Intestinal infection

INTESTINAL INFECTION
DEVIPRIYA P V
M PHARM

CONTENTS
 Poliomyelitis
 Hepatitis
 Cholera.
 Typhoid
 Food poisoning
 Hookworm infection.

POLIOMYELITIS
 Poliomyelitis is an acute viral infection of the
gastrointestinal tract of human beings.
 The virus can infect the central nervous system in some
patients and can produce paralysis in varying degree or
even death.
Causative agent:
 Polio virus (Type 1, 2 and 3 ).
 The virus can survive in water for 4 months and in faeces
for 6 months.
 Inactivated by pasteurization (heat treatment).
 The virus is found in the faeces and oropharyngeal
secretions of infected persons 7 to 10 days before and
after the onset of disease

Mode of transmission:
 Faecal- oral route.
 Spread directly through contaminated fingers or indirectly
through contaminated water, milk, food, flies and other
articles of daily use.
 Another route is droplet infection during the acute phase of
disease when virus is present in the throat
Incubation period:
 The average incubation period is 7 to 14 days ranging from
3 to 35 days.
 Clinical spectrum of the disease:
(a)Inapparent or subclinical infection:
 In 95% of cases there are no presenting symptoms.
(b)Abortive polio or minor illness
 In 4 to 8% cases the infection results only in mild self
limiting illness

(c)Non- paralytic polio
 It occurs in about 1 % of infections.
 The patient feels pain in the neck and back and recovers
within 2 to 10 days.
(d)Paralytic polio
 In less than 1% of infections.
 Virus affect the CNS and produces paralysis.
Prevention of polio:
 Immunization is the only effective method for prevention.
 Oral (Sabin) polio vaccine (OPV) is used for active
immunization.
 It is a live attenuated (activity is reduced) liquid vaccine.
 The vaccine is stored at 4°C

 3 drops of OPV are given orally with each dose of DPT
vaccine at the age of ½ months, 2 ½ months and 3 ½
months.
 Booster dose given at the age of 18 to 24 months.
 One dose of OPV is given (Zero polio) at birth along with
BCG vaccine.
 Eradication of polio:
 The eradication strategy includes the diagnosis of acute
flaccid paralysis cases as early as possible, laboratory
conformation and information to WHO within 48 hours
 Pulse Polio Immunization (PPI) is given for children below
3 years.
 All disease causing virus strains are suppressed and
replaced by vaccine virus strain
 OPV is heat sensitive

 Cold condition is maintained from manufacturing to use.
 Coloured vaccine vial monitors (VVM) are used to know
the potency of vaccine.
 The wrapper of the vial has a blue circle with a white
square in it
 The vaccine is potent till the square remains white.
 When it turns blue and matches with the colour of the
outer circle, the vaccine should be discarded.

 Acute Flaccid Paralysis (AFP) survey is also done.
 If the stool examination is positive for AFP, search for
more cases and stool examination of suspected cases
are done.
 Information is send to WHO immediately.
 Confirmed cases should be examined for residual
paralysis and advised rehabilitation
Acute Flaccid Paralysis (AFP) : Sudden onset of weakness or paralysis
in a previously normal limb over a period of 15 days in a patient aged
less than 15 years

HEPATITIS
HEPATITIS A:
 Infectious hepatitis or epidemic jaundice.
 It is an acute infectious disease of liver which starts with
non specific symptoms like fever chills, headache,
fatigue, generalized weakness and pains followed by
anorexia, nausea, vomiting, dark urine and jaundice
Causative agent:
 Hepatitis A virus (HAV) (an enterovirus of picornaviridae
family).
 It multiplies in hepatocytes (liver cells).
 The virus is found in abundance in faeces of the patient
during early acute phase of the disease and later part of
the incubation period

Mode of transmission
(a) Faecal or oral route:
 It is the major route of transmission.
 Transmitted directly from person to person or indirectly by
using contaminated water, milk or food.
(b) Parenteral route:
 Through needles, blood or blood products
(c) Sexual transmission:
 Mainly among the homosexual man
Incubation period:
 Usually 25 to 30 days ranging from 15 to 45 days

Prevention:
 The spread can be reduced by promoting personal and
community hygiene such as hand washing after toilet and
before meals, sanitary disposal of excreta, safe water
supply and proper sterilization of needles and syringes.
 Gamma globulins given exposure to virus or early during
the incubation period will prevent or attenuate a clinical
illness
 4 inactivated Hepatitis A vaccines are now available.
 2 doses are recommended at an interval of 6 to 18 months
 A combined vaccine containing inactivated Hepatitis A and
recombinant Hepatitis B vaccines is also available (total 3
doses- zero, one and six months)
 it is contraindicated in children below one year

HEPATITIS B:
 Serum Hepatitis
Causative agent:
 Hepatitis B virus (HBV)
 It is a complex 42 nm double shelled DNA virus .
 Three morphological forms of HBV are found in serum
 (a)Small spherical particles of diameter 22nm stimulates
production of antibodies.
 (b) Tubules of varying size
 (c) Dane particles which correspond morphologically to HBV
(a)Parenteral route:
 Blood borne infection transmitted by infected blood and blood
products through transfusion, dialysis, contaminated syringes
and needles, pricks of skin, ear or nose piercing etc

(b) Parenteral transmission:
 From carrier mother to babies
(c)Sexual transmission:
 Common in male homosexuals.
(d)Other routes:
 Transmission by blood sucking arthropods like mosquitoes
and bed bugs.
Incubation period:
 45 to 180 days
Clinical features:
 Signs and symptoms similar to viral hepatitis.
 Infection is followed by chronic liver disease which can
further progress to primary liver cancer

Prevention:
 There is no specific treatment for viral hepatitis
(a)Hepatitis B vaccine
 Formalin inactivated sub unit viral vaccine for intramuscular use.
 Given in 3 doses of 1 ml each (0.5 ml in children below 10 years).
 Second dose given one month after first dose.
 Third or booster dose is given 6 months after first dose
(b)Hepatitis B immunoglobulin(HBIg)
 Given immediately after accidental inoculation withih 6 to 48 hours.
 2 doses given in an interval of one month , contains 0.05 to 0.07 ml of
HBIg / kg body weight
 It produces passive immunity and provide protection for 3 months
(c)Passive active immunization:
 Simultaneous use of HBIg and hepatitis B vaccine
(d)Other measures.
 All blood donors should be screened for HBV infection
 Use only sterilized needles and surgical instruments.
 Carriers should not use the shaving brush or razor of other persons

DELTA HEPATITIS:
 Occurs in association with hepatitis B infection.
 Mode of transmission and control are identical to hepatitis
B
 Immunization against hepatitis B also protects Delta
hepatitis
HEPATITIS NON-A, NON-B (HNA, NB):
 Hepatitis which is not caused by agents that are not
related serologically to HAV or HBV.
 Diagnosis of HNA NB is made by the absence of both HAV
IgM and HBV IgM.
 Hepatitis virus C is transmitted parentrally
 Hepatitis virus E is transmitted through water

CHOLERA
 Cholera is an acute diarrheal disease.
Causative agent:
 Vibrio cholera 0 group or Vibrio cholera 01
 Faecally contaminated water, contaminated food and
drinks or by direct contact (through contaminated fingers)
Incubation period:
 1 to 2 days ranging from few hours to 5 days

Prevention and control:
 Based on the “ Guidelines of Cholera Control” by WHO
a) Verification of the diagnosis: investigate all cases of
diarrhoea for the presence of V. cholera in stool
b) Notification: notify the cases to the local authority for
action and further transmission of information
c) Early case finding: early detection is important for
treatment and prevention
d) Establishment of treatment centres: to avoid delay in
treatment
Rehydration therapy:
 By oral or intravenous
Sodium chloride 3.5 gms
Sodium bicarbonate 2.5 gms
Potassium chloride 1.5 gms
Glucose(Dextrose) 20 gms
Portable water 1 litre

 Instead of sodium bicarbonate, trisodium citrate dihydrate
is used to make more stable product.
 A simple mixture of table salt (10 gm) and sugar (40 gm) is
dissolved in 1 litre of water and given to patient in absence
of rehydration solution
Intravenous rehydration therapy:
 For patients who are unable to drink
 Ringer’s lactate is used (Dose- 110 ml/kg body weight)
Adjuncts to therapy:
 Tetracycline 500 mg 4 times a day for 3 days
Vaccination:
 Cholera vaccine is a suspension of killed vibrios preserved
in phenol.

 For primary immunization 2 doses (each of 0.5 ml) are
given subcutaneously at an interval of 4 to 6 weeks.
 Booster doses are recommended every 6 months.
 2 types of oral cholera vaccines are also available.
(1) Live attenuated single dose vaccine
(2) Combination of cholera vibrio with a recombinant B
subunit of cholera toxin.
 2 oral doses of the vaccine are given 10 to 14 days apart
Other measures:
 Sanitation measures (water control, excreta disposal,
food sanitation and disinfection)
 Health education etc

TYPHOID
 Typhoid fever is characterized by a continuous fever for 3 to 4
weeks, relative bradycardia, with involvement of lymphoid
tissue and constitutional symptoms.
Causative agent:
 Salmonella typhi
 Salmonella paratyphi A and Salmonella paratyphi B can also
cause the disease.
 Transmitted through faecal- oral route or urine-oral route.
 Direct transmission through contaminated hands or fingers is
also possible.
 Indirect transmission occurs by ingestion of contaminated
water, milk or food or through flies

Prevention:
 Prevention is done by control of reservoir, control of sanitation and by
immunization.
 Immunization against typhoid is done by anti-typhoid vaccine .
 TAB vaccine is used in India
 TAB vaccine contains Salmonella typhi(1000 million), Salmonella
paratyphi A (500 to 750 million)and Salmonella paratyphi B (500 to
750 million) organisms per ml.
 Primary immunization is done by given subcutaneously 2 dose each of
0.5 ml at an interval of 4-6 weeks.
 Booster dose are needed every 3 years.
 Oral typhoid vaccine:
 Live attenuated oral typhoid is also available in capsule for children
above 6 years and adults.
 Capsules are ingested on days 1, 3 and 5.
 Provide immunity for 3 years, so booster dose is needed after 3 years

FOOD POISONING
 Food poisoning is an acute gastroenteritis caused by ingestion of
food or drink contaminated either with bacteria or other toxins
or inorganic substances and poisons derived from plants and
animals.
 Disease is characterized by ingestion of common food, attack of
many person at the same time
Types of food poisoning:
 Non bacterial and Bacterial.
 Non bacterial is caused by chemicals such as fertilizers,
pesticides, cadmium, mercury etc
 The Bacterial food poisoning is caused by the ingestion of food
contaminated by living bacteria or their toxins

 The bacterial food poisoning can be Salmonella food poisoning,
Staphylococcal food poisoning , Botulism (caused by exotoxin of
Clostridium botulinum), Clostridium perfringens food poisoning
and Bacillus cereus food poisoning.
Prevention and control:
(1)Food sanitation
(2)Refrigeration
(3)Surveillance.
Food sanitation:
 This include inspection of food and of food animals.
 The animals should be free from infections.
 Personal hygiene of individuals involved I handling, preparation
and cooking of food need care.
 Milk and milk products should be pasteurised (heat treatment)
 Foods handlers must be educated in matters of clean habits and
personal hygiene

Refrigeration:
 Proper temperature control is needed.
 Food should be kept in warm pantries to avoid the
multiplication of bacteria.
 Cook and eat the same day can avoid food poisoning.
 Cold is bacteriostatic at temperature below 4°C
 Food stored at 4°C to 40°C is in the danger zone of bacterial
growth
Surveillance:
 Food samples must be obtained from the food establishments
periodically for laboratory analysis

HOOKWORM INFECTION
(ANCYLOSTOMIASIS)
 Hookworm infection is the infection caused by Ancylostoma
duodenate or Necator americans.
 Mixed infection can occur in the same person
Causative agent:
 The adult worm lives in the jejunum where they attach themselves
to the villi.
 Length of male worm is 8 to 10 mm and that of female is 10 to 13
mm.
 The egg is thin shelled and oval.
 2 to 8 lobes may be seen in the yolk of eggs.
 Eggs are passed n the faeces in thousands

 In warm moist soil the larvae develop and reach the filariform
infective stage.
 These larvae enter the body by penetrating the skin.
 After entering the blood via skin the larvae are carried to the lungs.
 Fro their they ascend the alveoli and are swallowed and develop in
the small intestine.
 They reach maturity in 4 to 7 weeks after infection.
 The larvae can also enter directly into the intestine by ingestion of
fruits and vegetables contaminated by them.
 Man is the only host for this worm
Effect of the disease:
 The infection results into abdominal pain and iron deficiency
anaemia

Prevention:
 Prevention is done by sanitary disposal of faeces, chemotherapy,
correction of anaemia and by giving health education.
Chemotherapy:
 Several effective drugs are used:
1. Mebendazole: 100 mg dose orally twice a day for 3 days
2. Albendazole: single dose of 400 mg
3. Pyrantal :single dose of 10 mg/kg body weight for 3 days.
 For treatment of anaemia, ferrous sulphate 200 mg is given orally
3 times a day for 3 months

Intestinal infection

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