RABIES

‐ An acute, progressive, fatal

encephalomyelitis caused by neurotropic

viruses

‐ Always almost fatal once manifestations

develop

‐ RHABDOVIRUS – a bullet-shaped virus with

strong affinity to CNS tissues

‐ Saliva of a rabid animal

‐ All mammals are believed to be

susceptible, but reservoirs are carnivores

and bats.

‐ Bite of an infected animal

‐ Licking of open wounds by a rabid animal

‐ Scratch of a rabid animal

‐ Man to man transmission (10%)

‐ Airborne (Rare)

‐ Dogs: 1 week to 7 and ½ months

‐ Humans: 10 days to 1 year

‐ Pain and numbness at the site of bite

‐ Flu-like symptoms

◦ Fever

◦ Headache

◦ Malaise/myalgia

◦ Sore throat

‐ Marked insomnia

‐ Apprehensive, Restlessness

‐ Sensitivity to light and sound

‐ Marked excitation and apprehension

‐ Maniacal behavior

‐ Paranoia, Hallucinations, Delirium

‐ Hydrophobia, Aerophobia

‐ Drooling of saliva

‐ Quiet and unconcscious

‐ Spasm ceases with progressive paralysis

‐ Tachycardia, labored respirations

‐ Respiratory paralysis, circulatory collapse

DEATH

‐ Isolation of virus from saliva

‐ Detection of antibodies to virus of serum or

spinal fluid

‐ Examination for rabies antigen in the

cutaneous nerves at the base of hair

follicles through Skin Biopsy

‐ Clinical observation (10-14 days)

‐ Direct Fluorescent Rabies Antibody Test

(DFRAT)

‐ Brain Biopsy: Detection of Negri Bodies

‐ No specific treatment

‐ Care of the patient is symptomatic and

supportive

‐ Clean the wound with soap and water

‐ Antiseptic solution: Povidone-Iodine

‐ Tetanus prophylaxis

‐ Post-exposure prophylaxis

PASSIVE VACCINATION

1. Human Rabies Immunoglobulin (RHIg)

‐ Rabuman, Imogam

‐ 20 IU/kg

2. Animal Serum Equine Rabies Immunoglobulin

(ASERIg)

‐ Antirabies Serum, HyperRAB

‐ 40 IU/kg

ACTIVE VACCINATION

‐ PVCV (Vero Rab): IM Day 0,7,21,90

‐ PDEV (Lyssavac): ID Day 0,3,7,28,90

‐ HDCV: IM 0,3,7,14,28

‐ PCEV: IM 0,3,7,14,28

ACTIVE VACCINATION

PASSIVE VACCINATION

‐ Is not required

‐ Isolation of patients

‐ Restrain when necessary

‐ Darken the room and provide a quiet

environment

‐ Stimulation of any senses by fluid is

prohibited

‐ Wear protective barriers

‐ Responsible Pet Ownership

‐ Victim Immunization

‐ Dog Immunization

‐ Immunization

‐ Keep away from stray animal

TETANUS ‐ Is an infectious disease caused by

Clostridium tetani which produces potent

exotoxin with prominent systemic

neuromuscular effects

‐ manifested by generalized spasmodic

contraction of the skeletal musculature

‐ Lockjaw

‐ CLOSTRIDIUM TETANI - Anaerobic, spore-

forming Gram (+) rod with drumstick

appearance

Two types of toxin:

Tetanospasmin, tetanolysin

‐ Soil

‐ Street dust

‐ Animal and human feces

‐ Rusty materials

‐ Through punctured wound that is

contaminated by dust, soil, or animal

excreta containing Clostridium tetani

‐ Adult: 3 days – 3 weeks

‐ Newborn: 3 – 30 days

‐ 1st

sign: difficulty in feeding and sucking

‐ High grade fever

‐ Stiffness of the jaw

‐ Excessive crying

‐ Muscle spasm

‐ Convulsion

‐ Low grade fever

‐ Diaphoresis

‐ Trismus

‐ Opisthotonus

‐ Risus sardonicus- pathognomonic sign

‐ Abdominal rigidity

‐ Stiffness of the extremity

‐ Severe cases: Laryngospasm

‐ The diagnosis is almost always made

clinically

‐ History of wound

‐ Lack of immunization: A factor

‐ ANTITOXINS

◦ Tetanus Immunoglobulin (TIG): 3,000-

6000 units IM

◦ Tetanus Antitoxin (TAT): 50,000-

100,000 units, half IV, the rest IM

◦ Antitetanus Serum (ATS): 40, 000 units

◦ Antibiotic: METRONIDAZOLE- drug of

choice

‐ Muscle Relaxant: Diazepam, Baclofen

‐ Maintain adequate airway

‐ Wound care: debridement

‐ Maintain fluid and electrolyte balance

‐ Place patient in quiet, darkened

environment

‐ Minimal handling

‐ Protect from injury

‐ Exteroceptive: bright lights and noise

‐ Interoceptive: Stress, pain

‐ Propioceptive: Turning, touching

‐ Ineffective breathing pattern related to

muscles spasm and neurologic impairment.

‐ Risk for injury related to muscle spasms.

‐ Immunization with tetanus toxoid for adults

‐ DPT for babies and children

LEPTOSPIROSIS ‐ A zoonotic infectious bacterial disease

carried by animals, both domestic and wild,

whose urine contaminates water or food

which is ingested or inoculated through skin

‐ Weil’s disease

‐ Canicola Fever

‐ Mud Fever

‐ Hemorrhagic jaundice

‐ Swineherd’s Disease

LEPTOSPIRA INTERROGANS

‐ Spirochete, Motile, Beta-hemolytic

‐ Chiefly saprophytic aquatic organisms

◦ river

◦ lake water

◦ Sewage

◦ sea

‐ 6-15 days

‐ Leptospira is found in the urine between 10

to 20 days after the onset

‐ Urine of infected animal

‐ Reproductive fluids (RARE)

1. Ingestion or contact with the skin and

mucous membrane of the infected urine or

carcasses of wild and domestic animals.

2. Through the mucous membrane of the

eyes, nose, and mouth, and through a break

on the skin.

3. Direct human to human transmission is

rare.

‐ Leptospira enters the blood to cause

damage, thereafter, in the:

Kidney

Liver

Eyes

Meninges

‐ Occupational risk factors include

veterinarians, slaughter house workers,

farmers, and sewer workers.

‐ Clinical course is generally biphasic and the

majority of the cases are anicteric.

‐ Remittent fever

‐ Chills

‐ Headache

‐ Anorexia

‐ Nausea and vomiting

‐ Prostration

‐ Abdominal pain

‐ Diarrhea

‐ UNICTERIC TYPE

◦ Conjunctival suffusion

◦ Uveitis or iritis

◦ Meningeal manifestations

◦ With CSF findings of aseptic

meningitis

‐ ICTERIC TYPE

◦ Jaundice and renal failure (Weil’s

syndrome)

◦ Hemorrhage

◦ CHF in severe cases

◦ Relapse may occur during the 4th

to 5th

week

‐ Usually based on Serology

‐ Culture

◦ Blood, CSF, Urine

‐ ELISA

‐ MAT: the recognized standard reference

test for serologic diagnosis of leptospirosis

‐ Antibiotic: PENICILLIN G (drug of choice)

‐ Oral doxycycline 100mg PO every 12 hours

x 1 week (prophylactic)

‐ Fight complications: require hospitalization

‐ Peritoneal dialysis

‐ Symptomatic and supportive

‐ Isolate the patient, urine must be properly

disposed of.

‐ Darken patient’s room

‐ Observe meticulous skin care to ease

pruritus.

‐ Keep clients under close surveillance.

‐ Sanitation in homes, workplaces, and farms

‐ Eradication of rats

‐ Animals must be vaccinated (cattle, dogs,

cats, and pigs)

SCHISTOSOMIASIS ‐ Is a parasitic disease caused by several

species of trematodes("flukes”)

‐ Primarily affects the liver and GIT.

‐ Capable of producing obstructive jaundice

and liver cirrhosis

‐ Second most socioeconomically devastating

parasitic disease after malaria

‐ Schistosoma japonicum- Intestinal

schistosomiasis

‐ Schistosoma mansoni- Intestinal

schistosomiasis

‐ Schistosoma haematobium- Urinary

schistosomiasis

‐ Skin penetration by cercaria

‐ Through ingestion of contaminated water

Incubation Period

‐ About 2-6 weeks from skin penetration

‐ Adult female and male parasites

‐ Ova

‐ Miracidium – infective stage in snails

‐ Cercaria – infective stage in man and

animals

‐ Snail (Oncomelania quadrasi)

‐ Thrives best along river banks, fresh water

streams, creeks, canals and swamps

‐ Greenish-brown in color and is just as big as

the smallest grain of palay

‐ Low-grade fever

‐ Abdominal pain- due to hepatomegaly,

splenomegaly, and lymphadenopathy

‐ Myalgia; fatigue

‐ Cough

‐ Bloody-mucoid stool, “dysentery-like”

‐ Swimmer’s itch

‐ Anemia and malnutrition

‐ When parasites reaches the brain--- severe

headache, dizziness, and convulsion

‐ Portal hypertension and signs of liver

cirrhosis

‐ Hematemesis

‐ Pulmonary hypertension

‐ Glomerulonephritis--- Renal failure

‐ KATO-KATZ TECHNIQUE

‐ is a laboratory method for preparing human

stool samples prior to searching for parasite

eggs

‐ is now most commonly used for detecting

schistosome eggs

‐ CIRCUM OVA PRECIPITIN TEST (COPT)

‐ Was used to detect serum antibodies

to Schistosoma mansoni, S. haematobium,

or both species by using eggs of either

species of schistosome

‐ Praziquantel (biltricide) – drug of choice;

single oral dose annually

‐ Oxamniquine- exclusively for treating S.

mansoni

‐ Metrifonate- exclusively for treating s.

haematobium

‐ No vaccines are currently available

‐ Eliminating the water-dwelling snails that

are the natural reservoir of the disease

‐ Clearing vegetation thus exposing the snail

to sunshine

‐ Constructing drainage to dry the land

surface where the snails thrive

‐ Improve farming by proper irrigation and

drainage

◦ Diminish infection rate:

◦ Proper waste disposal

◦ Control of stray animals

◦ Avoid bathing in infested streams