Rabies, STDs, RTI, ADIs Flashcards
Animal bite category
I. Licks: No tissue injury π, πΏ, domestic animal bites Wound management II. Abrasion/laceration: Wound management + ARV III. Wild animal bite: Wound management + ARV + rabies immunoglobulin π¦ bite no Anti Rabies Vaccine ARV
Within 15 minutes of animal bite
1. Local wound management: Continue for 25-20 min Wash it with running water and soap 2. ARV/ RIG: vaccine/Ig depends on class of bite 3. Antibiotics: depends on class of bite 4. Td vaccine
Rabies
Hydrophobia Agent: rhabdovirus (bullet shaped lyssavirus) Street virus or fixed virus π¦ Host: warm blooded animals (carnivores usually) 100% fatal Affecting CNS Bats are the M/C reservoir Dogs are the M/C source
Prevention of rabies
- Post exposure prophylaxis
- Post exposure prophylaxis for vaccinated persons:
0,3 or 4 site (0.1 ml) - Pre-exposure prophylaxis PrEP:
0, 7, 21/28 - Rabies in π
Post exposure prophylaxis of rabies
- Site of bite affects rate of progression
- Category of contact
- Washing with alcohol (only scenario)
- No suturing
- Anti tetanus prophylaxis
Immunisation for rabies
- Essen regimen: 0,3,7,14,28
- Zagreb regimen: 0+0, 7, 21
- Intradermal: 0+0, 3+3 ,7+7, 28+28
Occurrence of symptomatic STI patients vs asymptomatic STI patients
Symptomatic STI patients are commonly male
Asymptomatic patients are commonly female
Morbidity is more in men but more severe in females
High risk populations for STDs
CSWs Drug addicts Truck drivers Army Factory workers Tourists
Social and behavioural factors affecting STDs
Poverty Broken family Marital disharmony Urban migration Commercial sex work Easy money Lack of awareness Social stigma Changing behaviour
Advantages of syndromic case management of STIs
- Identified and treated by signs and symptoms
- Syndromes easily recognised clinically
- Small number of clinical syndrome
- Rx given for majority of organisms
- Simple and cost-effective
- Valid, feasibility, immediate Rx
- Risk assessment πΌ performance
Disadvantages of syndromic case management of STIs
- Tendency to overtreat: justifiable in high prevalence areas
- Decreased specificity
- Overuse of expensive drugs
- Asymptomatic cases not fully addressed even with risk assessment
- Management of cervical infections problematic
- Vagina discharge algorithm performs poorly on low prevalence areas
Requirements of syndromic case management of STIs
- Adequate medical history
- Good sexual history
- Complete STI clinical examination
- Management guidelines
- Good supply of effective drugs
Common syndromes and sequelae STD
Male urethritis
Low genital infections in women: vaginitis, cervicitis, urethritis
Genital ulcers
Proctitis/colitis
Treatment of STIs
basic features
Contact tracing Compliance Confidentiality Condom use Counselling
Control and prevention of STI
- STD clinic
- Laboratory services
- PHC
- Information system
- Legislation
- Social welfare measures
Circulating influenza viruses which are a pandemic threat
H1N1
H3N2
H1N5
B
Phenomena shown by influenza
1. Antigenic shift: Sudden, big changes Due to genetic reassortment 2. Antigenic drift: Subtle slow small changes Due to point mutations
Host and environmental factors of influenza
Host: affects all Most severe in ages <1 years and >60 year Environmental: N. Hemisphere: mostly βοΈ season S. Hemisphere: βοΈ, spring, π§
Influenza
incubation period
period of communicability
Incubation: 1-3 days
Period of communicability:
1-3 days before onset of disease to 2-3 days after
Influenza
clinical features
1. Category A: Mild π€(<38Β°C, <48 hr) w/o sore throat w/o cough/coryza 2. Category B: High π€ (>38Β°C, <48 hr), should be tested for influenza 3. Category C: Category A/B + red flag symptoms: β’ Adults: breathlessness >48 hr hypotension cyanosis/ hemoptysis β’ Children: shortness of breath convulsions, inability to feed
Influenza treatment
Oseltamivir 75 mg BD5 days
β’ in case of persistent π€ on day 6, it is extended for 10 days
β’ in case of RTI:
Oseltamivir 150 mg BD10 days + steps (low dose hydrocortisone) + mucolytic agent + bronchodilator + antibiotic
Prophylaxis: amoxicillin/ampicillin
Piperacilin (ventilator support)
Vaccines for influenza
A. Live B. Killed: 1. π₯ based: β’ Trivalent: Michigan, Colorado, Switzerland strain β’ Quadrivalent: Trivalent stains + Phuket stain 2. Non-π₯ based: Singapore strain FLAV - Flu Live attenuated vaccine nasal spray CI: >50 yr, π€°, HIV,β¦
Baloxavir, Marboxil
Approved drug for influenza Cap-dependent endonuclease inhibitor Prevents viral replication within host cell Indication: age >12 yr π€ <48 hr
Acute Respiratory Illness
examples
Children: Measles, influenza, diphtheria, pertussis, H. influenzae Adults: Klebsiella, Legionella No age distribution: Streptococcus : M/C cause of community acquired pneumonia Staphylococcus: nosocomial pneumonia Rhino virus, Corona virus
Classification of pneumonia
2 months-5 year
1. No pneumonia: Cough, cold, π€ 2. Pneumonia: π€ + cough/cold + tachypnea (RR>60 β‘οΈ age <2 months RR>50 β‘οΈ 2 months-1 year RR>40 β‘οΈ >1 year) 3. Severe pneumonia: Chest indrawing + tachypnea + nasal flaring) 4. Very severe pneumonia: Inability to feed, convulsion, somnolence, strider
Classification of pneumonia
<2 months
1. No pneumonia: Fever + cough/cold 2. Severe pneumonia: Chest indrawing + tachypnea 3. Very severe pneumonia: Inability to feed, convulsion, stridor, wheeze
Treatment of pneumonia
DoC: cotrimoxazole For severe: injectable antibiotics 1. Benzyl penicillin 2. Ampicillin 3. Gentamycin 4. Chloramphenicol
GAPPD
Integrated global action plan for prevention and control of pneumonia and diarrhea
objectives
- π½ pneumonia mortality by <3/1000 live births
- π½ diarrhea mortality by <1/1000 live births
- Decrease incidence is pneumonia and diarrhea by <75%
- Decrease prevalence of stunting by <40%
Immunization recommend in respiratory infections
- Measles
- HiB
- PPV23 / PCV13
Pneumococcal polysaccharide vaccine 23 / pneumococcal conjugate vaccine 13
Diarrhea definition
Change on consistency/frequency of stools >3 times a day
Types of diarrhea
1. Acute watery diarrhea: Cholera, rotavirus, E. coli 2. Persistent diarrhea: Diarrhea >14 days 3. Bloody diarrhea: Shigella
Diarrhea
agent factors
25-30%: cause unidentified Enterotoxigenic E. coli: 10-20% Rotavirus: 15-25% Campylobacter: 10-25% Shigella: 5-15% V. cholerae: 5-10%
Diarrhea
environmental and host factors
Environmental: all seasons
Rotavirus- after summer/early winter
Host: 6 month - 2 years of age (predominant)
Control of diarrhea
- Short term:
ORS, clinical management, of severe dehydration β‘οΈIV - Long term:
πΌ maternal and child health care
π½ outbreak of diarrhea by- πΌ health education and sanitation
Types of oral rehydration therapy
1. Reduced osmolarity ORS: 245 mmol/L 2. Super ORS: ORS with energy providing food products 3. Resomal: Rehydration solution for severely malnourished children 4. Home based ORS: Salt: sugar::1:6
Composition of reduced osmolarity ORS
Na: 75 mmol/L
Glucose: 75 mmol/L
Cl: 20 mmol/L
Citrate: 10 mmol/L
Super ORS
ORS with: β’ starch (rice π) β’ starch-free (glycine/glucose polymer) Advantage: 1. π½ dehydration 2. π½ stool frequency 3. Provides 180 kcal/L
Resomal
Rehydration solution for severely malnourished children Composition: 1. ORS pack 2. 2 L water 3. 50gm sugar 4. Mineral electrolyte solution K, Cl, Mg, Zn, Cu
Treatment of diarrhea using ORS
75 ml/kg + for every stool episode add 100 ml
Cholera
bacterial load
Carriers: 10^2-10^5 vibrio/gm stool
Case: 10^7-10^9 vibrio/gm stool
75% of cases of cholera are asymptomatic
Carriers of cholera and their infective period
- Health carriers and chronic carriers: months to years
- Incubatory carriers: 1-5 days
- Convalescent carriers: 2-3 weeks
- Contact carrier: 8-10 days
- Case of cholera: 8-10 days
Stages of cholera
1. Stage of evacuation: Persistent profuse diarrhea 2. Stage of collapse: Intense diarrhea + dehydration 3. Stage of recovery
Cholera pathogenesis
In gut V. cholerae secretes mucinase which helps the bacteria enter gut mucosa and secrete adherence factor.
This helps them to bind to gut epithelium and secrete toxins
Cholera treatment
For age: 1. <1 yr: 30 ml within 1st hour 70 ml in next 5 hr 2. >1 yr: 30 ml in 30 min 70 ml in next 150 min β’ In severe dehydration, prefer IV rehydration β’ πΌ feeding β’ chemoprophylaxis (doxycycline) β’ oral zinc supplement at 20 mg * 14 days
Vibrio cholera (physical) properties
Can be killed within 30 mins of heating Destroyed by dryness and sunshine Destroyed by chlorine, bleaching powder (6mg/L) Humans are the only reservoir High attack rate in children
Cholera toxins
- L toxic:
Combines with ganglioside in cell membrane and helps its attachment to cell membrane - H toxin:
Helps in activating adenyl cyclase and cAMP β‘οΈ secretory diarrhea
Cholera
diagnosis
- Hanging dropπ§ method
- Dark field illumination
- Holding media- Venkat Raman media
- Sample collectors:
Mc Cartney water bottles
Cholera
treatment
DoC: doxycycline
Other: tetracycline, ciprofloxacin
Cholera
vaccines
1. Dukoral: Whole cell recombinant vaccine 2. Shanchol: Oral cholera vaccine 3. Bivalent Shanchol: Used now 4. Euvichol: More stable and efficacious
Dukoral vaccine
For cholera
Whole cell-recombinant vaccine with Ξ² subunit to be taken with buffer
2 doses, 7 days apart
CI in ages <2 years
Shanchol vaccine
For cholera 2 doses, 10-14 days apart Oral cholera vaccine mORCVAX No Ξ² subunit No buffer required Can be given in age >1 yr Bivalent Shanchol: Used now Has both OI & OI39