contact zoonotic disease

05/01/2023 Dr.Wahid Elsaidy 1


CONTACT ZOONOTIC DISEASE

Dr. Wahid Elsaidy Assistant lecturer of public health and

community medicine


RABIES

RABIES (hydrophobia)

(From Latin: rabies, "madness)"السعار الكلب داء

DefinitionAcute viral zoonosis affecting domestic and wild animals, transmitted through the bit of rabid animal

05/01/2023 Dr.Wahid Elsaidy


Rabies .cont.OccurrenceIn Egypt estimated that 200000 animal bites occur each year Prepathogenic periodAgent : rabies virus is the type species of the Lyssavirus genus ,in the family Rhabdoviridae, order Mononegavirales. RNASource of infection: Carnivorous animals (dogs,foxes,raccoons,bats)Exit : saliva of the infected animals


Rabies .cont.


Rabies .cont.Mode of transmission:

1 -bite of rabid animals 2 -licks on skin(abraded) or

mucosa (abraded or non abraded)3 -aerosol of the virus that can

be present in caves where bats roots


Rabies .cont.Pathogenic period:

10 days to one year commonly (1-3) monthsعلى وتعتمد The bits : number , severity , distance from the brain The virus : amount , strain The skin : bare or covered with clothes


Rabies .cont.Clinical picture

The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as one year.

the symptoms expand to slight or partial paralysis, cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia, terror, hallucinations, progressing to delirium.


Rabies .cont. The production of large quantities of saliva and tears

coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in hydrophobia, in which the patient has difficulty swallowing because the throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his or her thirst.

Death almost invariably results two to ten days after first symptoms.


Rabies .cont.Diagnosis PCR or viral culture It is also possible to make the diagnosis from saliva,

urine and cerebrospinal fluid samples, but this is not as sensitive.

Cerebral inclusion bodies called Negri bodies are 100% diagnostic for rabies infection, but are found in only about 80% of cases. If possible, the animal from which the bite was received should also be examined for rabies.


Rabies .cont.PreventionA. Measures of animals Dogs should be licensed and immunized Destruction of stray dogs and cats Maintain active surveillance for rabies in domestic

animals


Rabies .cont.B. Specific prevention for human

Post-exposure prophylaxis1- Management of wound Treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, in general within ten days of infection. Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is very effective in reducing the number of viral particles. "If available, a virucidal antiseptic such as povidone-iodine, iodine tincture, aqueous iodine solution, or alcohol (ethanol) should be applied after washing.


Rabies .cont.2 -Seroprophylaxis

Half at site of wound (infiltration)And the rest IM GLUTEAL (away from site of animal bite )HRIG Human rabies immunoglobulin :20IU Per KGERIG Equine rabies immunoglobulin: 40 IU per KG

3 -Observing the animal4 -Post exposure vaccination


Rabies .cont.Rabies vaccines A. Human diploid cell vaccine (HDCV)B. Rabies vaccine adsorbed (RVA)C. Purified chick embryo cell vaccine(PCEC) DOSE : 1ml IM in deltoid or upper outer thigh in infants. 5 doses 0, 3 , 7 , 14 , 28-35 days if immunized only 2 doses 0 , 3 daysChemoprophylaxis : penicillin or antibiotic to prevent wound sepsis.


Rabies .cont.Pre exposure prophylaxis

In high risk groups sach as veterinrians , animal handlers , and certin laboratory workers Dose : 0 , 7 , 21 days booster every 2 years


Rabies .cont.Control Cases : Notification Isolation and hospitalization Treatment : supportive Concurrent disinfection of patient s discharge

Contacts: Enlistment Surveillance of contacts and animals Wearing PPE to prevent contact with patient saliva


TETANUS


TETANUSالكزاز DEFINITION

Acute disease from wound infection witch is caused by clostridium tetani exotoxins

OCCURRENCE1 million annually , underdeveloped countries

Neonatal tetanus accounts 50 % of tetanus related death


Tetanus .cont.Pre pathogenic period Agent : Clostridium tetani a mobile Spore-forming anaerobic , gram positiveBacillus, Reservoir: Intestines of horses and other animals and man.Exit : intestinal excreta Source of infection: soil , dust, clothing skin 10-15% of human GIT


Tetanus .cont.Mode of transmission: Neonatal tetanus Cord contamination Cephalic tetanus Head trauma , otitis media Local and generalized tetanus Wound injury (contaminated with soil)


Tetanus .cont.Entry : skin , wound , burn , or contaminated injection.Pathogenic period : 3 – 21 days ( 14 days )


Tetanus .cont.Clinical picture: 4 clinical typeNeonatal tetanus (tetanus neonatorum):infected infants become irritable, feed poorly, and developed rigidity with spasms (very poor prognosis for survival)


Tetanus .cont.

Local tetanus: persistent muscle contractions in the same anatomic area as the injury, which will however subside after many weeks; very rarely fatal; milder than generalized tetanus, although it could precede it.

Cephalic tetanus: occurs with ear infections or following injuries of the head; facial muscles contractions.


Tetanus .cont.

Most common types: Generalized tetanus -descending pattern: lockjaw stiffness of neck

difficulty swallowing rigidity of abdominal and back muscles.

-Spasms continue for 3-4 weeks, and recovery can last for months

-Death occurs when spasms interfere with respiration.


Tetanus .cont.

Tetanic seizures (painful, powerful bursts of muscle contraction) if the muscle spasms affect the larynx or chest wall, they may

cause asphyxiation stiffness of jaw (also called lockjaw) RISUS SARDONICUS stiffness of abdominal and back muscles

OPISTHOTONOUS contraction of facial muscles IRONIC SMILE fast pulse fever sweating


Tetanus .cont.

diagnosis •Based on the patient’s account and physical findings that are characteristic of the disease. Diagnostic studies generally are of little value, as cultures of the wound site are negative for C. tetani two-thirds of the time. –When the culture is positive, it confirms the diagnosis of tetanus


Tetanus .cont.Fatality

Neonatal tetanus : 90%Mild and moderate : 6%Sever tetanus: 60%Prevention

General prevention Health education ,personal hygiene, environmental sanitation , complete of immunization dose ,socioeconomic development


Tetanus .cont.

Specific preventionDPT : 2, 4, 6 ,18 months, DT at school age , and booster shot every 10 years.Immunization of pregnant female with tetanus toxoid : 2 doses (2 doses1 month interval after first trimester).Delivery under complete aseptic condition


Tetanus .cont.Control Cases : Early case finding, Notification Hospitalization but not isolation Treatment : Remove and destroy the source of the toxin through surgical

exploration and cleaning of the wound (debridement). Passive immunization with human tetanus immune globuline

(TIG) 500 U Bed rest with a non stimulating environment (dim light,

reduced noise, and stable temperature) may be recommended.


Tetanus .cont. Sedation may be necessary to keep the affected

person calm. Respiratory support with oxygen, endotracheal tube,

and mechanical ventilation may be necessary.

Contacts: Investigation of of contacts and source of infection

to determine the circumstances of injury


ANTHRAX الخبيثة الجمرة


Anthrax.cont.Agent • Caused by B anthrax a gram-positive spore

forming rod, aerobic• Spore if very hardy can survive for decades in

the soil killed by heat at 160 c for 1 hour


Anthrax.cont.Source of infection

• Contracted by contact of abraded skin with products of infected cattle, sheep and goats

• Products include hidesالجلود , hair, wool الصوف, bone and meat.

Mode of transmissionCoetaneous anthrax :direct contact with the infected animals

Gastrointestinal Anthrax is very rare and occurs from consuming infected meat


Anthrax.cont.Inhalational anthrax pneumonic(wool sorter’s disease) :from inhalation of spores from textile االغزل السلخانة and slaughterhouse workers والنسيج

Incubation period : hours to 7 days


Anthrax.cont.Clinical picture Cutaneous anthrax

• Progression of painless lesionsPapule/macule – pruritic

Vesicle/bulla – clear or serosanguinous

Ulcer – non pitting, gelatinous edema

black, depressed, rarely scars ,

24-48 hrs.

days


Cutaneous anthrax


Anthrax.cont.Intestinal anthrax Affect cecum primary cause multiple ulcers make patient complain of : Fever , nausea , vomiting. malaise , anorexia, abdominal pain hematemesis and bloody diarrhea.


Anthrax.cont.Pneumonic anthrax Hemorrhagic mediastinitis Pulmonary edema Hemorrhagic plural effusions Increase among wool sorters(( الصوف فرز

Bloodstream invasion may cause septicemic anthrax which may lead to death. Internal organs become darkly colored with widespread petechiae and hemorrhage


Hemorrhagic meningitis


Anthrax.cont.Diagnosis

Isolation of the causative bacilli in blood, lesion or discharge and serologic test

Complication Persistent circular scar at the site of

lesion(cutaneos anthrax) Fatality rate 100% in pneumonic anthrax


Anthrax.cont.Prevention

General prevention Measure to prevent occupational infection:(PPE, washing facilities, health education, vaccination)Measure to animal :Veterinary supervision, vaccination of animals , quarantine measures in case of an animal outbreaks Measure to animal products:Only health animal are slaughteredHair and wool adequate disinfection, imported wool must have a certificate of freedom anthrax


Anthrax.cont.Specific prevention

1. Human Vaccination : cell free vaccine for high risk persons2. Animals vaccination diseased animals :isolation, disinfection of

discharge, treatment with penicillin


Anthrax.cont.ControlCases: Early case finding Notification ,isolation in hospital Concurrent , terminal disinfection(steam, corrosive,

burn) Treatment :penicillin drug of the choice, ciprofloxacin

for 10 days in (cutaneous anthrax ) and 60 days in bio-terrorist attack (pneumonic anthrax)


Anthrax.cont.Contacts Enlistment Surveillance for maximum incubation period Isolation of contacts of pneumonic anthrax for 7 daysEnvironment Concurrent , terminal disinfection Investigate the source of infection Outbreak control measures Combating bioterrorism

contact zoonotic disease

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