meningitis, tetanus, leprosy,

7/29/2019 meningitis, tetanus, leprosy,

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COMMUNICABLE DISEASES THAT

AFFECTS OUR NERVOUS SYSTEM


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MENINGITIS

Also known as

cerebrospinal fever

Meningitis is theinflammation of the

meninges of the brain and spinal cord as aresult of viral and bacterial infection.

Such inflammation may involve the threemeningeal membranes the dura matter, thearachnoid, and the pia matter.


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WHAT CAUSES MENINGITIS?

The disease can be caused by several

kinds of organisms which include the

pneumococcus, staphylococcus, andtubercle bacillus. The specie Neisseria

meningitides (meningococcus) is the

organism causing most epidemics ofmeningitis


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MENINGOCCCUS

Human pathogen Non-motile diplococci

Small, kidney-bean

Shaped cells

Non-spore forming

Optimum growth in

Warm, moist environment

Aerobic Gram-negative

Strongly oxidase positive

Oxidative metabolism

Neisseriaminigitides


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MENINGOCOCCUS CONT

Energy obtained by Fermentation of varioussugars (N. meningitidis ferments glucose &maltose)

No Gas is Produced

Intracellular Growth Habit

Fastidious ( growth is inhibited by free fattyacids )

Susceptible to Drying Several of Neisseria are found in aquatic

environments

Incubation period varies, the extreme limit being

set from 1-10 days


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BACTERIA ACTION

Neisseria meningitidis is often transferred

from person to person in aerosol form as

from a sneeze. Upon infection, it first takes

residence on the muscosal membranesurface as in the nose, throat, and

respiratory tract by attaching with its pili. It

then gradually infects deeper into the tissueuntil it gains access to the bloodstream

where it then travels to infect the meninges

of the brain.


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HOW CAN IT BE TRANSFERRED?

By respiratory droplets through

nasopharyngeal mucosa ( droplet

transmission)

By direct invasion through otitis media

(vehicle transmission, Cotton buds)

May result after a skull fructure, a penetrating

head wound, lumbar puncture or ventricular

shunting preocedures


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SIGNS AND SYMPTOMS

Symptoms usually come on quickly, and

may include:

Fever and chills

Mental status changes

Nausea and vomiting

Sensitivity to light (photophobia)

Severe headache

Stiff neck (meningismus)


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S/S CONT

Other symptoms that can occur with this

disease:

Agitation

Bulging fontanels

Decreased consciousness


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S/S CONT

Poor feeding or

irritability in children

Rapid breathing

Unusual posture, with

the head and neck

arched backwards

(opisthotonos)


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DIAGNOSTIC PROCEDURES

Lumbar puncture

diagnostic purposes

To obtain specimen, the CSF

To take x-ray of the spinal canal and cord

Therapeutic purposes

to reduce intra-cranial pressure

to introduce serum and other medicationsTo inject an anesthetic agent


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DIAGNOSTIC PROCEDURES CONT

Gram staining

Smear and blood culture

Smear for petechiaeUrine culture


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MANAGEMENT AND TREATMENT

1. If meningitis is left untreated it has a mortality rate of 70 to 100per cent.

2. Treatment includes appropriate antibiotic therapy and vigoroussupportive care.

3. Usually IV antibiotics are given for 2wks. and are followed by oral

antibiotics such as: ampicillin, cephalosporin (ceftriaxone),aminoglycosides.

4. Digitalis glycoside (digoxin) is administered to control arrhythmias.

5. Mannitol is given to decrease cerebral edema

6. anticonvulsant or sedative is needed to reduce restlessness and

convulsions.7. Acetaminophen is helpful to relieve headache and fever.

8. Asses neurologic sign often. Observe the patients level ofconsciousness and check for increase intra-cranial pressure.


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MANAGEMENT & TREATMENT CONT

9. Monitor fluid balance. Maintain adequate fluid intake to avoiddehydration, but avoid fluid overload because of the danger ofcerebral edema. Measure central venous pressure and intakeand output.

10. Position the patient carefully to prevent joint stiffness and neck

pain. Turn the patient often to avoid pressure sores andrespiratory complications. Assist with ROM.

Tests that may be done include:

Blood culture

Chest x-ray

CSF examination for cell count, glucose, and protein CT scan of the head

Gram stain, other special stains, and culture of CSF


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PREVENTION

Haemophilus vaccine (HiB vaccine) in children will help preventone type of meningitis.

The pneumococcal conjugate vaccine is now a routine childhoodimmunization and is very effective at preventing pneumococcalmeningitis.

Household members and others in close contact with people whohave meningococcal meningitis should receive preventiveantibiotics to avoid becoming infected themselves.

The meningococcal vaccination is recommended for:

Adolescents ages 11 - 12 and adolescents entering high school(about age 15) who have not already received the vaccination.

All college freshmen who have not been vaccinated and areliving in dorms.

Children age 2 and older who do not have their spleen or whohave other problems with their immune system.


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TETANUS

Tetanus is an infectious disease caused by

Clostridium tetani which produces potentexotoxin with prominent systemicneuromuscular efforts manifested bygeneralized spasmodic contractions of the

skeletal musculator


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TETANUS CONT

Tetanus is fatal up to 66% of unimmunized

persons, usually within 10 days onset.

When symptoms develop within three days,

the prognosis is poor.


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WHAT CAUSES TETANUS?

The causative organism of the disease is

Clostr id ium tetani .

Sources of infection are:

animal and human feces. The organisms are

found in the intestinal wall of herbivorous

animals, including man.

Soil and dustPlaster of paris, unsterile sutures, pins, rusty

materials, scissors.


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CLOSTRIDIUM TETANI Anaerobic, gram positive with

round terminal spore withslender body giving a drumstickappearance.

The organism comes in 2forms, spore forming and thevegetative form.

Clostridium tetanireproducesvia an asexual reproductionprocess known as binary

fission. In this process a singlebacterium cell that has reachedits maximal growth stagedivides into two smalleridentical clone bacteria cells.

Due to this process, C.


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CONT

Incubation period is within 3 days to 3 weeks.

The organism releases 2 types of toxin:

Tetanospasmin that is responsible for muscle

spasm

Tetanolysin that is responsiblefor destruction of

RBC.


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ACTION

Spores of the bacteria C. tetanilive in the soil and arefound around the world. In the spore form, C.tetanimay remain inactive in the soil, but it canremain infectious for more than 40 years.

Infection begins when the spores enter the bodythrough an injury orwound. The spores releasebacteria that spread and make a poison calledtetanospasmin. This poison blocks nerve signals from

the spinal cord to the muscles, causing severemuscle spasms. The spasms can be so powerful thatthey tear the muscles or cause fractures of the spine.
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ACTION

The time between infection and the first sign

of symptoms is typically 7 to 21 days

The toxin (tetanospasmin) has a great affinity

to the central nervous system tissues and the

spinal motor ganglia, inducing

hyperexcitability of the motor neurons by

interfering with the release of inhibitorytransmitter.


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HOW CAN IT BE TRANSFERRED?

Normally, the mode of transmission isthrough punctured wound that iscontaminated by dust, soil, or animal excretacontaining Cl. Tetan i

1. Rugged traumatic wounds and burns 2. Umbilical stump in newborn especially for

babies delivered at home with faulty corddressing; babies delivered without tetanus

toxoid immunization 3. Unrecognized wounds (cleansing of the ears

with sharp materials)

4. Dental extraction, circumcision, ear piercing.


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SIGNS AND SYMPTOMS

Tetanus often begins with mildspasms in the jaw muscles(lockjaw). The spasms canalso affect the chest, neck,

back, and abdominal muscles.Back muscle spasms oftencause arching, calledopisthotonos.

Sometimes the spasms affectmuscles that help withbreathing, which can lead tobreathing problems.


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S/S CONT

Polronged muscularaction causessudden, powerful,

and painfulcontractions ofmuscle groups. Thisis called tetany.

These episodes cancause fractures andmuscle tears.


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S/S CONT

Other symptoms include:

Drooling

Excessive sweating

Fever

Hand or foot spasms

Irritability

Swallowing difficulty

Uncontrolled urination or defecation


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Antibiotics, including penicillin, clindamycin,erythromycin, or metronidazole (metronidazole hasbeen most successful)

Bedrest with a nonstimulating environment (dim light,

reduced noise, and stable temperature) Medicine to reverse the poison (tetanus immune

globulin)

Muscle relaxers such as diazepam

Sedatives Surgery to clean the wound and remove the source of

the poison (debridement)

Breathing support with oxygen, a breathing tube, anda breathing machine may be necessary.


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PREVENTION

1. Active immunization with tetanus toxoid for adults 2. DPT for babies and children.

Tetanus is completely preventable by active tetanusimmunization. Immunization is thought to provide

protection for 10 years. Studies of soldiers suggestthat good protection persists up to 12 years after thelast immunization.

Immunizations begin in infancy with the DTaP seriesof shots. The DTaP vaccine is a "3-in-1" vaccine thatprotects against diphtheria, pertussis, and tetanus. Itis a safer version of an older vaccine known as DTP,which is no longer used in the U.S.


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PREVENTION CONT

Td vaccine or Tdap vaccine is used to maintainimmunity in those age 11 and older. Tdapvaccine should be given once, prior to age 65,as a substitute for Td for those who have nothad Tdap. Td boosters are recommended every10 years starting at age 19.

Older teenagers and adults who have sustained

injuries, especially puncture-type wounds,should receive booster immunization for tetanusif more than 10 years have passed since thelast booster.


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PREVENTION CONT

Thorough cleaning of all injuries and wounds and theremoval of dead or severely injured tissue(debridement), when appropriate, may reduce the riskof developing tetanus. If you have been injured

outside or in any way that makes contact with soillikely, contact your health care provider regarding thepossible risk for tetanus.

Many people believe injuries caused by rusty nails

are the most dangerous. This is true only if the nail isdirty as well as rusty, as is usually the case. It is thedirt on the nail, not the rust, that carries the risk fortetanus.


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LEPROSY

Also known as

Hansens disease

Leprosy is a disease

that has been knownsince biblical times. It

causes skin sores,

nerve damage, andmuscle weakness

that gets worse over

time.


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WHAT CAUSES LEPROSY?

Leprosy is caused by the

bacterium Mycobacter ium leprae. It is not

very contagious and it has a long incubation

period (time before symptoms appear), whichmakes it hard to know where or when

someone caught the disease. Children are

more likely than adults to get the disease.


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MYCOBACTERIUM LEPRAE

Mycobacterium leprae acid fast Gram-positive

bacterium.

straight or slightlycurved rod-shapedorganism with parallelsized and rounded ends

It is an obligateintracellular organismand grows and dividesinside macrophages

and Schwann cells


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MYCOBACTERIUM LEPRAE CONT

. It is further characterised by an extremely

slow doubling time of 12-14 days, favouring

temperatures of around 30 degrees C. M.

leprae is the only species of mycobacteria toinfect peripheral nerves.

Incubation period of leprosy ranges from 5

and months to 8 years.


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ACTION

Mycobacterium leprae attacks the peripheralnerves, especially the ulnar, radial, posterior-popliteal, anterior-tibial and facial nerves.

when the bacilli damage the skins finenerves, they cause paralysis and dryness.

If they attack a large nerve trunk, motornerve damage, weakness and pain occur,followed by peripheral paralysis, muscleparalysis and atrophy.


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HOW IS IT TRANSFERRED?

1. Mycobacterium leprae is transmitted

through respiratory droplets (droplets

transmission)

2. inoculation breaks in the skin and possiblythrough environmental contacts.


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SIGNS AND SYMPTOMS

Skin lesions that are lighter than your normalskin color

Lesions have decreased sensation to touch,

heat, or pain Lesions do not heal after several weeks to

months

Muscle weaknessNumbness or lack of feeling in the hands,

arms, feet, and legs


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A number of different antibiotics (including dapsone,rifampin, clofazamine, fluoroquinolones, macrolides, andminocycline) are used to kill the bacteria that cause thedisease. More than one antibiotic is often given together.

Aspirin, prednisone, or thalidomide is used to control

inflammation. Tests done are:

Lepromin skin test can be used to tell the two differentforms of leprosy apart, but it is not used to diagnose thedisease

Skin lesion biopsy

Skin scraping examination


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PREVENTION

Prevention consists of avoiding close

physical contact with untreated people.

People on long-term medication become

noninfectious (they do not transmit theorganism that causes the disease).

meningitis, tetanus, leprosy,

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