emerging and reemerging diseases

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Published on July 26, 2012

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EMERGING & RE-EMERGING INFECTIOUS DISEASES : EMERGING & RE-EMERGING INFECTIOUS DISEASES Emerging And Re-emerging Infectious Diseases : Emerging And Re-emerging Infectious Diseases EMERGING DISEASES: EMERGING DISEASES Emerging diseases are those whose incidence in humans has increased during the last two decades or which threaten to increase in the near future Also refers to Newly appearing infectious diseases Diseases that are spreading to new geographical areas RE-EMERGING DISEASES: RE-EMERGING DISEASES These are the diseases which were previously easily controlled by chemotherapy and antibiotics, but now they have developed antimicrobial resistance and are often appearing in epidemic form PowerPoint Presentation: Global eradication of small pox in 1977 Antibiotics, vaccines discovery PowerPoint Presentation: Led to optimism and a sense of complacency that infectious diseases as public health problems could be eradicated or eliminated PowerPoint Presentation: The spectrum of infectious diseases is changing rapidly in conjunction with dramatic socio-economic and ecological changes With in the past two decades , innovative research and improved diagnostic & detection methods have revealed a no.of previously unknown human pathogens Eg : H.pylori List of NIAID Emerging and Re-emerging diseases: List of NIAID Emerging and Re-emerging diseases Group I Group II Group III Pathogens newly recognized in past two decades Re-emerging pathogens Agents with Bioterrorism potential Eg; Acanthamebiasis,Hepatitis C,Hepatitis E,etc Eg; Enterovirus 71,Clostridium difficile,Streptococcus groupA,Staphylococcus aureus A B C Anthrax,Viral hemorrhagic fever,Clostridium botulinum toxin,etc Japanese encephalitis,Qfever,Typhus fever,Brucellosis SARS,Yellow fever,Chikungunya Examples of: Examples of Re-emerging pathogens Few examples of Emerging pathogens: Few examples of Emerging pathogens PROBLEM STATEMENT: PROBLEM STATEMENT PowerPoint Presentation: Emerging & Reemerging infections are one of the major causes of death – 25% About 15 million (>25%) of 57 million annual deaths worldwide are the direct result of infectious disease The burden of these infectious diseases fall on population rich nations PowerPoint Presentation: Direct economic impact of selected infectious disease outbreaks, 1990-2003 Heymann DL. Emerging and re-emerging infections. In Oxford Textbook of Public Health , 5 th ed, 2009, p1267. These diseases have direct economic impact on countries BACTERIAL INFECTIOUS DISEASES: BACTERIAL INFECTIOUS DISEASES 14 th century- PLAGUE killed 20-45% world’s population In 1831- 13% population died due to cholera In 1854-56 deaths are due to dyscentry In 1899-1902 Boer war dyscentry CHOLERA: CHOLERA In 1 st half of 20 th century it is largely confined to A sia & severe epidemic in Egypt In 1992 ,largest outbreaks in India & Bangladesh 5634 cases were reported in Southern Sudan In 2000 , multiple outbreaks reported in Islands of OCEANIA PowerPoint Presentation: VIRAL INFECTIOUS DISEASES R ecent pandemics through out world :- - SARS - Swine flu, Bird flu - Japanese encephalitis SWINE FLU: SWINE FLU Recent pandemic occurred in 2009 WHO implemented ALERT LEVEL PHASE 6, which is highest level In India 1 st H1N1 case was reported at Hyderabad airport on 13 th may 1 st death at Pune By 24 th may 2010 , 10193 confirmed cases , 1035 deaths were reported. PowerPoint Presentation: World wide PowerPoint Presentation: World wide HIV: HIV 1989: U.S. AIDS cases reported are 100,000 1991: Estimated HIV infected in USA 1.5 million Magic Johnson announces he is HIV positive 1993: Multiple drugs fail in clinical trials Period of extreme pessimism for HIV infected 1995: First protease inhibitor approved: Inverase,saquinivir PowerPoint Presentation: SARS - Feb 10 th 2003,305 cases reported (including 105 health careworkers ) -China, Hongkong is the most effected country ( upto may 2004) FIGURE 3. Probable cases of severe acute respiratory syndrome (SARS) with onset of illness from 1 November 2002 to 31 July 2003.: FIGURE 3. Probable cases of severe acute respiratory syndrome (SARS) with onset of illness from 1 November 2002 to 31 July 2003. DENGUE: DENGUE It is most important mosquito borne disease world wide Mostly in India, SEA, Southern China, Central South America, Mexico, Africa. In 2003 , 1723 cases were recorded in Delhi. 4deaths were reported PowerPoint Presentation: Japanese encephalitis : . 1145 cases reported in U.P IN INDIA in 2005 . of which 1/4 th of them died . 90 cases were reported from BIHAR PowerPoint Presentation: Schistosomiasis PowerPoint Presentation: BASIC ELEMENTS OF PREPAREDNESS IHR (International health regulation) GOARN – global outbreak alert and response network 1. In 2000-02 ,responded to 34 events in 20 countries 2. Coordination of SARS & Birdflu Daily Flow of GPHIN Information: Daily Flow of GPHIN Information scanning global news filtering & sorting process 800-1000 articles selected daily 1 2 3 review for relevancy Mon-Fri 7am-5pm EST (Hours are extended during a public health crisis) Ongoing 24/7 Emerging & Re-emerging Infectious Diseases factors responsible: Emerging & Re-emerging Infectious Diseases factors responsible Factors Contributing To Emergence: Factors Contributing To Emergence AGENT Evolution of pathogenic infectious agents (microbial adaptation & change) Development of resistance to drugs Resistance of vectors to pesticides Factors Contributing To Emergence: Factors Contributing To Emergence HOST Human demographic change (inhabiting new areas) Human behaviour (sexual & drug use) Human susceptibility to infection (Immunosuppression) Poverty & social inequality Factors Contributing To Emergence: Factors Contributing To Emergence ENVIRONMENT Climate & changing ecosystems Economic development & Land use (urbanization, deforestation) Technology & industry (food processing & handling) CONTD.: CONTD. International travel & commerce Breakdown of public health measure (war, unrest, overcrowding) Deterioration in surveillance systems (lack of political will) Transmission of Infectious Agent from Animals to Humans: Transmission of Infectious Agent from Animals to Humans >2/3 rd emerging infections originate from animals- wild & domestic Emerging Influenza infections in Humans associated with Geese, Chickens & Pigs Animal displacement in search of food after deforestation/ climate change (Lassa fever) Humans themselves penetrate/ modify unpopulated regions- come closer to animal reservoirs/ vectors (Yellow fever, Malaria) Climate & Environmental Changes: Climate & Environmental Changes Deforestation forces animals into closer human contact- increased possibility for agents to breach species barrier between animals & humans El Nino- Triggers natural disasters & related outbreaks of infectious diseases (Malaria, Cholera) Global warming- spread of Malaria, Dengue, Leishmaniasis, Filariasis Poverty, Neglect & Weakening of Health Infrastructure: Poverty, Neglect & Weakening of Health Infrastructure Poor populations- major reservoir & source of continued transmission Poverty- Malnutrition- Severe infectious disease cycle Lack of funding, Poor prioritization of health funds, Misplaced in curative rather than preventive infrastructure, Failure to develop adequate health delivery systems Uncontrolled Urbanization & Population Displacement: Uncontrolled Urbanization & Population Displacement Growth of densely populated cities- substandard housing, unsafe water, poor sanitation, overcrowding, indoor air pollution (>10% preventable ill health) Problem of refugees & displaced persons Diarrhoeal & Intestinal parasitic diseases, ARI Lyme disease (B. burgdorferi)- Changes in ecology, increasing deer populations, suburban migration of population Human Behaviour: Human Behaviour Unsafe sexual practices (HIV, Gonorrhoea, Syphilis) Changes in agricultural & food production patterns- food-borne infectious agents (E. coli) Increased international travel (Influenza) Outdoor activity CONTD.: CONTD. Loss of effectiveness: Community-acquired (TB, Pneumococcal) & Hospital-acquired (Enterococcal, Staphylococcal Antiviral (HIV), Antiprotozoal (Malaria), Antifungal PowerPoint Presentation: Anti Microbial Resistance Def : Resistance by disease causing organism to Antimicrobial drugs. Deadly impact on control of disease such as Antimicrobial Drug Resistance: Antimicrobial Drug Resistance Consequences Prolonged hospital admissions Higher death rates from infections Requires more expensive, more toxic drugs Higher health care costs PowerPoint Presentation: Examples Multi drug resistance Tuberculosis Malaria Resistance of Plasmodium parasites to Antimicrobial drugs Resistance of Anopheles mosquitoes to Insecticides. PowerPoint Presentation: HUMAN ANIMALS ENVIRONMENT VECTORS Zoonosis Population Growth Mega-cities Migration Exploitation Pollution Climate change Vector proliferation Vector resistance Transmission Antibiotics Intensive farming Food production Examples of Emerging Infectious Diseases: Examples of Emerging Infectious Diseases Hepatitis C- First identified in 1989 In mid 1990s estimated global prevalence 3% Hepatitis B- Identified several decades earlier Upward trend in all countries Prevalence >90% in high-risk population CONTD.: CONTD. Zoonoses- 1,415 microbes are infectious for human Of these, 868 (61%) considered zoonotic 70% of newly recognized pathogens are zoonoses Bioterrorism: Bioterrorism Possible deliberate release of infectious agents by dissident individuals or terrorist groups Biological agents are attractive instruments of terror- easy to produce, mass casualties, difficult to detect, widespread panic & civil disruption CONTD.: CONTD. Highest potential- B. anthracis, C. botulinum toxin, F. tularensis, Y. pestis, Variola virus, Viral haemorrhagic fever viruses Likeliest route- aerosol dissemination Key Tasks in Dealing with Emerging Diseases: Key Tasks in Dealing with Emerging Diseases Surveillance at national, regional, global level epidemiological, laboratory ecological anthropological Investigation and early control measures Implement prevention measures behavioural, political, environmental Monitoring, evaluation CONTD.: CONTD. Delays in reporting, poor analysis of data and information at all levels No feedback to periphery Insufficient preparedness to control epidemics No evaluation Solutions: Solutions Public health surveillance & response systems Rapidly detect unusual, unexpected, unexplained disease patterns Track & exchange information in real time Response effort that can quickly become global Contain transmission swiftly & decisively EMERGING & REEMERGING BACTERIALDISEASES: EMERGING & REEMERGING BACTERIALDISEASES EMERGING PATHOGENS (in last 2 decades): EMERGING PATHOGENS (in last 2 decades) YEAR 1981 ORGANISM Staph.aureus DISEASE Respiratory diseases 1982 E.coli Diarrhoea , Haemorrhagic collitis 1982 Borrelia burgdorferi Lyme disease 1983 H.pylori Peptic ulcer 1992 Vibrio chlorea , cl.deficile Diarrhoea 1995 Salmonella, shigella , gonococci Enteric fever 1997 & 1999 Anthrax bacilli Anthrax 7/26/2012 54 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. REEMERGING PATHOGENS: REEMERGING PATHOGENS - Plague bacilli - Anthrax bacilli - Streptococcus - Staphylococcus 7/26/2012 55 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. ANTHRAX: ANTHRAX Word means - coal, comes from the black colour of eschar . Acute infectious disease of animals. PROBLEM STATEMENT :- - M ostly seen in tropics, - 20,000 to 1,00,000 cases were reported all over the world. 7/26/2012 56 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. CLINICAL FEATURES : CLINICAL FEATURES Exists in 3 clinical forms 1.Cutaneous anthrax 2.Pulmonary anthrax 3.Intestinal anthrax 7/26/2012 57 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. PowerPoint Presentation: Cutaneous anthrax:- ( Hideporters disease) Starts as a pustule, becomes vesicle & develops in to black eschar with hard swelling.. 7/26/2012 58 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. PowerPoint Presentation: Pulmonary anthrax:- (Wool sorters disease) - Affects lungs - Sputum contains clotted blood and spores of anthrax bacilli. Intestinal anthrax:- - Affects intestines. Shivering, hemorrhages & septicemic are common on all the 3 forms. 7/26/2012 59 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. PowerPoint Presentation: Diagnosis- Microscopy Culture Serology Treatment- Immediate antibiotic therapy Doxycycline Ciprofloxacin Pencillins 7/26/2012 60 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. METHODS OF CONTROL: METHODS OF CONTROL Measures directed towards animals Measures directed towards man Prevention of spread through environment 7/26/2012 61 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. PowerPoint Presentation: PLAGUE 7/26/2012 62 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. PLAGUE: PLAGUE It is a primary zoonotic disease caused by Yersinia pestis . Tranmission is from rats to fleas by direct contact with infected tissue or by droplet infection 7/26/2012 63 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. PowerPoint Presentation: CLINICAL FORMS:- a.Bubonic plague (50% fatal) b.Pneumonic plague (100%fatal) c.Septicemic plague 7/26/2012 64 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. PowerPoint Presentation: TREATMENT:- Streptomycin Tetracyclin Gentamycin PREVENTION & CONTROL:- Health education Environmental modification Proper sanitation Vaccination 7/26/2012 65 copyright 2006 www.brainybetty.com ALL RIGHTS RESERVED. VIRAL EMERGING AND RE-EMERGING DISEASES: VIRAL EMERGING AND RE-EMERGING DISEASES PowerPoint Presentation: VIRUSES 1]Infecting CNS-Japanese encephalitis 2]Infecting RESPIRATORY SYSTEM -SARS -Pandemic influenza JAPANESE ENCEPHALITIS: JAPANESE ENCEPHALITIS History Geographical distribution Transmission Clinical features Diagnosis and Treatment Prevention and Control PowerPoint Presentation: Genus Flavivirus Name derived from the Latin flavus meaning “yellow” Single stranded, enveloped RNA virus Different genotypes with single serotype Replication-Regional lymphnodes Invasion of CNS- via- Blood I.P-5 to 15 days History: History 1940 to 1978 Disease spread with epidemics in China, Korea, and India [Tamilnadu-1955] Geographic Distribution: Geographic Distribution Endemic in temperate and tropical regions of Asia Disease control by vaccination Japan China Korea Indonesia India Philippines AREA OF HIGH OCCURRENCE IN INDIA: AREA OF HIGH OCCURRENCE IN INDIA The three southern states of Tamil Nadu (TN), Andra Pradesh, Karnataka were reporting higher incidence. JE is emerging as a public health problem in Kerala In a few villages of Cuddalore district of Tamil Nadu, a known JE-endemic area (Chidambaram, Virudhachalam , Thittakudi ) Transmission: Transmission Vector-borne Enzootic cycle Mosquitoes: Culex species Culex tritaeniorhynchus Reservoir/amplifying hosts Pigs, bats, Ardeid (wading) birds Possibly reptiles and amphibians Incidental hosts Horses, humans, others PowerPoint Presentation: Center for Food Security and Public Health, Iowa State University, 2011 Clinical Signs: Severe: Clinical Signs: Severe Prodromal stage: 1-6 days Acute encephalitis Headache, high fever, stiff neck, stupor May progress to paralysis, seizures, convulsions, coma, and death Neuropsychiatric sequelae 45 to 70% of survivors In utero infection possible Abortion of fetus Diagnosis and Treatment: Diagnosis and Treatment Laboratory diagnosis required Tentative diagnosis Antibody titer: HI, IFA, CF, ELISA JE-specific IgM in serum or CSF Definitive diagnosis Virus isolation: CSF, brain No specific treatment Supportive care Prevention: Prevention Vector control Eliminate mosquito breeding areas Adult and larvae control Vaccination Equine, swine, humans Personal protective measures Avoid prime mosquito hours Use of repellants containing DEET Center for Food Security and Public Health, Iowa State University, 2011 SARS [Severe Acute Respiratory Syndrome] : SARS [Severe Acute Respiratory Syndrome] Caused By- Varient of corona virus Emerging disease-2002-03 Rapid spread in asian countries WHO-8422 cases -916 deaths from 30 countries MOT-Respiratory droplets - Direct contact -Possible fecal tranmission I.P-2 to 7 days Clinical Symptoms : Clinical Symptoms High fever Virus Detection: Virus Detection Virus isolation : inoculate suitable cell culture with patient specimens Antibody Detection: Antibody Detection When infected by SARS- CoV  a ntibodies (e.g. IgM and IgG ) are produced / change in level Enzyme-linked immunosorbent assay (ELISA ) Immunofluorescence assay (IFA): Clinical Findings: Clinical Findings Clinical history & observation Chest radiography: important role 70-80% patients have abnormal chest radiographs Normal SARS patient TREATMENT: TREATMENT Immunomodulatory therapy -Corticosteroid Antiviral Agents - Ribavirin Protease inhibitor - Lopinavir -ritonavir co-formulation Principle of Disease Confinement: Principle of Disease Confinement Principle: to break the chain of transmission from infected to healthy person 3-step protocol of disease confinement Case detection Prompt isolation Contract tracing Daily health check Voluntary home isolation Epidemic Containment: Epidemic Containment Creation of emergency operating center Institutional support Efficient quarantine measures Legislation International collaboration—WHO Travel alerts and restrictions Coordination for research Agreement of countries on containment protocol Pandemic Influenza: Pandemic Influenza PowerPoint Presentation: Seasonal Influenza A public health problem each year Usually some immunity built up from previous exposures to the same subtype Infants and elderly most at risk Influenza Pandemics Appear in the human population rarely and unpredictably Human population lacks any immunity All age groups , including healthy young adults Seasonal Epidemics vs. Pandemics Circulating Influenza Strains and Pandemics in The 20th Century: Circulating Influenza Strains and Pandemics in The 20 th Century 1920 1940 1960 1980 2000 H1N1 H2N2 H3N2 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” 20-40 million deaths 1-4 million deaths 1-4 million deaths Prerequisites for pandemic influenza: The new virus must be efficiently transmitted from one human to another Prerequisites for pandemic influenza A new influenza virus emerges to which the general population has little/no immunity The new virus must be able to replicate in humans and cause disease PowerPoint Presentation: Viral Re-assortment Reassortment in pigs Reassortment in humans Pandemic Influenza Virus Signs and Symptoms: Signs and Symptoms Human Influenza Type of infection Upper and lower respiratory Fever Yes Headache Yes Cough Yes Respiratory symptoms Varies; sore throat to difficulty breathing Gastrointestinal symptoms Uncommon, except children, elderly Recovery 2-7 days PowerPoint Presentation: Isolation Precautions PowerPoint Presentation: Source: Rosie Sokas, MD MOH UIL at Chicago Droplet precautions: Surgical Masks N-95 Filtering Masks: N-95 Filtering Masks PowerPoint Presentation: Personal Protective Equipment (PPE) PowerPoint Presentation: VIRAL EMERGING AND RE-EMERGING DISEASES Contd …… Viral hemorrhagic diseases: Viral hemorrhagic diseases By Divya P ravalika What is Viral Hemorrhagic Fever ?: What is Viral Hemorrhagic Fever ? Severe multisystem syndrome Damage to overall vascular system Symptoms often accompanied by hemorrhage − may/may not be threatening − includes conjunctivitis, petechiae, echymosis. PowerPoint Presentation: Arenaviridae Bunyaviridae Filoviridae Flaviviridae Junin Crimean- Congo H.F. Ebola Kyasanur Forest Disease Machupo Hantavirus Marburg Omsk H.F. Sabia Rift Valley fever Yellow Fever Guanarito Dengue Lassa Classification of Viruses PowerPoint Presentation: Dengue fever What is dengue fever ? Causative virus ? Epidemiology ? Characteristics of Aedes mosquito ? Life cycle of Aedes mosquito ? How the Aedes mosquito transmits disease ? Clinical manifestations of Dengue ? How to prevent the spread of disease ? PowerPoint Presentation: What is Dengue fever ? It is an illness caused by infection with a virus transmitted by Aedes mosquito. It is a self limiting disease . PowerPoint Presentation: Causative Virus Arbovirus , within this group Flavivirus Composed of ss RNA 4 serotypes (1,2,3&4) Each serotype provides specific lifetime immunity & short term cross immunity. PowerPoint Presentation: Epidemiology In India first outbreak of dengue was recorded in 1812 A double people heamorrhagic fever epidemic occurred in India for the first time in Calcutta between JULY 1963 & MARCH 1964 In New Delhi, outbreaks of Dengue fever reported in 1967, 1970, 1982 & 1996. PowerPoint Presentation: Characteristics of Aedes Mosquito Close-up of an Aedes mosquito One distinct physical feature – black and white stripes on its body and legs. Bites during the day. Lays its eggs in clean, stagnant water. PowerPoint Presentation: Stagnant water Pupae Larvae Eggs 1-2 days 4-5 days 2-3 days Life cycle of Aedes aegypti PowerPoint Presentation: How Do Aedes mosquito transmit diseases………. Virus is carried in its body. Mosquito bites and sucks blood containing the virus from an infected person. And passes the virus to healthy people when it bites them. PowerPoint Presentation: Clinical manifestations of Dengue…. Undifferentiated fever Classical Dengue fever Dengue haemorrhagic fever Dengue shock syndrome PowerPoint Presentation: Undifferentiated fever most common. Asymptomatic or mildly symptomatic. Classical Dengue fever BREAK BONE FEVER caused by atleast 4 serotypes can occur epidemically/ endemically. PowerPoint Presentation: Dengue haemorrhagic fever Severe form of Dengue fever. Infected with >1 Dengue virus. Severe illness due to double infection with Dengue viruses. Incubation Period : 4-6 days. Changes that determine the severity of disease Plasma leakage, Abnormal haemostasis, raising PCV value marked Thrombocytopenia PowerPoint Presentation: Example of a skin rash due to dengue fever Symptoms of dengue fever PowerPoint Presentation: Grade 1 Fever and nonspecific constitutional symptoms Positive tourniquet test is only hemorrhagic manifestation Grade 2 Grade 1 manifestations + spontaneous bleeding Grade 3 Signs of circulatory failure (rapid/weak pulse, narrow pulse pressure, hypotension, cold/clammy skin) Grade 4 Profound shock (undetectable pulse and BP) Four Grades of DHF PowerPoint Presentation: Dengue Shock Syndrome Severe form of DHF. PowerPoint Presentation: Clinical Evaluation PowerPoint Presentation: Clinical laboratory tests CBC—WBC, platelets, hematocrit Albumin Liver function tests Urine—check for microscopic hematuria Dengue-specific tests Virus isolation Serology Laboratory Tests: PowerPoint Presentation: If no hemorrhagic manifestations and well-hydrated, Patient can be sent home with instructions for " followup ”. If hemorrhagic manifestations or hydration status is borderline, the patient should be observed, either in an outpatient observation center or in the Hospital. If warning signs are present even without evidence of shock, or if DSS is present, the patient should be hospitalized TREATMENT PowerPoint Presentation: Absence of fever for 24 hours (without anti- fevertherapy ) and return of appetite. Visible improvement in clinical picture. Stable hematocrit 3 days after recovery from shock Platelets >50,000/mm³ No respiratory distress from pleural effusions/ ascites Indications for Hospital Discharge PowerPoint Presentation: How do we Prevent Dengue from Spreading………….. No licensed vaccine at here. We avoid Dengue, when we avoid mosquito bites. Prevent Aedes from Breeding . PowerPoint Presentation: Remove ALL sources of stagnant water. Deny the Aedes mosquito of any chance to breed. Prevent Aedes from Breeding! PowerPoint Presentation: Change water in vases on alternate days. Remove water from flowerpot plates on alternate days. PowerPoint Presentation: Cover bamboo pole holders when not in use. PowerPoint Presentation: Feature CHIKV DENGUE Presentation A+F ± mild rash A+F+Rash Arthralgia Moderate Severe Arthritis Not common Frequent Bone pains None Break bone fever Thrombocytopenia Mild (Not <1K) May be severe Hemorrhage None May be present Shock syndrome Never May occur Immunity (IgG) Life long 2 nd attack fatality PowerPoint Presentation: Skin rash in Dengue Skin rash in CHIKV EMERGING AND REEMERGING PARASITIC INFECTIONS: EMERGING AND REEMERGING PARASITIC INFECTIONS CRYPTOSPORIDIUM: CRYPTOSPORIDIUM OTHER PARASITIC INFECTIONS: OTHER PARASITIC INFECTIONS Cryptosporidium parvum Enterocytozoon bieneusi Cyclospora cayetanensis Encephalitozoon hellem New species of Babesia Encephalitozoon cuniculi SYMPTOMS: SYMPTOMS Immunocompetent Mild self-limiting enterocolitis (watery bloodless diarrhea, abdominal pain, nausea, vomiting, and fever ). Spontaneous remission is common (usually within 10 days) Immunocompromised 50 or more stools per day Dehydration (fatigue, abdominal cramping, and nausea ). Lasts months or years. Common in AIDS patients LAB DIAGNOSIS: LAB DIAGNOSIS Microscopic exam Acid fast stain of stool sample Endoscopic biopsy of small intestine LIFE CYCLE: LIFE CYCLE Cryptosporidium lives and grows in variety of animals– geese to snakes to cows, sheep and pigs to humans Cryptosproridium completes its cycle in a single host . The Species of Crypto known to infect humans is Cryptosporidium Parvum. LIFE CYCLE: LIFE CYCLE Infectious agents are the OOCYSTS. In immunocompromised patients ID 50 is about 10 to 30 oocysts . Autoinfection takes place in 2 ways- > Merozoites attach to nearby epithelial cells and spread infection > thin walled oocysts excyst and continue to spread infection within the body. A scanning electron micrograph of Cryptosporidium lining the intestinal tract. (From: Gardiner et al., 1988, An Atlas of Protozoan Parasites in Animal Tissues, USDA Agriculture Handbook No. 651.) : A scanning electron micrograph of Cryptosporidium lining the intestinal tract. (From: Gardiner et al ., 1988, An Atlas of Protozoan Parasites in Animal Tissues, USDA Agriculture Handbook No. 651.) INTERESTING FACT: INTERESTING FACT In Uganda, the human population shares habitat with free ranging gorillas. These people are infected with animal-adapted genotype of Cryptosporidium parvum. Schistosomiasis - life cycle: Schistosomiasis - life cycle Geographic distribution of Schistosomiasis: Geographic distribution of Schistosomiasis S. mansoni S. hematobium S. japonicum Schistosomiasis - pathogenesis: Schistosomiasis - pathogenesis egg granuloma (type IV reaction)--> fibrosis morbidity ~ worm (egg) burden concomitant immunity to schistosomula adult worms: invisible to the immune system (survive for years) Schistosomiasis- clinical features: Schistosomiasis- clinical features Cercarial dermatitis Intestinal schistosomiasis (granulomas --> polyps, protein loss, malabsorption, strictures ) Hepatosplenic schistosomiasis (portal hypertension --> ascites, varices, splenomegaly, normal hepatic function ) Urinary schistosomiasis (hematuria, chronic infection, obstruction ) Other (cardiopulmonary, CNS, etc.) Drug treatment of schistosomiasis: Drug treatment of schistosomiasis Praziquantel increases permeability of adult parasite to Ca ++ . Tetanospasm --> death Control of Schistosomiasis: Control of Schistosomiasis REDUCE CARRIERS mass rx program ELIMINATE SNAILS molluscicides destroy snail habitats snail-eating fish PREVENT WATER CONTAMINATION latrines, toilets public health education PREVENT HUMAN EXPOSURE water systems

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