LEPROSY

Leprosy is a chronic disease affecting skin and nerve. It is caused by Mycobacterium leprae. The clinical form of these diseases is determined by cell-mediated immunity. About 70 percent of the world’s leprosy patients live in India, Brazil, Indonesia.The medical complications of leprosy are due to nerve damage, immunological reactions and bacillary infiltration. Untreated leprosy patients discharge bacilli from the nose. Infection occurs through nose followed by haematogenous spread to skin and nerve. The incubation period is 2-5 years .There is three important aspects of leprosy pathogenesis, the spectrum of immune response, nerve damage and immune-mediated reactions. Patients commonly present with skin effects of a peripheral nerve lesion, weakness or an ulcer in an anesthetic hand or foot. Borderline patients may present with a reaction nerve pain, sudden palsy and new multiple skin lesions. It is most common cause of peripheral nerve thickening. Effective treatment can only be achieved with the patient’s cooperation and confidence. Educating leprosy patients about their disease is vital for successful management. All leprosy patients should be given an appropriate multidrug combination. Rifampicin is a drug which is given along with other anti-leprotics to cure this leprosy. The previous strategy of vertical leprosy has now been superseded by integrated programmes with primary health care workers in many countries now responsible for case detection.BCG vaccination has been shown to give good protection against leprosy

CHOLERA

Cholera caused by Vibrio Cholerae is the bacterial cause of acute watery diarrhea. It is most common in South and Central America. Infection spreads via stools or vomit of symptomatic patients or of the much larger number of subclinical cases. It survives for up to 2 weeks in fresh water and 8 weeks in salt water. Transmission is normally through infected drinking water, shellfish and food contaminated by flies or on the hands of carriers. Death from acute circulatory failure may occur rapidly unless fluid and electrolytes are replaced and improvement is rapid with proper treatment. Clinical diagnosis is easy during an epidemic. Otherwise the diagnosis should be confirmed bacteriologically and this disease is notifiable under international health regulations. Some treatment like Oral rehydration solution is effective and safe for all but the most severely dehydrated patients. Vomiting usually stops once the patient is rehydrated and in children careful attention to fluid balance is required they are prone to hypoglycaemia.Some of the preventive measures are strict personal hygiene is vital and drinking water should come from a clean piped supply or be boiled, flies must be denied access to food. Proper vaccination with a killed suspension of V.cholerae may provide limited protection. In epidemics public education and control of water sources and population movement are vital. Disinfection of discharges and soiled clothing and hand-washing by medical attendants reduce the danger spread of Cholera

LEPTOSPIROSIS

Leptospirosis has emerged as an important public health problem during the last few years due to sudden increase in the number of reported cases and outbreaks world-wide. It is one of the most common zoonotic diseases, favoured by a tropical climate and flooding during the monsoon. This disease is caused by the virus name called Leptospires which can enter their human hosts through intact skin or mucous membranes, but entry is facilitated by cuts and abrasions. In humans the main organs affected are the kidneys, liver and brain. Mostly this disease is common in tropical countries and also in freshwater areas. The incubation period averages 1-2 weeks. The symptoms produced by this disease are non specific illness in which there is high fever accompanied by weakness, muscle pain, headache etc.Diagnosis of this disease depends upon isolation oforganism, serological tests or the detection of specific DNA and it appear in urine during the second week of illness but in case of untreated patients it may be recovered on culture for several months. Antibiotic s for the treatment of leptospirosis are a form of care for which the evidence is insufficient to provide clear guidelines for practice. The general care of the patient is critically important .Blood should be taken early for grouping and cross-matching, and hemorrhage treated by blood transfusion and renal failure demands very careful management since it is the usual cause of death.

WHOOPING COUGH

Whooping cough is a highly contagious disease caused by the Bordetella pertussis.It is also known as cough of 100 days. The infection is transmitted by droplets from the infected persons .It occurs more commonly in the late winter and early spring months. This cough occurs at an earlier age in developing countries due to earlier exposure to the source of infection. There are no reservoirs or carrier state, though asymptomatic infections are known to occur. The incubation period is 7-14 days. These clinical manifestations may be divided into three stages catarrhal, paroxysmal, convalescent stages and other complications include pneumonia, bronchiectasis, and subcutaneous emphysema. Severe malnutrition may result from persistent vomiting and disinclination to eat the food because of fear of cough occurring with attempts at feeding. Infants younger than six months or those with severe illness should be hospitalized and antibiotics given in this stage shorten the course of illness and prevent the contagion.Erythromycin are the perfect antibiotics used to cure this cough. Active immunization with triple antigen should be given at monthly intervals starting from 6 weeks of age. Generally 3 injections are given and a booster dose should be given after 1 year and acellular vaccine can be used for both primary vaccination .Immunization should be discontinued if the child develops a seizure. The precaution is necessary to minimize the risk of encephalopathy following pertussis vaccine

TUBERCULOSIS

Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. The disease is characterized by vague constitutional symptoms and a protracted course of illness with remissions and exacerbations. This disease is widely prevalent throughout the world with nearly 1, 70,000 children dying of it every year. Due to improved standard of living and better sanitation the incidence of tuberculosis has steadily declined in the affluent and highly developed countries. Cases of tuberculosis in children represent 5-15 percent of all the tubercular cases. Childhood tuberculosis is mainly a result of tuberculosis control in adults. The usual mode of infection is through of droplets of infected secretions and this may be a source of infection through breathing. Rarely infection may be transmitted through skin, mucous membrane or transplacentally. The incubation period varies between 4 and 8 weeks and the clinical features usually start with the development of hypersensitivity to tubercular proteins. The cough is an inconstant symptom and may be absent even in the advanced disease, fever for more than weeks, recent loss of appetite and weight or failure to thrive. Tests like tuberculin test is a useful diagnostic aid and frequently used tests are Monteux and multiple puncture tests. Some principles of treatment of this disease are the diagnosis should be made early, treatment should be prompt, adequate, vigorous and prolonged depending on the severity of the illness and intercurrent infections should be prevented or treated vigorously.

POLIOMYELITIS

Poliomyelitis is an acute infectious disease caused by RNA enterovirus.Only six countries in the world were still reporting this disease by the end of 2003.Man is the only reservoir and natural host of the virus and it is excreted in the stools of patients for two weeks before and 6 to 8 weeks after the onset of the illness.Rarely, the virus may be water-borne virus because of contamination with sewage. Poliovirus enters the human body, through the mouth and alimentary tract. The virus ofpoliomylitis multiplies in the intestines, if there is no local tissue immunity against the infection. If conditions for the spread of virus are present, the virus involves the nervous system, reaching there either along the nerve pathways or through the blood stream. This virus damages motor and automatic nervous system and commonly affected areas are the anterior horns of spinal cord, vestibular and nuclei in the roof of the cerebellum. The incubation period ranges from 1-2 weeks. The illness aborts in another 4 percent of cases and mimics any other viral illness there are no neurological symptoms. The diagnosis of this disease is based on the history and characteristic clinical manifestations of asymmetrical flaccid paralysis. There is no specific treatment for poliomyelitis apart from this rest in bed, relief of pain; neutral positioning of the limbs, physiotherapy and good nursing help to reduce this disease. Individual children should be protected by immunization with polio vaccine.

CHICKEN POX

Chicken pox is highly contagious disease, presenting with sudden onset of low fever, mild constitutional symptoms. It is caused by varicella zoster virus which belong to the family of herpevirus.The infection is transmitted by direct contact or indirectly through a third person. The crusts from chicken pox lesions do not contain viable virus and are therefore not infective. Period of infectivity ranges from a day prior to the illness and up to 5 days after the onset. Most cases are reported between the months of January and may.Infected tissues include thymus,spleen,lymph nodes,liver,skin,and lungs.The incubation period is usually between 14 to 16 days.Prodromal symptoms are minimal.These include mild fever,malaise and impaired appetite.The severity of the disease is generally more pronounced in adults.The rash may rarely become hemorrhagic and this disease is more severe in patients on suppressive drugs.Fetal infection may cause skin scarring, neurological and eye manifestations. Personal hygiene should be optimized to avoid this chicken pox and drugs like aspirin will reduce the risk of this disease.Oral acyclovir given to healthy children with varicella within24 hours of onset of rash reduces the duration of rash by 1 day.Infants under the age of 1 month ,pregnant women,patient with leukemia need this protection.The vaccine ,if given within 3 days of exposure ,may prevent the disease in more than 80 percent individuals.