food poisining.pptx

WOLLEGA UNIVERSITY
COLLAGE OF HEALTH SCIENCES
1
By:
Fekeded Abera(RN,Bsc,N)
DEPARTMENTS OF NURSING
10/10/2023 CDC

2
FOOD BORNE DISEASES
10/10/2023 CDC

Learning Objectives
After completion of this chapter students will be able to:-
 Define food-borne diseases.
 Identify the potential for a food-borne aetiology in a
patient's illness with their epidemiology and
transmission methods.
 Identify clinical pictures of common food-borne
diseases in our country
 Manage patients with food-borne diseases
 Formulate nursing care plan for patient with food
poisoning
 Discuss the ways to prevent and control food-borne
infections
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Session outline
Introduction
Staphylococcal food poisoning(Intoxication)
Botulism
Salmonellosis
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 Food-borne diseases, including food borne
intoxications and food-borne infections, are terms
applied to illnesses acquired by consumption of
contaminated food.
 While those terms would include illnesses caused by
chemical contaminants/heavy metals and organic
compounds, in which bacterial growth takes place in
the food before consumption.
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Introduction
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Introduction Cont’d…
 The severity of the food borne illness depends on:-
The pathogenic microorganism or toxin ingested
The amount of food consumed (dose) and
The health status of the individual
 For individuals who have immune compromised
health conditions, or for the aged, children, or
pregnant women, any food borne illness may be life-
threatening.
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 Patients with food borne illnesses typically present
with gastrointestinal tract symptoms (e.g. vomiting,
diarrhoea , abdominal pain)
 However, nonspecific symptoms and neurologic
symptoms may also occur.
 The most common symptom associated with food
borne illnesses is diarrhea.
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 For a food borne illness (poisoning) to occur, the
following conditions must be present:
o The microorganism or its toxin must be present in
food.
o The food must be suitable for the microorganism to
grow.
o The temperature must be suitable for the
microorganism to grow.
o Enough time must be given for the microorganism to
grow (and to produce a toxin). 8
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Causes (factors) of Food borne Illness
Contaminated Ingredients
Temperature Control
Personal Hygiene
Cross Contamination
Sanitation
9
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Common Food Borne Intoxications
(Food-borne infections or food poisoning)
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I. Staphylococcal food
poisoning(Intoxication)
 It is intoxication (not infection) of abrupt and
sometimes violent onset.
 Staphylococcal food intoxication results from
consuming food contaminated with the toxin
produced by Staphylococcus aureus
Infectious agent (toxic agent)
 Several enterotoxins of staphylococcus aurous,
stable at boiling temperature, staphylococci multiply
in food and produce the toxins
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Staphylococcal food poisoning Cont’d...
Epidemiology
o wide spread and relatively frequent
Reservoir
o Humans in most instances; occasionally cows
Mechanisms of transmission
o By ingestion of a food product containing
staphylococcal enterotoxin
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 Foods involved are particularly those that come in
contact with food handlers hands either without
subsequent cooking or with inadequate heating or
refrigeration, (e.g. salad, sandwiches, sliced meat
and meat products pastries etc).
 When these foods remain at room temperature for
several hours before being eaten, toxin producing
staphylococci multiply and elaborate the heat
stable toxin.
 The organisms may be of human origin from
purulent discharges of an infected finger or eye,
abscesses, nasopharyngeal secretions.
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Infective Dose
The toxin is produced when the Staphylococcus
aureus populations exceed 106 / gram of food.
Less than 1.0 microgram of the toxin in food will
produce staphylococcal intoxication symptoms.
Incubation period
30 minutes to 8hours, usually 2-4 hours
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Period of Communicability
Not applicable
Susceptibility and Resistance
Most people are susceptible
Clinical manifestation
Sudden onset of vomiting and watery diarrhoea
Fever and abdominal cramp
The intensity of illness may require hospitalization
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Diagnosis
 Group of cases with characteristic acute predominantly
upper gastrointestinal symptoms and the short interval
between eating a common food item and the onset of
symptoms
 Culture
staphylococcal recovery (greater than or equal to 10
organisms per gram of food) or
detection of enterotoxin from an epidemiologically
implicated food item confirms the diagnosis 16
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Treatment
 Fluid and electrolyte replacement if fluid loss is
significant particularly in severe cases
Prevention and control
 Educated food handless in food hygiene, sanitation
and cleanliness of kitchens, proper temperature
control, hand washing, cleaning of finger nails,
strict need to cover wounds on the skin.
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 Proper sanitation of food contact surfaces and
utensils.
 Reduce food handling time (initial preparation to
service) to an absolute minimum, with no more
than 4hours at ambient temperature. Keep
perishable food hot (>600C or cold (below 100C).
 Temporarily exclude people with boils, abscesses
and other purulent lesions of hands, face or nose
from food handling. 10/10/2023 CDC 18

II. Botulism
Definition
o A paralytic disease that begins with cranial
nerve involvement and progresses gradually to
involve the extremities.
Infectious agent (Toxic agent)
o Toxin produced by clostridium botulinum
(Neurotoxin)
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Botulism Cont’d...
Epidemiology
 Worldwide occurrence with home canned foods,
particularly vegetables, fruits and less commonly
with meat and fish.
 Outbreaks have occurred from contamination
through cans damaged after processing.
 Commercial products occasionally cause
outbreaks but some of these outbreaks have
resulted from improper handling after purchase.
 Food born botulism can occur when a food to be
preserved is contaminated with spores
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Reservoir
◦ The bacteria found in the soil and in the intestine of
animals
 Food infection in which preformed toxin is found
 Sources of the spore:
Vegetables
Fish
Meat
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 Associated foods
Home canned low acid foods
Honey (infant botulism)
Baked Potatoes
Fried onions
Garlic in oil mixtures
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Infective Dose
◦ Humans are so susceptible to botulism that if very small
amounts of the toxin are consumed, they will become ill.
Incubation period
◦ Neurological symptoms of food borne botulism usually
appear within 12-36 hours, sometimes several days,
after eating contaminated food
◦ not communicable
Susceptibility and Resistance :- Susceptibility is general
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Clinical Manifestations
 Illness varies from a mild condition to very severe disease that
can result in death within 24 hours.
 Symmetric descending paralysis is characteristic and can lead
to respiratory failure and death.
 Cranial nerve involvement makes the onset of symptoms,
usually produces diplopia (double vision) dysphasia (difficult in
swallowing).
 Weakness progresses' often rapidly, from the head to involve
the neck, arms, thorax and legs; the weakness is occasionally
asymmetric. 24
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 Nausea, vomiting, abdominal pain may proceed or follow
the onset of paralysis.
 Dizziness, blurred vision ,dry mouth and occasionally sore
throat is common.
 No fever; ptosis (abnormal dropping of upper eyelids) is
frequent
 Papillary reflexes may be depressed: fixed or dilated
pupils are noted in half of patients
 The gag reflex may be suppressed; deep tendon reflexes
may be normal or decreased
 Paralytic ileus (a decrease in or absence of intestinal
peristalsis), severe constipation and urinary retention are
common.
 Double vision
 Droopy eye lids
 Difficulty speaking and swallowing
 Difficulty with breathing
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Diagnosis
 Clinical- a febrile, mentally intact patients who have
symmetric descending paralysis without sensory
findings
 Appropriate history
 Demonstration of organisms or its toxin in vomitus,
gastric fluid or stool is strongly suggestive of the
diagnosis
 Wound culture
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Treatment
 Hospitalize the patient and monitor closely
 Intubation and mechanical ventilation may be
needed
 Antitoxin administration after hypersensitivity test to
horse serum
 Emesis and lavage if short time after ingestion of
food to decrease the toxin
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 Ensure effective control of processing and
preparation of commercially canned and preserved
food
 Education about home canning and other food
preservation techniques regarding the proper time,
pressure and temperature required to destroy
spores. The need for adequate refrigeration,
storage, boiling with stirring home-canned
vegetables for at least 10 minutes to destroy
botulinum toxin.
 Canned foods in bulging containers should not be
used eaten or tasted.
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iii. Salmonellosis
Definition
 A bacterial disease commonly manifested by an acute
enterocolitis (inflammation involving both the large & small
intestines)
Infectious agent
 Salmonella typhimurium and salmonella enteritidis are the
two most commonly reported
 Salmonella typhimurium has been the species that
accounts for most food borne illnesses related to these
bacteria.
 The bacteria are easily destroyed with heat
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Salmonellosis Cont’d...
Epidemiology
 It occurs world wide
Reservoir
 Domestic and wild animals including poultry, swine,
cattle, rodents and pets (tortoises, dogs, cats, and
humans) and patients or convalescents are carriers
esp. of mild and unrecognized cases
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 Ingestion of organisms in food derived from infected
food animals or contaminated by faeces of an
infected animal or person, raw and under cooked
eggs and egg products, raw milk and its products,
poultry and its products consumption of raw fruits and
vegetables contaminated during slicing (cutting in to
pieces)
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 Associated foods:
◦ Raw meat
◦ Poultry
◦ Eggs
◦ Milk and dairy products
◦ Fish, shrimp
◦ Cream-filled desserts and toppings
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Infective Dose
◦ As few as 15-20 cells; depends on age and health
of host, and strain of Salmonella
Incubation period
◦ From 6-72 hours, usually about 12-36 hours
◦ Extremely variable through the course of infection;
usually several days to several weeks
Susceptibility and Resistance
◦ Susceptibility is general and increased by
achlorhydria, antacid therapy, GI surgery, prior or
current broad spectrum antibiotic Rx, neo plastic
disease, Immuno suppressive Rx and malnutrition.
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Clinical Manifestation
◦ Self limited fever and diarrhoea (Bloody or
dysenteric when colon is involved)
◦ Nausea, vomiting and abdominal cramp
◦ Microscopic leukocytosis
Diagnosis
◦ Blood culture initially
◦ Stool culture
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Treatment
 Symptomatic
 If there is an underlying immunosuppressive disease
(condition like AIDS, lymphoma, immunosuppressive
treatment) treat the underlying cause
 Improved animal rearing and animal marketing
 Quality testing of the known and commonly
contaminated foods
 Avoid consuming raw or partially cooked ages
 Wear gowns and gloves when handling stool and
urine and hand washing after patient contact.
 Use only pasteurized milk
 Use clean utensils and surfaces to prepare foods
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Nursing Care Plan for Food poisoning
 Monitor the patient’s fluids status carefully.
 Plan care to allow uninterrupted rest periods for the patient.
 If the patient is nauseated, advise him to avoid quick
movements, which can increase the severity of nausea
 If the patient can tolerate oral fluids, replace lost fluids and
electrolytes with broth, ginger, ale, and lemonade, as tolerated.
 Assess vital signs at least every 4 hours, weigh him daily, and
record intake and output.
 Teach the patient about gastroenteritis, describing its symptoms
and varied causes.
 Teach the patient the proper preventive measures
 If dehydration occurs, administer oral and I.V. fluids as ordered.
 To ease anal irritation caused by diarrhoea, clean the area
carefully and apply repellent cream, such as petroleum jelly.
 Wash hand thoroughly after giving care to avoid spreading of
infection, and use standard precaution whenever handling
vomits or stools
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Prevention and Control of
Zoonotic Diseases
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Learning objectives
After completion of this chapter students will be able to:
 Define zoonotic diseases.
 Identify the potential causative agents for zoonotic
diseases.
 Explain methods of transmission zoonotic diseases.
 Identify clinical pictures of zoonotic diseases.
 Manage patients with zoonotic diseases.
 Discuss the ways to prevent zoonotic diseases.
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Introduction
 A zoonotic disease is a disease that can be passed
between animals and humans.
 Zoonotic diseases can be caused by viruses,
bacteria, parasites, and fungi.
 These diseases are very common.
 It is estimated that more than 6 out of every 10
infectious diseases in humans are spread from
animals.
 For most of these diseases, man is a dead end of
the transmission cycle.
 This means under normal conditions, man will not
infect other human beings
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individual ASSIGNMENTS
 When animals used as a food
◦ Taeniasis
◦ Brucellosis
◦ Trichinellosis or trichinosis
◦ Toxoplasmosis
 Animal Bite diseases
◦ Rabies
 Direct contact diseases
◦ Anthrax
 Animal reservoir diseases
◦ Leishmaniasis
◦ African Trypanosomiasis
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I. Anthrax
 An acute bacterial disease primary of grass eating
animals, and occasionally infect man.
 In man it primary affects skin but very rarely lower
respiratory tract oropharynx , mediastinum or
intestinal tract.
Cause
 Bacillus anthrax, spore forming a Gram positive, rod–
shaped bacterium
Reservoir
 Animal normally herbivores
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Anthrax Cont’d...
 Occupational Hazard of workers who process hides,
hair bone and bone products
 Coetaneous anthrax
by contact with tissue of animals (cattle, sheep,
goat…) those dying of the disease
Bite of flies that had partially feed on such animal
Contaminated materials (hair, wool, hide) that has
contact with soil associated with infected individuals
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Anthrax Cont’d...
 In halation Anthrax
◦ Inhalation of spores in risky industrial process such
as tanning of hides, wool or bone processing where
a aerosols of B. Anthrax may be produced.
 Intestinal or oropharyngeal anthrax
◦ Ingestion of contaminated meat, but no evidence for
milk
Incubation period
◦ Few hours to seven days, most cases 48 hr.
Period of communicability
◦ Transmission from person to person is rare, but
contaminated article remain communicable for
years (decades) 43
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Anthrax Cont’d...
Susceptibility and resistance
Uncertain
Clinical manifestations
 Cutaneous Anthrax
 95% of the cases
 At first small red macules appear on exposed
areas, head, neck face, then to papule that changed
to blackened necrotic centre surrounded by highly
expanding zone of oedema
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Anthrax Cont’d...
Sweaty and clammy (moist) skin
Loss of appetite
Fatigue
Blueness of the skin
Nausea, vomiting
Mood swings
Joint pains or muscle aches
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Anthrax Cont’d...
 Inhalation anthrax
 Mild symptom of URTI (early sign)
 Acute phase occur after 1-3 days with increasing fever,
dyspnoea, strider, hypoxia, and hypotension usually
leading to death with in 24 hr.
High fatality rate
 Gastro intestinal anthrax
 Early sign: vomiting & watery diarrhoea (occasional)
Variable, fever, abdominal pain, bloody diarrhoea,
sometimes rapid developing ascetics.
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Anthrax Cont’d...
 Oropharyngeal anthrax
 Fever
 sore throat
 Dysphasia
 Painful regional L/Adenophathy
 Primary lesion most often on tonsil
 Respiratory distress
 Toxaemia
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Anthrax Cont’d...
Diagnosis
 Clinical data
 Lab Diagnosis from fluid of vesicle, sputum and
stool
 Gram stain
 Culture
Treatment
 Penicillin G 10Mu IV daily or TTC 2gm po daily for
two weeks
 Clean & cover the cutaneous lesion 48
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Anthrax Cont’d...
Prevention and Control
 Decontamination of wool and goat’s hair or others
 Improvement of working condition of animal
product
 Vaccination of susceptible groups & animals
 Treat all exposed animal.
 Health education
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II. Brucellosis (Undulant Fever)
Definition
 A systemic bacterial disease with acute or insidious
on set transmitted to humans from infected animals
Agents
◦ Brucella melitensis (most common worldwide)
acquired primary from goats, sheep, and camel
◦ Brucella abortus from goats
◦ Brucella suis from pig
◦ Brucella canis from dogs
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i.Am proud,pretty.smart and genies
boy!!!!

Brucellosis Cont’d...
Risk groups
o Slaughter house workers
o Meat-packing plant employees ,veterinarians
o Hunters
Reservoir
o Cattle, goat sheep, dogs
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Mechanism of transmission
o By contact with tissue, blood, urine, vaginal
discharge aborted foetuses especially placentas
o Through break in the skin
o Ingestion of row milk most commonly
o Ingestion of diary products from infected animal (raw
meat, bone morrow
o Air born infection those working in Abattoirs
o Person-to-person spread of brucellosis is extremely
rare
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Incubation Period:- 1-3 weeks or longer
No evidence from person to person
Abrupt onset of symptoms. i.e. fever, chills,
diaphoresis, headache, myalgia, fatigue ,anorexia,
joint pain, sore throat, dry cough
Spinal tenderness
Hepatospleenomegally
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Asymmetric polyarthritis (knee, hip, shoulder)
Epididymoorchitis
Skin rash
Cardiac murmur
Pneumonia
Diagnosis
Clinical features with history of exposure or contact
Blood or bone cultures
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Treatment
 Doxcycline + aminoglycoside for 2 weeks
 Doxcycline + refampicin for 4-8 weeks
 Bactrim + Rifampicin in children <7 years and pregnant
mother for 8-12 weeks
Prevention & Control
 Elimination of disease in domestic animals
 Health Education
 Proper disposal system
 Animal examination and treatment
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III. Toxoplasmosis
Definition
o Chronic or acute systemic protozoal disease caused by
Toxoplasma gondii
Reservoir:- Cats
◦ Ingestion of cyst in raw &under cooked meat.
◦ Ingestion of Oocyte in food, drink, or from hands
contaminated with faeces of infected cat.
◦ Transplacental
◦ Organ donation 56
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Toxoplasmosis Cont’d...
Risk of Exposure
◦ Anyone who is exposed to the bacteria that cause
brucellosis is at risk for infection.
◦ Occupational Risks
◦ slaughterhouse workers
◦ meat-packing employees
◦ veterinarians
◦ laboratory workers
Incubation Period:- 10-23 days
◦ Not directly from person to person except
transpalcental
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 Acute form
Chills, Fever head ache, myalgia , fatigue,
lymphadenitis
Maculopapular rash
Encephalomyelitis
Retinochorditis that may leads to blindness
 In infected child if transpalcental / congenital
Hydrocephaly
Convulsion
Motor disturbance 58
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Diagnosis
◦ Clinical manifestations
◦ Cell culture
Treatment
 Pyrimethamine 100-200mg PO daily followed by
maintenance dose 25mg PO/d for 4 weeks
 Note – treatment indicated in sick
immunocompromised case
 Folinic acid
◦ Eat cooked meat and animal products (60c)
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IV.
Rabies
Definition
◦ An acute viral disease of CNS invariably (always) fatal
that affect all animals and is transmitted by infected
secretion mainly saliva.
Agent:- Rabies virus
Reservoir:- Dog, rats
◦ Transmitted with saliva of infected animal and
introduced to body by bite or scratch
Incubation Period:- 3-8 weeks (40 days)
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o Usually 3-7 days before the onset of the disease and
throughout the course of disease.
o Occasionally inhalation, ingestion and tissue
transplantation
Pathogenesis
o A bullet shaped virus which has many strain recovered
from rabid street dog called “street virus”
o The virus multiplies in muscle at site of inoculation then
ascends along the nerve to CNS where from it
subsequently spread to all parts of the body via emerging
net work of ANS. 61
Rabies Cont’d...
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Rabies Cont’d...
Classification of animal bite
Class I
◦ Abraded skin, scratches that bleed
Class II
◦ Bite on any part of the body other than head, neck
&fingers
◦ None ulcerated wounds less than 5 in number
Class III
◦ All cases of bite on finger, hand or neck
◦ Wounds >5 anywhere on the body
◦ Lacerated wounds
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Rabies Cont’d...
 Prodormal phase
◦ Headache
◦ Fever
◦ Nausea and
◦ Abnormal sensation at site of inoculation
 Excitatory phase or Aerophobia
 Slight sound and wind excites the victim
 Irritability ,restless, nervousness tendency to bite
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Rabies Cont’d...
 Paralytic phase (full blown rabies)
◦ Spasm of swallowing muscle leads to drooling of
saliva and fear of water (hydrophobia)
◦ Delirium
◦ Convulsion
◦ Death due to respiratory muscle paralysis
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Rabies Cont’d...
Diagnosis
◦ History of bite by known rabid animal
◦ Nigri bodies
Treatment
 Wound care
◦ Wash the wound with soap and water
◦ Stop bleeding
◦ Cover the wound
◦ Never stitch/suture as it may facilitate the spread
 TAT
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Rabies Cont’d...
 Anti Rabies vaccination
◦ 5ml SC (periumbilical area) daily for 14 days and
two booster doses on 14th and 30th days
◦ Indication for anti rabies vaccination
◦ Bite from known rabid animal or contact with saliva
to lesioned tissue
◦ The animal escaped
◦ The animal show clinical pictures after 10 days
observation
◦ The animal died
 Sedation
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Rabies Cont’d...
Immunize all dogs and cats
Detain & clinically observe for 10 days any
unhealthy appearing dog or cat known to have bitten
a person
Post exposure prophylaxis
• Treatment of bite wounds
• Specific immunologic protection
Keep dogs and cats at home
Destroy stray animals where rabies is endemic
Keep dog and cat at home
Kill rabid animal.
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V. Trichinellosis or Trichinosis
Definition
◦ Trichinosis is a disease caused by intestinal round
worm whose larvae (trichinae) migrates to and
become encapsulated in the muscles.
Infectious agent
◦ Trichinella spiralis, an intestinal nematode
Epidemiology
◦ It occur worldwide, but variable incidence, depending
in part on practices of eating and preparing pork or
wild animal meat.
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Trichinellosis or Trichinosis Cont’d...
Reservoir
 Swine, dogs, cats, horses, rats and many wild
animals, including fox, wolf etc.
Mode of transmission
 By eating raw or insufficiently cooked flesh of animals
containing viable encysted larvae, chiefly pork and
pork products and 'beef' products such as hum burger
adulterated either intentionally or inadvertently with
raw pork.
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Incubation period
 Systemic symptoms usually appear about 8-15
days after ingestion of infected meat.
 Susceptibility is universal. Infection results in
partial immunity
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o Symptoms result from invasion of the body by larvae
produced by the adult female worm in the intestine and
from their encystment in striated muscles
o Infection ranges from symptomatic to mild febrile illness
to a severe progressive illness with multiple system
involvement.
o Fever(low-high grade), muscle pain mainly up on
movement, oedema, and spasm (periorbital and facial|),
photophobia and conjunctivitis 71
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o Weakness or prostration; pain on swallowing;
dyspnoea, coughing and hoarseness;
subconjuctival, retinal and nail splinter haemorrhage
and rashes; diarrhoea, abdominal cramps, nausea
and vomiting.
o Inflammatory reactions around larvae that reach
tissues other than muscles may result in: Meningitis,
encephalitis, myocarditis, bronchopneumonia,
nephritis, peripheral and cranial nerve disorders
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Diagnosis
History of ingestion of raw or inadequately cooked
pork,
Larvae in muscle biopsy
Positive serologic test
Oesinophilia
Treatment
Hospitalization of the Patient
Mebendazole or
Albendazole or Thiabendazole
High dose of corticosteroids for 1-2 days followed
by lower doses for several days or weeks. But not
for intestinal stage.
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 Educate the public on the need to cook all
fresh pork and pork products and meat from
wild animals
 Freezing of pork and its products inactivates
trichinae
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Other Infectious
Diseases
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Learning objectives
After completion of this chapter students will be able to:
Define Tetanus and Scabies
Identify the potential causative agents for Tetanus
and Scabies
Explain methods of transmission Tetanus and
Scabies
Identify clinical pictures of Tetanus and Scabies
Describe the management of Tetanus and Scabies
Explain the prevention and control methods for
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I. Tetanus (Lock jaw)
Definition
o An acute bacterial disease caused by a toxin
produced by tetanus bacilli characterized by
painful contraction of voluntary muscle.
Aetiology and pathogenesis
o Tetanus is caused by clostridium tetani gram-
negative rod, obligate anaerobic, terminal spore
forming bacteria.
o Terminal spore gives drumstick shape
77
10/10/2023 CDC

Tetanus Cont’d...
o The spore is highly resistant to drying and
temperature
o The organism found naturally in soil, horse and
cattle dung, less commonly and human excrete
sometimes in those who have association with
cattle.
o Because the organism can only live and multiply
in the absence of O2, tetanus most likely develop
in deep penetrating wounds with tissue necrosis
78
10/10/2023 CDC

Tetanus
Cont’d...
o Wounds those favours tetanus are
Umbilical stamp in new born
Deep (stab) wounds
Burns
Endometritis after abortion
Surgical wounds from dressing or instruments
Chronic ulcer
 Any other wounds
o After the organism enters to deep wound, it multiplies
anaerobically and produce toxin which can be transported
to CNS and affects Nerves 79
10/10/2023 CDC

Tetanus Cont’d...
Reservoir
◦ Intestine of animals
◦ Soil
Mechanism of Transmission
◦ Through punctured wound contaminated with
animal dust, street dust etc
◦ Not directly transmitted from person to person
80
10/10/2023 CDC

Tetanus Cont’d...
◦ General
◦ Active immunity is induced by tetanus toxoid and
persists for at least 10 years
Incubation Period
◦ 3-21 days, average 3-12 days
◦ Short incubation period indicates sever disease
81
10/10/2023 CDC

Tetanus Cont’d...
o Stiffness of jaw (Lock jaw) with inability to open mouth
fully is the1st symptom.
oRisus sardonicus- sustained
contraction
o Tetanus spasm develops within 24-72hour, the shorter
this period, the poorest the prognosis.
o Pts are fully conscious
o Minor stimuli like sound, light or touch can precipitate
82
10/10/2023 CDC

Tetanus Cont’d...
o Dyspagia, hyper reflexia and fevers are invariable.
o There is no bacteraemia and organism localized to
the wound
o death from tetanus occur due to
 Spasm of glottis, thoracic muscle and diaphragm
 Chronic hypoventilation
 periods of apnoea
 Aspiration and subsequent suffocation
o Inability to suck is the first symptom in new born
83
10/10/2023 CDC

Tetanus Cont’d...
Diagnosis
◦ Clinical
Management
Non drug Management
◦ Admit patient in quite place, in severe cases ICU if
possible for continuous cardio pulmonary
monitoring
◦ Wound care
◦ Intubations or tracheotomy if possible
◦ Nutrition through NGT 84
10/10/2023 CDC

Tetanus Cont’d...
Drug management
 Control of spasm by
◦ Diazepam 10 mg IV Q 4hr or
◦ Phenobarbitone 50-100mg Q.6hr
◦ Plus, chlorpromazine 25-50mg IM 6 hr alternated
with diazepam
 Antibiotics
◦ Metronidazole 500mg po TID for 7-10 days
85
10/10/2023 CDC

Tetanus Cont’d...
 Tetanus Human immunoglobulin 500 IU IM once
 ATS (anti tetanus serum) + (IIG ) 500 IU IM
◦ 10,000 units IM /IV for both adult& children
◦ Give test dose first, keeping adrenaline at hand b/c
allergic reaction is common & dangerous
 Propronanol for ANS dysfunction 60mg PO/d
86
10/10/2023 CDC

Tetanus Cont’d...
 Surgical treatment
◦ Look for wound & clean with savlon
◦ Operative procedures are not recommended b/c sever,
uncontrolled spasm commonly accompany surgery
◦ Tracheotomy ( sever case)
 Intensive care unit (ICU)
◦ Nursed is dark & isolated room
◦ AR if patient develops breathing arrest (tetanus is not
infections)
◦ immediate sedation with spasm
87
10/10/2023 CDC

Tetanus Cont’d...
◦ Observation from minute to minute
◦ Semi-prone position (never on back)
◦ Change position every 2 hours
◦ Raise the foot of bed to stimulate lung drainage
 Toxoid (TT)
 Patients with Tetanus do not develop immunity so they
must be immunized TT after recovery to prevent re
occurrence.
88
10/10/2023 CDC

Tetanus Cont’d...
Active Immunization (DPT currently penta
valent)
Active immunization with TT
Passive protection ATS is only for 10 days
so it should not be given without active
immunization
89
10/10/2023 CDC

Tetanus Cont’d...
Tetanus of new born
◦ Active immunization of mother during pregnancy
◦ DPT Should have be given for adults
◦ Pertusis part causes severe reaction
◦ DPT/Pentavalent Cannot replace TT so give
DPT/pentavalent for new borns(6weeks,10weeks,
14weeks)
◦ Sterilization of equipments
◦ Proper care of wound
90
10/10/2023 CDC

Tetanus Cont’d...
TT immunization schedule
91
Dose When to give Protection
%
Duration of
protection
TT1 At first contact first pregnancy Nill None
TT2 At least 4 weeks after TT1 80 3years
TT3 At least 6 months after TT2 or
next pregnancy
95 5years
TT4 1year after TT3 next
pregnancy
99 10 years
TT5 After 1yrs of TT4 next 99 70years
10/10/2023 CDC

II. Scabies
Definition
◦ An infestation of the skin with itchy mite (sarcoptes
scabies; or hominis).
Common site
◦ Space between finger
◦ Wrist
◦ Hand
◦ Axilla
◦ Extensor surface of elbow and knee
◦ Buttock
◦ Groin region
92
10/10/2023 CDC

Scabies Cont’d...
◦ Pustule lesion
◦ Itchy scratch syndrome
◦ Vesicle
◦ Excoriation
◦ Crust
Diagnosis
◦ Identification of sarcoptes scabies or mite under
microscope of any stage (adult, egg, larvae)
◦ Clinical
93
10/10/2023 CDC

Scabies Cont’d...
Treatment
◦ Sulfur ointment applied daily for 3 days.
◦ Body bath before and after application
◦ Treatment of the whole family
◦ Personal hygiene
◦ Treat the whole family
94
10/10/2023 CDC

HAVE A
NICE DAY
10/10/2023 95
CDC

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