This document discusses three surface infections - trachoma, tetanus, and leprosy. It describes the causative agents, clinical presentations, and the role of pharmacists in educating people and preventing the spread of these diseases. For each disease, it outlines the bacteria or virus that causes it, how it is transmitted, symptoms, treatment recommendations including antibiotics, immunizations, and importance of hygiene and wound care. The document emphasizes that pharmacists can help prevent these diseases through health education focused on sanitation, immunization, early detection and treatment, and addressing social factors.

1. Surface Infections
Trachoma, Tetanus,
Leprosy
Presented by Miss Sudipta Roy
Associate Professor
East Point College of Pharmacy Bangalore

2. • It is a chronic infectious disease.
• Causative Agent.
• The causative agent is Chlamydia trachomatis. It has
been eleven known serotypes. It primarily causes
conjunctivitis. Eye to eye transmission is possible.
Contamination with ocular discharges of infected
persons or fomites like infected fingers, towels, kajal,
or sruma play a role in spreading the infection. It
tends to be a familiar disease. The incubation period
is 5-12 days.

3. • Clinical Presentation.
• The infection tends to inflammation. The
inflammation may undergo spontaneous resolution
or may progress to conjunctival scarring which can
cause inward deviation of eye lashes, termed as
trichiasis or of the lid margin termed as entropin.
• The aberration of cornea by eye lashes frequently
results in corneal ulceration, followed by scarring and
visual loss. Hence, the disease is termed as ''blinding
trachoma''

4. Role of Pharmacist in Education
and Prevention.
• Chemotherapy is one of the effective intervention. 1% opthalmic
ointment or oily suspension of tetracycline is suggested.
Alternatively, Erythromycin and Rifampicin is recommended. In
long run most of the antibiotic treatment should be carried out by
affected population itself, hence education of population is
needed. Mothers of young children should be the target of health
education.
• Measures of personal and community hugiene should be
incorporated in programmes of health education.
• Safe use of opthalmic solutions to avoid contamination during
handling and maintenance of sterile condition of opthalmic
solutions during storage should be essential components of
health education.
• Tetanus.
• It is an acute disease induced by exotoxin of the infective
organism.

5. • Causative Agent.
• The causative agent is Clostridium tetani. It is gram-positive, anaerobic, spore
bearing organism. The spores are terminal and gove the organism a drum stick
appearance. The spores are highly resistant to a number of injurious agents,
including boiling, phenol, cresol and autoclaving for 15 minutes at 120 degree
centrigrade.
• They germinate under anaerobic conditions and produce a potent exotoxin,
called tetatnospasmin. The spores are best destroyed by steam under pressure
at 120 degree centrigrade for 20 minutes or by gamma radiation. The lethal
dose for a 70 kg man is 0.1 mg. The toxin is water soluble. The natural habitat of
the organism is soil and dust. The bacilli are found in intestine of cattle, horses,
goats, and sheep and are excreted in their faeces.
• The spores survive for years in nature. The bacilli may be found frequently in the
intestine of man without causing ill efffects. The spores are brown about in dust
and may occur in a wide variety of situations, including operation theatres. The
incubation period is usually 6-10 days, however it may be as short as 1 day or as
long as several months. The infection is acquired by contamination of wounds
with tetanus spores.

6. Clinical Presentation.
• It is characterized by muscular rigidity which
persists throughout illness. It is accmpanied by
periodic spasms of voluntary muscles, especially
the lock-jaw muscle, the facial muscles, the
muscles of the back and neck, and those of lower
limbs and abdomen. The mortality is very high,
varying from 40-80%.

7. Role of Pharmacist in Education
and Prevention.
• Tetanus is best prevented by active immunization
with tetanus toxoid. It stimulates the production of
protective antitoxin. Two preparations are available
for active immunization.
• Combined vaccine (DTP):
• Under expanded immunization programme it is a
combined vaccine against Diptheria, Pertusis, and
Tetanus.

8. • Monovalent vaccines.
• 1. Plan or fluid (formal) toxoid.
• It contains detoxified form or only clostridium.
• 2. Tetanus vaccine, adsorbed (PTAP, APT):
• Purified tetanus toxoid (adsorbed) has largely
replaced plain toxoid becuase it stimulates a higher
and long lasting immunity response than plain
toxoid. A primary course of immunization consists
of two doses of tetanus toxoid adsorbed, each dose
of 0.5 ml, injected into the arm at intervals of 1-2
months.

9. • Unlike active immunization, temprary protection
against tetanus can be provided by human tetanus
hyperimmunoglobulin (TIG/ATS). It is the best
prophylactic to use.
• The dose for all ages is 250-500 I.U.
• Whenever there is any injury, it is suugested that all
wounds should be thoroughly cleaned soon after
injury. All foreign bodies, soil, dust and narcotic
tissues should be removed.
• This procedure will abolish anearobic conditions
which favour germination of tetanus spores.

10. • Leprosy.
• Leprosy is also termed as Hanson's disease. It is a chronic
infectious disease. It is widely prevalent in India. The disease
manifests in two polar forms, lepromatous leprosy and
tuberculoid leprosy. Between these polar forms, a borderline and
intermediate form also is expressed depending on the host's
response to infection.
• Causative Agent.
• The causative Agent is Mycobacterium leprae. These are acid-fast
bacteria and occur in the human body and are called as globi.
• They have an affinity for Schwann cells and the
reticuloendoendothelial system.
• They remain dormant in various sites and cause relapse. Nose is a
major portal of exist. The bacilli can also exit through ulcerated or
broken skin. The incubation period is 3-5 years.

11. • Clinical Presentation.
• It is clinically characterized by one of the following
features.
• Hypopigmented patches.
• Partial or total loss of cutaneous sensation in the
affected areas.
• Presence of thickened nerves.
• Presence of acid-fast bacilli in the skin and nasal
smears.

12. • The signs of advanced disease are : presence of
nodules or lumps especially in the skin of the face
and ears, plantar ulcers, loss of fingers or toes,
nasal depression, foot-drop, claw toes and other
deformities.
• Role of pharmacist in education and prevention.
• Leprosy is often termed as a 'social disease'. There
are various social factors which favour spread of
the disease in the community such as poverty and
poverty related circumstances like overcrowding,
poor housing , lack of education and lack of
personal hygiene. The social stigma associated with

13. • Medical measures.
• It is subdivided into several other measures.
• 1. Early case detection.
• The incubation period for the disease is 2-3 years.
Early detection by laboratory diagnosis can help in
starting the treatment early.
• This can limit consequences of the disease like loss
of organs. Contact survey, group survey, and mass
survey are some of the measures of early
detection.

14. • Multi-drug therapy:
• Following drug regimen is recommended by WHO:
• a. Rifampicin: 600 mg, once monthly, under
supervision.
• b. Dapsone: 100 mg daily, self-administered.
• c. Clofazamine: 300 mg once monthly under
supervision and 500 mg daily self administered.
• It is recommended that the therapy should be given
at least for two years.

15. • Surveillance.
• Clinical and bacteriological surveillance of cases
after completion of trearment is necessary. The
patient should be followed up for preventing
relapse.
• Immunoprophylaxis.
• BCG vaccine can provide some protection. Several
alternative vaccines are under development.
• Chemoprophylxis:It is suggested that Dapsone
prophylaxis, at the dose of 1-4 mg/kg per week
gives a reasonable protection in children.

16. • Rehabilitation:
• It is suggested that rehabilitation is an integral part
of leprosy control. It must begin as soon as the
disease id diagnosed. The chapest and surest
rehabilitation is to prevent physical deformities
along with social and vocational disurption by early
diagnosis and adequate treatment.
• Rehabilitation measures are medical, surgical,
social, educational and adequate treatment.
Rehabilitation measures are medical, surgical,
social, educational and vocational-consistently over
years with sustained counselling and health

17. • Health education.
• It should be directed towards the patient and
his/her family as well as general public. In case of
patients and family, poor patient compliance and
high drop out rates is the main issue.
• Consequences of non-compliance resulting into
relapse of disease should be reemphasized. At the
public level, it should be emphasized that it is not a
hereditary disease. It is curable , not all leprosy
patients are infectious. Adequate and regular
treatment can avoid deformity. What patient needs
is sympathy and social support.

18. • Social support.
• Chemotherapy alone is not the only solution.
Following social supports are advised:
• Assistance for travel from to and from clinic.
• Help to needy families in terms of food and clothes.
• Care of chidren and their education.
• Job placement.
• Avoiding social evil of beggary.

19. • Programmes like slum improvement.
• National programme management.
• The National Eradication Programme (NLEP) is a
long term activity. It involves availability of
resources like adequate infrastructure, trained
health personnel, adequate supply of drugs and
vehicles and financial allocation.