternative of ciprofloxacin or furazolidone
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PREVENTION• Vaccination• Other preventive measures for travelers to high-risk areas include
the following:– Only use water that has been boiled or chemically disinfected for:
• Drinking, or preparing beverages, such as tea or coffee• Brushing teeth• Washing face and hands (can also use alcohol-based gel to wash hands)• Washing fruits and vegetables• Washing eating utensils and food preparation equipment• Washing the surfaces of tins, cans, and bottles that contain food or beverages
– Do not eat food or drink beverages from unknown sources– Do not put ice in drinks– Avoid eating food from street vendors – Any raw food could be contaminated and should be avoided, including:
• Fruits and vegetables, particularly those that cannot be peeled • Salad greens • Unpasteurized milk and milk products• Raw meat• Shellfish• Any fish caught in tropical reefs rather than the open ocean
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HEPATITIS A
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HEPATITIS A Etiologic Agent:
Hepatitis A virus, single stranded RNA virus
Other names: Infectious hepatitis Epidemic hepatitis Catarrhal jaundice
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HEPATITIS A Predisposing factors:
Poor sanitation Contaminated water supplies Unsanitary method of preparing serving of
food malnutrition
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HEPATITIS A Incubation period:
15-50 days Description:
Influenza like such as HA malaise and easy fatigability anorexia and abdominal discomfort nausea and vomiting Fever Jaundice accompanied by pruritus and urticaria
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HEPATITIS A Period of Communicability
Maximum infectivity during the latter half of the incubation period, continuing for a few days after onset of jaundice
No carrier state or chronic infection
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HEPATITIS A Diagnosis:
Demonstration of virus in stool or by four fold or greater rise of IgM antibodies against Hepa A
Anti-HAV (IgM) – recent acute infection Anti-HAV (IgG) – past HAV infection
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HEPATITIS A Prevention:
Immunization Good sanitation and personal hygiene Proper sanitary disposal of feces Careful handwashing
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CHOLERA (EL TOR)
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CHOLERA Etiologic agent:
Vibrio El Tor Vibrio cholerae
A curved, alkali and salt tolerant, Gram (-) rod bacterium
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CHOLERA Sources of infection:
Vomitus and feces of infected persons Feces of convalescent or healthy carriers
Incubation period: Few hours to 5 days
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CHOLERA Description:
An acute serious illness characterized by: Sudden onset of acute and profuse colorless
diarrhea Vomiting Severe dehydration Muscular cramps Cyanosis Shock and death may occur because of fluid
loss from the circulatory system
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CHOLERA Period of communicability:
7-14 days after onset
Diagnosis: Culture of vomit or feces
Prevention: Immunization Purification of water Careful handwashing
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CHOLERA Treatment
Rehydration with a solution of electrolytes and glucose given IV in severe cases or by mouth in milder cases
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AMOEBIASIS
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AMOEBIASIS Etiologic agent:
Entamoeba histolytica, a protozoan
Mode of Transmission: Contaminated water containing cysts from
feces of infected persons Spread by hand to mouth transfer of feces Contaminated raw vegetables Flies Sexually transmitted
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AMOEBIASIS Reservoir:
Man, usually a chronically ill or asymptomatic cyst passer
Description: Intestinal disease varies from acute,
fulminating dysentery with fever, chills and bloody mucoid diarrhea to mild abdominal discomfort with diarrhea containing blood or mucus
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AOMEBIASIS Incubation period:
Variable, from a few days to several months
Period of communicability: During the period of cyst passing, this may
continue for years
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Amebiasis Diagnosis:
Direct microscopic demonstration of trophozoites or cysts in fresh fecal specimen
Smears obtained by proctoscopy Aspirates of abscesses or tissue secretions
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AMEBIASIS Prevention:
sanitary disposal of human feces Protection of public water supplies against
fecal contamination Fly control and protection of food, fruits and
vegetables against fly contamination
Treatment: Metronidazole Paronomycin
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ESCHERICHIA COLI DIARRHEAL ILLNESS
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E. coli Diarrheal Illness Etiologic agent:
Escherichia coli
Incubation period: 12-72 hours
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E. coli Diarrheal Illness Manifestations:
ETEC (Enterotoxigenic E. coli) Watery diarrhea without blood or mucus “Traveler’s diarrhea” Self limiting Prophylaxis : bismuth subsalicylate and with use of
antimicrobial chemoprophylaxis EPEC (Enteropathogenic E. coli)
No enterotoxins Mechanism not known Common cause of infantile diarrhea Self-limiting
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E. coli Diarrheal Illness Manifestations:
EIEC (Enteroinvasive E. coli) Less volume but with bloody mucoid stools Fever Headache Myalgia
EHEC (Enterohemorrhagic E. coli) Serotype O157:H7 Bloody diarrhea Severe abdominal cramps Nausea and vomiting Self-limiting
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E. coli Diarrheal Illness Manifestations:
EAEC (Enteroadherent E. coli) Associated with both acute and chronic diarrhea
Mode of transmission: Fecal-oral route
Reservoir Commonly asymptomatic carrier
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E. coli Diarrheal Illness Diagnosis:
Stool culture and serotyping
Prevention: Personal hygiene Handwashing Proper sanitary fecal disposal
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E. coli Diarrheal Illness Treatment:
Replacing the fluid from vomiting and diarrhea
Infants may require antibiotics such as gentamycin for a few days or flouroquinolones
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BACILLARY DYSENTERY (SHIGELLOSIS)
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Bacillary Dysentery (Shigellosis) Etiologic agent:
Four main groups: S. flexneri S. boydii S. sonnei S. dysenteriae
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Bacillary Dysentery (Shigellosis)
Source of Infection: Feces of infected persons, many in apparent
mild and unrecognized infections. Description:
An acute bacterial infection of the intestine characterized by Diarrhea Fever Tenesmus in severe cases bloody and mucoid stools.
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Bacillary Dysentery (Shigellosis) Mode of Transmission:
Eating contaminated foods drinking contaminated water or milk by hand to mouth transfer of contaminated
materials by flies by objects soiled with feces of a patient or
carrier.
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Bacillary Dysentery (Shigellosis) Incubation Period:
1 day, usually less than 4 days.
Period of Communicability: During acute infection and until
microorganism is absent from feces.
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Bacillary Dysentery (Shigellosis) Prevention:
Sanitary disposal of human feces sanitary supervision of processing, preparation
and serving of food particularly those eaten raw
fly control and screening to protect foods & water against fly contamination.
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Bacillary Dysentery (Shigellosis) Treatment:
Antibacterial medications such as ampicillin and cotrimoxazole (trimethoprim /
sulfamethoxazole) shorten the duration of symptoms and time shigellas are excreted