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INF > INTRO TO NEGLECTED TROPICAL DISEASES > Flashcards

INTRO TO NEGLECTED TROPICAL DISEASES Flashcards

1
Q

NEGLECTED TROPICAL DISEASES - MEANING OF THE TERM

A

NEGLECTED: HISTORICALLY NOT REALLY DEALT WITH BY DRUGS COMPANIES DUE TO ECONOMIC CONSIDERATIONS

TROPICAL: OCCURING IN DEVELOPING REGIONS OF AFRICA, ASIA, AND SOUTH AND CENTRAL AMERICA

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2
Q

IN 2007 WHO AND PARTNERS BROUGHT TOGETHER VARIOUS DISEASE INITIATIVES UNDER THE UMBRELLA OF THE NEGLECTED TROPICAL DISEASE (NTD) ‘BRAND’… WHAT WAS THE RASON FOR COINING THIS TERM AND WHAT WERE THE INCLUSION CRITERIA?

A
  • GOAL WAS TO ICREASE LOBBYING POWER AND RAISE THE PROFILE OF THE DISEASES
  • INCLUSION ON THE BAIS THAT DISEASES ARE GOOD CANDIDATES FOR CONTROL AND ELIMINATION:THEIR TRANSMISSION CHARACTERISTICS + TREATMENT OPPORTUNITIES
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3
Q

HOW MANY NEGLECTED TROPICAL DISEASES HAS WHO DESIGNATED, AND HOW MANY ARE INFECTIOUS?

A

20 DESIGNATED

- 19 OF THOSE ARE INFECTIOUS

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4
Q

WHAT IS THE MOST COMMON CAUSATIVE PATHOGEN OF NEGLECTED TROPICAL DISEASES? WHAT ARE THE OTHER PATHOGENS?

A

PARASITIC WORMS

OTHERS: PROTOZOA; SINGLE CELL EUKARYOTES, VIRUSES, BACTERIA..

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5
Q

WHICH NEGLECTED TROPICAL DISEASE IS NOT AN INFECTIOUS DISEASE?

A

SNAKEBITE ENVENOMING (SNAKE BITES)

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6
Q

HOW ARE MOST NTDs SPREAD? WHAT ARE SOME OTHER MODES OF TRANSMISSION?

A
  • MOTLY SPREAD BY A VECTOR (I.E. INTERMEDIATE HOST); E.G. MOSQUITOS, FLIES, WATER FLEAS, MITES, SNAILS, BITING DOGS, CONTAMINATED FOOD
  • TRANSMISSION FOR SOME DISEASES OCCURS PERSON TO PERSON, OR VIA CONTAMINATED SOIL, AND FOR SOME DISEASES THE MECHANISM OF TRANSMISSION ISN’T KNOWN
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7
Q

HOW PREVALENT ARE NTDs? DEATHS, PEOPLE AT RISK, PEOPLE INFECTED…

A
  • LIKELY THAT ALL OF THE WORLD’S POPULATION LIVING BELOW THE WORLD BANK POVERTY LINE OF 1.9 US DOLLARS PER DAY ARE INFECTED WITH ONE OR MORE NTD
  • THIS CORRESPONDS TO 10% OF THE GLOBAL POPULATION!!!
  • ESP. PREVALENT IN INDIA, SOUTH EAST ASIA, CENTRAL AFRICA..

2016 DATA:

  • CCA 1 BIL PEOPLE ARE INFECTED WITH A NTD
  • ANOTHER 1-2 BIL ARE AT RISK OF AN NTD
  • > 186,000 PEOPLE DIE PER YEAR FROM NTDs
  • > 18.6 MIL DALYs FROM NTDs
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8
Q

HOW IS HEALTH IMPACT OF NTDs MEASURED?

A
  • MORTALITY; NUMBER OF DEATHS
  • MORBIDITY; DISABILITY ADJUSTED LIFE YEARS (DALYs) —> DALYs= YLLs (YEARS OF LIFE LOST) + YLDs (YEARS LIVED WITH DISABILITY)
  • NUMBER OF PEOPLE AT RISK (LIVING IN EDNEMIC AREAS AND COULD BE INFECTED AND CONTRACT A NTD)
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9
Q

ECONOMIC REASONS FOR SPENDING ON NTDs PREVENTION?

A
  • NTD INTERVENTIONS ARE ONE OF THE ‘BEST BUYS’ IN GLOBAL PH; IMPROVE HEALTH AND WEL-BEING OF POPULATIONS, BENEFIT THE MOST DISADVANTAGEOUS CITIZENS FINANCIALLY, INCREASE SOCIETAL PRODUCTIVITY
  • EVERY 1$ INVESTED IN PREVENTATIVE CHEMOTHERAPY FOR NTDs GIVES RISE TO A NET BENEFIT OF UP TO 25$
  • EVERY 1$ INVESTED IN IMPROVING WATER AND SANITATION GIVES RISE TO A RETURN OF >5$
    (BOTH PREVIOUS POINTS BECAUSE OF REDUCED MEDICAL EXPENSES, REDUCED LOSS OF PRODUCTIVITY)
  • ESTIMATEED COST FOR DELIVERING PREVENTATIVE CHEMOTHERAPY FOR NTDs IS ESTIMATED TO BE 0.4$ PER PERSON
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10
Q

FUNDING FOR NTDs HAS BEEN ESSENTIALLY FLAT FOR THE PAST DECADE AT HOW MUCH $?

A

300 MILLION $

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11
Q

HOW MANY TABLETS OF MEDICINES ARE DONATED BY PHARMACEUTICALS COMPANIES ANNUALLY FOR NTDs PROGRAMMES?

A

3 BILLION

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12
Q

WHO ESTIMATED THAT NTD INTERVENTIONS WOULD COST HOW MUCH ANNUALLY BY 2020?

A

750 MIL $

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13
Q

THE FIRST WHO ROADMAP (SERIES OF GOALS AND STRATEGIES) TO COMBAT NTDs WAS SET OUT FOR WHICH DURATION?

A

2012-2020

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14
Q

2012-2020 WHO ROADMAP; KEY PROGRESSIONS ON NTD INTERVENTIONS IN THIS PERIOD?

A
  • 600 MILLION FEWER PEOPLE REQUIRE INTERVENTIONS AGAINST NTDs THAN IN 2010
  • 42 COUNTRIES, TERRITORIES AND AREAS HAVE ELIMINATED AT LEAST ONE NTD BY 2020
  • 66% PREVENTATIVE COVERAGE IN 2019 FOR POPULATIONS AT RISK IN ENDEMIC AREAS, COMPARED TO 42% IN 2012

DENGUE: VECTOR CONTROL INTERVENTIONS ESTABLISHED IN 10 ENDEMIC PRIORITY COUNTRIES, CONROL AND SURVEILLANCE SYSTEMS ESTABLISHED IN 5/6 WHO REGIONS
SCHISTOSOMIASIS: 67% PREVENTATIVE CHEMOTHERAPY COVERAGE RATE ACHIEVED FOR SCHOOL AGED CHILDREN
SOIL-TRANSMITTED HELMINTHIASES: 59% OF PRESCHOOL AND SCHOOL-AGED CHILDREN WHO REQUIRE TREATMENT ARE REGULARLY TREATED
TRACHOMA: MORE THAN 1 MILLION SURGICAL TREATMENTS PROVIDED
- NEW TREATMENT PPROACHES/MEDICATIONS
- NEW RAPID DIAGNOSITC TESTS
- NOVEL VECTOR CONTROL TOOLS

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15
Q

ERADICATION MEANING:

A
  • PERMANENT REDUCTION TO 0 OF THE WORLDWIDE INCIDENCE OF INFECTION CAUSED BY A SPECIFIC PATHOGEN
  • NO RISK OF REINTRODUCTION
  • SMALLPOX: THE ONLY HUMAN DISEASE TO EVER BE ERADICTED
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16
Q

WHAT IS THE ONLY HUMAN DISEASE TO EVER BE ERADICATED?

A

SMALLPOX

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17
Q

ELIMINATION (INTERRUPTION OF TRANSMISION) DEFINITION:

A
  • REDUCTION TO 0 OF THE INCIDENCE OF INFECTION CAUSED BY A SPECIFIC PATHOGEN IN A DEFINE GEOGRAPHICAL AREA, WITH MINIMAL RISK OF REINTRODUCTION
  • CONTINUED ACTIO TO PREVENT RE-ESTABLISHMENT OF TRANSMISSION MAY BE REQUIRED
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18
Q

‘ELIMINATION AS A PUBLIC HEALTH PROBLEM’, DEFINITION?

A
  • REDUCTION OF INFECTION AND DISEASE TO MEASURABLE TARGETS SET BY WHO
  • CONTINUED ACTION IS REQUIRED TO MAINTAIN THE TARGETS AND/OR TO ADDVANCE INTERRUPTION OF TRANSMISSION
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19
Q

DISEASE CONTROL DEFINITION?

A
  • REDUCTION OF DISEASE INCIDENCE, PREVALENCE, MORBIDITY AND/OR MORTALITY TO A LOCALLY ACCEPTABLE LEVEL
  • CONTINUED INTERVENTIONS ARE REQUIRED TOMAINTAIN THE REDUCTION
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20
Q

EXAMPLE OF NTD ON THE VERGE OF ERADICATION?

A

DARCUNCULIASIS (ONLY 54 CASES IN 2019)

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21
Q

NE WHO ROADMAP FOR NEGLECTED TROPICAL DISEASES?

A
  • 2021-2030
  • ‘ENDING THE NEGLECT TO ATTAIN THE SUSTAINABLE DEVELOPMENT GOALS’
  • ‘BY 2030, WE AIM TO FREE MORE THAN 1 BILLION PEOPLE WHO CURRENTLY REQUIRE INTERVENTIONS AGAINST NEGLECTED TROPICAL DISEASES, AND SAVE MILLIONS MORE FROM CATASTROPHIC OUT-OF-POCKET EXPENDITURE
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22
Q

TARGETS TO BE ACHIEVED BY 2030 ACCORDING TO THE NEW WHO ROADMAP TO TACKLING NEGLECTED TROPICAL DISEASES?

A
  • 90% REDUCTION IN PEOPLE REQUIRING INTERVENTIONS AGAINST NTDs
  • 75% REDUCTION IN DISABILITY-ADJUSTED LIFE YEARS RELATED TO NTDs
  • 100 COUNTRIES HAVING ELIMINATED AT LEAST ONE NEGLECTED NTDS
  • 2 NTDs ERADICATED
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23
Q

WHICH NEGLECTED TROPICAL DISEASES DOES WHO AIM TO ERADICATE BY 2030?

A

DRACUNCULIASIS AND YAWS

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24
Q

STRATEGIES TO ACHIEVE WHO NEGLECTED TROPICAL DISEASES 2021-2030 GOALS?

A

MAIN STRATEGIES:

1) INTEGRATE NTDs INTO NATIONAL HEALTHCARE SYSTEMS
2) WHERE POSSIBLE DO AN INTEGRATED NTD APPROACH (MOST PEOPLE AFFECTED BY MORE THAN ONE NTD, SO RATHER THAN TREATING DISEASE SPEIFIC, APPROACH SHOULD BE MORE PATIENT CENTRED) —> 43% OF PEOPLE SUFFERING FROM NTDs HAVE 3 OR MORE DISEASES

CORE STRATEGIC INTERVENTIONS:

  • PREVENTIVE CHEMOTHERAPY
  • WASH (WATER, SANITATION AND HYGIENE)
  • VECTOR CONTROL
  • VETERINARY PUBLIC HEALTH
  • CASE MANAGEMENT
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25
Q

DESCRIBE THE MEANING AND IMPORTANCE OF THE ‘WASH’ STRATEGY FOR TACKLING NTDs

A

WATER, SANITATION AND HYGIENE
- 785 MILLION PEOPLE DO NOT HAVE ACCES TO BASIC DRINKING WATER SERVICES
- 663 MILLION PEOPLE DO NOT HAVE ACCESS TO ADEQUATE WATER SOURCES
- 2.4 BILLION PEOPLE LACK ACCESS TO ADEQUATE SANITATION
- 946 MIL PEOPLE PRACTICE OPEN DEFECATION
- 2 BILLION P[EOPLE STILL DO NOT HAVE ACCESS TO BASIC SANITTATION FACILITIES
LEADS TO: CONTAMINATION O THE ENVIRONMENT IN COMMUNITIES, EXPOSURE TO INFECTION, DISABILITY, MEDICAL COSTS, STIGMATIZATION AND EXCLUSION..

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26
Q

HOW MANY PEOPLE DO NOT HAVE ACCESS TO BASIC DRINKING-WATER SERVICES?

A

785 MILLION PEOPLE

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27
Q

HOW MANY PEOPLE DO NOT HAVE ACCES TO ADEQUATE WATER SOURCES?

A

663 MIL

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28
Q

HOW MANYPEOPLE LACK ACCESS TO ADEQUATE SANITTATION?

A

2 BIL

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29
Q

HOW MANY PEOPLE PRACTICE OPEN DEFECATION?

A

946 MIL

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30
Q

HOW MANY PEOPLE DO NOT HAVE ACCESS TO BASIC SANITATION FACILITIES SUCH AS PRIVATE TOILETS?

A

2 BIL

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31
Q

HICH PROPORTION OF PEOPLE IN THE DEVELOPING WORLD ARE SUFFERING FROM ONE OR MORE DISESES ASSOCIATED WITH INADEQUATE WASH (WATER, SANITATION AND HYGIENE)?

A

1/2

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32
Q

DIARRHEAL ILLNESS: NUMBER OF DETAHS YEARLY + WHO IS AFFECTED?

A
  • 1.5 MIL DEATHS

- MOSTLY AMONG CHILDREN YOUNGER THAN 5

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33
Q

WHAT IS THE LEADING CAUSE OF PREVENTABLE BLINDNESS WORLDWIDE AND HOW MANY PEOPLE ARE AFFECTED?

A
  • TRACHOMA

- CCA 8 MIL PEOPLE WORLDWIDE BLIND BECAUSE OF IT, 84 MILL NEED TREATMENT

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34
Q

WHO HAS A PLAN OF ACTION FOR EACH OF THE 20 NTDs… IN WHICH CATEGORIES IS THE PLAN SPLIT?

A
  • BEHAVIOUR
  • ENVIRONMENT
  • SOCIAL INCLUSION
  • TREATMENT AND CARE
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35
Q

ROLE OF DIAGNOSIS IN TACKLING NTDs?

A
  • IDENTIFICATION AND TREATMENT OF CASES SO THAT THEY ARE NOT POTENTIAL SOURCES OF INFECTION
  • REDUC MORBIDITY BY ENSURING EARLY DETECTION AND MANAGEMENT
  • MONITOR DISEASE TRENDS AND EFFECTIVENESS OF CONTROL PROGRAMMES
  • ESPECIALLY IMPORTANT FOR DISEASES THAT ARE NEAR ELIMINATION, HIGHLY SENSITIVE AND SPECIFIC DIAGNOSTICS REQUIRED TO REDUCE FALSE POSITIVES AND NEGATIVES
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36
Q

% OF NTD BUDGET ALLOCATED TO DIAGNOSIS AND DIAGNOSTIC EFFORTS?

A

5%

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37
Q

MOST OF THE BUDGET FOR TCKLING NTDs IS ALLOCATED TO WHICH ASPECT?

A

TO MEDICINES AND VACCINES (39%)

38
Q

CURRENT TYPES OF DIAGNOSIS FOR NTDs + FUTURE RECOMMENDATIONS?

A
  • MANY OF THE DIAGNOSTICS ARE 19TH CENTRUY TECHNOLOGY NOT SUITABLE FOR 21ST CENTURY PROGRAMS; E.G. MICROSCOPIC OBSERVATION OF FAECES
  • THERE IS A NEED TO DEVELOP FAST, ACCURATE AND CHEAP MOLECULAR DIAGNOSTICS THAT REQUIRE LITTLE TRAINING ——-> MOLECULAR TESTS ALL RELY ON A BIOMARKER (ANTIGEN IN LATERAL FLOWS, ANTIBODY IN ELIS AND RAPID LATERAL FLOW, NUCLEIC ACID IN PCR AND LAMP..
  • ANTIBODY TESTS SHOW THAT SOMEONE HAS BEEN EXPOSED TO A DISEASE/PATHOGEN, BUT NOT THAT THEY NECESSARILY CURRENTLY HAVE THE DISEASE —> USEFUL FOR EPIDEMIOLOGY STUDIES AND TO STUDY IF A PATHOGEN ON THE VERGE OF ERADICATION IS ‘COMING BACK’
39
Q

HOW DOES A LATERAL FLOW ANTIGEN TEST WORK?

A
  • IDENTIFY A BIOMARKER (USUALLY, BUT NOT ALWAYS, A PATHOGEN ANTIGEN ACTS AS A BIOMARKER)
  • ADD BIOLOGICAL SAMPLE TO THE SAMPLE PAD
  • THE SAMPLE FLOWS THROUGH THE CONJUGATE PAD THAT CONTAINS LABELLED (WITH SOMETHING GIVING COLOR) ANTIBODIES SPECIFIC TO THE ANTIGEN 9CONTROL LINE - CONTAINS ‘NORMAL’ IMMUNE SYSTEM ANTIBODIES)
  • ANTIBODIES SPECIFIC TO THE ANTIGEN ARE ALSO ADHERED TO THE TEST LINE
  • IF THE ANTIGEN IS PRESENT IT IS CAPTURED BY THE TEST LINE ALONG WITH THE LABELLED ANTIBODIES, VISIBLE AS A LINE
40
Q

WHAT IS SENSITIVITY?

A
  • TRUE POSITIVE RATE
  • PROPORTION OF PEOPLE WHO ARE POSITIVE THAT TEST POSITIVE
    SENSITIVITY=TP/(TP+FN)
41
Q

WHAT IS SPECIFICITY?

A
  • TRUE NEGATUVE RATE
  • PROPORTION OF PEOPLE WHO ARE NEGATIVE THAT TEST NEGATIVE
    SPECIFICITY=TN/(TN+FP)
42
Q

WHEN DISEASE INCIDENCE IS LOW, A USEFUL DIAGNOSTIC TEST MUST HAVE HIGHER SENSITIVITY OF SPECIFICITY?

A

SPECIFICITY

ESP RELEVANT DURING THE LAST MILE OF DISEASE ELIMINATION

43
Q

CHALLENGES WITH NTD CONTROL?

A

POLITICAL INSTABILITY:
- GAPS IN GOVERNANCE DUE TO WARS, DIVERSION OF NTD FUNDING TO OTHER CAUSES, DISRUPTED INFRASTRUCTURE, RESTRICTED ACCESS TO LOCAL POPULATIONS, RISKS TO HCPs, MIGRATION CAN RESULT IN INTRODUCTION OR REINTRODUCTION OF DISEASES
CLIMATE CHANGE:
- ALTERS THE EPIDEMIOLOGY OF VECTOR BORNE DISEASES AND THE SPREAD OF NTDs
ANTIMICROBIAL AND INSECTICIDE RESISTANCE:
- EXPANSION OF PREVENTIVE CHEMOTHERAPY, WIDESPREAD USE OF INSECTICIDES FOR VECTOR CONTROL
ZOONOSES:
- PROVIDES AN ANIMAL RESERVOIR

44
Q

OTHER NAMES FOR SCHISTOSOMIASIS?

A

BILHARZIA, SNAIL FEVER, KATAYAMA FEVER

45
Q

SCHISTOSOMIASIS CAUSE?

A

CAUSED BY 6 DIFFERENT SPECIES OF PARASITIC HELMINTH WORMS (AKA BLOOD FLUKES) WITH A HIGHLY COMPLEX LIFE CYCLE

46
Q

A PATHOGEN CAUSING WHICH DISEASE IS SOMETIMES REFREED TO AS ‘BLOOD FLUKES’?

A

SCHISTOSOMIASIS

CAUSED BY PARASITIC HELMINTH WORMS, SCHISTOSOMAS

47
Q

WHAT IS THE DEFINITIVE HOST (THE HOST WHERE THE PATHOGEN SEXUALLY REPRODUCES) AND WHAT IS THE INTERMEDIATE HOST OF SCHISTOSOMA (PARASITIC HELMINTH WORMS)?

A

INTERMEDIATE - SNAILS

DEFINITE - MAMMALS (INCLUDING HUMANS)

48
Q

DESCRIBE HOW SCHISTOMAS AFFECT HUMANS?

A
  • HUMAN HOSTS ARE USUALLY INFECTED THROUGH CONTACT WITH CONTAMINATED WATER
  • MOST SPECIES END UP LIVING IN THE MESENTERIC VEIN SYSTEM NEAR THE GUTS
  • FEMALE WORMS LAY 200-3 000 EGGS PER DAY IN THE BLOOD (DEPENDING ON THE SPECIES)
  • THE EGGS MAKE THEIR WAY INTO THE GUT LUMEN (MECHANISM UNKNOWN)
  • HUMANS EXCRETE THE EGGS IN FECES OR URINE, DEPENDING ON THE SPECIES)
  • LIFECYCLE IN HUMAN IS 6-7 WEEKS
49
Q

HOW LONG IS THE LIFE CYCLE OF PARASITIC HELMINTH WORMS CAUSING SCHISTOSOMIASIS IN HUMANS?

A

6-7 WEEKS

50
Q

WHERE DO MOST PECIES OF PARASITIC HELMINTH WORMS CAUSING SCHISTOSOMIASIS RESIDE IN HUMANS?

A

IN THE MESENTERIC VEIN SYSTEM NEAR THE GUTS

51
Q

WHAT IS MIRACIDIUM?

A

a free-swimming ciliated larval stage in which a parasitic fluke passes from the egg to its first host, typically a snail

52
Q

WHAT HAPPENS TO EGGS OF PARASITIC HELMINTH WORMS THAT CAUSE SCHISTOSOMIASIS WHEN THEY ARE EXCREETED BY HUMAN HOST THROUGH URINE OR FECES?

A
  • WHEN REACHING FRESH WATER, THE EGGS HATCH (MIRACIDIUM, HATCHLINGS)
  • MIRACIDIUM HAVE JUST A FEW HOURS TO SWIM TO A SNAIL OF RIGHT SPECIES
  • THE PARASITE MIGRATS THROUGH THE SNAIL AND ULTIMATELY SHEDS CERCARIA (LARVAE): STRUCTURES WITH SORT OF A HEAD AND A TAIL WHICH HELPS THEM TO SWIM
  • CERCARIA THEN SWIM USIN POSITIVE PHOTOTROPISM AND CHEMOATTRACTANTS (REACT TO LIGHT AND CHEMICALS) TO FIND A NEW HOST AND REINFECT BY PENETRATING THE (UNEVEN BROKEN) SKIN
53
Q

SCHISTOSOMA NAME EXPLANATION?

A
  • MEANS ‘SPLIT BODY’
  • THE WORMS FORM MALE-FEMALE PAIRS IN THE VEINS, NAME REFERS TO THE ADULT MALE WORM’S LATERAL EDGES THAT FOLD TO FORM A GROOVE (‘GYNECOPHORAL CANAL’) WHERE THE FEMALE WORM RESIDES
54
Q

SCHISTOSOMA STRUCTURE IN THE HUMAN BODY + WHERE AND HOW THEY FROM?

A
  • FMALE AND MAIL WORM PAIRED TOGETHER, ADULT MALE WORM FORMS A GROOVE, ‘GYNECOPHORAL CANAL’ WHERE THE FEMALE WORM RESIDES
  • THE PAIRING OCCURS IN THE LIVER AND THE PAIR MIGRATES EN COPULA TO EITHER THE MESENTERIC VEINS DRAINING THE INTESTINES OR VESICAL VENOUS PLEXUS OF THE UROGNITAL SYSTEMS
  • MALE WORM: 10-20mm
  • MALES HAVE SUCKERS TO HOLD ON WITH
55
Q

HOW LONG CAN SCHISTOMA WORMS SURVIVE IN A HUMAN HOST?

A

SEVERAL YEARS

56
Q

LENGTH OF MALE SCHISTOMA WORM

A

10-20mm

57
Q

WHER ARE SCHISTOMA WORM PAIRS FORM? WHERE DO THEY MIGRATE TO AFTER FORMATION?

A
  • FORMED IN THE LIVER

- MIGRATE TO MESENTERIC VEINS DRAINING THE INTESTINES PR VESICAL VENOUS PLEXUS OF THE UROGENITAL SYSTEM

58
Q

HOW MANY PEOPLE ARE AFFECTED BY SCHISTOSOMIASIS?

A

240 MILLION

59
Q

IN HOW MANY COUNTRIES IS SCHISTOSOMIASIS ENDEMIC?

A

51 COUNTRIES

- MOSTLY IN AFRICA (90% OF CASES) + ASIA AND PARTS OF SOUTH AMERICA

60
Q

RANGE OF SCHISTOSOMIASIS IS MOSTLY DEFINED BY?

A

PRESENCE OF THE SPECIFIC SNAIL SPECIES

61
Q

HOW MANY PEOPLE ARE AT RISK OF ACQUIRING SCHISTOSOMIASIS?

A

779 MILLION

62
Q

ATER MALARIA, WHICH DISEASE RANKS SECOND FOR PARASITIC DISEASES?

A

SCHISTOSOMIASIS

63
Q

HOW MANY DEATHS WERE CAUSED IN SCHISTOSOMIASIS IN 2016?

A

240 000 (200+ thousand)

64
Q

KATAYAMA SYNDROME?

A

A SYSTEMIC HYPERSENSITIVITY REACTION AGAINST THE MIGRATING SCHISTOSOMULA AND EGGS

  • ACUTE PHASE OF SCHISTOSOMIASIS
  • LASTS 14-84 DAYS
  • CHARACTERISTICS: NOCTURNAL FEVER, COUGH, MYALGIA (MUSCLE ACHES AND PAIN), HEADACHE, ABDOMINAL TENDERNESS
65
Q

PATHOLOGY OF SCHISTOSOMIASIS?

A
  • INITIAL RASH AT SITE OF INOCULATION
  • ACUTE PHASE CHARACTERISED BY KATAYAMA SYNDROME (LASTS 14-84 DAY, RECTION TO MIGRATING PARAITES AND EGG DEPOSITION, NOCTURAL FEVER, COUGH, MYALGIA, HEADACHE, ABDOMINAL TENDERNESS
  • CHRONIC PHASE: WEAKNES, FATIGUE, ANDOMINAL PAIN, MAIN DAMANGE DONE BY EGGS STIMULATING THE IMMUNE SYSTEM, GRANULOA FORMATION AROUND SCHISTOSOME EGGS, FIBROSIS AND LESIONS OF ORGANS CONTAINING TRAPPED EGGS (E.G. LIVER), KIDNEY DISFUNCTION, BLOOD IN URINE, PAINFUL URINATON, BLOOD IN STOOLS, IRREGULAR BOWEL MOVEMENTS, DIARRHOEA, MALE AND FEMALE FERTILITY DEFECT, HEPATOSPLENOMEGALY (LIVER AND SPLEEN SWELLING)
66
Q

ESCRIBE THE CHARACTERISTICS OF THE CHRONIC PHASE OF SCHISTOSOMIASIS

A

WEAKNES, FATIGUE, ANDOMINAL PAIN, MAIN DAMANGE DONE BY EGGS STIMULATING THE IMMUNE SYSTEM, GRANULOA FORMATION AROUND SCHISTOSOME EGGS, FIBROSIS AND LESIONS OF ORGANS CONTAINING TRAPPED EGGS (E.G. LIVER), KIDNEY DISFUNCTION, BLOOD IN URINE, PAINFUL URINATON, BLOOD IN STOOLS, IRREGULAR BOWEL MOVEMENTS, DIARRHOEA, MALE AND FEMALE FERTILITY DEFECT, HEPATOSPLENOMEGALY (LIVER AND SPLEEN SWELLING)

67
Q

IN ENDEMIC AREAS, CHILDREN USUALLY HAVE THEIR FIRST SCHISTOSOMIASIS INFECTION BY WHICH AGE?

A

BY THE TIME THEY ARE 2 YEARS OLD

68
Q

WHICH POOR OUTCOMES IS SCHISTOSOMIASIS ASSOCIATED WITH?

A
  • UNDER-NUTRITION
  • LOST YEARS OF SCHOOLING
  • HROWTH STUNTING
  • COGNITIVE IMPAIRMENT
  • EXERCISE INTOLERANCE OR GENERAL FATIGUE
  • CHRONIC ILL HALTH
  • SOMETIMES DEATH
  • IF INFECTIONS ARE PERSISTENT AND /OR SEVERE, CHILDREN ARE ALSO LIKELY TO HAVE CHRONIC AND IRREVERSIBLE DISEASES LATER IN LIFE, E.G. BLADDER CANCER
  • IN WOMEN, INFECTION CAN LEAD TO FEMALE GENITAL SCHISTOSOMIASIS (FSG) WHICH CAN CAUSE PREGNANCY COMPLICATIONS AND TRIPLE THE RISK OF CONTRACTING HIV
69
Q

HOW DOES FEMALE GENITAL SCHISTOSOMIASIS (FSG) INFLUENCE RISK OF CONTRACTING HIV?

A

IT TRIPLES IT

70
Q

THE ONLY WHO RECOMMENDED DRUG TO TREAT SCHISTOSOMIASIS?

A

PRAZIQUANTEL

CHEAP, SAFE, CURE RATES UP TO 100%

71
Q

WHO STRATEGIES TO ELIMINATE SCHISTOSOMIASIS?

A

DRUGS: PREVENTATIVE CHEMOTHERAPY TO BRK THE CHAIN OF TRANSMISSION (DRUG: PRAZIQUANTEL)
IMPROVED SANITATION: HYGIENE EDUCATION, ACCESS TO POTABLE DRINKABLE WATER, ACCESS TO TOILETS AND REDUCING OPEN DEFECATION, SEWAGE TREATMENT, PRE-TREATMENT OF ‘NIGHT SOIL’ (HUMAN FECES) BEFORE USING AS A FERTILISER
SNAIL CONTROL: NEED FOR CHEAP AND SAFE MOLLUSCICIDES
VACCINES: 3 VACCINE CANDIDATES ARE UNDERGOING CLINICAL TRIAL, NO VACCINE YET

72
Q

HOW MANY VACCINES FOR SCHISTOSOMIASIS ARE CURRENTLY UNDERGOING CLINICAL TRIAL?

A

3

73
Q

OTHER NAME FOR DRACUNCULIASIS?

A

GUINEA WORM DISEASE (GWD)

74
Q

DRACUNCULIASIS HISTORY?

A
  • KNOWN AS A PARASITE OF HUMANS SINCE ABOUT 1530 B.C.
  • GUINEA WORM IS THOUGHT TO BE THE ‘FIERY SERPENT’ REFERRED TO IN THE BIBLE
  • DRACUNCULUS MEDINENSIS LITERALLY MEANS ‘THE LITTLE DRAGON FROM MEDINA’
75
Q

DRACUNCULUS MEDINENSIS MEANING?

A

LITERALLY MEANS ‘THE LITTLE DRAGON FROM MEDINA’

76
Q

THE SYMBOL OF A PHYSICIAN IS THE ‘CADUCEUS’. WHAT ARE THE SERPENTS ON THE SYMBOL THOUGHT TO REPRESENT?

A

BELIEVED TO REPRESENT THE GUINEA WORM BEING WRAPPED AROUND A STICK (AND THE STICK IS WHAT DOCTORS USE TO REMOVE THE WORM FROM THE BODY)

77
Q

MALE AND FEMALE GUINEA WORM MATE HOW LONG AFTER IFECTION OF A HUMAN HOST?

A

30-60 DAYS

78
Q

DRACUNCULIASIS; LIFE CYCLE

A
  • PEOPLE GET INFECTED AFTER DRINKING WATER CONTAINING COPEPODS (WATER FLEAS)THAT HARBOUR INFECTIVE LARVAE OF THE WORM
  • THE INGESTED COPEPODS ARE KILLED BY THE DIGESTIVE JUICES IN THE STOMACH
  • THE RELEASED LARVAE THEN MOVE INTO THE SMALL INTESTINE AND PENETRAT THE INTESTINAL WALL, ALLOWING THEM TO MIGRATE TO THE CONNECTIVE TISSUES OF THE ABDOMINAL WALL AND THE THORAX
  • MALE AND FEMALE LARVAE MATURE AND MATE 60-90 DAYS AFTER THE INFECTION
  • THE MALE WORM DIES SHORTLY AFTER MATING, AND THE FEMALE MATURES OVER THE SUBSEQUENT 10-14 MONTHS AND SLOWLY MIGRATES TO THE SURFACE OF THE BODY
  • A BLISTER THEN FORMS ON THE SIN WHERE THE WORM WILL EVENTUALLY EMERGE —> USUALLY HAPPENS ON THE LEGS AND FEET!!!!!!!!!!!!!
  • THE BLISTER CAUSES A VERY PAINFUL BURNING FEELING AND BURSTS WITHIN 24-72 HRS
  • WHEN BLISTERS ARE SUBMERGED IN THE WATER, THE FEMALE WORM RELEASES LARVAE. WHICH ARE INGESTED BY COPEPODS, THUS COMPLETING THE LIFECYCLE (THE WATER SOOTHS THE PAIN OF THE BLISTER AND IS ESSENTIAL FOR THE LIFE CYCLE PROGRESION; DISEASE PATHOLOGY ENSURES CONTINUATION OF THE LIFE CYCLE?)
79
Q

DRACUNCULIASIS BLISTERS?

A
  • FORMS AFTER THE MALE AND FEMALE WORMS MATE, THE MALE DIES, AND THE FEMALEM MIGRATES FOR 10-14 MONTHS UNTIL REACHING THE SURFACE WHERE THE BLISTER WILL FORM
  • USULLY FORM ON LEGS OR FETT, PAINFUL BURNING SENSATION
  • BURSTS WITHIN 24-72 HRS
  • SOOTHING TO PUT LEGS IN THE WTER, WHEN THE WORM RELEASES LAVRAE AND ENSURES CONTINUATIO OF THE LIFECYCLE
80
Q

WHO IS AFFECTED BY DRACUNCULIASIS?

A
  • MOSTLY POOR COMMUNITIES IN REMOTE PARTS OF AFRICA THAT DO NOT HAVE SAFE WATER TO DRINK (UNSAFE STAGNANT ATER LIKE PONDS, POOLS IN DRYING RIVERBEDS, SHALLOW WELLS….) —> THE WORM IS USUALLY NOT ACQUIRED FROM DRINKING FLOWING WTER (LIKE FROM RIVERS OR STREAMS)
  • MOST COMMONLY AFFECTS YOUNG ADULTS (15-45 Y.O.); FARMERS, HERDES AND THOSE FETCHING DRINKING WATER FOR THE HOUSEHOLD MAY BE AT A HIGHER RISK
81
Q

THE GREATEST RISK FOR DRACUNCULIASIS?

A
  • HAVING THE WORM THE YEAR BEFORE (PEOPLE DO NOT BECOME IMMUNE + THE SAME WATER RESOURCES ARE REPEATEDLY CONTAMINATED AND CONDITIONS THAT SUPPORT THE DISEASE ARE NOT EASILY CHANGED)
82
Q

SEASONALITY OF DRACUNOLA WORM TRANSMISION?

A

IN DRY REGIONS: PEOPLE GENERALLY GET INFECTED DURING THE RAINY SEASON, WHEN STAGNNT SURFACE WATER IS AVAILABLE

IN WET REGIONS: PEOPLE GENERALLY GET INFECTED DURING THE DRY SEASON, WHEN SURFACE WATER IS DRYING UP AND BECOMING STAGNANT

83
Q

WHICH ORGANISM IS INTERMEDIATE FOR DRACUNCULIASIS?

A

COPEPODS (WATER FLEAS)

84
Q

DRACUNCULISIS WORM CHARACTERISTICS?

A
  • 1-2mm WIDE, BUT 60-100cm LONG (ADULT FEMALE WORM)

- CAUSES NO SYMPTOMS IN THE 1ST YEAR

85
Q

DRACUNCULIASIS PATHOLOGY?

A
  • NO SYMPTOMS IN THE FIRST YER, AND THEN: SLIGHT FEVER, ITCHY RASH, NAUSEA, VOMITING, DIARRHOEA, DIZZINES
  • THE WOUND OFTEN BECOMES INFECTED CAUSING SEPSIS, TETANUS, ABSCESES, CELLULITIS
  • RARELY LETHAL
  • THE DISABILITY THAT OCCURS DURING WORM REMOVAL AND RECOVERY PREVENTS PEOPLE FROM WORKING IN THE FIELDS, TENDING ANIMALS, GOIN TO SCHOOL, AND CARING FOR THEIR FAMILIES
  • DISABILITY LASTS FOR 8.5 WEEKS ON AVERAGE, BUT CAN BE PERMANENT
  • WORM OUTLINES VISIBLE THROUGH SKIN
86
Q

AVERAGE DURATION OF DISABILITY CAUSED BY DRACUNCULIASIS?

A

8.5 WEEKS (BUT CAN BE PERMANENT)

87
Q

MANAGEMENT OF DRACUNCULIASIS?

A
  • NO VACCINES OR DRUGS
  • ONCE THE WORM STARTS TO PARTIALLY COME OUT OF THE WOUND, THE REST OF THE WORM CAN ONLY BE PULLED OUT A FEW CENTIMETERS EACH DAY BY WINDING IT AROUND A PIECE OF GAUZE OR A SMALL STICK
  • THE PROCES USUALLY TAKES WEKS
  • MUST BE CAREFUL NOT TO BREK THE WORM DURING REMOVAL (IF A PART OF THE WORM I NOT REMOVED, THERE IS A RISK FOR SECONDARY BACTERIAL INFECTIONS RESULTING IN COMPLICATIONS)
  • ANTIINFLAMMATORY MEDICINE CAN HELP REDUCE PAIN AND SWELLING, ANTIBIOTICS CAN HELP PREVENT INFECTIONS
    !!!!!IT IS CRITICAL TO REMOVE THE WORM BEFORE THE INFECTED PATIENT CAN CONTAMINATE DRINKING WATER!!!!!!!!!!!!!
88
Q

WHEN DID THE DRACUNCULIAIS ERADICATION PROGRAM BEGIN?

A

1980

89
Q

MAIN INTERVENTIONS TO ERADICATE DRACUNCULISIS?

A

EDUCATION:

  • DRIK ONLY WATER FROM PROTECTED SOURCES THAT ARE CONTAMINATION FREE
  • COOK FISH AND OTHER AQUATIC ANIMALS WELL BEFORE EATING THEM
  • PREVENT PEOPLE WITH BLISTERS, SWELLINGS, WORMS AND VISIBLE WORMS EMERGING PONDS AND OTHER WATER SOURCES

WASH INTERVENTIONS:

  • DISTRIBUTE BASIC WATER FILTERS TO REMOVE THE COPEPODS
  • TREAT UNSAFE DRINKING WATER SOURCES WITH CHEMICALS TO KILL THE COPEPODS
  • PROVIDE TARGETED COMMUNITIES WITH NEW SAFE WATER SOURCES IF POSSIBLE
90
Q

IN 2018, HOW MANY HUMAN DRACUNCULIASIS CASES WERE REPORTED?

A

28 (CHAD 17, SOUTH SUDAN 10, ANGOLA 1)

91
Q

IF DRACUNCULIASIS BECOME THE 2ND EVER HUMAN ERADICATED DISEASES, WHAT CAUSES POTENTIAL FOR REINTRODUCTION?

A
  • IT IS A ZOONOTIC DISEASE (AFFECTS HUNDREDS OF DOGS AND CATS EACH YEAR)
  • INTERVENTIONS NOW ENCOMPASS INFECTED ANIMALS (MOSTLY DOGS); PREVENTING INFECTED DOGS FROM ENTERING PONDS AND OTHER WATER SOURCES = AVOID FEEDING RAW AND UNDERCOOKED FISH OR AQUATIC ANIMALS TO DOGS
92
Q

LIST THE NEGLECTED TROPICAL DISEASES

A

Bacteria

  1. Buruli ulcer (Mycobacterium ulcerans)
  2. Leprosy (Mycobacterium leprae)
  3. Trachoma (Chlamydia trachomatis)
  4. Yaws (Treponema pallidum)
Protozoa (single celled eukaryotic)
1. Chagas disease (Trypanosome cruzi)
2. Human African trypanosomiasis 
(Trypanosoma brucei)
3. Leishmaniasis (Leishmania spp)

Parasitic worms

  1. Dracunculiasis (guinea worm)
  2. Echinococcosis (tapeworm)
  3. Foodborne trematodiases (platyhelminth worm)
  4. Elephantitis/ Lymphatic filariasis (nematode worms)
  5. River blindness / Onchocerciasis (Onchocerca volvulus)
  6. Schistosomiasis (schistosoma worm)
  7. Soil-transmitted helminthiases (nematode worm)
  8. Taeniasis and cysticercosis (tapeworm)

Viruses
1. Dengue and chikungunya (virus)
2. Rabies (rabies virus)
WHO have designated 20 Neglected tropical diseases

Others
1. Mycetoma, chromoblastomycosis and other
deep mycoses (fungus)
2. Scabies and other ectoparasitoses (mites)
3. Snakebite envenoming (snake bites)

All but 1 are infectious diseas

INF (40 decks)

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