Comm disease 2.pptx communicable disease for gnm students

communicable diseases

1. Spores of bacterium is found throughout the world in the soil and in animal and human intestines Remain inactive in the soil, but can remain infectious for more than 40 years Contaminated wounds are the sites where bacteria multiply – Deep wounds or devitalized tissue Incubation period – 4 to 21 days (average 10 days)

2. Risk factors Lack of immunization Inadequate immunization – failure to receive timely booster shots Penetrating injury Presence of other infective bacteria

3. Pathophysiology Spores of tetanus enter through open wound They germinate and produce toxin called tetanospasmin Tetanospasmin can spread through the bloodstream Toxins absorbed by peripheral nerves and carried to spinal cord Block the action of inhibitory transmitter Continuous excitatory stimulation Uncontrolled muscle spasm and rigidity(stiffness)

4. Clinical features Lockjaw (spasm of muscle of chewing) Spasm of facial muscles – Risus sardonicus Opisthotonus position Difficult swallowing Tonic spasms Fever Restlessness Exaggerated reflexes Urinary retention Laryngeal spasmn – death Profuse sweating

5. Management Clean the wound with soap and water Human tetanus immunoglobulin Antibiotics – penicillin 1.2 million units Q6H, metronidazole Spasms and convulsions are controlled by Diazepam Neuromuscular blocking agent – vecuronium Supportive care Nutrition and breathing Kept patient in a room away from excessive stimuli Respiratory support Oxygen inhalation NG feeding Vitals monitoring antipyretics

6. Control and prevention Active immunization DPT vaccine Primary doses - 6,10 and 14 th week Booster – 4.5 and 14 th year Tetanus toxoid vaccine (TT) Primary dose 0.5ml 2 doses with 1-2 months gap followed by booster after 1 yr- protection for 5 years Passive immunization Post exposure: TT first dose followed by second dose after one month and booster after 1 year Prevention of neonatal tetanus – 2 doses of TT at 16 th and 20 th week of pregnancy

7. Reservoir Carriers act as reservoir – carries organism in the gall bladder or biliary tract Incubation period 10 to 14 days

8. Diarrhea – pea soup stool Fever in a ladder pattern

9. DIAGNOSIS CBC Blood culture Stool culture ELISA urine test Platelet count 9low) Fluorescent antibody study

10. Management Control of fever – antipyretics Antibiotic therapy – ciprofloxacin, chloramphenicol Oral and dental hygiene Constipation – laxatives Soft diet with plenty of fluids

11. A case of typhoid should be notified immediately Hospitalization is recommended Isolation Concurrent disinfection Improvement of basic sanitation Milk should be boiled before use Food and personal hygiene Safe drinking water

12. Types Amoebic dysentery or intestinal dysentery Caused by single celled microscopic parasite living in the large intestine Bacillary dysentery Caused by invasive bacteria

13. Bacterial dysentery Causative organisms Shigella Campylobacter jejuni E. Coli Salmonella Spread among humans through contaminated food or water Organism lives in the intestine and is passed in the stool

14. Risk factors Poor environmental sanitation Overcrowded living condition Close contact with infected person Use of public swimming pools

15. Clinical features Abdominal pain and bloating Bloody diarrhea (may also be watery or with mucus) Cramping Flatulence Nausea with or without vomiting

16. Other symptoms – dehydration Decreased urine output Dry skin and mucus membrane Feeling very thirsty Fever and chills Muscle cramps Muscle weakness Weight loss Serious – life threatening Change in level of consciousness Change in mental status High grade fever Tachycardia Severe abdominal pain Severe dizziness

17. Diagnosis Symptoms Stool analysis Antibody blood test

18. Management Antibiotics – ciprofloxacin, ofloxacin, levofloxacin, azithromycin Antiparasitic – metronidazole iodoquinol Fluid replacement – ORS Severe – iv fluid replacement

19. Toxin producing bacteria Invasive bacteria Enterotoxin : Stimulate secretion of water and electrolytes into the intestinal lumen leads to massive watery diarrhea Cytotoxin : Damage the intestinal lining, causing bleeding and inflammation leads to bloody diarrhea (dysentery) and tissue necrosis Some bacteria invades Destroy epithelial cells Triggering inflammatory responses Ulceration

20. CONTAMINATED FOOD AND WATER Colonization in intestinal mucosa

21. Warning signs

22. NPO if excess vomiting IV fluids along with electrolytes Antibiotics

23. Nursing management Hydration and Electrolyte Balance Monitor fluid intake and output strictly Assess signs of dehydration frequently Administer oral rehydration solution (ORS) or IV fluids (RL or NS) Monitor serum electrolytes and correct imbalances Infection Control Practice and teach hand hygiene Use gloves and disposable items if needed Isolate the patient if symptoms are severe or if pathogen is highly contagious

24. Nutritional Support Encourage small, frequent meals once vomiting subsides Easily digestible foods (e.g., rice, bananas, toast, boiled potatoes)Avoid dairy, spicy foods, and caffeine during recovery. Symptom Management Administer antipyretics (e.g., paracetamol) for fever Administer antiemetics or antidiarrheals only if prescribed Provide comfort measures (warm compress for cramps, clean bed linens)

25. Monitoring Observe stool for frequency, consistency, color, and presence of blood Monitor weight, especially in children and elderly Monitor for signs of complications (persistent vomiting, high fever, bloody stools, signs of shock) Patient Education Importance of handwashing and hygiene Safe food and water practices When to seek medical help (e.g., signs of dehydration, persistent symptoms)Completion of prescribed antibiotics if applicable

26. CHOLERA Is an infection of the small intestine that causes large amount of watery diarrhea, which can lead to dehydration and even death, if untreated.

27. Pathophysiology Vibrio cholerae (contaminated food and water) Colonization of bacteria in intestine Bacteria release toxin that causes increased secretion of water and electrolytes Severe diarrhea

28. Rapid pulse Low urine output Lack of tears Sunken “soft spots” (fontanelles) in infants Unusual sleepiness or tiredness

29. Treatments Rehydration Therapy: ORS or IV fluids to replace lost fluids and electrolytes. Antibiotics: Such as doxycycline, azithromycin, or ciprofloxacin Zinc Supplements: In reducing the duration and severity of cholera Isolation and Hygiene Measures: Isolating infected individuals and practicing good hygiene, including proper sanitation and safe drinking water, are essential for preventing the spread of cholera. Vaccination: Cholera vaccines can provide protection against the disease and are recommended for individuals traveling to endemic areas or during outbreaks.

30. Meningitis is a rare but serious bacterial infection that result in swelling and irritation (inflammation) of the membrane covering the brain and spinal cord

31. Causative agent, bacteria: Neisseria meningitidis Mode of transmission: N.meningitidis is transmitted from person-to-person through droplets of respiratory (i.e. kissing, sneezing or coughing) or throat secretions from carriers. Pathogenesis: The illness occurs when the bacteria break through the protective lining of the nose and throat and enter the bloodstream. Once in the bloodstream, they multiply rapidly, overwhelming the body’s defenses thus allowing bacteria to cross the blood-brain barrier infecting the meninges, causing meningitis.

32. Infants less than one year and people ages 16 through 23 years are more likely to be infected than other age groups, but cases occur in all age groups including the elderly Meanwhile, some risk factors for the disease can include: Household or dormitory crowding Active and passive smoking Previous case of upper respiratory tract infection Chronic underlying illness (e.g. liver failure, lupus) Dysfunctional or absence of a spleen Properdin deficiency (a rare, genetically-linked condition where a deficiency of a blood plasma component affects immunity) Human immunodeficiency virus (HIV)

33. Clinical features General poor feeling Neck stiffness – meningismus Purple, bruise-like areas – purpura Rash, pinpoint red spots – petechiae Confusion or other mental changes

34. Diagnosis WBC Blood culture

35. Antibiotics Ceftriaxone Penicillin

36. Mainly involves lungs (Pulmonary tuberculosis) Can spread to other organs

37. Risk factors Close contact with someone who has active TB Immunocompromised status – HIV infection, cancer, transplanted organs, prolonged high dose corticosteroid therapy Substance abuse – Alcoholism and IV drug abuse Pre existing medical conditions – DM, CRF, leukaemia, Hodgkin’s disease Certain treatments- Hemodialysis, gastrectomy, treatment for rheumatoid arthritis or Crohn's disease Living overcrowded or substandard housing Any person without adequate health care – homelessness, poverty or low socio economic status Children under age of 15 years Malnutrition – Health care worker

38. The bacterium is spread by an infected individual by coughing or sneezing, when the pathogen comes out of his (Person A) body and starts residing in the form of aerosol; The aerosols, containing MTB, are inhaled by a healthy person (Person B) with air; The next step is often a pulmonary infection when the pathogen reaches the effective titre in the lung of person B; Self-inoculation results in the spread of infection from the lung to GI tract. 'Self-inoculation' is used because it takes place when person B, infected with pulmonary tuberculosis, swallows his own infected sputum.

39. Primary Tuberculosis:- TB bacteria enter the body, often through inhaling infected droplets. The bacteria are taken up by macrophages (immune cells) in the lungs. Primary tuberculosis occurs when the immune system fails to combat Mycobacterium tuberculosis bacterium (MTB) infection, primarily affecting the lungs, which is spread through the air through coughing, sneezing, or spitting. Primary TB causes fever, chills, malaise, weight loss, and persistent cough

40. Latent TB Infection (LTBI):- In this type, the bacteria are present in the body but remain inactive. The immune system effectively walls off the bacteria, preventing them from multiplying or causing illness. This type does not cause symptoms People with latent TB cannot transmit the infection to others and can continue their usual activities. Despite being highly contagious, TB is treatable. Regular medication and following the prescribed course are the best ways to avoid complications and complete the full course of treatment.

41. 3. Active Pulmonary Tuberculosis: - The immune system is unable to control the TB bacteria, which begin to multiply and cause symptoms. Active TB is contagious, meaning individuals with the disease can spread it to others Characterized by severe respiratory symptoms such as a persistent cough lasting more than three weeks, chest pain, coughing up blood or sputum, fever, night sweats, fatigue, and weight loss.

42. TB spreads through blood and lymph to many parts of the body – Miliary TB Lymph glands Gut and abdomen Bones and joints Heart Kidney and bladder Brain Skin

43. Diagnostic evaluation Medical History: A thorough medical history, including information about prior TB exposure, symptoms, and medical conditions, is important for diagnosis. Physical Examination: A physical exam may reveal signs and symptoms of active TB disease, such as cough, chest pain, fever, and weight loss.

44. Sputum Smear Microscopy: To identify acid-fast bacilli (AFB), TB bacteria. Nucleic Acid Amplification Tests (NAATs): Rapid detection of TB bacteria and identification of resistance to rifampin. Chest X-ray: Abnormalities in the lungs, such as irregular patches or infiltrates. TB Blood Test (IGRA): Measures the immune response to TB antigens in the blood TB Skin Test (TST): Injecting a small amount of TB protein under the skin and measuring the reaction. A positive reaction indicates exposure to TB bacteria. Culture: This is the gold standard for confirming TB diagnosis, involving growing the TB bacteria in a laboratory. Drug Resistance Testing: These tests determine if the TB bacteria are resistant to specific antibiotics

45. The DOTS strategy, or Directly Observed Treatment-Short-course Is a tuberculosis (TB) control strategy recommended by the World Health Organization (WHO). It focuses on ensuring TB patients adhere to and tolerate their prescribed treatment by having a healthcare worker or designated person observe them taking each dose. A health worker or designated person watches the patient swallow each dose of the anti-TB medication. This strategy is considered highly effective in controlling TB and preventing the development of drug-resistant strains. Standardized treatment regimens, typically 6-8 months, are used for all confirmed smear-positive cases.

46. DOTS PLUS DOTS Plus is  a strategy for managing drug-resistant tuberculosis (DR-TB), particularly multidrug-resistant tuberculosis (MDR-TB), in areas where DOTS, or Directly Observed Treatment Short-course, is already in place .

47. Nursing management of tuberculosis (TB)  Focuses on preventing the spread of infection, ensuring treatment adherence, and providing patient education and support

48. Infection Control: Airborne Isolation: Patients suspected or confirmed to have TB should be placed in a negative pressure room with proper ventilation. Respiratory Hygiene: Educate patients and visitors on proper cough etiquette, including covering coughs and sneezes with a tissue or elbow. Personal Protective Equipment (PPE): Healthcare workers should wear an N95 respirator or higher level of respiratory protection when interacting with patients. Hand Hygiene: Strict adherence to hand hygiene practices is crucial to prevent the spread of infection.

49. Medication Management: Treatment Adherence: Nurses play a crucial role in ensuring patients adhere to their prescribed multi-drug regimen, often involving Directly Observed Therapy (DOT). DOT: This involves observing patients taking their medications, which helps ensure adherence and monitor for side effects. Medication Monitoring: Nurses monitor patients for adverse drug effects and interactions with other medications.

50. Patient Education: Disease Information: Provide patients and their families with information about TB, including its transmission, symptoms, and treatment. Treatment Adherence: Explain the importance of completing the full course of medication, even if they feel better, to prevent drug resistance and recurrence. Infection Control: Teach patients how to prevent the spread of infection, including covering coughs and sneezes, and proper disposal of tissues.

51. Support and Counseling: Emotional Support: Address psychosocial needs of the patient and their family. Referrals: Connect patients with necessary resources, such as social workers, mental health professionals, and support groups. Identifying Contacts: Identify and assess individuals who have been in close contact with the patient. Preventative Measures: Provide appropriate treatment or preventative measures for those identified as contacts. Monitoring and Reporting: Patient Status: Regularly assess patients for signs and symptoms of TB, side effects of medication, and adherence to treatment. Data Collection: Collect and report relevant data to the local health department

52. Depiction of the Black Death in Florence. 1348.

53. PLAGUE Plague is an infectious disease caused by the bacteria Yersinia pestis , a zoonotic bacteria, usually found in small mammals and their fleas. Incubation period of 1 to 7 days

54. There are many names for this disease such as Black Plague, because black rats are the carriers of this deadly disease. The plague was also known as the 'Black Death' in the Middle Ages (5th-15th century), as it was responsible for the deaths of millions of people

55. Causes of plague People usually get the plague through the bite of fleas that have previously fed on infected animals like mice, rats, rabbits, squirrels, etc. It can also be spread through direct contact with an infected person or animal or by eating an infected animal. Spread through scratches or bites of infected domestic dogs or cats Pneumonic plague can be spread from person to person through cough droplets that contain plague bacteria.

56. Risk factors Living in an area where plague is common Having contact with sick animals, small rodents, or other possible hosts Participating in wilderness activities Exposure to flea bites Exposure o infected person Veterinarian

57. Types of plague

58. Bubonic plague The most common form. It’s usually spread by the bite of an infected flea. Infects the lymphatic system, causing inflammation in lymph nodes and causes swollen, painful lymph nodes (buboes). Untreated, it can move into the blood (causing septicemic plague) or to the lungs (causing pneumonic plague).

59. Septicemic plague When the bacteria enter the bloodstream directly and multiply there, it’s known as septicemic plague. When both bubonic and pneumonic are left untreated, plague can lead to septicemic plague.

60. Pneumonic plague Occurs w hen the bacteria spread to or first infect the lungs. T he most lethal form of the disease if untreated. T he bacteria from their lungs are expelled into the air. Other people who breathe that air can also develop this highly contagious form of plague. Recover y rates are very high if treated within the first 24 hours. It is the only form of that can be transmitted from person to person.

61. Signs and symptoms People who have the plague usually develop flu-like symptoms 2 to 6 days after infection. There are other symptoms that can help distinguish the three forms of the plague.

62. Bubonic plague symptoms Symptoms of bubonic plague generally appear within two to 8 days of infection. They include: fever and chills headache muscle pain general weakness May also experience painful, swollen lymph glands, called buboes. These typically appear in the groin, armpits, neck, or site of the insect bite or scratch. The buboes are what give the bubonic plague its name.

63. Acral necrosis, often seen as dark discoloration and tissue death in the extremities, is a common symptom of bubonic plague. 

64. Septicemic plague symptoms Usually start within a few days after exposure, but septicemic plague can lead to death before symptoms even appear. Symptoms can include: abdominal pain diarrhea nausea and vomiting fever and chills extreme weakness bleeding (blood may not be able to clot) shock skin turning black (gangrene)

65. Pneumonic plague symptoms Symptoms may appear as quickly as one day after exposure to the bacteria (1 – 4 days). Symptoms like flue initially and rapidly progress to pneumonia Cough Fever Headache Overall weakness Severe cough and trouble breathing Chest pain Bloody sputum (saliva and mucus or pus from the lungs)

66. Diagnosis F or the presence of the bacteria in your body A blood test can indicate whether you have septicemic plague. To check for bubonic plague, doctor will use a needle to take a sample of the fluid in your swollen lymph nodes. To check for pneumonic plague, doctors will either take a blood sample or sample from the swollen lymph node and send it for laboratory testing. The samples will be sent to a laboratory for analysis. Preliminary results may be ready in just 2 hours, but confirmatory testing takes 24 to 48 hours.

67. Treatment If the plague is suspected, your doctor will still begin treatment with antibiotics even before the diagnosis is confirmed. This is because the plague progresses rapidly, d eath can occur within 24 hours after the appearance of the first symptom. B eing treated early can make a big difference in your recovery.

68. Prevention Keep the rodent population in your home and workplace under control. Avoid keeping piles of debris such as firewood, rocks, in your areas. Protect any outdoor pets from getting fleas by using flea control products. Don’t allow pets to roam freely outside or sleep in your bed. If your pet starts getting sick, visit the veterinarian right away. Always wear insect repellent (chemical or natural) while outdoors. Be able to recognize symptoms of each type of plague in order to get treated as soon as possible. Avoid direct contact with those you suspect have been exposed to plague bacteria. There’s currently no commercially available vaccine against plague

69. LEPTOSPIROSIS (WEIL DISEASE) Leptospirosis is a widespread infectious disease caused by the spirochete Leptospira ; (caused by a bacterium Leptospira interrogans ), can be found in fresh water that has been contaminated by animal urine a potentially fatal zoonotic bacterial disease Host: It has a spectrum of reservoir hosts which includes rodents, wild and domestic animals. It is called “ eli pani ” in Malayalam, meaning rat fever. It is named so because of the belief that rats are the sole cause of the disease, which is not true.

70. Incubation period: 2 to 14 days Transmission: Direct or indirect contact with urine or reproductive fluids of infected animals. Severity: Ranges from a mild flu-like illness to being life-threatening. Risk Season: Monsoon rains or flooding exposes the people to contaminated water.

71. Risk factors

72. Signs and symptoms The symptoms of leptospirosis appear 1 to 2 weeks after infection, but severe symptoms may appear only after 29 days. As a biphasic disease, the first phase (acute or septic phase) ends after 3 to 7 days of illness. The second phase (immune phase) starts with the resolution of symptoms and the appearance of antibodies. Of those infected 90% experience mild symptoms while 10% experience severe leptospirosis

73. Diagnosis Biochemical tests Complete blood count high white cell count and a low platelet count low hemoglobin count ESR and C-reactive protein may also be elevated. RFT : blood urea and creatinine levels will be elevated. low potassium and low sodium level in the blood Urinalysis may reveal the presence of protein, white blood cells, and microscopic haematuria . The bacteria only move into kidneys after 10 days of infection, urine culture will only remain positive for leptospirosis from 10 days until 30 days of infection

74. LFT : elevated bilirubin levels and liver enzymes Abnormal serum amylase and lipase levels (associated with pancreatitis For those with severe headache who show signs of meningitis, a lumbar puncture can be attempted. (cerebrospinal fluid examination) Serological tests Rapid detection of Leptospira can be done by quantifying the IgM antibodies using ELISA.

75. Treatment Antibiotic therapy First choice drugs: Oral doxycycline (within 48 hours of illness) Oral amoxicillin, ampicillin and doxycycline – mild to moderate illness IV penicillin – drug of choice for severe illness Third generation cephalosporins ( cefotaxime, ceftriaxone) Supportive care For hypotension, hemorrhage, ARF and liver failure Corticosteroids Vit K – hypoprothrombinaemia

76. Vector-borne diseases (illnesses caused by parasites, viruses and bacteria transmitted by arthropod vectors)

77. Common VBD Dengue Chikungunya Japanese Encephalitis Plague Malaria Yellow Fever Filariasis

78. Causative organism There are five main types of Plasmodium parasites that can cause malaria in humans,

79. The malaria incubation (time taken to initiate symptoms) period varies between different subspecies of Plasmodium (P) as follows: P. falciparum: 8 to 11 days P. vivax: 8 to 17 days P. ovale : 10 to 17 days P. malariae: 18 to 40 days P. knowlesi: 9 to 12 days

80. Mode of transmission Female anopheline mosquito bite human and transmit infection Direct transmission: transfusion of blood infected malaria Congenital malaria: New born get infection from infected mother

81. Pathophysiology Malaria cycle begins when an infected female Anopheles mosquito bites a person . During the bite, the mosquito injects Plasmodium parasites into the bloodstream . Once in the blood, these parasites travel to the liver, where they can hide and multiply for about 7 to 15 days. During this time, they remain undetected by the body’s immune system. After maturing in the liver, the parasites re-enter the bloodstream and invade red blood cells .

82. This invasion is when malaria symptoms start to show up. The parasites reproduce inside the red blood cells , causing them to burst and release even more parasites into the blood. As this cycle continues, the person begins to experience symptoms like high fever, chills, and fatigue. If another mosquito bites an infected person, it can pick up the parasites in the blood. This allows the cycle to continue, as the new mosquito becomes a carrier, ready to infect someone else.

83. Signs and symptoms Malaria symptoms typically appear 10-15 days after infection High Fever with Chills Sweating Headache Muscle and Joint Pain Fatigue and Weakness Nausea and Vomiting Coughing Anaemia Abdominal Pain

84. Complications In severe cases, particularly with P. falciparum or If malaria is not treated promptly, it can lead to serious health issues, they include Cerebral Malaria: leading to confusion, seizures, or coma, a medical emergency. Respiratory Distress: Severe cases can cause fluid buildup in the lungs, resulting in difficulty breathing. Severe Anaemia Kidney Failure: Severe malaria can damage the kidneys, potentially requiring dialysis. Spleen and Liver Complications Confusion and Neurological Symptoms

85. Malaria diagnosis Patient's travel history, such as: Recently visited places How far did the patient travel and return back Intake of any prophylactic medication (travel-related prevention) following diagnostic tests (malaria test) to detect the presence of malaria pathogen, Microscopy Rapid Diagnostic Test Serology

86. Treatment Treated early with antimalarial medicines Chloroquine is the frequently used anti malarial medication For chloroquine resistant infection Quinidine or quinine plus Doxycycline Tetracycline or clindamycin Malarone or mefloquine Combination of pyrimethamine and sulfadoxine

87. Tab Chloroquine 100-150 mg available, 300 mg per week for prophylaxis For treatment, 600mg of first and second day and 300 mg on third day People with P. Falciparum treated in ICU Aggressive supportive medical acre IV fluids Respiratory support

88. Nursing management Individualized Patient Care: Tailors interventions to the specific needs and conditions of the patient. Considers factors such as age, severity of symptoms, presence of complications, and comorbidities. 2. Symptom Management: Helps manage symptoms such as fever, chills, and pain. Includes monitoring vital signs and providing medications to control fever and pain. 3. Preventing Complications: Early identification and management of complications like anemia, cerebral malaria, and organ failure. Ensures timely administration of antimalarial drugs and supportive therapies. 4. Hydration and Nutrition: Addresses dehydration and nutritional deficiencies. Encourages fluid intake and provides nutritional support as necessary.

89. 5. Education and Prevention: Educates patients and families about malaria transmission, prevention, and the importance of completing treatment regimens. Promotes the use of mosquito nets, repellents, and other preventive measures. 6. Monitoring and Evaluation: Regularly assesses the patient’s response to treatment. Adjusts the care plan based on the patient’s progress and any emerging needs. 7. Coordination of Care: Ensures effective communication among healthcare team members. Facilitates referrals to specialists if needed 8. Emotional and Psychological Support: Provides support to patients and families coping with the stress of illness. Addresses any concerns or anxieties 9. Documentation: Maintains detailed records of the patient's condition, treatment,etc Ensures continuity of care and legal accountability.

90. Lymphatic filariasis, commonly known as elephantiasis, is a painful and profoundly disfiguring parasitic disease, caused by three species of thread-like nematode worms(round worms) , known as filariae – Wuchereria bancrofti , Brugia malayi and Brugia timori .

91. And Vessel wall thickening Proliferation of connective tissue and damage to valves With hard and brawny changes in the overlying skin

92. Clinical manifestations There are no immediate symptoms after filarial infection. It may take years to have acute inflammation due to immune response against the worm. In the second phase of acute inflammation, there may be fever with chills, general feeling of ill health, skin infections, painful lymph nodes and the skin of the lymph edematous extremities become tender . The symptoms may subside after 5-7 days. There may be inflammation of the testes (orchitis) and spermatic cord (epididymitis).

93. In the third obstructive phase there are lymph varices, lymph scrotum, hydrocele, Lymph in urine (chyluria) and elephantiasis . In the last phase there is the development of scars on the affected area. Gradually the parasite attacks the lymphatic system and there is a thickening of the skin and elephantiasis

94. Finding microfilariae in blood or lymph The standard method for diagnosing active infection is the identification of microfilariae in a blood smear by microscopic examination . The microfilariae that cause lymphatic filariasis circulate in the blood at night (called nocturnal periodicity). Blood collection should be done at night Lymph node aspiration Assays for antigen PCR

95. Administration (MDA) is a key strategy for eliminating lymphatic filariasis, involving annual doses of these drugs to the at-risk population. Diethylcarbamazine (DEC): A primary drug used to kill both microfilariae (immature worms) and adult worms. It is often administered as a single dose or over a 12-day period. Ivermectin: Used in combination with albendazole in areas co-endemic with onchocerciasis. Albendazole: Often used in combination with DEC or ivermectin as part of MDA programs.

96. Supportive management Bed rest Elevation of affected limb Elastic stockings Injecting sclerosants for hydrocele Surgical management – drain the fluid around the damaged lymphatic vessel

97. Also called Sylvatic fever/ Viral hemorrhagic fever

98. Yellow Fever is caused by a virus belonging to the Flaviviridae family . The disease is transmitted to humans by the bite of an infected Aedes mosquito (particularly A. aegypti). It is called "Yellow Fever" because, in severe cases, the skin turns yellow in colour, just like in jaundice. The current estimate indicates that Yellow Fever claims 30,000 lives every year globally.

99. Types of yellow fever Jungle yellow fever Jungle yellow fever is a disease which directly related to monkeys. It is spread from infected mosquitoes to monkeys in the tropical rain forest, It spread to the humans when humans are bitten by same mosquitoes which have been infected by monkeys. It is a rare disease and mainly occurs in persons who work in tropical rainforests. Urban yellow fever It is spread by mosquitos that have been infected by other people. Aedes aegypti usually spreads this type among humans

100. 3 stages Infection (first stage) Mild stage - for 3-4 days Headache, fever, muscle and joint pain, loss of appetite, vomiting, jaundice Remission (second stage) After 3-4 days, symptoms go away Most recover, others may move to third Intoxication (third Stage) Multi organ dysfunction

101. Signs and symptoms Many people do not develop symptoms once they contract the virus, it takes 3 to 6 days for the illness to manifest. Fever and chills Severe headaches Muscle and joint pains Vomiting Loss of appetite Severe back pain

102. In most cases, people tend to feel better after 3 to 5 days of infection. But, in some (1 in 5 patients), the disease progresses to a more toxic stage after the initial symptoms resolve. At this stage, the patient will have the following. Extremely high fever Jaundice (yellowing of the skin and eyes, hence the name) Bleeding from the eyes, mouth, nose, and stomach Abnormal heartbeat Kidney failure accompanied by black urine Seizures Sudden loss of thinking and confusion Coma Death is possible within 7 to 10 days in half of those who develop severe symptoms. For those who survive, recovery can take a long time, often with life-threatening sequelae.

103. Diagnosis of Yellow Fever Diagnosing Yellow Fever is often challenging, especially in the initial stages of infection, because it can be easily confused with a wide range of diseases Doctor may ask questions about your recent travel and probably would do a blood test to confirm the diagnosis. Polymerase Chain Reaction (PCR) to detect the virus directly in the blood in the initial stages of infection). ELISA to identify virus-specific antibodies in the later infective stages.

104. Treatment Yellow Fever has no effective treatment. Supportive care will focus on providing the following. Restoration of bodily fluids Oxygen support Substitution of lost blood Dialysis for renal insufficiency Antibiotic therapy for secondary infections Pain treatment using traditional medications Do not take aspirin and other NSAID medicines such as ibuprofen unless prescribed, as these medications can raise the risk of bleeding.

105. Prevention Vaccination is the most important means to combat the Yellow Fever virus. A single dose can provide 99% protection when taken within 30 days of the onset of symptoms.