6/16/2011 11:59:00 PM Communicable disease Bacterial TYPHOID CHOLERA VIRAL Hepa Amoebaisis Ascariasis TYPPHOID Definition Typhoid fever

is a general infection caused by SALMONELA TYPHI, involving primarily the lymphoiod tissues (PAYERs PATCHES) of the small intestines Transmitted by contaminated water, milk, shellfish and other foods SYNONYMS enteric fever Typhus Abdominalis SOURCE OF INFECTION By carriers, patients who have recovered from fever but stools or urine are contaminated Infected shellfish contaminated by of fshore sewage disposal depots Flies INCUBATION 5 to 40 days average 10-20 days PERIOD OF COMMUNICABILITY As long as the bacteria as excreted PATHOGENESIS y y y Organism enters thru the UGIT and localized in the reticuloendothelial system and enters to the blood streams Results to hyperplasia and hypertrophy of the lymph nodes Enlargement of the spleen, liver and gall bladder

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Necrosis and ulceration of affected areas particularly the Peyers patches hemmorrage and perforation due to extensions symptoms are due to systematic effects of endotoxin and other bacterial product CLINICAL MANIFESTATIONS Fetal typhoid 1. Fetus may be infected if a pregnant women contacts typhoid 2. May result to premature labor or small for gestational age 3. Abrupt onset of fever, vomiting and convulsions

TYPHOID IN INFANCY 1. resembles septicemia or GI disturbance 2. irregular fever lasting to about 2 weeks 3. diarrhea 4. abdominal distension 5. ROSE SPOTS and spleenomegaly 6. convulsions CLINICAL MANIFESTATIONS (CHILDREN AND ADULTS) INITAIAL STAGE 1. resembles acute respiratory infection 2. intermittent fever 3. diarrhea and abdominal pain and skin eruption 2ND WEEK 1. high fever 2. disorientation stupor, delirium due to toxemia 3. teeth and lips accumulates a dirty brown collection of dried mucus known as SORDES 3RD WEEK 1. gradual decline in fever and symptoms 2. complications may include hemorrhage and perforation DIAGNOSIS 1. blood culture 2. Urine culture 3. Stool culture

4. Widal test 5. Bone marrow puncture or culture TREATMENT SPECIFIC 1. CHlORAMPHENICOL 2. combination of sulamethoxazole and Trimethoprim y y y y Cotrimoxazole is added to number 2 Amoxicillin o Given for chloram and cotri resistant sratins o o NON SPECIFIC o 1. Acetaminophen and hydrotherapeutic measures o 2. Steroids o 3. Supportive care for non typhid salmonella infection o NSG INTERVENSIONA 1. give supportive care y y y y y y y restore or maintain f&e balance position the pts to prevent aspiration support pts durong period of toxemia I&O watch for blader distention Take temp regularly Observe retention of feces Give high calorie low resdue non irritating foods durinmg febrile stage 2. watch for complications y y y y y y y y perform of the intestine intestinal hemorrhage other complications thrombophlebitis urinary infection cholectocystitis meningitis osteomyelitis given for chloram resistant straisn

y CHOLERA Cholera is a severe GI disease characterized by vomiting massive watery diarrhea with rapid dehydration and shock Causative organism is VIBRO CHOLERA ETHIOLOGICAL AGENT Vibro coma Vibro cholerae Sprillum Cholerae Sprillum cholerae ASIATICAE MOT Fecal-oral route via water and ingestion Flies, soiled hands utencils IP From a few hours to 5 days Ave 1-3 days PERIOD of Com Not known, presumably for the duration of the stool positives carrier state PATHOGENESIS y y y y y Organism adhere to the epothilium and multiply and produce enterotoxins Toxins converts atp to cyclic adenosines monophosphate (camp) camp promotes excretions of water and choride-diarrhea toxins acts on the epithelium vasculat ure of the bowel resulting un outpouring of intestinal content toxins results in hypertrophy of lymphoid tissues and inflammatory reacrion of the bowels chareacterizrd by engorgement of the capillaries and cellular infiltration of mononuclear cells, plasma cells, lymphocytes and histiocytes CLINICAL MANIFEST Massive or profuse diarrhea

Stools Signs of severe diarrhea Aphonia (loss of voice) Vomiting, muscle cramps and exhaustion Oliguria and even anuria Fever Tetany and abdominal distention Encepahalitis-like symptoms Acidosi, hypokalemia, ECF volume loss Dx STOOL CULTURE y y y y y y Identification of vibro cholera 4 fold increase in antibody titer during acute phase Elevated hemoglobin levels Mark acidosi Decrease potassium level Elevetade blood plasma specifis gravity SEROLOGY LBORATORY DATA

NSG INTER 1. isolation enteric precaution 2. care of rxposed person hygiene 3. provide physical mental health 4. accurate recording of v.s. 5 accurate measurement of I&O 6. carte of buttocks keep dry and clean 7. proper disposal of the excreta 8. boil water used for drinking 9. proper preparation of food SHIGELLOSIS Shigellosis is an acute bacterial disease of the intestinal tract caused by bacilli of the SHIGLLA group Shigella dysenteria Shigella FLexneri Shigella Boydi Shigella Sonnei

MOT Fecal oral route Anal oral contact (SEXUAL ORIGIN) INCUBATION 7hours -7days 3-4 days average POC 1-4 weeks PATHOGENESIS Ingested organism multiply in the mucosa and produce an enterotoxins Affects small intestinal and colonic lining and the capilliary endothelium Local inflammation with neuthrophilic infiltration and secretion of mucus Necrosis and superficial ulcers with fibronopurulent exudate Hyperplasia of lyphoid CLINICAL MANIFESTATIONS Fever Vomiting and head ache Colicky or cramping abdominal pain tenderness Anorexia, malaise and weakness Diarrhea progressing into stools containing blood streaks Straining during defecation may lead to rectal prolapse Dx Microscopic examination of the stool Rectal swab culture Peripheral blood examination Blood culture Tx Adequate fluid and electrolyte therapy Antibiotic therapy Ampicillin Trimethropin sulfamenthoxazole

Chloramphenicol Antiperstaltic drugs Control of pyrexia and convulsion Avoid antimotility drugs (LOMOTIL)

6/16/2011 11:59:00 PM

6/16/2011 11:59:00 PM