Successfully reported this slideshow.
Your SlideShare is downloading. ×

Leptospirosis and Anthrax

Ad

J.N. Medical College, Belgaum 1 
06/08/14

Ad

J.N. Medical College, Belgaum 2

Ad

Mr A is a 38 year old sheep farmer who 
presented with a 3 day history of generalised 
muscle aches, anorexia, mild diarrh...

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Upcoming SlideShare
Leptospirosis- Dr Ajay Tyagi
Leptospirosis- Dr Ajay Tyagi
Loading in …3
×

Check these out next

1 of 120 Ad
1 of 120 Ad
Advertisement

More Related Content

Advertisement
Advertisement

Leptospirosis and Anthrax

  1. 1. J.N. Medical College, Belgaum 1 06/08/14
  2. 2. J.N. Medical College, Belgaum 2
  3. 3. Mr A is a 38 year old sheep farmer who presented with a 3 day history of generalised muscle aches, anorexia, mild diarrhoea and vomiting. Mr A had a fever of 38 degrees and a normal physical examination. J.N. Medical College, Belgaum 3
  4. 4. The initial diagnosis was a viral illness with gastroenteritis and he was advised to take paracetamol, rest and return if the symptoms changed or worsened J.N. Medical College, Belgaum 4
  5. 5. The patient returned within 2 days with a backache and worsening of his generalised muscle pain. He also had hyperaemic conjunctiva and headaches that were the worst he had ever experienced. Further examination did not demonstrate any further clinical signs and he did not have any neck stiffness. J.N. Medical College, Belgaum 5
  6. 6.  Due to rapid ecological changes, many zoonosis have emerged as epidemics  Leptospirosis is a zoonosis spread throughout the world  Surveillance data suggests - most common zoonosis in the world J.N. Medical College, Belgaum 6
  7. 7.  The disease is often overlooked and under reported  It is an emerging zoonotic disease of major public health problem  It often peaks seasonally sometimes in outbreaks J.N. Medical College, Belgaum 7
  8. 8. Leptospira -from the Greek leptos, meaning fine or thin, and the Latin spira, meaning coil 1886- Adolf Weil described the disease 1907- Stimson named the organism Spirochaeta interrogans 1915- etiologic agent by Inada and Ido 1930- it was identified as a separate disease entity J.N. Medical College, Belgaum 8
  9. 9.  It is most widespread disease in the world  Incidence of the disease is significantly higher in tropical countries as compared to temperate regions  Outbreaks mostly occur – heavy rainfalls and consequent flooding J.N. Medical College, Belgaum 9
  10. 10.  The number of human cases worldwide is not known precisely know  The WHO estimates- incidence ranges from approx 0.1 - 1 per 1,00,000 per year in temperate climates  10 - 100 per 1,00,000 in the humid tropics. J.N. Medical College, Belgaum 10
  11. 11. J.N. Medical College, Belgaum 11
  12. 12. Epidemics of Leptospirosis - Andaman and Nicobar islands, southern and western parts of India For the past 10 years Mumbai - seasonal increase  A post – cyclone outbreak was reported in Orissa, India in 1999. J.N. Medical College, Belgaum 12
  13. 13.  Outbreaks of leptospirosis have increasingly been reported from Kerala, Gujarat, Tamil Nadu and Karnataka  Sporadic cases have been reported from Goa, Andhra Pradesh and Assam J.N. Medical College, Belgaum 13
  14. 14. SS.. NNoo.. YYeeaarr SSttaattee 11 11998844 TTaammiill NNaadduu 22 11998888 AAnnddaammaann && NNiiccoobbaarr 33 11999944 GGuujjaarraatt 44 11999955 GGuujjaarraatt 55 11999977 GGuujjaarraatt,, AA && NN 66 11999999 GGuujjaarraatt,, TTaammiill NNaadduu 77 22000000 MMaahhaarraasshhttrraa,, GGuujjaarraatt,, TTaammiill NNaadduu,, KKeerraallaa 88 22000011 MMaahhaarraasshhttrraa,, GGuujjaarraatt,, TTaammiill NNaadduu,, KKeerraallaa && GGooaa 99 22000022 KKeerraallaa,, MMaahhaarraasshhttrraa,, GGuujjaarraatt,, TTaammiill NNaadduu 1100 22000033 KKeerraallaa,, GGuujjaarraatt,, TTaammiill NNaadduu,, AA && NN 1111 22000044 Kerala, Gujarat, Andaman & NNiiccoobbaarr,, KKaarrnnaattaakkaa J.N. Medical College, Belgaum 14
  15. 15. J.N. Medical College, Belgaum 15
  16. 16.  7th Day disease  Weil’s disease  Ictero-hemorrhagic fever  Swineherd's disease  Rice-field fever  Pea picker’s disease  Cane-cutter fever J.N. Medical College, Belgaum 16
  17. 17.  Swamp fever  Mud fever  Hemorrhagic jaundice  Stuttgart disease  Infectious jaundice  Canicola fever J.N. Medical College, Belgaum 17
  18. 18. 1) Agent  Order: Spirochetales  Family: Leptospirideae  Genus: Leptospira  Species: L. interrogans (pathogenic) and L. biflexa (saprophytic)  Serovars: > 250  Serogroups: 23; L. icterohemorrhagica, gryppotyphosa, caniciola, pomona, andmanii, etc J.N. Medical College, Belgaum 18
  19. 19.  MORPHOLOGY: Delicate, flexible Helical rods Actively motile. aerobic Hooked ends- umbrella handles Seen best with dark field Microscopy 6-20micrmeter long 0.1micrometer thick J.N. Medical College, Belgaum 19
  20. 20. o Electron Microscopy show thin axial filament a delicate membrane o In dark field it chain of miniature cocci. J.N. Medical College, Belgaum 20
  21. 21.  Culture: o Leptospira grows best under aerobic conditions at 280 to 300c best demonstrated in Semisolid agar media o Optimal Media Stuart’s and Fletcher’s Media EMJH (semisynthetic media) Optimal growth after 1 – 2 weeks J.N. Medical College, Belgaum 21
  22. 22.  Resistance : o Susceptible to heat o Sensitive to acid o Destroyed by chlorine, antiseptics o Hence their survival depends on- Temperature, acidity, salinity Die rapidly in non aerated sewage, acid urine, saltish and brackish water J.N. Medical College, Belgaum 22
  23. 23. o Source of infection: Urine of infected animals Rodents excrete in urine for lifelong. o Animal reservoirs: Wild and domestic animals Rodents – Rats, mice and voles Domestic animals – cows, buffalo, sheep, goats, pigs, horses. Pet animals – dogs J.N. Medical College, Belgaum 23
  24. 24. J.N. Medical College, Belgaum 24
  25. 25. Host :  Animals- Rodents, insectivores, dogs, cattle, pigs, horses, etc  Humans – accidental infection contact with infected urine  Even some birds • Micro-abrasions, intact skin and mucosa • Infected animal tissues and blood J.N. Medical College, Belgaum 25
  26. 26.  Age: children > adults  Sex: males > females  Immunity : serovar specific immunity  Occupation: J.N. Medical College, Belgaum 26
  27. 27. 1 Farmers 2 Sewage workers 3 Veterinarians 4 Fishermen and water bailiffs 5 Abattoir workers Recreational hazard- water sports, tourists J.N. Medical College, Belgaum 27
  28. 28. J.N. Medical College, Belgaum 28
  29. 29.  Leptospira – survive for weeks in soil and water  Poor housing, limited water supply, inadequate waste disposal are risk factor both rural and urban population. J.N. Medical College, Belgaum 29
  30. 30. J.N. Medical College, Belgaum 30
  31. 31. Mode of transmission: 1) Direct contact 2) Indirect contact 3) Droplet infection J.N. Medical College, Belgaum 31
  32. 32. J.N. Medical College, Belgaum 32
  33. 33.  Incubation period : usually 10days 2-20days  Entry: through cuts and abrasions in skin & mucous membranes of the eyes, nose and mouth Inhalation- rare Ingestion- rare Human-to-human transmission –rare J.N. Medical College, Belgaum 33
  34. 34.  Leptospiremic/ Septicaemic phase › Systemic vasculitis › Migration of organisms into tissues-inflammation and multi-organ dysfunction from direct cyto-toxicity  Immune phase/ Leptospiruric Phase › Second fever and organ involvement through immunological mechanisms-  Persistence of organisms › Renal tubules, aqueous humor J.N. Medical College, Belgaum 34
  35. 35. Wide range of severity and clinical features A. Subclinical infection B. Self limited systemic illness 90 % C. Severe potentially fatal illness consisting of  Renal failure 15 %  Liver failure 15%  Pneumonitis >30 to 40% mortality  Hemorrhagic diathesis J.N. Medical College, Belgaum 35
  36. 36.  Leptospiremic/ Septicaemic phase  Immune phase/ Leptospiruric Phase J.N. Medical College, Belgaum 36
  37. 37.  High fever and chills  Severe headache, eyeball pain, photophobia  Mental confusion  Muscle pain & tenderness (calves and back)  Redness in the eyes & conjunctival injection  Sore throat  Rash- maculopapular J.N. Medical College, Belgaum 37
  38. 38.  Abdominal pain  Vomiting and diarrhea  Jaundice, hepatosplenomegaly  Lymphadenopathy -rare  Hemorrhages in skin and mucous membranes  Cough, chest pain & hemoptysis J.N. Medical College, Belgaum 38
  39. 39.  Early myalgia.  Hepatitis with fever.  Renal impairment.  Lymphocytic meningitis.  Conjunctivitis.  Rash, sometimes haemorrhagic.  Thrombocytopenia.  Blood, protein and/or bilirubin in the urine.  Rare, nodular pneumonitis. J.N. Medical College, Belgaum 39
  40. 40. J.N. Medical College, Belgaum 40
  41. 41. J.N. Medical College, Belgaum 41
  42. 42. J.N. Medical College, Belgaum 42
  43. 43.  Severe Leptospirosis (Weil's Syndrome) Weil's syndrome-,characterized by jaundice, renal dysfunction, and hemorrhagic diathesis By pulmonary involvement in many cases mortality rates of 5–15 This syndrome is frequently but not exclusively associated with infection due to serovar L. icterohaemorrhagiae/copenhageni. J.N. Medical College, Belgaum 43
  44. 44. Renal Failure: › Migrate to interstitium, renal tubules and tubular lumen – interstitial nephritis and tubular necrosis › Hypovolemia J.N. Medical College, Belgaum 44
  45. 45. Liver: › Centrilobular necrosis and Kupffer cell hyperplasia › No hepatocellular necrosis J.N. Medical College, Belgaum 45
  46. 46. Pulmonary: Hemorrhage and not much inflammation - hemoptysis, patchy lung - infiltrates and ARDS Muscles: Direct cytotoxicity CNS: Organisms in the CSF X 2 weeks with mild CSF changes Meningitis in immune phase J.N. Medical College, Belgaum 46
  47. 47.  Rhabdomyolysis  Hemolysis  Myocarditis  Pericarditis  CHF  Necrotising Pancreatitis  MOF J.N. Medical College, Belgaum 47
  48. 48.  Faine had evolved a criteria (WHO Guidelines) for diagnosis of Leptospirosis  On basis of clinical (A), epidemiological (B) laboratory data (C) (A+B+C) J.N. Medical College, Belgaum 48
  49. 49. J.N. Medical College, Belgaum 49
  50. 50. J.N. Medical College, Belgaum 50
  51. 51. J.N. Medical College, Belgaum 51
  52. 52.  Diagnosis of Leptospirosis (Part A) or (Part A& Part B Score) : 26 or more Part A, B & C (Total) : 25 or more J.N. Medical College, Belgaum 52
  53. 53.  Isolation of organism 1. Before tenth day of illness: Blood - i. Dark field examination of the patient’s blood ii. Culture on a semisolid medium (eg. Fletcher’s EMJH) J.N. Medical College, Belgaum 53
  54. 54. 2. After tenth day of illness: Urine - i. Dark field examination of the patient’s urine ii. Culture of urine (for several months in untreated patient) J.N. Medical College, Belgaum 54
  55. 55.  Serology Aggutination tests : Paired sera (fourfold or greater rise in titer) i. Microscopic, using live organisms (MAT) ii. Macroscopic, using killed antigen J.N. Medical College, Belgaum 55
  56. 56. o ELISA IgM and Slide agglutination tests (SAT) : - Measure IgM antibodies - Single sample adequate - The ELISA IgM test helpful for early diagnosis (positive 2 days into illness) o Dot-ELISA and dip-stick methods: - Newer screening methods (for detecting IgM antibodies) J.N. Medical College, Belgaum 56
  57. 57.  Detection of specific DNA PCR test Leptospiral DNA: - Detected in blood, urine, CSF, and aqueous humor J.N. Medical College, Belgaum 57
  58. 58. In September 2002, my mother was admitted in a Hyderabad nursing home with what was thought to be viral hepatitis. The doctor said she was doing fine. But she died after 12 days. She was only 47 years old. I was 17. Ten days later, I developed the same symptoms that my mother had. J.N. Medical College, Belgaum 58
  59. 59. The doctor in Tirupati we consulted insisted that it was viral hepatitis. When I didn’t get better, a trainee nurse suggested a blood test for Leptospirosis, which was confirmed at Tirupati and Chennai labs Alekhya Mandadi, Tirupati, Andhra Pradesh J.N. Medical College, Belgaum 59
  60. 60.  Influenza  Meningitis (encephalitis)  Viral hepatitis  Rickettsiosis  Malaria  Typhoid fever  Septicemia  Toxoplasmosis  Legionnaire’s disease J.N. Medical College, Belgaum 60
  61. 61.  General and Supportive Care › Antipyretics › Antimicrobial › Rest › Hydration › Ventilator support › Liver support › Renal support › Transfusion support J.N. Medical College, Belgaum 61
  62. 62.  Antimicrobials  Penicillin- 6 million units daily intravenously is the drug of choice in severe leptospirosis Effective if started within first four days of illness. Jarisch-Herxheimer reactions may occur Total duration of therapy should be 10-14 days J.N. Medical College, Belgaum 62
  63. 63.  Amoxycillin and erythromycin  Doxycycline in a dosage of 100 mg twice daily for 7 days Effective in treatment of mild and moderate leptospirosis J.N. Medical College, Belgaum 63
  64. 64.  Anicteric leptospirosis usually has a good prognosis.  Without jaundice the disease is almost never fatal  Fatal pulmonary haemorrhage and myocarditis have been reported occasionally in anicteric cases  case fatality rate for Weil’s disease is 15-40%  higher for patients over 60 years of age J.N. Medical College, Belgaum 64
  65. 65.  Prevention and control should be targeted at: a) Source of infection b) Route of transmission c) Infection/ Disease in humans J.N. Medical College, Belgaum 65
  66. 66. a) Source of infection  Prevent contamination of living, working and recreational areas by urine of infected animals.  Control rodent populations in areas of human habitation.  Contact with wildlife ( e.g., do not feed pets outside or allow animals to roam unsupervised) J.N. Medical College, Belgaum 66
  67. 67.  Do not allow animals to urinate in or near ponds or pools.  Keep animals away from gardens, playgrounds, sandboxes, and other places children may play.  Among domesticated animals, vaccination of swine, cattle, and dogs. J.N. Medical College, Belgaum 67
  68. 68. b) Interruption of transmission  Avoid swimming- contaminated water  Protective clothing, footwear  Adopt a reasonable standard of hygiene  Public health engineering  Waste management J.N. Medical College, Belgaum 68
  69. 69. c) Human protection  Chemoprophylaxis Effective prophylaxis consists of doxycycline,200 mg orally once weekly, during the risk of exposure  Vaccination  IEC activities J.N. Medical College, Belgaum 69
  70. 70.  Government of India – pilot project  For control of Leptospirosis (Gujarat, TN- 2008 trial ; Karnataka , Maharashtra 2011)  NCDC is the nodal agency  Main Objective- Reduce morbidity and mortality related to leptospirosis J.N. Medical College, Belgaum 70
  71. 71.  Leptospirosis Burden Epidemiology Reference Group (LERG) Goals:  To provide estimates on the global burden of Leptospirosis according to age, sex and region.  To increase awareness of and commitment to the disease in developing countries.  To encourage developing countries to undertake active disease surveillance and strengthen control measures. J.N. Medical College, Belgaum 71
  72. 72.  In the ICD10 disease classification system, leptospirosis is code A27  The International Leptospirosis Society (ILS) was formed in 1994 to promote knowledge on leptospirosis through the organisation of regional and global leptospirosis meetings J.N. Medical College, Belgaum 72
  73. 73.  Leptospirosis should be a notifiable disease  Need to increase awareness  Better diagnosis and surveillance programmes J.N. Medical College, Belgaum 73
  74. 74. J.N. Medical College, Belgaum 74
  75. 75. A 40 y/o police officer presents with fever and muscle aches. He is pale, has a temperature of 102°F. His physical exam and labs are unremarkable so he is discharged and given flu instructions. He says his partner is also ill. J.N. Medical College, Belgaum 75
  76. 76. Later, a 35 y/o female clerk also presents complaining of myalgias, shaking chills, and vomiting. She is pale, and has a temperature of 102.4°F. Her physical exam is non-focal, she improves with antipyretics and the patient is sent home with viral syndrome instructions. J.N. Medical College, Belgaum 76
  77. 77. The next day several more patients present with fever, chills and myalgias J.N. Medical College, Belgaum 77
  78. 78. The 40 yr policeman returns 3 days later because he is feeling much worse and is short of breath. This is the chest x-ray that was obtained J.N. Medical College, Belgaum 78
  79. 79. A mother brings in her adolescent son for a strange black scab/rash that started out as a small papule but formed a black painless eschar over the past 5 days J.N. Medical College, Belgaum 79
  80. 80. J.N. Medical College, Belgaum 80
  81. 81.  The word “Anthrax” originates from Greek for black or coal  The black eschar which is characteristic of the cutaneous form of Anthrax infection.  It is principally a disease of herbivores But has the potential to infect all mammals and even some birds J.N. Medical College, Belgaum 81
  82. 82.  Bacillus anthracis , zoonotic disease  Anthrax may be the prototypic disease of bioterrorism  Humans almost invariably contract anthrax directly or indirectly from animals  “Malignant pustule” and “Wool sorter’s disease”. J.N. Medical College, Belgaum 82
  83. 83. J.N. Medical College, Belgaum 83
  84. 84. J.N. Medical College, Belgaum 84
  85. 85. Bacillus anthracis › Aerobic, Gram positive rod › Long (1-10μm), thin (0.5-2.5μm) › Forms inert spores when exposed to O2  Infectious form, hardy  Approx 1μm in size › Vegetative bacillus Non-infectious, fragile J.N. Medical College, Belgaum 85
  86. 86.  Environmental Survival Spores Resistant to drying, boiling <10 minutes Survive for years in soil Favorable soil factors for spore viability High moisture Organic content Alkaline pH High calcium concentration J.N. Medical College, Belgaum 86
  87. 87.  Anthrax is a seasonal disease  The occurrence of anthrax among animals in any one place is related to temperature and rains.  However, the conditions which predispose to outbreaks differ widely J.N. Medical College, Belgaum 87
  88. 88. › Primarily disease of herbivorous animals  Sheep, goats, cattle  Many large documented epizootics  Carnivores are not immune › Human disease  Epidemics have occurred but uncommon  Rare in developed world J.N. Medical College, Belgaum 88
  89. 89.  Many countries have weaponized anthrax › Former bioweapon programs  U.S.S.R.,U.S.,U.K., and Japan › Recent bioweapon programs  Iraq › Attempted uses as bioterrorism agent  WW I: Germans inoculated Allied livestock  WW II: Alleged Japanese use on prisoners J.N. Medical College, Belgaum 89
  90. 90.  In September 2001, the American public was exposed to anthrax spores as a bio-weapon delivered through the U.S. Postal System  CDC identified 22 confirmed cases J.N. Medical College, Belgaum 90
  91. 91. J.N. Medical College, Belgaum 91
  92. 92. J.N. Medical College, Belgaum 92
  93. 93.  Features of anthrax suitable as BT agent › Fairly easy to obtain, produce and store › Spores easily dispersed as aerosol › Moderately infectious › High mortality for inhalational (86-100%) J.N. Medical College, Belgaum 93
  94. 94. Three forms of natural disease › Inhalational  Rare (<5%)  Most likely encountered in bioterrorism event › Cutaneous  Most common (95%)  Direct contact of spores on skin › Gastrointestinal  Rare (<5%), never reported in U.S.  IngestionJ.N. Medical College, Belgaum 94
  95. 95. Mortality › Inhalational 86-100% (despite treatment)  Era of crude intensive supportive care › Cutaneous <5% (treated) – 20% (untreated) › GI approaches 100% J.N. Medical College, Belgaum 95
  96. 96. Incubation Period › Time from exposure to symptoms › Very variable for inhalational  2-43 days reported  Theoretically may be up to 100 days  Delayed germination of spores J.N. Medical College, Belgaum 96
  97. 97.  Transmission › No human-to-human (very rare) › Naturally occurring cases  Skin exposure  Ingestion  Airborne › Bioterrorism  Aerosol (likely)  Small volume powder (possible)  Foodborne (unlikely) J.N. Medical College, Belgaum 97
  98. 98.  Anthrax has at least three proteins which play a role in virulence A-B model of toxicity Edema factor (EF), Lethal factor (LF) and Protective antigen (PA) EF and LF need PA to get into the cell to cause damage J.N. Medical College, Belgaum 98
  99. 99. J.N. Medical College, Belgaum 99
  100. 100.  Progression of painless lesions Papule/macule – pruritic Vesicle/bulla – clear or serosanguinous Ulcer – non-pitting, gelatinous edema Eschar – black, depressed, scars J.N. Medical College, Belgaum 100
  101. 101. J.N. Medical College, Belgaum 101
  102. 102.  Initially starts with a non-specific flu-like illness and then progresses to: › Respiratory Distress › Shock › May see a widened mediastinum on x-ray J.N. Medical College, Belgaum 102
  103. 103. J.N. Medical College, Belgaum 103
  104. 104.  Nausea, anorexia, vomiting, fever  Progresses to severe abdominal pain and bloody emesis and diarrhea  Ascites may develop on day 2 - 4  Death 2 to 5 days after onset of symptoms  Very difficult to diagnose J.N. Medical College, Belgaum 104
  105. 105.  Microscopy  Blood culture  Serology- Specific Enzyme - Linked Immunosorbent Assays (ELISAs) J.N. Medical College, Belgaum 105
  106. 106. Stained with polychrome methylene blue (M’Fadyean stain). On blood agar, the colony is non-haemolytic J.N. Medical College, Belgaum 106
  107. 107. PLET agar. These are typically ‘”bee’s-eye” J.N. Medical College, Belgaum 107
  108. 108. Anthrax Meningitis :  Haematogenous spread of the pathogen Meningitis - to 100% mortality. J.N. Medical College, Belgaum 108
  109. 109. Inhalational, GI, Sepsis  Ciprofloxacin, 400 mg IV q12h or  Doxycycline, 100 mg IV q12 plus  Clindamycin, 900 mg IV q8h and/or rifampin, 300 mg IV q12h; switch to PO when stable x60 d total J.N. Medical College, Belgaum 109
  110. 110. Cutaneous Anthrax  without systemic signs, extensive edema or lesions located on head and neck.  Initial recommended treatment: Doxycycline 100mg BD or Ciprofloxacin 500mg BD PO for 60 days (Amox 500 mg PO q8h, likely to be effective if strain penicillin sensitive) J.N. Medical College, Belgaum 110
  111. 111. Cutaneous Anthrax  with systemic signs, extensive edema or lesions on the head and neck.  Initial recommended treatment: › Doxycycline or Ciprofloxacin IV › May switch to PO when clinically appropriate J.N. Medical College, Belgaum 111
  112. 112.  Control of the disease in animals  Correct disposal of carcasses of anthrax cases  Proper disinfection, decontamination and disposal of contaminated materials J.N. Medical College, Belgaum 112
  113. 113.  Vaccine › Anthrax Vaccine Adsorpbed (AVA) › Supply- controlled by CDC  Newer vaccines including a plasmid DNA vaccine and vaccines for intranasal use are under development J.N. Medical College, Belgaum 113
  114. 114. Chemoprophylaxis:  Ciprofloxacin or Doxycycline for four weeks for unimmunized individuals.  longer duration - for complete clearance of spores from the lungs J.N. Medical College, Belgaum 114
  115. 115.  Suspicious letters/packages – “Do not X-ray”, “Fragile”, “Confidential” Do not open or shake Place in plastic bag or leakproof container If visibly contaminated or container unavailable Gently cover – paper, clothing, box, trash can Leave room/area, isolate room from others Thoroughly wash hands with soap and water Report to local security / law enforcement J.N. Medical College, Belgaum 115
  116. 116.  NCDC under the Ministry Of Health – Proposed to set up Surveillance system for micro-organisms with bio-terrorism potential J.N. Medical College, Belgaum 116
  117. 117. Single inhalational case is an emergency › Contact Local Health Departments J.N. Medical College, Belgaum 117
  118. 118. 1. Harrison’s Principles of Internal Medicine- 18th edition 2. Goldman Cecil Medicine- 23rd ed. 3. Park’s textbook of Preventive &Social Medicine 22nd edition 4. Text Book of Public Health and Community Medicine- AFMC Pune 5. Leptospirosis – An Overview TK Dutta, M Christopher. 6. Ananthanarayan and Paniker’s Textbook Of Microbiology- 18th edn 7. National Health Programs Of India -J. Kishore’s 11th edn J.N. Medical College, Belgaum 118
  119. 119. 8) Infection Microbiology and Management Barbara Bannister 9) Guidelines for the Surveillance and Control of Anthrax in Human and Animals. 3rd edition 10) Leptospirosis in India and the Rest of the World Rao R. Sambasiva, Gupta Naveen. 11) www.who.org.in 12) www.google.in J.N. Medical College, Belgaum 119
  120. 120. J.N. Medical College, Belgaum 120

×