contact zoonotic disease
TRANSCRIPT
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CONTACT ZOONOTIC DISEASE
Dr. Wahid Elsaidy Assistant lecturer of public health and
community medicine
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RABIES
RABIES (hydrophobia)
(From Latin: rabies, "madness)"السعار الكلب داء
DefinitionAcute viral zoonosis affecting domestic and wild animals, transmitted through the bit of rabid animal
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Rabies .cont.OccurrenceIn Egypt estimated that 200000 animal bites occur each year Prepathogenic periodAgent : rabies virus is the type species of the Lyssavirus genus ,in the family Rhabdoviridae, order Mononegavirales. RNASource of infection: Carnivorous animals (dogs,foxes,raccoons,bats)Exit : saliva of the infected animals
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Rabies .cont.
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Rabies .cont.Mode of transmission:
1 -bite of rabid animals 2 -licks on skin(abraded) or
mucosa (abraded or non abraded)3 -aerosol of the virus that can
be present in caves where bats roots
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Rabies .cont.Pathogenic period:
10 days to one year commonly (1-3) monthsعلى وتعتمد The bits : number , severity , distance from the brain The virus : amount , strain The skin : bare or covered with clothes
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Rabies .cont.Clinical picture
The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as one year.
the symptoms expand to slight or partial paralysis, cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia, terror, hallucinations, progressing to delirium.
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Rabies .cont. The production of large quantities of saliva and tears
coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in hydrophobia, in which the patient has difficulty swallowing because the throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his or her thirst.
Death almost invariably results two to ten days after first symptoms.
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Rabies .cont.Diagnosis PCR or viral culture It is also possible to make the diagnosis from saliva,
urine and cerebrospinal fluid samples, but this is not as sensitive.
Cerebral inclusion bodies called Negri bodies are 100% diagnostic for rabies infection, but are found in only about 80% of cases. If possible, the animal from which the bite was received should also be examined for rabies.
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Rabies .cont.PreventionA. Measures of animals Dogs should be licensed and immunized Destruction of stray dogs and cats Maintain active surveillance for rabies in domestic
animals
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Rabies .cont.B. Specific prevention for human
Post-exposure prophylaxis1- Management of wound Treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, in general within ten days of infection. Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is very effective in reducing the number of viral particles. "If available, a virucidal antiseptic such as povidone-iodine, iodine tincture, aqueous iodine solution, or alcohol (ethanol) should be applied after washing.
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Rabies .cont.2 -Seroprophylaxis
Half at site of wound (infiltration)And the rest IM GLUTEAL (away from site of animal bite )HRIG Human rabies immunoglobulin :20IU Per KGERIG Equine rabies immunoglobulin: 40 IU per KG
3 -Observing the animal4 -Post exposure vaccination
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Rabies .cont.Rabies vaccines A. Human diploid cell vaccine (HDCV)B. Rabies vaccine adsorbed (RVA)C. Purified chick embryo cell vaccine(PCEC) DOSE : 1ml IM in deltoid or upper outer thigh in infants. 5 doses 0, 3 , 7 , 14 , 28-35 days if immunized only 2 doses 0 , 3 daysChemoprophylaxis : penicillin or antibiotic to prevent wound sepsis.
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Rabies .cont.Pre exposure prophylaxis
In high risk groups sach as veterinrians , animal handlers , and certin laboratory workers Dose : 0 , 7 , 21 days booster every 2 years
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Rabies .cont.Control Cases : Notification Isolation and hospitalization Treatment : supportive Concurrent disinfection of patient s discharge
Contacts: Enlistment Surveillance of contacts and animals Wearing PPE to prevent contact with patient saliva
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TETANUS
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TETANUSالكزاز DEFINITION
Acute disease from wound infection witch is caused by clostridium tetani exotoxins
OCCURRENCE1 million annually , underdeveloped countries
Neonatal tetanus accounts 50 % of tetanus related death
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Tetanus .cont.Pre pathogenic period Agent : Clostridium tetani a mobile Spore-forming anaerobic , gram positiveBacillus, Reservoir: Intestines of horses and other animals and man.Exit : intestinal excreta Source of infection: soil , dust, clothing skin 10-15% of human GIT
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Tetanus .cont.Mode of transmission: Neonatal tetanus Cord contamination Cephalic tetanus Head trauma , otitis media Local and generalized tetanus Wound injury (contaminated with soil)
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Tetanus .cont.Entry : skin , wound , burn , or contaminated injection.Pathogenic period : 3 – 21 days ( 14 days )
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Tetanus .cont.Clinical picture: 4 clinical typeNeonatal tetanus (tetanus neonatorum):infected infants become irritable, feed poorly, and developed rigidity with spasms (very poor prognosis for survival)
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Tetanus .cont.
Local tetanus: persistent muscle contractions in the same anatomic area as the injury, which will however subside after many weeks; very rarely fatal; milder than generalized tetanus, although it could precede it.
Cephalic tetanus: occurs with ear infections or following injuries of the head; facial muscles contractions.
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Tetanus .cont.
Most common types: Generalized tetanus -descending pattern: lockjaw stiffness of neck
difficulty swallowing rigidity of abdominal and back muscles.
-Spasms continue for 3-4 weeks, and recovery can last for months
-Death occurs when spasms interfere with respiration.
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Tetanus .cont.
Tetanic seizures (painful, powerful bursts of muscle contraction) if the muscle spasms affect the larynx or chest wall, they may
cause asphyxiation stiffness of jaw (also called lockjaw) RISUS SARDONICUS stiffness of abdominal and back muscles
OPISTHOTONOUS contraction of facial muscles IRONIC SMILE fast pulse fever sweating
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Tetanus .cont.
diagnosis •Based on the patient’s account and physical findings that are characteristic of the disease. Diagnostic studies generally are of little value, as cultures of the wound site are negative for C. tetani two-thirds of the time. –When the culture is positive, it confirms the diagnosis of tetanus
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Tetanus .cont.Fatality
Neonatal tetanus : 90%Mild and moderate : 6%Sever tetanus: 60%Prevention
General prevention Health education ,personal hygiene, environmental sanitation , complete of immunization dose ,socioeconomic development
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Tetanus .cont.
Specific preventionDPT : 2, 4, 6 ,18 months, DT at school age , and booster shot every 10 years.Immunization of pregnant female with tetanus toxoid : 2 doses (2 doses1 month interval after first trimester).Delivery under complete aseptic condition
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Tetanus .cont.Control Cases : Early case finding, Notification Hospitalization but not isolation Treatment : Remove and destroy the source of the toxin through surgical
exploration and cleaning of the wound (debridement). Passive immunization with human tetanus immune globuline
(TIG) 500 U Bed rest with a non stimulating environment (dim light,
reduced noise, and stable temperature) may be recommended.
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Tetanus .cont. Sedation may be necessary to keep the affected
person calm. Respiratory support with oxygen, endotracheal tube,
and mechanical ventilation may be necessary.
Contacts: Investigation of of contacts and source of infection
to determine the circumstances of injury
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ANTHRAX الخبيثة الجمرة
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Anthrax.cont.Agent • Caused by B anthrax a gram-positive spore
forming rod, aerobic• Spore if very hardy can survive for decades in
the soil killed by heat at 160 c for 1 hour
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Anthrax.cont.Source of infection
• Contracted by contact of abraded skin with products of infected cattle, sheep and goats
• Products include hidesالجلود , hair, wool الصوف, bone and meat.
Mode of transmissionCoetaneous anthrax :direct contact with the infected animals
Gastrointestinal Anthrax is very rare and occurs from consuming infected meat
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Anthrax.cont.Inhalational anthrax pneumonic(wool sorter’s disease) :from inhalation of spores from textile االغزل السلخانة and slaughterhouse workers والنسيج
Incubation period : hours to 7 days
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Anthrax.cont.Clinical picture Cutaneous anthrax
• Progression of painless lesionsPapule/macule – pruritic
Vesicle/bulla – clear or serosanguinous
Ulcer – non pitting, gelatinous edema
black, depressed, rarely scars ,
24-48 hrs.
days
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Cutaneous anthrax
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Anthrax.cont.Intestinal anthrax Affect cecum primary cause multiple ulcers make patient complain of : Fever , nausea , vomiting. malaise , anorexia, abdominal pain hematemesis and bloody diarrhea.
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Anthrax.cont.Pneumonic anthrax Hemorrhagic mediastinitis Pulmonary edema Hemorrhagic plural effusions Increase among wool sorters(( الصوف فرز
Bloodstream invasion may cause septicemic anthrax which may lead to death. Internal organs become darkly colored with widespread petechiae and hemorrhage
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Hemorrhagic meningitis
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Anthrax.cont.Diagnosis
Isolation of the causative bacilli in blood, lesion or discharge and serologic test
Complication Persistent circular scar at the site of
lesion(cutaneos anthrax) Fatality rate 100% in pneumonic anthrax
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Anthrax.cont.Prevention
General prevention Measure to prevent occupational infection:(PPE, washing facilities, health education, vaccination)Measure to animal :Veterinary supervision, vaccination of animals , quarantine measures in case of an animal outbreaks Measure to animal products:Only health animal are slaughteredHair and wool adequate disinfection, imported wool must have a certificate of freedom anthrax
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Anthrax.cont.Specific prevention
1. Human Vaccination : cell free vaccine for high risk persons2. Animals vaccination diseased animals :isolation, disinfection of
discharge, treatment with penicillin
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Anthrax.cont.ControlCases: Early case finding Notification ,isolation in hospital Concurrent , terminal disinfection(steam, corrosive,
burn) Treatment :penicillin drug of the choice, ciprofloxacin
for 10 days in (cutaneous anthrax ) and 60 days in bio-terrorist attack (pneumonic anthrax)
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Anthrax.cont.Contacts Enlistment Surveillance for maximum incubation period Isolation of contacts of pneumonic anthrax for 7 daysEnvironment Concurrent , terminal disinfection Investigate the source of infection Outbreak control measures Combating bioterrorism
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