• Typhoid fever is the result of systemic infection mainly by salmonella typhi found in only humans.
• The disease is clinically characterized by a typical continuous fever for 3 to 4 weeks, relative bradicardia with involvement of lymphoid tissues and considerable constitutional symptoms.
• The term “enteric fever” includes both typhoid ad paratyphoid fevers.
• Typhoid fever is endemic in India.
• Reported data for the year 2013 shows 1.53 million cases and 361 deaths.
• The factors which influence the onset of typhoid fever in man are the infecting dose and virulence of the organism.
• Man is the only known reservoir of infection, viz., cases and carriers.
• The primary source of infection are faeces and urine of cases or carriers, the secondary sources are contaminated water, food, fingers and flies.
• There is no evidence that typhoid bacilli are excreted in sputum or milk.

CAUSES:

• Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water.
• People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria.
• About 3%-5% of people become carriers of the bacteria after the acute illness. Others suffer a very mild illness that goes unrecognized.
• These people may become long-term carriers of the bacteria even though they have no symptoms and be the source of new outbreaks of typhoid fever for many years.

SIGNS AND SYMPTOMS:

• High fever
• Diarrhea
• Rose spots
• Aches and pains
• Poor appetite
• Lethargy

MODE OF SPREAD:

• Typhoid fever is transmitted via the faecal- oral route or urine- oral route.
• This may take place directly through soiled hands contaminated with faeces or urine of cases or carriers, or indirectly by the ingestion of contaminated water, milk and/or food or through flies.

INCUBATION PERIOD:

• Usually 10-14 days. But it may be as short as 3 days or as long as 3 weeksdepending upon the dose of the bacilli ingested.

CLINICAL FEATURES:

• FIRST WEEK: malaise, headache, cough and sore throat in prodromal stage. The disease classically presents with step- ladder fashion rise in temperature over 4 to 5 days., accompanied by headache, vague abdominal pain and constipation or pea soup diarrhea.
• SECOND WEEK: between the 7 – 10 days of illness, mild hepatoslenomegaly occurs in majority of the patients. Relative bradycardia may occur and rose spots may be seen.
• THIRD WEEK: the patient will appear in the typhoid state, which is a state of prolonged apaty, toxemia, delirium, disorientation and/or coma. Diarrhea will then become apparent. If left untreated by this time, there is a risk( 5-10%) of intestinal hemorrhage and perforation.

PATHOPHYSIOLOGY:

Ingestion of contaminated food/ water

Carried by white blood cells in the liver, spleen and bone marrow

Multiply and reenter the bloodstream

Bacteria invade the gallbladder, biliary system and the lymphatic tissue of the bowel and multiply in higher number.

Then pass into the intestinal tract and can be identified for diagnosis in cultures from the stool tested in the laboratory.

LAB INVESTIGATIONS:

• Blood culture.
• Specific serologic test:
  • Identify salmonella antibodies/ antigens
  • Widal test and ELISA.
• Urine and stool culture.
• Marrow culture*: 90% sensitive unless until after the commencement of the antibiotics.
• Punch – biopsy samples of rose spots culture: 63% sensitive.
• Clot culture.

TREATMENT:

• SUPPORTIVE CARE:   –    maintenance of adequate hydration.

–    Appropriate nutrition

• SPECIFIC CARE:          –     Antibiotics
• Corticosteroids
• Antipyretics
• ANTIBIOTICS like chloramphenicol(200mg,QID), ampicillin(750mg, QID), Co- trimaxazole( 2 tablets/ IV BDS), fluroquinolones like ciprofloxacin(500mg BDS).
• Incase of quinolone resistance – Azithromycin(500mg/ OD) and third generation cephalosporins like ceftriaxone( alternative).
• The treatment should be continued for 14 days.

PREVENTION:

• Regular hand wash.
• Drinking boiled water.
• Cleaning fruits and vegetables before their use.
• Get vaccinated.

RED FLAGS:

                      Sudden onset severe abdominal pain with garding and rigidity.

PITFALLS:

                      Other infection peptic ulcer with perforation.

PEARLS:

                     To avoid outside food intake &contaminated food intake.

REFERENCES:

• https://www.slideshare.net/yuyuricci/enteric-fever-typhoid-fever.
• www. webmd. com .

•    It is viral infection of nose & throat.

•    The term common cold refer as mild upper respiratory viral illness.

•    Usually lasts approximately for 7 days.

•    Cold caused by many viruses which is having similar symptoms. (Eg. Rhinovirus, coronavirus, adenovirus, echovirus, enterovirus)

TRANSMISSION

•    Direct contact- primary spread from person to person person to person through hands. If sick person shake someone’s hand and that percentage is eye, nose or mouth, the viras can           transmitted & later infect.

•    Indirect- virus can survive on surface  for few hours can transmitted touching the surface and then touching his nose, mouth or eyes.

•    Inhaled viral particles- droplet containing viral particle can be transmitted while coughing, sneezing, breathing to close standing person.

CLINICAL FEATURES

•    Rhinitis (runny nose)

•    Sore throat

•    Sneezing

•    Cough

•    Headache

•    Fever seen in children, uncommon in adults.

•    Feeling tired.

INCUBATION PERIOD (24-72 hrs)

Symptoms usually 3- 10 days, last upto 2 weeks in some peoples

DIAGNOSIS

  The diagnosis is based on symptoms and observed signs:-

•    Swelling and congestion of nasal passages

•    Redness of the throat

•    Enlarged lymph nodes in the neck

•    Normal lung exam

Chest x-rays not needed unless chest exam is abnormal

LAB TEST

generally not needed

•    Detection of antigen (rapid test)

•    Viral isolation

•    Serology

COMPLICATIONS

•    exacerbation of  Asthma, COPD.

•    Acute bacteria bronchitis

•    Pneumonia

•    Strep throat (sore & scratchy throat)

•    Acute ear infections

TREATMENT Symptomatic

•    Antihistamine – for runny nose, sneezing, cough.

• diphenhydramine (benadryl) –  300mg/QID
• levocitrizine- 10mg/day – OD
• Chlor pheneramine – 24mg/ day – TID

•    Antitussive– for dry cough.

• Codeine- 10mg/5ml – TID ODextra methorphan – 30mg/5ml – TID

•    Expectorant– for productive cough.

•  Guaifenesis- 2.4g/day – TID
•  Acetyl cystein- 5- 10ml of 10-20% of solution 6-8 hr if needed.
•  Bromhexin- 400mg/5ml – TID

•    Docongestants– for block nose. OEphedrine-5-25mg iv

•  Phenyl ephedrine- 200mcg
•  Oxymethazoline 0.05% 2-3 sprey

•    Analgesic– for headache, sore throat, muscle ache, fever, chillness, sinus, ear ache.

•  Acetaminophen- 650mg
•  Ibuprofen- 200mg

•    Glucocorticoids- generally not needed 

•  Dexamethasone-  4mg
•  Methyl prednisolone- 4mg

•    Vit. C table

•    Zinc tablet (for loss of smell)

•    Antiviral therapy

•    Antibiotics therapy

PREVENTIONS

•    General hygiene should be maintained like washing hands.

•    Use alcohol containing sanitizer regularly

•    Avoid being close to infected person

•    Cover your mouth & nose while sneezing/coughing.

Red flags

• Difficult in swallowing & cough

Pearls

• Preventing aspects
• Social distance
• Maintain hand hygiene
• Arousal spread using mask

REFERENCE

•    Cooley, B. & McNeely, M. (1996). ETR Associates. Santa Cruz, CA.www.etr.org.

•   www.nature.com/news/commoncold 

•    World Health Organization(WHO)- viral diseases in India

Ø Tuberculosis or TB is a potentially serious infectious disease.

Ø It is caused by Bacteria called Mycobacterium Tuberculosis.

Ø TB mainly affects the Respiratory system but can affect other organ systems like Gastrointestinal system, the Lymphoreticular system, the skin, the Central nervous system, the Musculoskeletal system, Reproductive system and the liver.

Ø Tuberculosis that affects lungs is called Pulmonary tuberculosis.

Ø Tuberculosis that affects organs other than lungs is called Extrapulmonary tuberculosis.

TYPES OF TB

Latent TB

Many of those who are infected with TB bacteria do not develop disease ,the bacteria in their body are inactive that cause no symptoms and their chest X ray will be normal. Latent TB also called inactive TB, isn’t contagious. Latent TB can turn into active TB, so treatment is important in certain group of people. This latent TB only diagnosed through Tuberculin skin test or Interferon gamma release assay (IGRA).

Active TB

It is an illness in which the TB bacteria are rapidly multiplying and invading different organs of the body.

• Coughing for two or more weeks
• Expectoration
• Hemoptysis (sometimes)
• Fever – mostly low grade, evening raise of hemoptysis
• Chills
• Chestpain
• Loss of apettite
• Unintentional weight loss
• Fatigue

In case of Extrapulmonary tuberculosis, signs and symptoms vary according to the organs involved. For example, TB of the spine cause back pain and TB of the kidneys might cause blood in urine, TB of the intestine cause abdomen pain, diarrhea.

MODE OF TRANSMISSION

Tuberculosis is transmitted between person to person through air. When people with PTB cough , snneze, or spit, microscopic droplets released into air. IF the healthy people inhale only a few of these germs present in the droplets, they will get infected.

Although TB is contagious, its not easy to catch. It is much more likely to get TB from someone you live or work with than from a stranger.

Most people with Active TB who have had appropriate drug treatment for atleast two weeks are no longer contagious.

PATHOPHYSIOLOGY

                                M.Tuberculosis starts replication inside macrophages

                                                                    ê

                                                  Primary infection occurs

                                                                    ê

Cell mediated immunity gets activated , surrounds the cell to forms granuloma (3 weeks)

                                                                   ê

                                  Leads to necrosis of tissues at infection site

                                                                   ê

                                      Involve nearby lymph nodes (Gohn’s complex)

                                                                   ê

                                    Calcification of Gohn’s complex (Latent T.B)

Incubation period:  Approximately 2 to 12 weeks. However, the risk for developing active disease is highest in the first two years after infection.

DIAGNOSIS

Physical exam

 Check  lymphnodes for swelling and use a stethoscope to listen to the sounds lungs make when breathe, patients with PTB have abnormal breath sounds, especially over the upperlobes or involved areas.

Sputum microscopy

• Sputum for AFB
• Early morning sputum sample should be tested
• May need to repeat 2-3 times

CBNAAT/Genexpert

• Early morning sputum
• It is more sensitive than microscopy
• It can diagnose TB and also give Rifampicin sensitive/resistance status

Imaging tests

• Chest X ray
• CT chest

Other tests

• Sputum for MTB culture-MGIT
• LPA- Lime probe assay

Tuberculin skin test/montoux test and IGRA/TB gold test

• These tests are used mainly to diagnose latent TB
• Their role in diagnosing active TB is very low

TREATMENT

For drug sensitive TB,treatment include 8 weeks of intensive phase with Isoniazide(H), Rifampicin(R), Ethambutol(E), Pyrazinamide(Z) followed by 16 weeks of continuation phase with Isoniazide(H), Rifampicin(R), Ethambutol(E)

If patient had a history of PTB and ATT intake in the past, then drug sensitivity for latest TB infection should be carefully assess and treated accordingly

T.Benadon 20-40mg OD should be added ATT

Can use other symptomatic medication along with ATT

For drug resistance TB, treatment is complicated which include combination of first and second line Anti tubercular medication which depends on the resistance pattern

First line drugs                                                  Side effects

H-Isoniazid  5mg/kg  – change in memory, Hallucination, Psychosis, Anemia, Neuropathy,  

                                     Gynecomastia, Euphoria

 R-Rifampicin 10mg/kg- Interstitial nephritis, flu, anemia, orange coloured urine, pulmonary

                                        syndrome, contraception failure

E-Ethambutol 15mg/kg – Eye toxicity, Ooptic neuritis, red green colour blindness,

                                         hyperurecimia

Z-Pyrazinamide 25mg/kg – Hepatotoxic, neuropathy, hyperuricemia, arthralgia

Second line drugs:

Levofloxacin

Moxifloxacin

Bedaquiline

Linezolid

Amikacin

Ofloxacin

Ciprofloxacin 

If the patient have latent TB, recommend treatment with medication if the patient at high risk of developing active TB. For active tuberculosis, patient must take ATT drugs for at least six to nine months. The exact drugs and duration of treatment depends on the patient age, overall health, possible drug resistance and where the infection is in the body.

PREVENTION

As TB is an airborne infection, TB bacteria released into the air when someone with infectious TB coughs or sneezes. The risk of infection can be reduced by using a few simple precautions

Good ventilation: As TB can remain suspended in the air for several hours with no ventilation

Natural light: UV light kills off TB bacteria

Good hygiene: covering the mouth and nose when coughing or sneezing reduces the spread of TB bacteria

Use of protective masks: wearing a facemask when you are around other people during the first three weeks of treatment may help lessen the risk of transmission

Stay home: Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment

RED FLAGS:

• Weight loss
• Anorexia
• Evening rise of temperature
• Productive cough over 2 weeks
• Hemoptysis

PIT FALLS:

• Bronchogenic carcinoma
• Lymphomas

PEARLS:

• Always sent for CBNAAT when suspecting TB
• Do not prescribe levofloxacin when suspecting TB

Submitted by

P.Bharathi

• It is an infectious disease caused by the SARS -Cov 2 ( severe acute Respiratory syndrome- Corona virus 2)
• Corona virus derive their name from the Latin word “corona” meaning crown

• The name refers to the unique appearance of the virus under an electron microscope as round particles with a rim of projections resembling the solar corona
• They are enveloped , positive sense, single stranded RNA viruses which were first isolated from humans in 1965.
• Corona virus belongs to the family coronaviridae which is known to produce mild respiratory disease in humans.

Variants

• In the last 2 years, we have seen 5 variants of concerns- Alpha, Beta, Gama, Delta and Omicron
• WHO has said that omicron won’t be the last variant .

• SARS-Cov 2 is the seventh known corona virus to infect people after 229E, NL63, OC43, HKUI, MERS-Cov and the original SARS- Cov

EPIDEMIOLOGY

• On 31 Dec 2019, WHO was informed of cases of Pneumonia of unknown cause in Wuhan city, China.
• A novel coronavirus was identified as the cause by chinese authorities on 7 jan 2020 and was temporarily named “2019-nCov”.
• Recently, there have been 3 major corona virus leading to disease outbreaks, beginning with the (SARS- COV) in 2002, followed by the Middle east respiratory syndrome coronavirus (MERS-Cov) in 2012 , and now the SARS- Cov 2
• Since the initial report from china, the disease spread rapidly, and the number of causes increased exponentially.
• On Jan 11, the 1st case was reported outside mainland china in Thailand, within months the disease spread to all the continents except Antarctica.

• India reported its 1st case of COVID-19 on Jan 30, 2020. This rose to 3 cases by Feb 3 2020, by mid march. The number of infected cases started to increase. The first COVID 19 related to death in India was reported on March 12, 2020.

INCUBATION PERIOD

• The mean or median incubation period of disease ranges from 5 to 6 days

• The median duration of virus shedding was 20 days , mild cases tend to clear the viruses early, while severe cases can have prolonged viral shedding.

MODE OF TRANSMISSION

• Commonly through droplets/ Airborne transmission
• Sometimes by surface/fomite transmission

CLINICAL MANIFESTATIONS

COVID 19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalization.

Most common symptoms:

• Fever
• Cold

• Cough

• Sorethroat

• Headache

• Body pains

• Tiredness

• Loss of taste or smell

Less common symptoms

• Diarrhoea
• Skin rash
• Conjuctivitis

Serious symptoms:

 seen in small proprtions of patients

• Difficulty breathing or shortness of breath

• Chest pain

People with mild symptoms should manage their symptoms at home. On average it takes 5-6 days from when someone is infected with the virus for symptoms to show, however it can take upto 14 days.

DIAGNOSTIC TESTS

Rapid antigen test -Nasal /Throat swab

                                                              Less sensitive, more specific

RT PCR –   Nasal /Throat swab

                   Less sensitive, more specific

HRCT scan – Helps in diagnosis and also in assessing severity of the disease

                       More sensitive and specific

                       Timing is important

     Routine blood tests

• CBC
• RFT
• Blood sugars etc

Inflammatory markers: Helps to assess severity and to monitor treatment

• CRP
• D- Dimer
• LDH
• IL-6 –Can be sent in rapidly detoriating  patients

TREATMENT

Mild disease: Fever, upper respiratory tract symptoms without SOB or Hypoxia

Symptomatic management- Hydration

                                             Paracetamol

                                             Anti tussives

Monitor vitals regularly

Moderate disease

If SOB is present, Tachypnea present or SPO2 < 94% room air

• Low dose steroids (Dexamethasone/ Methylprednisolone)
• Anticoagulant prophylaxis : If there is no contraindication or high risk of bleeding

(eg. Enoxaparin 0.5mg/kg/day subcutaneous route)

• Antiviral

Inj. Remdesivir 200mg for 1^st day followed by 100mg for 5 days

• Oxygen supplementation and other supportive medication

Severe disease

If SOB is present, severe tachypnea or SPO2 < 94% room air

Need ICU admission

• Parenteral steroids  -should ruleout sepsis
• Anticoagulants – If there is no contraindication or high risk of bleeding
• Anti viaral

Inj .Remdesivir for 5 days

• Oxygen supplementation or NIV or Invasive ventilation depending on patient clinical condition

Red flags

• Pulmonary embolism is a complication during and after Covid which can cause rapid deterioration of patient condition
• Mucormycosis or other fungal infections can occur during or after Covid

Pearls

Monoclonal antibodies: Different combinations of monoclonal antibodies are being tried for treatment of infection with different strains

PREVENTION

Protect yourself and those around you:

• Get vaccinated as soon as it’s your turn and follow local guidance on vaccination.
  • Keep physical distance of at least 1 metre from others, even if they don’t appear to be sick. Avoid crowds and close contact.
  • Wear a properly fitted mask when physical distancing is not possible and in poorly ventilated settings.
  • Clean your hands frequently with alcohol-based hand rub or soap and water.
  • Cover your mouth and nose with a bent elbow or tissue when you cough or sneeze. Dispose of used tissues immediately and clean hands regularly.
  • If you develop symptoms or test positive for COVID-19, self-isolate until you recover.

To properly wear your mask:

• Make sure your mask covers your nose, mouth and chin.
  • Clean your hands before you put your mask on, before and after you take it off, and after you touch it at any time.
  • When you take off your mask, store it in a clean plastic bag, and every day either wash it if it’s a fabric mask or dispose of it in a trash bin if it’s a medical mask.
  • Don’t use masks with valves.

   Submitted by

P.Bharathi

 INTRODUCTION

• Cholera is an acute diarrheal illness caused by infection of the intestine with the bacteria vibrio cholera
• It causes severe diarrhea lead to dehydration and if untreated death may occur.
• It spread by ingestion of contaminated food and water.

EPIDEMIOLOGY:

• It has become an increasing public health concern around the world.
• It kills an estimated 95000 people/year, and infects 2.9 m people

ETIOLOGY:

• Age & Low personal hygiene.                  
• Low immunity
• Low gastric acid levels
• Soil and water pollution
• Contaminated food and water

SIGNS & SYMPTOMS :

• Pain in abdomen
• Nausea
• Severe diarrhea ,watery diarrhea
• Dehydration
• Water electrolyte imbalance
• Lethargy (lack of energy)

TYPES:

1.RICE WATER DIARRHEA

       * It causes painless diarrhea & vomiting of clear fluid

       *Loss of 1L/HR

       *Without treatment death occurs with in 18hrs-7 days

2.CHOLERA GRAVIS

       *More severe

       *Loss of 6L/HR

       *Death with in 2-3 hrs

3.CHOLERA SICCA

       *Rare & severe

DIAGNOSIS

• Stool specimen
• Cholera toxin by culture
• Cholera rapid test dipsticks
• Rectal swab method
• Catheter swab method 

TREATMENT

   A.RE HYDRATION PHASE

• To restore normal hydration status
• Set rate of I.V infusion in severely dehydrated patients at 50-100ml/kg/hr.
• Lactate ringer solution is preferred    

   B.MAINTENANCE  PHASE 

• To maintain normal hydration status by replacing ongoing losses.
• Oral route is preferred, use of ORS at 500-1000ml/hr.

   C.ANTIBIOTIC TREATMENT

   Drug                             Adult                    Child

1.DOXY                           300mg                    –

2.TETRACYCLINE          500mg                  12.5mg/kg  QID -3 DAYS

3.COTRIMOXAZOLE     TMP-160              TMP-5mg/kg

                                        SMX-800              SMX-25mg/kg 

4.FURAZOLIDONE        100 mg                 1.25mg/kg

5.AZITHROMYCIN         1gm/PO               20mg/kg (<1gm)

6.ERYTHROMYCIN          –                          12.5mg/kg(6hrs/3 days)

IN PREGNANCY:

AZITHROMYCIN   –      1gm/OD

ERYTHROMYCIN  –      500mg/6hrs/3days

 D. ZINC SUPPLEMENT

• Increase absorption of water and electrolytes
• Boosts immune system

NON-PHARMACOLOGICAL TREATMENT

• Drink and use safe water.
• Washing hands with safe water.
• Use latrines.
• Cook food well.
• Use flush toilet.
• Proper washing of clothes.
• Using sanitizer and Mask.
• Use disinfectant in cleaning

VACCINATION

1.DUKORAL  

• 3ml/ single dose vial
• Not for children< 2years

2.SANCHOL

• Administrate orally in 2doses in gap of 14days
• Booster dose recommend after 2 years.

3.VAXCHORA

• Use in adults (18-64).

    ABOUT DRUGS

DOXYCYCLINE & TETRACYCLINE :

MOA- Inhibits bacterial protein synthesis by binding to 30S

 ribosomal subunits.

SE- Dizziness, fast heart rate, indigestion sore throat

CI- In pregnancy, breast feeding, liver and kidney dis function.

   Child< 12 years ( discoloration of teeth)

 COTRIMOXAZOLE :

MOA- Inhibits folic acid synthesis

SE- Rashes ,sore throat, SOB ,cough

CI-Pregnancy, renal patients

FURAZOLIDINE :

MOA-Bind to DNA &induce crosslinks

SE- lower B.P,  fever, joint pain

AZITHROMYCIN & ERYTHROMYCIN :

MOA-Binds to 50S subunit of bacterial ribosome

SE – abdominal pain

cI – liver problems, slow heart rate, myasthenia gravis

RED FLAGS:

• Hypovolemic shock

PIT FALLS:

• Other diarrheal infections
• Arsenic poisoning

PEARLS:

• Adequate hydration

 REFERENCE:

      www.webmd.com

• Amoebiasis is a parasitic,protozoan disease that effects the gut mucosa and liver, resulting in dysentery,colitis and liver abscess.
• The causative agent is Entamoeba histolytica, sapotent pathogen that is spread via ingestion of contaminated food and water.
• Globally,amoebiasis is highly prevalent and is the second leading cause of death To parasitic disease.

ETIOLOGY:-

• Contaminated food and water.
• Oral rectal contact specially among male homosexual.
• Vectors.

EPIDEMIOLOGY:-

• A worldwide distribution.
• Major health problem in the whole china, South Eastand WestAsia and latin America, specially Mexico.
• Worldwide 50 million people carry E.histolytica in their intestinal tract.
• 10%of infected people suffer from Invasive amoebiasis.
• Probable that invasive amoebiasis, accounted For about 10 lakhs deaths in the world.
• INDIA: Amoebiasis affects about 15%of the Indian Population.

SIGN & SYMPTOMS:

• Pain in the abdomen.
• Blood in stool, diarrhoea, orflatulence.
• fatigue, fever,or loss of appetite.
• Weightloss.

MODE OF TRANSMISSION:-

1. Faecal oral route-Intake of contaminated food and water, vegetables & fruit
2. Sexual transmission–oral rectal contact, specially among male homosexuals.
3. Vectors- flies, cockroaches and rodents are capable of carrying cysts and contaminated food and water.

INCUBATION PERIOD:-

• 2-4 weeks or longer than that.

Host factor contribution:–

1. Stress
2. Malnutrition
3. Alcoholism
4. Corticosteroidtherapy
5. Immunodeficiency

RISK FACTORS:-

1. Travellers to developing countries.
2. People who live in institutions that have poor sanitary conditions.
3. HIV-positive patients.
4. Homosexuals.

PATHOPHYSIOLOGY:-

   Ingestion of cysts through   contaminated food and water.

 |

 Excystation in small intestin

 |

      Division of cysts into 4 & then 8 trophozoits.

 |

                                                   Trophozoits moves to colonize the colo

 |

       Encystation

 |

                             Excretion of cysts

 |

Ingestion of cysts by the patients.

LAB INVESTIGATION:-

• Bloodtest
• Stooltest– ELISA test
• Indirect haemagglutination test regarded as the test (IHA) is most sensitive serological test.

TREATMENT:-

1.Metronidazole- 500-750mg – oral – TID – For8-10days.

2.Tinidazole- 600mg – oral – BD– for 5days.

MOA-Kills trophozoites in intestine & tissue.

3.Iodoquinol– 650mg – oral -TID – for 10days.

4.Diloxanidefuroate–500mg – oral – TID – for 10days.

MOA–Luminal Eradicate cysts.

PREVENTION:-

Primary prevention:-

• Safe excreta disposal
• Safe water supply
• Hygiene
• Health education

Secondary prevention

• Early diagnosis
• Treatment

Red flags :-

• Dysentery
• Large intestine effect

Pearls :-

• Avoid outside unhygienic food.

REFERENCES:-

•Parasitology,K.D.Chatterjee.

•Harrison’s principals of internal medicines

•Medscape

•www.Webmd.Com