Preventing and Managing

Common Communicable and

Neglected Tropical Diseases

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1.1. Definition of communicable diseases:
• It is an infectious disease caused by microorganism and
transmitted from one individual to another either directly
by contact or indirectly by fumets and vectors.

• It is an illness caused by transmission of a specific agent

or its toxic products from an infected person or animal to
a susceptible host either directly or indirectly through an
intermediate animal host or inanimate environment.

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 Definition…
Burden due to communicable disease
heavy mortality
disability
economic loss to the country.
• Health workers have an important role to play in the control
of these diseases by applying effective and efficient
management, prevention and control measures.
• Health workers need to be equipped with capacity to target
CD for eradication
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 Natural history of communicable diseases
• The natural history of disease has four classical stages.
1.Stage of susceptibility of exposure:
 Disease has not develop, but there are factors that favor
occurrence
2. Stage of sub clinical disease (pre symptomatic
stage) – the disease process has already begun, but the
disease is not manifested.
3. Stage of clinical disease: S & S of the disease are
manifested
4. Stage of disability or death: the disease has occurred
and left over damage to the body that limits the activity of the
victim (disability) or has ended with the death of the victim.
• N.B. recovery can take place at any stage in the course of
the disease.
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 Natural history…
• Causal concepts of disease

• A cause of a disease can be a factor (characteristic,

behavior, event) that influences the occurrence of disease.

• Almost always no one cause acts alone, but different

factors act in a combined manner.

• If disease does not develop without the factor being

present, then we term the causative factor "necessary".

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 Natural history…
• The epidemiologic triad or triangle of infectious disease causation.

Agent

Host Environment

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 Natural history…
• Course of an infectious disease over time
 Infectivity:- the ability of an agent to cause infection to
susceptible host.
 Can be measured by infection rate.
• Infection rate= total number of infected people ×100
Total number of susceptible people exposed
 Pathogenicity:- the ability of microorganism to induce disease,
 it is measured by the proportion of infections that result in
clinically apparent diseases
 Pathogenicity = Total number of clinical cases
Total number of sub clinical cases
 Virulence:- the ability to cause severe outcome of the disease.
 Resistance:-the ability of the agent to survive adverse
environmental conditions during transmission from one to another.
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 Natural history…
Course of an infectious disease over time
• Incubation period: The time interval between infection and the
first clinical manifestation of disease,
• Communicable period: the period during which an infected
host can transmit the infection to others
• Generation time: is the period between the onset of infection in
a host and the maximal communicability of that host.
• The maximal communicability may be during or after the
incubation period.
• Latent period: the time interval between recovery and the
occurrence of a relapse or reconsiders
• Carriers-an infected person without manifestation of disease but
capable of transmitting to others.
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 Natural history…
• Epidemic (out break) -the occurrence of a specific disease
more than or in excess of expected number in a given area
or among a specific group of people over a specified period.
• Endemic - the constant presence of a disease or infectious
agent with a given geographic area or population group; may
also refer to the usual prevalence of a given disease with in such
area or group.
• Sporadic is a disease that occurs infrequently and irregularly.
• Pandemic is an endemic occurring over a very wide area
(several countries or continents) and usually affecting a large
proportion of the population.
• Cluster is an aggregation/accumulation of cases in a given
area over a particular period without regard to whether the
number of cases is more than expected.
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 Natural history…
• Types of epidemic
1.Common source- exposure of a group of susceptible persons
to a common source of pathogenic organisms or chemicals
 Point source (one exposure)-a single exposure of a
population group to the agent. E.g. a food borne epidemic
 Continuous (exposure uninterrupted)- repeated multiple
or continued exposure over a period of time
2. Propagated (contagious)-in which an organism is
propagated in the community by passage from person to
person or it can involve complex cycle
 Serial transfer of infection
3. Mixed epidemic - begins with a single common source of
infectious agent with subsequent propagative spread
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Disease Prevention and control of communicable diseases

Levels of prevention
1. Primary prevention: protection of healthy people from
becoming sick by altering susceptibility or reducing exposure for
susceptible individuals.
 The objectives are health promotion, prevention of exposure
and prevention of disease.
Health promotion: consists of general non specific intervention
that enhances health./aim to improve socio economic,
organizational, behavioral and related factors.
Prevention of exposure: provision of safe and adequate water,
proper excreta disposal, vector control.
Prevention of disease: takes place between exposure and
biological onset. E.g. immunization. breast feeding
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Disease Prevention and control of communicable diseases

2. Secondary prevention:
 Early detection and prompt treatment of disease.
 Possible to cure disease or slow its progression,
 Prevent complications, limit disabilities, and reverse
communicability of infectious disease.
3. Tertiary prevention: after permanent damage has set in.
Limitation of disability and rehabilitation or left residual
damage.
Tertiary prevention have two aims.
 Treatment to prevent further disability and death.
 New training and special education to restore the patient to
some useful work and life in the community. Eg. early
physiotherapy to an affected limb, special education/training e
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Goals and principles of communicable disease control and
prevention

• Goals

Eradication: reducing the incidence to zero level

Elimination: Reducing the incidence of disease to

zero level in specified geographic areas.

Control: reducing the incidence to the level where the

disease is no more of public health importance.

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 Chain of Disease Transmission
Factors involved in the chain of disease transmission

Infectious agent (etiology or causative agent)

Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host

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 1.Infectious agent
An organism that is capable of producing infection or
infectious disease.
Classification based on their size and etiology
Metazoan multicellular organisms). (E.g. Helminthes).
Protozoa (Unicellular organisms) (e.g. Amoeba)
Bacteria (e.g. Treponema palladium, M. tuberculosis,
Fungus (e.g. Candida albicans)
Virus (e.g. Chickenpox, polio, etc.)
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 2.Reservoir of infection
• Any person, animal, arthropod, plant, soil or substance (or
combination of these) in which an infectious agent normally lives
and multiplies,
• Types of reservoirs
1. Man: pathogens that are specifically adapted to man
 The cycle of transmission is from human to human.
2. Animals: Some infective agents that affect man have their
reservoir in animals.
 “zoonosis” -disease transmission from animals to man under
natural conditions.
 For example:
 Bovine tuberculosis - cow to man
 Brucellosis - Cows, pigs and goats to man
 Anthrax - Cattle, sheep, goats, horses to man
 Rabies - Dogs, foxesCDand
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 Reservoir…
3. Non-living things : Many of the agents are basically
saprophytes living in soil and fully adapted to live freely in
nature.
• Biologically, they are usually equipped to withstand marked
environmental changes in temperature and humidity.
• E.g. Clostridium botulinum -etiologic agent of Botulism
• Clostridium tetani -etiologic agent of Tetanus
• Clostridium welchi -etiologic agent of gas gangrene

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3.Portal of exit (mode of escape from the reservoir)
• The site through which the agent escapes from the
reservoir.

• GIT: typhoid fever, bacillary dysentery, amoebic

dysentery, cholera, ascariasis, etc.

• Respiratory: tuberculosis, common cold, etc.

• Skin and mucus membranes: Syphilis

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4.Mode of transmission
The mechanisms by which an infectious agent is
transferred from one person to another or from a
reservoir to a new host.
This may be direct or indirect.
1. Direct transmission: transfer of infectious agents
from an infected host or reservoir to an appropriate portal
of entry.
a. Direct Vertical : Trans placental transmission of
syphilis, HIV, etc.
b. Direct horizontal;- Direct touching, biting, kissing,
sexual intercourse, droplet spread onto the mucus
membrane during sneezing coughing, spitting or talking
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 Mode of transmission…
2. Indirect transmission

a. Vehicle-borne transmission: Indirect contact

through contaminated inanimate objects (fomites) like:

• Bedding, toys, handkerchiefs, soiled clothes, cooking or

eating utensils, surgical instruments.

• Contaminated food and water

• Biological products like blood, serum, plasma or IV-fluids

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 Mode of transmission…
b. Vector-borne transmission: the infectious agent is
conveyed by an arthropod (insect) to a susceptible host

1. Mechanical transmission: The arthropod transports the

agent by soiling its feet or proboscis
 multiplication of the agent in the vector does not occur.
(E.g. common house fly.)

2.Biological transmission: The agent multiplies in the

arthropod before it is transmitted, such as the transmission
of malaria by mosquito.
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 Mode of transmission…
C. Air-borne transmission: Dissemination of microbial
agent by air to a suitable portal of entry, usually the
respiratory tract.
Two types of particles
Dust: small infectious particles arise from soil,
clothes, bedding or contaminated floors and be
suspended by air currents.
Droplet nuclei: Small residues resulting from
evaporation of fluid (droplets emitted by an infected
host).
• They usually remain suspended in the air for long
periods of time
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 5. Portal of entry
• The site in which the infectious agent enters to the
susceptible host.
 Mucus membrane
 Skin
 Respiratory tract
 GIT
 Blood

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 6.Susceptible host (host factors)
 A person or animal lacking sufficient resistance to a particular
pathogenic agent to prevent disease if or when exposed.
 Immunity- is the ability of the host to resist infection.
 Resistance to infection is determined by non-specific and specific
factors:
 Non-specific factors - Skin and mucus membrane, Mucus, tears,
gastric secretion Reflex responses such as coughing and sneezing.
 Specific factors -Genetic-hemoglobin resistant to some specific
infections naturally acquired or artificially induced immunity.
• Acquired immunity may be active or passive.
• Active immunity- acquired following actual infection or
immunization.
• Passive immunity- pre-formed antibodies given to the host.
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 Carrier and its type
• A carrier is an infected person or animal who does not have
apparent clinical disease but is a potential source of infection
to others.
A. Healthy or asymptomatic carriers: the infection
remains unapparent. Eg polio virus ,Hepatitis virus
B. Incubatory or precocious carriers: individuals or
persons excrete the pathogen during the incubation period
(Measles etc)
C. Convalescent Carriers: who continue to harbor the
infective agent after recovering from the illness. Eg diphteria,
Hep-B
D. Chronic Carriers: The carrier state persists for a long
period of time. E.g. Typhoid fever, Hepatitis B virus infection
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 Time Course of Infectious Diseases
• Incubation period: It is the interval of time between infection
of the host and the first appearance of symptoms and signs of the
disease
• Prodromal period: It is the interval between the onset of
symptoms of an infectious disease and the appearance of
characteristic manifestations. Eg, in a measles patient, from fever
and coryza to skin lesions appearance on the fourth day.
• Period of communicability: The period during which that
particular communicable disease (infectious agent) is transmitted
from the infected person to the susceptible host.

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 Oral-fecal transmitted diseases
• Common causative organisms are excreted in the stools
of infected persons (or, rarely, animals).
• The portal of entry for these diseases is the mouth
• Oral-fecal transmission occurs mostly through
unapparent fecal contamination of food, water and
hands
• The five “F” s which play an important role in fecal oral
diseases transmission (finger, flies, food, fomites
and fluid)
• The diseases in this group are mainly transmitted
through fecal contaminated water rather than food.

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 1.Feces Mainly in water
1.1 Typhoid fever
A systemic infectious disease characterized by high continuous
fever, malaise and involvement of lymphoid tissues.
 Infectious agent; -Salmonella typhi, Salmonella enteritis
(rare cause)
 Epidemiology Occurrence- It occurs worldwide,
particularly in poor socio- economic areas.
• In endemic areas the disease is most common in preschool
and school aged children (5-19 years of age).
 Reservoir- Humans
 Mode of transmission- By water and food contaminated by
feces and urine of patients and carriers.
• Flies may infect foods in which the organisms then multiply
to achieve an infective dose.
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 Typhoid fever…
 Incubation period –1-3 weeks
 Period of communicability- As long as the bacilli appear in excreta,
usually from the first week throughout convalescence.
 About 10% of untreated pt discharge bacilli for 3 months after onset
of symptoms, and 2%-5% become chronic carriers.
 Susceptibility and resistance- increased in individuals with gastric
achlorhydria and HIV positive.
 Clinical manifestation
 1st week fever rising stepwise (ladder type),anorexia, lethargy, malaise
and general aches.
 2nd week- Sustained temperature (fever). Severe illness with
weakness, mental dullness or delirium, abdominal discomfort and
distension. Diarrhea is more common than first week and feces may
contain blood.
 3rd week- continues to be febrile and increasingly exhausted. If no
complications occur, patient begins to improve and temperature
decreases gradually.
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 Typhoid fever…
• Treatment

ciprofloxacin, ceftriaxone
• Prevention and control
Treatment of patients and carriers
Education on hand washing, particularly food handlers,
patients and childcare givers
Sanitary disposal of feces and control of flies.
Provision of safe and adequate water
Safe handling of food
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 1.2 Bacillary Dysentery (Shigellosis)
• Definition;- An acute bacterial disease involving the large and distal
small intestine, caused by the bacteria of the genus shigella.
• Infectious agent -Shigella is comprised of four species or serotypes.

Group A= Shigella dysenteries (most common cause)

Group B= Shigella flexneri
Group C= Shigella boydii
Group D= Shigella sonnei

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 Bacillary Dysentery…
• Epidemiology- It occurs worldwide, and is endemic in both
tropical and temperate climates. Outbreaks common in crowding
and where poor personal hygiene is such as in jails, institutions for
children, day care centers, mental hospitals and refugee camps.
• Two-thirds of the cases, and most of the deaths, are in children
under 10 years of age.
• Reservoir- Humans
• Mode of transmission-by direct or indirect fecal-oral
transmission
• Incubation period- 12 hours-4 days (usually 1-3 days)
• Period of communicability- During acute infection and until the
infectious agent is no longer present in feces, usually within four
weeks after illness.
• Susceptibility and resistance-general community but more
severe in young children, the elderly and the malnourished.
Breast-feeding is protective for CD
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 Bacillary Dysentery…
• Clinical Manifestation
• Clinical Manifestation
 Fever, rapid pulse, vomiting and abdominal cramp are
prominent.
 Diarrhea usually appears after 48 hours with dysentery
supervening two days later.
 Generalized abdominal tenderness.
 Tenesmus is present and feces are bloody, mucoid and of small
quantity.
• Dehydration is common and dangerous - it may cause muscular
cramp, oliguria and shock
• Diagnosis
 Based on clinical grounds
 Stool microscopy (presence of pus cells)
 Stool culture confirms the diagnosis
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 Bacillary Dysentery…
• Treatment
1. Fluid and electrolyte replacement
2. Co-trimoxazole in severe cases or Nalidixic acid in the
case of resistance.
• Prevention and control
 Detection of carriers and treatment of the sick will
interrupt an epidemic.
 Hand washing after toilet and before handling or eating
food
 Proper excreta disposal especially from patients,
convalescent and carriers.
 Adequate and safe water supply.
 Control of flies.
 Cleanliness in food handling and preparation
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 1.3 Amoebiasis (Amoebic Dysentery)
• Definition ;- A protozoan parasite infection that causes
intestinal or extra-intestinal disease.
• Infectious agent -Entamoeba histolytic
• Epidemiology & Occurrence- worldwide but most
common in the tropics and sub-tropics.
• Prevalent in areas with poor sanitation, in mental
institutions and homosexuals.
• mostly a disease of adults and rare below 5 years of
age, especially below 2 years.
• Mode of transmission – Fecal-oral transmission by
ingestion of food or water contaminated by feces
containing the cyst..

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 Amoebiasis…
• Incubation period-few days to several months or years;
commonly 2-4 weeks.
• Period of communicability- During the passing cysts of E.
histolytica, which may continue for years
• Susceptibility and resistance- Susceptibility is general.
• Clinical Manifestation
 diarrhea, abdominal cramps, nausea, vomiting and Tenesmus.
 With dysentery, feces are generally watery, containing mucus
and blood.
• Diagnosis - E. histolytica cyst or trophozoite in stool.
• Treatment - Metronidazole or Tinidazole
• Prevention and control
Adequate treatment of cases
Provision of safe drinking water
Proper disposal of human excreta (feces) and hand washing
following defecation.
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 1.4 Giardiasis
• A protozoan infection of the upper small intestine

• Infectious agent- Giardia lamblia

• Epidemiology & Occurrence- Worldwide

distribution.
Children are more affected than adults.
The disease is highly prevalent in areas of poor
sanitation
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 Giardiasis…
• Reservoir- Humans
• Mode of transmission- feco-oral transmission of cysts
from feces of an infected individual
• Period of communicability- Entire period of infection,
often months.
• Susceptibility and resistance-
Asymptomatic carrier rate is high.
Infection is frequently self-limited.
Persons with AIDS may have more serious and
prolonged infection.
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 Giardiasis…
Life cycle and transmission
1. Cysts ingested in food, water or from hands
contaminated with feces
Human host
2. Cysts excyst, forming trophozoite
3. Multiply in intestine
4. Trophozoite encysts.
5. Infective cysts passed in feces. * * trophozoite passed
in feces disintegrate.

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 Giardiasis…
Environment
6. Feces containing infective cysts contaminate the
environment.
Clinical Manifestation
• Ranges from asymptomatic infection to severe failure to
thrive and mal-absorption
• chronic diarrhea, steatorrhea abdominal cramps, bloating,
frequent loose and pale greasy stools, fatigue and weight
loss
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 Giardiasis…
• Diagnosis
 Demonstration of Giardia lamblia cyst or trophozoite in
feces.
• Treatment
 Metronidazole or Tinidazole
• Prevention and control
1. Good personal hygiene
2. Sanitary disposal of feces
3. Protection of public water supply from contamination of
feces
4. Case treatment
5. Safe water supply
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 1.5. Cholera
• An acute illness caused by an enterotoxin of vibrio cholerae.
• Infectious agent; - Vibrio cholera
Epidemiology and Occurrence-
• periodic outbreaks in different parts of the world and given
rise to pandemics.
• Endemic predominantly in children.
Reservoir- Humans
Mode of transmission- ingestion of contaminated . food or
water with feces or vomitus
Incubation period- from a few hours to 5 days, usually 2-3
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 Cholera…

Period of communicability- for the duration of the

stool positive stage, usually only a few days after
recovery.
• Antibiotics shorten the period of communicability
Susceptibility and resistance- Variable. Gastric
achlorhydria increases risk of illness.
• Breast-fed infants are protected

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 Cholera…
Clinical Manifestation
 Abrupt painless watery diarrhea; the diarrhea looks like
rice water.
 In severe cases-shock due to dehydration, cyanosis,
sunken eyes and cheeks, scaphoid abdomen, poor skin
turgor, and thread or absent pulse.
 Loss of fluid continues for 1-7 days.
Diagnosis
• Based on clinical grounds
• Culture (stool) confirmation

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 Cholera…
Treatment
1. Prompt replacement of fluids and electrolytes
 Rapid IV infusions of large amounts
 Isotonic saline solutions alternating with isotonic
sodium bicarbonate or sodium lactate.
2. Antibiotics like tetracycline dramatically reduce the
duration and volume of diarrhea resulting in early
eradication of vibrio cholera.
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 Cholera…
Prevention and control
1. Case treatment
2. Safe disposal of human excreta and control of flies
3. Safe public water supply
4. Hand washing and sanitary handling of food
5. Control and management of contact cases

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 1.6. Infectious hepatitis
• An acute viral disease characterized by abrupt onset of
fever, malaise, anorexia, nausea and abdominal
discomfort followed within a few days by jaundice
• The most common form of acute hepatitis is caused by
HV (A,B,C,D,E,G )
• HDV is an incomplete RNA virus and requires the
presence of HBV to cause infection.
• Transmission- Person to person by fecal-oral route
• HAV and HEV - feaco-oral. (water and food borne)
• HBV- parenteral (blood and blood products, contaminated
needles), sexual contacts and perinatal route.
• HBV found in all body fluids and excreta.
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 Hepatitis…
• Like HBV, HCV is largely transmitted parenterally.
• It is the main cause of post transfusion hepatitis, but
less frequently through the sexual and perinatal routes
• Incubation period- 15-55 days, average 28-30 days
• Period of communicability- High during the later half
of the incubation period and continuing for few days
following onset of jaundice.
 Most cases are non-infectious following first week of
jaundice.
• Susceptibility and resistance- general. Life long
Immunity probably following infection.

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 Hepatitis…
• Clinical manifestation
• The prodromal phase lasts for several days -malaise,
fatigue, anorexia, nausea, vomiting, myalgia & headache.
• Arthritis and urticaria may be present particularly in HBV
• Jaundice appears late, usually when the patients start to
improve in their sense of well being.
• Dark urine and pale stool is common in cholestasis
• The liver is usually tender and enlarged, and
splenomegaly occurs in 20% of the cases.

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 Hepatitis…
• Diagnosis ;-
 Based on clinical and epidemiological grounds
 Demonstration of IgM (IgM anti-HAV) in the serum of
acutely or recently ill patients.
 Liver enzymes and Antigens

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 Hepatitis…
• Treatment
• Symptomatic: Rest, high carbohydrate diet with low fat and
protein.
• Prevention and control
1. Promote good sanitation and personal hygiene, with special
emphasis on careful hand washing and sanitary disposal of
feces.
2.Proper water treatment and distribution systems and sewage
disposal.
3.Proper management of day care centers to minimize
possibility of fecal-oral transmission.
4.Provide vaccine for all travelers to intermediate or highly
endemic areas and health care workers and day care centers’
employees
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 2. Feces Mainly in Soil
Mainly transmitted through fecal contamination of soil
2.1. Ascariasis- A helminthic infection of the small intestine
generally associated with few or no symptoms.
Infectious agent ;-Ascaris lumbricoides.
Epidemiology & Occurrence
 The most common parasite of humans where sanitation is
poor.
 School children (5-10 years of age) are most affected.
 Highly prevalent in moist tropical countries
Reservoir-Humans; ascarid eggs in soil.
Mode of transmission- Ingestion of infective eggs from
contaminate soil or uncooked food but not directly from
person to person or from fresh feces.
Incubation period- 4-8 weeks
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 Ascariasis…
• Period of communicability- As long as mature fertilized
female worms live in the intestine.
• Usual life span of the adult worm is 12 months
• Susceptibility and resistance- Susceptibility is general
Life Cycle
1. Infective eggs ingested in food or from contaminated
hands
2. Larvae hatch and migrate through liver and lungs.
3. Pass up trachea and are swallowed
4. Become mature worms in small intestine
5. Eggs produced and passed in feces.
6. Eggs become infective (embrocated) in soil in 30-40 days.
7. Infective eggs contaminate the environment.
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 Ascariasis…
• Clinical Manifestation
 Asymptomatic until large worm is passed in feces and
occasionally the mouth and nose.
 Itching, wheezing and dyspnea, fever, cough productive of
bloody sputum due to migrating larvae
 Abdominal pain may arise from intestinal or duct (biliary,
pancreatic) obstruction.
 Serious complications like bowel obstruction due to
knotted/intertwined worms.
• Diagnosis;-
 Microscopic identification of eggs in a stool sample
 Adult worms passed from anus, mouth or nose.
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 Ascariasis…
• Treatment
1. Albendazole or
2. Mebendazole or
3. Piperazine or
4. Levamisole
• Prevention and control
Treatment of cases
Sanitary disposal of feces
Prevent soil contamination in areas where
children play
Promote good personal hygiene (hand washing).

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 2.2.Trichuriasis
• A nematode infection of the large intestine, usually
asymptomatic in nature
• Infectious agent ;- Trichuriasis trichuria (whip worm)
• Epidemiology and Occurrence- Worldwide, especially in
warm moist regions.
 Common in children 3-11 years of age.
• Reservoir- Humans
• Mode of transmission- Indirect, ingestion of contaminated
vegetables.
Not immediately transmissible from person to person.
• Incubation period- Indefinite, /unspecified
• Period of communicability- Several years in untreated
carriers.
• Susceptibility and resistance- Susceptibility is universal
3/31/2025 CD and NTD KGY 2024 56
 Trichuriasis…
• Life Cycle
1. Infective eggs ingested in food or from contaminated hand
2. Larvae hatch, develop in small intestine and migrate to
caecum.
3. Become mature worms.
4. Eggs produced and passed in feces.
6. Eggs become infective (embryonated) in soil after 3 weeks.
7. Infective eggs contaminate the environment
• Clinical manifestation
 Most infected people are asymptomatic.
 Abdominal pain, tiredness, nausea and vomiting, diarrhea or
constipation
 Rectal prolapse may occur in heavily infected very young
children
3/31/2025 CD and NTD KGY 2024 57
 Trichuriasis…
• Diagnosis
 Demonstration of eggs in feces.
• Treatment
Albendazole or Mebendazole
• Prevention and control
Sanitary disposal of feces
Maintaining good personal hygiene
Washing vegetables and other soil contaminated foods)
Cutting nails especially in children
Treatment of cases

3/31/2025 CD and NTD KGY 2024 58

 2.3 Entrobiasis (Oxyuriasis, pinworm)
• A common intestinal helminthic infection that is often
asymptomatic.
• Infectious agent;- Entrobius vermicularis
• Epidemiology and Occurrence-
Worldwide, affecting all socio-economic classes with high
rates in some areas.
Prevalence is highest in preschool and school-aged children.
• Reservoir- Human
• Mode of transmission- Directly from anus to mouth of the
same or another person
indirectly through clothing, bedding, food or other articles
contaminated with eggs of the parasite.
• Incubation period- 2-6 weeks
3/31/2025 CD and NTD KGY 2024 59
 Entrobiasis…
• Period of communicability-
As long as gravid females are discharging eggs on
perianal skin.
Eggs remain infective in an indoor environment for
about 2 weeks.
• Susceptibility and resistance- universal.
• Clinical manifestation
 Perianal itching disturbed sleep,
 irritability and sometimes secondary infection of the
scratched skin.
• Diagnosis
Stool microscopy for eggs or female worms
3/31/2025 CD and NTD KGY 2024 60
 Entrobiasis…
• Treatment
1. Mebendazole.
• Prevention and control
Hygiene (hand washing before eating or preparing food,
keeping nails short and discourage nail biting).
Treatment of cases
Reduce overcrowding in living accommodations.
Provide adequate toilets

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 2.4.Strongyloidiasis
• An often asymptomatic helminthic infection of the duodenum
and upper jejunum.
• Infectious agent;- Strongyloidiasis stercolaris
• Epidemiology and Occurrence- More common in warm
and wet regions of tropical and temperate areas.
• Reservoir- Human
• Mode of transmission-Infective (filariform) larvae penetrate
the skin and enter the venous circulation.
• Incubation period- 2-4 weeks (from skin penetration up to
larvae appear in the feces).
• Period of communicability- As long as living worms
remain in the intestine; up to 35 years in cases of auto-
infection.
3/31/2025 CD and NTD KGY 2024 62
 Strongyloidiasis…
• Susceptibility and resistance-universal.
 Patients with AIDS or on immuno-suppressive medication are
at risk of dissemination
• Life Cycle
1. Infective filariform larvae penetrate skin, e.g. feet. Autoinfection
also occurs
2. Larvae migrate, pass up trachea and are swallowed.
3. Become mature worms in small intestine
4. Eggs laid. Hatch Rhabditiform larvae in intestine.

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 Strongyloidiasis…
5. Rhabditiform larvae - Passed in feces, or
- Become filariform larvae in intestine, causing
autoinfection
6. In soil larvae become free living worms produce more
Rhabditiform larvae
7. Become infective filariform larvae in the soil

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 Strongyloidiasis…
• Clinical Manifestation
 Pneumonia occurs during heavy larval migration.
 Mild peptic ulcer like epigastric discomfort to severe watery
diarrhea.
 Heavy infection may result in malabsorption syndrome.
• Diagnosis
 Identification of larvae in stool specimen
• Treatment
1. Albendazole or 2. Thiabendazole
• Prevention and control
Proper disposal of human excreta (feces)
Personal hygiene including use of footwear.
Case treatment.
3/31/2025 CD and NTD KGY 2024 65
 2.5. Hookworm disease
(Ancylostomiasis, Necatoriasis)
A common chronic parasitic infection with a variety of
symptoms usually in proportion of the degree of anemia
• Infectious agent;- Ancylostoma duodenal and Necator
americanus
• Epidemiology and Occurrence-
• Widely endemic in tropical and subtropical countries with
poor sanitary disposal practice
• Reservoir- Humans
• Mode of transmission-Through skin penetration by the
infective larvae.

3/31/2025 CD and NTD KGY 2024 66

 Hookworm…
• Incubation period- Symptoms may develop after a few
weeks to many months depending on intensity of infection
and iron intake of the host.
• Period of communicability- Infected people can
contaminate the soil for several years in the absence of
treatment.
• Susceptibility and resistance-universal.
• Life cycle
• Same with Strongyloidiasis…
3/31/2025 CD and NTD KGY 2024 67
 Hookworm…
• Clinical Manifestation
1. Larval migration of the skin
 localized maculopapular rash associated with itching
called ground itch.
2. Migration of larva to the lungs.
 Produces cough, wheezing and transient
pneumonitis.
3. Blood sucking
 Light infection-no symptoms
• Heavy infection-
• peptic ulcer disease
• epigastric pain and tenderness.
• loss of blood leads to sign of anemia
3/31/2025 CD and NTD KGY 2024 68
 Hookworm…
Diagnosis; -Demonstration of eggs in stool specimen.
Treatment
1. Mebendazole or
2. Albendazole or
3. Levamisole
Prevention and control
1. Sanitary disposal of feces
2. Wearing of shoes
3. Case treatment.
3/31/2025 CD and NTD KGY 2024 69
 3. Direct Contact with Feces
• Transmitted mainly through direct contact with feces of the
infected person
3.1. Poliomyelitis
• A viral infection most often recognized by the acute onset of
flaccid paralysis.
• Infectious agent; - Polio viruses (type I, II and III)
• Epidemiology & Occurrence – Worldwide prior to the
advent of immunization.
• Cases of polio occur both sporadically and in epidemics.
• Primarily a disease of infants and young children.
• More than 90% of infections are unapparent and flaccid
paralysis occurs in less than 1% of infections
3/31/2025 CD and NTD KGY 2024 70
 Poliomyelitis…
• Reservoir – humans, especially children
• Mode of transmission- Primarily person-to-person,
spread principally through the fecal-oral route. In rare
instances, milk,food stuffs and other materials
contaminated with feces have been incriminated as
vehicles.
• Incubation period- commonly 7-14 days
• Period of communicability – not precisely known, but
transmission is possible as long as the virus is excreted.
• Susceptibility and resistance- common in children but
paralysis rarely occurs.
• Infection confers permanent immunity
3/31/2025 CD and NTD KGY 2024 71
 Poliomyelitis…
• Clinical manifestation
 Usually asymptomatic or non-specific fever is manifested in
90% of cases.
 severe muscle pain, stiff neck and back with or without flaccid
paralysis
 Paralysis occurs within three to four days of illness.
 The legs are more affected than other part of the body.
 Paralysis of respiratory and swallowing muscles is life-
threatening.
• Diagnosis
• Based on clinical and epidemiological ground
• Treatment--Symptomatic
• Prevention and control
Immunization in early childhood with trivalent live attenuated
vaccine (OPV) at birth.
Safe disposal of human excreta (feces).
3/31/2025 CD and NTD KGY 2024 72
 3.2. Hydatid Disease (Echinococcosis)
• The tapeworm Echinococcus granulosus is the most common species of
Echinococcus and causes cystic hydrated disease.
• Infectious agent;- Echinococcus granulosus, a small tapeworm of dog
• Epidemiology
• Occurrence – occurs on all continents except Antarctica. Especially
common in grazing countries where dogs consume viscera containing
cysts.
• Reservoir- Domestic dogs and other canids are definitive hosts; they
may harbor thousands of adult tapeworms in theirintestines without signs
of infection. Sheep act as intermediate hosts.
• Mode of transmission– directly with hand to mouth transfer of eggs
after association with infected dogs or indirectly through contaminated
food, water, soil or fomites

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 Hydatid Disease…
• Incubation period – variable from 12 months to many years,
depending on the number and location of cysts and how rapidly they
grow.
• Period of communicability – Infected dogs begin to pass eggs
approximately 7 weeks after infection. Most canine infections resolve
spontaneously by six months.
• Susceptibility and resistance – Children exposed to infection
because they are more likely to have close contact with infected
dogs.
• Clinical manifestations; -
 vary according to location of the cyst and number.
 Ruptured or leaking cysts can cause severe anaphylactic
reactions.
• Cysts are typically spherical, thick walled and are most frequently
found
3/31/2025 in the liver and lungs CD and NTD KGY 2024 74
 Hydatid Disease…
• Diagnosis
 History of residence in an endemic area along with association
with canines’
 Solography and CT scan
 Serologic test
• Treatment
1. Surgical resection of isolated cysts is the most common
treatment.
2. Albendazole (Mebendazole)
3. If cysts rupture, praziquantel
• Prevention and control
1. Educate the public at risk to avoid exposure to dog feces.-
Hand washing should be emphasized.
2. Interrupt transmission from intermediate to definitive hosts -
preventing dogs’ access to uncooked viscera.
3. Safe disposal of infected viscera.
4. Periodical treatment of
3/31/2025 high-risk
CD and NTD KGY 2024 dogs. 75
 3. Air-borne diseases
• The diseases in the air-borne group enter the body via the
respiratory tract when a patient or carrier of pathogens talks,
coughs, laughs, or sneezes, he/she discharges fluid droplets.
3.1. Common Cold (Acute Viral Rhinitis or Coryza)
• An acute catarrhal infection of the upper respiratory tract.
• Infectious agent Rhino viruses (100 serotypes),Parainfluenza
viruses, respiratory syncytial viruses (RSV), Influenza, and Adeno
viruses cause common cold-like illnesses in infants and children
• Epidemiology Occurrence- Worldwide both in endemic and
epidemic forms.
• Greater incidence in the highlands and high in children under 5
years
• Mode of transmission- by direct contact or inhalation of
airborne droplets.
• Indirectly by hands and articles freshly soiled by discharges from pt.
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 Common Cold…
• Incubation period-12 hrs to 5 days, usually 48 hrs
• Period of communicability- 24 hrs before onset and for 5 days after
onset.
• Susceptibility and resistance- universal. Repeated infections (attacks)
due to multiplicity of agents.
• Clinical Manifestation
 Coryza, sneezing, lacrimation, pharyngeal or nasal irritation, chills and
malaise
 Dry or painful throat.
• Diagnosis;- Based on clinical grounds
• Treatment
• 1.No effective treatment but supportive measures like: Bed rest, Steam
inhalation, High fluid intake, Anti-pain , Balanced diet intake
• Prevention and Control
1. Educate the public about the importance of:
 Hand washing, Covering the mouth when coughing and sneezing,
Sanitary disposal of nasal and oral discharges
2. Avoid
3/31/2025
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KGY 2024
especially in institutions 77
 3.2. Measles (Rubella)
• An acute highly communicable viral disease
• Infectious agent; -Measles virus
• Epidemiology Occurrence- Prior to widespread immunization,
common in childhood so that more than 90% of people had been
infected by age 20
• Reservoir- Humans
• Mode of transmission- Airborne by droplet spread
• Greater than 94% herd immunity may be needed to interrupt
community transmission.
• Incubation period-7-18 days from exposure to onset of fever
• Period of communicability- slightly before the prodromal period to
four days after the appearance of the rash and minimal after the
second day of rash.
• Susceptibility and resistance- All non-vaccinated or have not had the
disease are susceptible.
• Permanent immunity is acquired after natural infection or
immunization
3/31/2025 CD and NTD KGY 2024 78
 Measles (Rubella)…
• Clinical Manifestation
Prodromal fever, conjunctivitis, coryza, cough and Koplik spots on
the buccal mucosa
A characteristic red blotchy rash appears on the third to seventh
day, beginning on the face, gradually becoming generalized,
lasting 4-7 days.
Leucopoenia is common.
Complications like otitis media, pneumonia, diarrhea,
encephalitis, croup (Laryngo trachea bronchitis) may result from
viral replication or bacterial super infection.
• Diagnosis
 Based on clinical and epidemiological grounds
• Treatment
1. No specific treatment
2. Treatment of complications
3. Vitamin A provision CD and NTD KGY 2024
3/31/2025 79
 Measles (Rubella)…
• Nursing care
1. Advise patient to have bed rest.
2. Relief of fever.
3. Provision of non-irritant small frequent diet.
4. Shorten the fingernails.
• Prevention and control
1. Educate the public about measles immunization.
2. Immunization of all children (less than 5 years of
age) who had contact with infected children.
3. Provision of measles vaccine at nine months of age.
4. Initiate measles vaccination at 6 months of age
during epidemic and repeat at 9 months of age.
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 3.3. Influenza
• An acute viral disease of the respiratory tract
• Infectious agent;- Three types of influenza virus (A,B and C)
• Epidemiology Occurrence- In pandemics, epidemics and localized
outbreaks.
• Reservoir-Humans are the primary reservoirs for human infection.
• Mode of transmission- Airborne spread predominates among crowded
populations in closed places such as school buses.
• Incubation period- short, usually 1-3 days
• Period of communicability-3-5 days from clinical onset in adults; up
to 7 days in young children.
• Susceptibility and resistance- when a new sub-type appears, all
children and adults are equally susceptible.
 Infection produces immunity to the specific infecting agent.
• Clinical Manifestation ;- Fever, head ache, myalgia, prostration, sore
throat and cough
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 Influenza…
• Diagnosis; - Based on clinical ground
• Treatment
Same as common cold, namely:
• Prevention and control
1. Educate the public in basic personal hygiene, especially the
danger of unprotected coughs and sneezes and hand to mucus
membrane transmission.
2. Immunization with available may provide 70-80% protection.
3. Amantadine hydrochloride chemoprophylaxis of type A virus but
not others
3/31/2025 CD and NTD KGY 2024 82
 3.4. Diphtheria
• An acute bacterial disease involving primarily tonsils, pharynx,
nose, occasionally other mucus membranes or skin and
sometimes the conjunctiva or genitalia.
• Infectious agent;- Corynebacterium diphtheria
• Epidemiology & Occurrence-Disease of colder months in
temperate zones,
• primarily non-immunized children less than 15 years of age
• Reservoir- Humans
• Mode of transmission-contact with oral or nasal secretions
or infected skin of a patient of carrier..
• Incubation period- usually 2-5 days
• Period of communicability- variable, until virulent bacilli
have disappeared from discharges and lesion; usually 2
weeks or less.
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 Diphtheria…
• Susceptibility and resistance-universal.
• Infants borne to immune mothers are relatively up 6 months.
• Prolonged active immunity can be induced by diphtheria
toxoid.
• Clinical Manifestation
lesion marked by a patch/s of an adherent grayish
membrane with a surrounding inflammation (pseudo
membrane).
 Sore throat in pharyngo tonsillar diphtheria, enlarged and
tender cervical lymph nodes in severe cases, swelling and
edema of neck.
• Diagnosis
 Based on clinical and epidemiological grounds
 Bacteriologic examination of discharges from lesions.
3/31/2025 CD and NTD KGY 2024 84
 Diphtheria…
• Treatment
• Diphtheria antitoxin
• Erythromycin for 2 weeks but 1 week for cutaneous form
or Procaine penicillin for 14 days or single dose of
Benzathine penicillin
• Primary goal of antibiotic therapy for patients or carriers is
to eradicate C. diphtherias and prevent transmission from
the patient to susceptible contacts.

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 Diphtheria…
• Prevention and control
• Educate the public, of the hazards of diphtheria and
the necessity for active immunization of young
children .
• Immunization of infants with diphtheria toxoid.
• Concurrent and terminal disinfection of articles in
contact with patient and soiled by discharges of
patient.
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 3.5. Pertussis (whooping cough)
• An acute bacterial disease involving the respiratory tract.
• Infectious agent;- Bordetella pertussis
• Epidemiology Occurrence-
An endemic disease common to children. Outbreaks occur
periodically.
Endemic in developing world and 90% of attacks occur in
children under 6 years of age.
• Reservoir- Humans
• Mode of transmission- direct contact with discharges from
of infected persons by airborne route, probably by
droplets.
Indirectly by handling objects freshly solid with
nasopharyngeal secretions.
• Incubation period- 1-3 weeks
3/31/2025 CD and NTD KGY 2024 87
 Pertussis…
• Period of communicability-
• Highly communicable in early catarrhal stage before
the paroxysmal cough stage.
• The most contagious disease with an attack rate of
75-90%.
• Gradually decreases when treated with
erythromycin, infectiousness is usually 5 days or
less after onset of therapy
• Susceptibility and resistance- non-immunized
individuals is universal.
 One attack usually confers prolonged immunity
but may not be lifelong.
3/31/2025 CD and NTD KGY 2024 88
 Pertussis…
• Clinical manifestation
3 phases:
1. Catarrhal phase
 Lasts 1-2 weeks
 Cough and rhinorrhea
2. Paroxysmal phase
 Explosive, repetitive and prolonged cough
 Child usually vomits at the end of paroxysm
 Expulsion of clear tenacious mucus often followed by
vomiting
 Whoop (inspiratory whoop against closed glottis) between
paroxysms
 Child looks healthy between paroxysms
 Paroxysm of cough interferes with nutrition and cough
 Cyanosis and sub conjunctiva hemorrhage due to violent
3/31/2025 CD and NTD KGY 2024 89
 Pertussis…
3. Convalescent phase
 The cough may diminish slowly or may last long time.
 After improvement the disease may recur.
• Diagnosis
Difficult to distinguish it from other URTI
History and physical examination at phase two
(paroxysmal phase) ensure the diagnosis.
Marked lymphocytosis.
• Treatment
1.Erythromycin- to treat the infection in phase one but to
decrease transmission in phase two
2.Antibiotics for super infections like pneumonia because of
bacterial invasion due to damage to cilia.
3/31/2025 CD and NTD KGY 2024 90
 Pertussis…
• Nursing care
Proper feeding of the child.
Encourage breastfeeding immediately after an attack (each
paroxysm).
Proper ventilation- continuous well humidified oxygen
administration.
Reassurance of the mother (care giver),
• Prevention and control
 Educate the public about the dangers of whooping cough and
the advantages of initiating immunization at 6 weeks of age.
 Consider protection of health workers at high risk of exposure
by using erythromycin for 14 days.

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 3.5. Pneumococcal pneumonia
• An acute bacterial infection of the lung tissue and bronchi.
• Infectious agent;- Streptococcus pneumonia
(pneumococcus)
• Epidemiology Occurrence-
Endemic particularly in infancy, old age and persons with
underlying medical conditions.
Epidemics can occur in institutions, barracks and on board
ship where people are living and sleeping in close quarters.
Common lower socio-economic groups and developing
countries.
• Reservoir- Humans - pneumococci are usually found in the
URT of healthy people throughout the world.
•
3/31/2025 CD and NTD KGY 2024 92
 Pneumonia…
• Mode of transmission- droplet spread, direct oral
contact or indirectly through freshly soiled articles.
Person to person transmission is common.
• Incubation period- not well determined, may be as
short as 1-3 days.
• Period of communicability- Until discharges of
mouth and nose no longer contain virulent pneumococci
in significant number.

3/31/2025 CD and NTD KGY 2024 93

 Pneumonia…
• Susceptibility and resistance-
Susceptibility is increased by influenza, aspiration, chronic
lung disease, exposure to irritants in the air,
Malnutrition and low birth weight
Immunity following an attack may last for years.

3/31/2025 CD and NTD KGY 2024 94

 Pneumonia…
• Clinical Manifestation
 Sudden onset of chill, fever, pleural pain, dyspnea,
tachypnea, a cough productive of rusty sputum,
 Chest in drawing, shallow and rapid respiration in
infants and young children.
 Vomiting and convulsion may occur in infants and
young children.
• Diagnosis
 Based on clinical grounds
 Chest X-ray- reveals consolidation of the affected lung
tissue but not in children.
 Sputum gram stain- reveals gram negative diplococcic
3/31/2025 CD and NTD KGY 2024 95
 Pneumonia…
• Treatment
 Antipyretic and antipain
 Antibiotics
 Anti convulsant for infants.
• Nursing care
Monitor vital signs especially of children.
Maintain high body temperature to normal.
Intermittent administration O2 if indicated
Timely administration of ordered medication.
• Prevention and control
 Treatment of cases
 Treatment of other underlying medical conditions
 Improve standard of living (adequate and ventilated
housing and better nutrition)
 Avoid overcrowding.
3/31/2025 CD and NTD KGY 2024 96
 3.6. Meningococcal Meningitis
Meningitis;- An acute bacterial disease that causes inflammation
of the pia and arachnoid space of meninges
• Infectious agent ;- Neisseria meningitides (the meningococcal)
• Epidemiology Occurrence-
 Greatest incidence occurs during winter and spring.
 Epidemics occur irregularly.
 Common in children and young adults.
 It is also common in crowded living conditions.

• Reservoir- Humans
• Mode of transmission- Direct contact with respiratory droplets
from nose and throat of infected
3/31/2025 CD and NTD person.
KGY 2024 97
 Meningitis…
• Incubation period- 2-10 day, commonly 3-4 days.
• Period of communicability-as long as the bacteria is
present in the discharge.
• Susceptibility and resistance- Susceptibility is low
and decreases with age

3/31/2025 CD and NTD KGY 2024 98

 Meningitis…
• Clinical Manifestation
 Sudden onset of fever, intense headache, nausea and often
vomiting, neck stiffness and frequently, petechial rash with
pink macules.
 Kernig’s sign may be positive (i.e. patient feels back pain
when one of the lower limbs is flexed at the knee joint and
extended forward in an elevated position)
 Brudinski’s sign may be positive (i.e. when the patient’s neck
is flexed, the two lower extremities get flexed or raised up).
 Delirium and coma often appear
3/31/2025 CD and NTD KGY 2024 99
 Meningitis…
• Diagnosis
 Based on clinical and epidemiological grounds
 White blood cell count. (neutrophils)
 Cerebrospinal fluid analysis (Gram stain, white cell count, etc.)
• Treatment
 Admit the patient and administer high dose of IV antibiotic
 Antipyretic
• Nursing care
Maintain fluid balance (input and output)
Maintain body temperature to normal
Timely administration of antibiotics
 Monitor vital signs.
3/31/2025 CD and NTD KGY 2024 100
 Meningitis…
• Prevention and control
1.Reduce direct contact and exposure to droplet
infection.
2. Reduce overcrowding in work places, schools, camps
3. Vaccines containing group A,C and Y strains.
4. Chemotherapy of cases.
5. Chemo prophylaxis (e.g. Rifampin for 2 days)
6. Report to the concerned health authorities.
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 3.7.Tuberculosis- TB
• TB- A chronic and infectious mycobacterial disease cause
of illness and death in many parts of the world.
• Infectious agent.
 Mycobacterium tuberculosis- human tubercle bacilli
(commonest cause)
 Mycobacterium bovis- cattle and man infection
 Mycobacterium valium- infection in birds and man

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 Tuberculosis…
• Epidemiology & Occurrence
Worldwide, however underdeveloped areas are more
affected.
Affects all ages and both sexes but 15-45 years are mainly
affected.
Tuberculosis has two major clinical forms.
Pulmonary (80%)-mainly affects lungs
Extra pulmonary,( 20%) affects all parts of the body.
Most common sites are lymph nodes, pleura, GUT, bone
and joints, meninges and peritoneum.
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 Tuberculosis…
• Mode of transmission-
 direct droplets mainly from lung expelled during talking,
sneezing, singing, or coughing directly.
 Untreated PTB+ cases are the source of infection.
 The intimate, prolonged or frequent contact is required for
transmission
 Transmission through contaminated fomites (clothes, personal
articles) is rare.
 Ingestion of unpasteurized milk transmits bovine tuberculosis.
 Overcrowding and poor housing conditions favor the disease
transmission
• Incubation period- 4-12 weeks
• Period of communicability- as far as the bacilli is present in
the sputum
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 Tuberculosis…
• Susceptibility and resistance-
 under 3 years old children, adolescents, young adults,
 very old and the immunosuppressed are susceptible.
 Everyone who is non-infected or non-vaccinated can be infected.
 HIV increases the risk factor for the development tuberculosis by
facilitating:
 Reactivation or Progression of recent infection or
Reinfection
• Clinical Manifestation
 Pulmonary tuberculosis
Persistent cough for 3 weeks or more
Productive cough with or without blood-stained sputum
Shortness of breath and chest pain
Intermittent fevers, night sweats, loss of weight, loss of
appetite, fatigue and malaise.
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 TB Clinical manifestation…
TB lymph adenitis
painless enlargement of lymph nodes followed by drainage of
pus.
Tuberculosis pleurisy
Pain while breathing in, dull lower chest pain, slight cough,
breathlessness on exertion.
TB of bones and joints
Localized pain and/or swelling, discharging of pus, muscle
weakness, paralysis and stiffness of joints.
Intestinal TB
Loss of weight and appetite
Abdominal pain, diarrhea and constipation
Mass in the abdomen
Fluid in the abdominal cavity (ascites)
Tuberculosis meningitis
Headache,
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 Tuberculosis…
• Diagnosis
1. Clinical manifestations
2. Sputum smears (AFB), which is the Golden standard.
3. AFB can be done for extra pulmonary tuberculosis having
pusy discharge.
4. Radiological examination:
5.Histopathological examination: Biopsies for extrapulmonary
TB
6. Tuberculin test (mantoux): Helpful in non-BCG vaccinated
children under 6 years of age
7. Culture: Complex and sophisticated tool, which takes several
weeks to yield results. Not a primary diagnostic tool in our
country.

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 Tuberculosis…
• Treatment
• Drugs are being used for treatment of TB in Ethiopia.
 Streptomycin (s) daily IM injection ---
 Ethambutol (E)
 Rifampin (R)
 Thiacetazone (T)
 Isoniazid (H)
 Pyrazinamide (Z)

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 Tuberculosis…
• Drug regimens (prescribed course of therapy)
1) Short course chemotherapy regimen (DOTS)
 Intensive phase- S(RH)Z for two months
 Continuation phase- TH (EH) for the next 6 months.
2) Long course chemotherapy regimen.
 Intensive phase- S(TH)or S(EH) for 2 months
 Continuation phase-TH or EH for the next 10 months

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 Tuberculosis…
• Nursing care
 Educate the patient how and when to take the prescribed
medication.
 Tell the patient not to stop the medication unless he/she is
told to do so.
 Tell the patient to come to the health institution if he/she
develops drug side effects
 Advice the patient on the importance of taking adequate
and balanced diet and to eat what is available at home.
• Prevention and control
Chemotherapy of cases
Chemoprophylaxis for contacts
INH (Isoniazid) for adults and children who have close
contact with the source of infection
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Tuberculosis…
Immunization of infants with BCG
Educate patients with TB about the mode of disease
transmission and how to dispose their sputum and cover
their mouth while coughing, sneezing, etc.
Public health education about the modes of disease
transmission and methods of control
Improved standard of living
 Adequate nutrition
 Health housing
 Environmental sanitation
 Personal hygiene; etc.
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 Active case finding and treatment
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 3.7 Leprosy (Hansen’s disease)
Leprosy;- A chronic bacterial disease of the skin, peripheral
nerves and, upper airway in lepromatous patients,
 Infectious agent; -Mycobacterium leprae
 Epidemiology & Occurrence-common in rural tropics and
subtropics, socio-economic conditions.
Endemic in south and southeast Asia, tropical Africa and
Latin America.
• Reservoir- Humans
• Mode of transmission-
 Not clearly established.
 Prolonged close contact with nasal discharges, cutaneous
ulcers in lepromatous patients
 Organisms gain access through the URT and possibly
through broken skin.
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 Leprosy…
• Incubation period- 9 months to 20 years.
• Period of communicability- Infectiousness is lost in most instances
within 3 months of continuous and regular treatment with dapsone or
clofazimine or within 3 days of rifampicin treatment.
• Susceptibility and resistance- The presence and form of leprosy
depend on the ability to develop effective cell mediated immunity.
• Clinical Manifestation-Clinical manifestations vary between two polar
forms:
Lepromatous (Multibacillary form)
Tuberculoid (Paucibacillary form)
Lepromatous (Multibacillary form)
♦ Nodules, papules, macules and diffused infiltration are bilaterally
symmetrical and usually numerous and extensive.
♦ Involvement of the nasal mucosa may lead to crusting, obstructed
breathing and epistaxis.
Ocular involvement leads toCD and
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 Leprosy…
Tuberculoid (Paucibacillary form)
 Skin lesions are single or few, sharply demarcated,
anesthetic or hyperesthetic and bilaterally symmetrical.
 Peripheral nerve involvement tends to be severe.
Borderline

• Has features of both polar forms and is more liable to

shift toward the lepromatous form in untreated patients
and toward the tuberculoid form in treated patients2
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 Leprosy…
• Diagnosis
Complete skin examination (hyperesthesia, anesthesia,
paralysis, muscle wasting or trophic ulcer which are
signs of peripheral nerve involvement) with bilateral
palpation of peripheral nerves (ulnar nerve at the
elbow, peroneal nerve at head of fibula and the great
auricular nerve) for enlargement and tenderness.
Skin lesions are test for sensation (light touch, pink
prick, temperature discrimination). Demonstration of
AFB in skin smears made by scraped incision method.
Skin biopsy confined to the affected area should be
sent to the experienced pathologists in leprosy
diagnosis.
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 Leprosy…
• Treatment
1. Dapsone
Three drugs for 12 months and then
2. Rifampicin
Dapsone alone for the next 12 months.
3. Clofazimine
4. Aspirin for mild reactions and inflammation
5. Severe reaction can be treated with corticosteroids

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 Leprosy Treatment
• The drug administration for treatment of leprosy with MDT
has two phases
1.Daily-self-administered treatment and taken every day at
home.
1. Monthly, Directly- Observed treatment taken at a health
facility to observe the patient taking the drugs.
Duration of MDR
• For PB 6 month the monthly dose is Rifampcin & dapsone
(R& DDS)taken monthly for 6 month
• The daily self-administer dose is Dapsone take daily for 6
month
• N.B the full course of treatment must be completed with in 9
months after initiation of treatment .
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• For MB 12 months the monthly dose is Rifampcin,
clofazemine & Dapsone (R,C& DDS) and self
administered dose is Clofazemine and Dapsone is taken
every day for 12 month.

• The full course of treatment must be completed with in

15 months .

• Table1 1.1 MDT regimen for (PB) leprosy

• Table 11.2 MDT regimen for MB Leprosy

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4.Arthropod or intermediate vector-borne diseases
 Mosquito-Borne Diseases
4.1.Malaria - An acute infection of the blood caused by
protozoa of the genus plasmodium
• Infectious agent.
 Plasmodium falciparum/malignant tertian
 Plasmodium vivax/benign tertian
 Plasmodium ovale/tertian
 Plasmodium Malariae/Quartan malaria
 Epidemiology Occurrence-
Endemic in tropical and sub-tropical countries of the world.
Affects 40% of the world population.
Children less 5 years of age, pregnant women and travelers
to endemic areas are risk groups.
Plasmodium falciparum 60% and vivax 40% are common
in Ethiopia.
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 Malaria…
• Predisposing factors are:
Environment- physical environment for the
propagation
Patient source
Susceptible recipients
Anopheles capable to transmit the parasite
Socio-economic factors (immigration, war, poverty,
ignorance, agricultural irrigation farms, etc.
• Reservoir- Humans
• Mode of transmission- By the bite of an infective
female anopheles mosquito, Blood transfusion,
hypodermic needles, organ transplantation and mother
to fetus transmission is possible.
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 Malaria…
• Incubation period- Varies with species
Plasmodium falciparum 7-14 day’s
Plasmodium vivax 8-14 days
Plasmodium ovale 8-14 days
Plasmodium malariae 7-30 days
• Period of communicability-
Mosquitoes are infective as long as infective
gametocytes are present in the blood of patients.
Once infected, mosquito remains infective for life.
• Susceptibility and resistance- universal except in
some host-resistance factors:

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 Malaria…
• Clinical Manifestation
Chills, rigor, fever, head ache, diarrhea, hallucinations,
abdominal pain, aches, renal or respiratory symptoms,
jaundice, etc.
• Diagnosis
Clinical manifestation and epidemiological grounds
Blood film for hemoparasite
White blood cell count
Blood culture to rule out sepsis
Chest X-ray to rule out pneumonia
• Treatment
1.Plasmodium vivax, ovale and sensitive plasmodium
falciparum
Chloroquine, Coartem, Artesunate
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 Malaria…
• Prevention and control
1. Chemoprophylaxis- for those who go to endemic
areas but not for those who live in the endemic area
(travelers and newcomers); for under-five children and
pregnant mothers who have not enough immunity.
2. Vector control
Avoiding mosquito breeding sites
Residual DDT spray or other chemicals
Personal protection against mosquito bite (use of
bed nets, etc.)
3. Chemotherapy of cases

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4.2.Human African Trypanosomiasis(sleeping sickness)
 It is a severe and fatal disease if left untreated.
 Infectious agent- protozoan parasites of the genus
Trypanosoma, transmitted between infected humans and animals
by tsetse flies (Glossina spp.)
 Two species )Trypanosoma brucei rhodesiense and T. b.
gambiense)
 Clinical features: malaise, lassitude and irregular fevers,
enlarged lymph glands and spleen
 Later symptoms- headache, anemia, joint pains, swollen tissues
and a primary chancre;
 Advanced symptoms-neurological and endocrine disorders;
leading to coma and death.
 T.b rhodesiense infection is usually acute, causing severe
symptoms and death within a few days or weeks.
 T.b. gambiense infection tends to progress more slowly (over
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several years) and is less severe.

 Sleeping sickness
Diagnosis-based on clinical algorithms, diagnostic tools
are not readily available
Treatment- Benznidazole and Nifurtimox
-Flexinidazole
Prevention-
• reduction of tsetse fly by extensive clearance of bush to
destroy breeding and resting sites
• Widespread application of insecticides.
• ITN usage in endemic area

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 4.3. Bancroftian filariasis
A disease caused by the reaction of the body to the presence
of worms in the lymphatic system.
• Infectious agent;-
Wucheriria bancrofti (vectors are culex, Anopheles and
Aedes species)
Brugia malayi and (vector is mansonia species)
Brugia timori (vector is Anopheles)
• Epidemiology & Occurrence- Widely prevalent in tropical
and subtropical areas of Africa, Asia, Pacific Region, Central
and South America. Found in Gambella region (western
Ethiopia).
• Reservoir- Humans are definitive hosts.
• Mode of transmission- by bite of mosquito harboring
infective larvae
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 Bancroftian filariasis…
 Incubation period- one month, while allergic inflammatory
manifestations may appear.
 Period of communicability
 Human infect mosquitoes when microfilariae are present in the
peripheral blood (for 5-10 years or longer)
 The mosquito becomes infective about 12-14 days after an
infective blood meal.
 Susceptibility and resistance-Universal, susceptibility is
probable.
 Clinical Manifestation. Three phases may be distinguished.
• Acute phase
 Starts within a few months after infection
 Lymphadenopathy
 Fever
 Eosinophilia
Microfilariae are not demonstrable
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 Bancroftian filariasis…
• Sub-acute phase:
 occurs after about one year following acute phases.
 worms have matured and micro filariae are present in the peripheral
blood.
 Reactions to the adult worms cause Epididymitis and later lead to
hydrocele.
• Chronic phase:
 After many years of repeated attacks, lymph glands and lymph vessels
become obstructed; as a result lymph edema develops.
 Lymph edema most commonly seen in the legs or scrotum
(elephantiasis) but may also be present in vulva, breasts, or arms.
 Since the adult worms have usually died, microfilariae are not seen in
the blood
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 Bancroftian filariasis…
• Diagnosis
Clinical and epidemiological grounds
Obstructive signs with history and travel to and residence in
endemic areas.
Identifying microfilariae in the peripheral blood (blood film).
• Treatment
1. Diethyl carbamazin Citrate (DEC) rapid disappearance of most
microfilariae from blood but may not destroy the adult worm;
repeat DEC annually for some years.
2. Refer the patient for surgical treatment of hydrocele.
• Prevention and control
 Reducing the vector population
 Mass and selective treatment
 Personal protection against mosquito bite
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 4.4. Yellow fever
• An acute infectious viral disease of short duration and varying
severity.
• Infectious agent;- Yellow fever virus
• Epidemiology & Occurrence- two transmission cycles.
 Sylvatic or Jungle cycle, occurs between mosquitoes and non-
human primates,
 Urban cycle, involving Aedes aegypti mosquitoes and humans.
 Found in southwest Ethiopia (Gambella region).
• Reservoir-
 Urban areas- humans and Aedes aegypti mosquitoes.
 Forest areas- Vertebrates other than humans (mainly monkeys)
and forest mosquitoes.
• Mode of transmission- By the bite of infective Aedes aegypti
mosquitoes
• Incubation period- 3-6 days
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 Yellow fever…
• Period of communicability- Blood of patients is infective for
mosquitoes shortly before onset of fever and for the first 3-5 days
of illness.
• Susceptibility and resistance-
Long lasting immunity from recovery of yellow fever ; second
attacks are unknown.
Transient passive immunity in infants born to immune mothers
may persist for up to 6 months.
In natural infections, antibodies appear in the blood within the
first week

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 Clinical Manifestation
 Sudden onset of fever, chills, headache, backache,
generalized pain, prostration, nausea and vomiting.
 Slow and weak pulse.
 Epistaxis, bleeding of gums, hematemesis, melena, Jaundice
 Albumin urea occurs due to nephritis and this may result in
kidney failure and anuria.
 Patients surviving the seventh day of the disease usually
recover.
Diagnosis
History of residence and/or travel to endemic area
Clinical manifestation
Treatment
• No specific treatment.
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 Yellow fever…
Nursing care
1. Monitor vital signs regularly.
2. Maintain body temperature to normal.
3. Monitor input and output balance.
4. Keep patient in screened rooms or under mosquito nets
to avoid further infection.
Prevention and control
Active immunization of all people greater than 9 months
of age necessarily exposed to infection because of
residence, occupation or travel.
Eradication or control of Aedes aegypti mosquitoes in
urban areas.
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 5. Sexually transmitted diseases (STD’S)
A group of infections, caused by different types of
microbial agents
Frequently transmitted by sexual contact, both
heterosexual or homosexual behavior, (genital, oral-
genital, oral-anal, and genital-anal contact)
STDs rarely transmitted by fomites, food, flies, or casual
contact
Epidemiology of STIs
• STIs are major public health problems in all countries,
but severe in developing countries.
• A large proportion of STIs are symptomatic and most
symptomatic patients seek treatment from traditional
healers , pharmacists , drug vendor shops and market
places
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 Sexually transmitted…
1. Urethral discharge is the most common compliant of
men and vaginal discharge is in woman with STD
• Gonococcal urethritis (GC): caused by Nisseria
gonorrhea
Has a short incubation period (2-3days)
most cases present with abundant and purulent
discharge
dysuria, urgency and frequency.
• Nongonococcal urethritis (NGU): usually caused by
Chlamydia trachomatis
Has long incubation period (1-3 weeks)
Has scanty to moderate, white, mucoid or serous
discharge.
Mild urinary tract infection symptoms
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 Sexually transmitted…
• Treatment: When the accurate etiologic diagnosis is
made
• Gonococcal Urethritis:
• Ceftriaxone 250mg IM stat
OR
• Ciprofloxacin 500mg PO stat
OR
• Spectinomycin 2mg IM stat.
• NGU: Doxycycline 100mg PO BID for 7 days or
Tetracycline 500mg PO QID for 7 days
OR Erythromycin 500mg PO QID for 7 days if the patent
has contraindication for TTC..
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 Sexually transmitted…
2. Vaginal Discharge – common causative
agents
1. N. gonorrhea
2. Chlamydia trachomatis
3. Trichomonas vaginalis
4. Gardnerella vaginalis
5. Candida albicans
6. Vaginal anaerobes (“bacteria vaginosis”)
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 Sexually transmitted…
• Clinical feature: Vaginal Discharge
• Excessive amount of vaginal discharge
• Changes in colour and/or odour of discharge
• Associated itching, dysuria, dyspareunia
• Redness of vulva
• Sometimes may be accompanied by lower abdominal
pain
• Rx – similar with male case

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 Sexually transmitted…
Risk factors for STI
• Multiple sexual partners in the last 3 months
• New sexual partners in the last 3 months
• Age less than 25 years
• Having ever traded sex
Complications
• PID
• Premature rapture of membrane
• Preterm labour
• Infertility
• Chronic pelvic pain

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 Sexually transmitted…
3. Genital Ulcer
A loss of continuity of the skin of the genitalia.
Genital ulcers may be painful or painless and are
frequently accompanied by inguinal lymphadenopathy.
Common Etiology agents:
•Treponema pallidum (syphilis)
• Haemophilus ducreyi (chancroid)
• Lymphogranuloma granuloma inguinale (LGI)
• Lymphogranuloma venereum (LGV)
• Herpes virus 1 or 2 (Herpes simplex virus or HSV)

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 Sexually transmitted…
Syphilis
Caused by Treponema pallidum
• Genital ulcer occurs in the primary stage of the
diseases
• It starts as a small popular lesion that rapidly
ulcerates to produce a non tender indurated lesion
with a clean base and raised margins known as
chancre
• Chancres may appear at any point of contact :
genitals, anus, mouth, lips
• Heal without treatment in 1 to 6 weeks
• Swollen lymph nodes may appear
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 Sexually transmitted…
• Genital Herpes
• caused by HSV virus of two types
• HSV-1 causes dominantly oral disease
• HSV-2 causes dominantly genital disease
• Worldwide the most common cause of genital ulcer
• Herpetic ulcers
• Are usually painful and multiple
• Starts as clear vesicle and becomes pustule, which later erodes
to an ulcer and then crusts
• Heals spontaneously after 2-3 weeks
• Recurrence possible but milder (number of vesicles are fewer)
• It tends to be aggressive in HIV patients with extensive tissue
involvement and chronic ulceration.
• It may also be dissemination to CNS, skin etc
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 Sexually transmitted…
Chancroid
• Caused by Haemophilus ducreyi
• Commonest causes of GU in most developing countries, but
not found to be a common cause of GU in Ethiopia.
• Incubation period: 3 -15 days
• Ulcer on the penile shaft or prepuce
• It is painful small papule to pustule and then ulcer with soft
margins called soft chancre , yellow gray exudative covering
and erythema
• Inguinal adenopathy that becomes necrotic and fluctuant (
bubo ) follows the ulcer within 1-2 weeks
• penile autoamputaion
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 Sexually transmitted…
Lymphogranuloma Venereum (LGV)
• Caused by L1, L2 and L3 serovars of Chlamydia
trachomatis
• Little evidence on the prevalence of LGV in Ethiopia
• Major pathology occurs in the lymphatic system
• Primary stage is marked by a painless vesiculo-papular
ulceration at the site of inoculation
• Located in the penis in men and on the labia and
posterior vagina in women.
• Primary lesion usually not noticed

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 Sexually transmitted…

• The secondary stage -described as the inguinal

syndrome
• A painful inguinal lymphadenitis with constitutional
symptoms
• In men infection spreads through the lymphatics
causing inguinal and femoral lymphadenitis.
• In women upper vaginal and cervical infection results in
enlargement of the pelvic nodes
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 Sexually transmitted…
Granuloma Inguinale (Donovanosis)
• Chronic: progressively destructive bacterial infection of the genital
region without systemic symptoms
• Etiology: Calymmatobacterium granulomatis a gram-negative
intra-cellular bacteria
• Transmission –sexual and non-sexual contact
• Incubation period – usually1 to 4 weeks, as long as a year
Clinical Manifestation
• A non suppurative genital lesion develops from a small firm papule
to painless ulcer with a beefy-red appearance and non-purulent
base
• Lesion bleeds easily, expand gradually
• Extra inguinal in 6% of cases
• 50% women have lesion on cervix
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 6. Zoonotic Diseases
An infectious disease that is transmitted between species
from animals to humans or from humans to animals.

• It difficult to control as the non-human animal acts as a

reservoir of infection that can be passed on to humans.

• Rabies and taeniasis- common diseases

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 Zoonotic…
• Rabies- The infectious agent of rabies virus of
the rhabdovirus family,
• It attacks the nervous system and a severe life-
threatening viral disease
Transmitted to humans in saliva in the bite of infected
animals, particularly those in the dog family (canines).
Foxes, wolves, hyenas, bats, raccoons and skunks
Bats are the main cause of rabies transmission in the
USA and Canada.
Death is almost inevitable if an infected person is not
treated very quickly

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 Rabies…
• The rabies virus exists in the saliva of the infected
animal (as well as in its nervous system)
• Transmitted to a person through a bite.
• If an infected animal licks a fresh break in the person’s
skin or mucus membranes, e.g. in the mouth.
• The virus travels in the nerves to the brain and causes
inflammation
• Incubation period -usually lasting one to three months,
but sometimes even up to one year after the bite
• The speed of progression is faster if the original site of
infection was in an area of the body that is close to the
spinal cord or brain
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 Rabies…
• Clinical manifestations and diagnosis
Early stage -fever, headache, vomiting and general
weakness.
As disease gets worse(Encephalitis phase)
anxiety, confusion, aggressive behavior, difficulty
sleeping, hallucination, spreading paralysis (inability to
move the muscles), difficulty swallowing, , salivation,
irregular pupils and convulsions
• A late-stage (Brainstem dysfunction)-hydrophobia (fear of
water), paralyzed, Excessive salivation and drooling, inability
to swallow results, and lose consciousness before death
• Death: rapidly develop coma and death is usually due to
respiratory failure (by apnea).
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Rabies…

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 Rabies…
Diagnosis

 Keep the dog or cat for at least 10 days under supervision

for any behavioral changed
 Rabies diagnosis in animals (after the animal is dead)
Tissue from brain stem and cerebellum
 Rabies diagnosis in human
Samples of saliva, serum, spinal fluid
Skin biopsy, cutaneous at the base of hair follicles
 Rabies virus is not found in blood, urine or feces
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 Rabies…
Treatment
• Once clinical disease appears, mortality is almost 100%.
• Post exposure prophylaxis: for physical contact with saliva or
secretions of infected animals or bitten by unprovoked animals.
• Should be initiated as long as there is no clinical evidence of rabies
• Rigorous cleansing and treatment of the wound
• Administration of rabies vaccine together with anti-rabies
immunoglobulin.
• Pre-exposure Prophylaxis: for people at risk of contact with
rabies like veterinarians, laboratory workers and animal handlers
• Antibiotic coverage
• Staphylococci
• Anaerobes
• Tetanus
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 Rabies…
Prevent rabies in animals
1. A regular basis and up-to-date rabies vaccinations for
all cats, and dogs.

2.keeping cats and dogs indoors under direct supervision.

3.Reduce the number of unwanted pets that may not be

properly cared for or vaccinated regularly.

4. Call animal control to remove all stray animals

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 Anthrax
 Anthrax is an infection that is caused by Bacillus anthracis.
 It mainly affects herbivorous animals (cattle, sheep and goats)
while grazing on contaminated grass
 Humans are infected by contact with the agent from infected
animals, through contact, ingestion or inhalation.
 Occurrence - 1. Cutaneous anthrax -95%
2. Inhalation anthrax -5%,
3. gastrointestinal (GI) is very rare
 Clinical Manifestations
1. Cutaneous anthrax
• Lesions on exposed areas like face, neck and extremities.
• painful regional lymphadenopathy
• about 10% develop progressive infection, bacteremia, high
grade fever and rapid death.
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 Anthrax…
2. Inhalation anthrax
severe viral respiratory disease- fever, dyspnea, stridor,
hypoxemia, hypotension and may die within 24 hours
may be used as biological warfare
3.Gastrointestinal anthrax:
nausea, vomiting, abdominal pain, bloody diarrhea,
and fever
Pt may develop ascites.
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 Anthrax…
Treatment
Cutaneous anthrax
• Can be treated with penicillin until edema subsides, then oral
penicillin for 7-10 days.
• For allergic patients, ciprofloxacin, erythromycin, TTC or
chloramphenicol may be given.
• Wound should be cleaned, debrided and dressed.
Inhalation or GI form
• Should be treated with high dose penicillin 8-12 million units per
day, divided into 4-6
doses or in combination with clindamycin / clarithromycin
Mortality rate
Cutaneous Anthrax is 10-20%, for and almost.
GI Anthrax can 50%
Inhalational
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Anthrax…

 Prevention:
 Mass vaccination of animals
Avoiding feeding on infected cattle
 Proper disposal of dead animals and
 Keeping personal hygiene

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 Brucellosis
Caused by Brucella species, characterized by remittent
type of fever and multi-organ involvement.
• It is transmitted to humans from infected animals
commonly through the ingestion of untreated milk or milk
products; raw meat and bone marrow
• it can also be transmitted by inhalation from close contact
with animals.
Four types of Brucella
Brucella melitensis (the most common and most
virulent type) acquired from goats, sheep and camels.
Brucella abortus from cattle
Brucella suis from hogs (pig)
Brucella canis from dogs
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 Brucellosis…
The incubation period is about 1-3 weeks
Clinical manifestations
 Fever, chills, diaphoresis, headache, myalgia, fatigue,
anorexia, joint and low back-pain, weight loss,
Respiratory manifestations- sore throat, tonsillitis, dry
cough and even pneumonia and lung abscess.
Gastrointestinal manifestations - nausea, vomiting,
constipation, abdominal pain and diarrhea
 Diagnosis
The combination of history of exposure, clinical features
Significantly raised levels of Brucella agglutinin -active
brucellosis
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 Brucellosis…
Treatment
• The combination of doxycycline and aminoglycoside
(gentamicin, or streptomycin) for 4 weeks or
• combination of doxycycline and rifampin given for 8 to
12 weeks.
• Patients with serious illness and complication need
admission for treatment with IV medications
Prevention-
Immunization of animals
Boiling or pasteurizing milk

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 Cysticercosis(Cestodes)- Tapeworms or Taeniasis

Taeniasis- segmented worms and parasitic

tissue infection caused by larval cysts of the
tapeworm
The tapeworms can be
• Taenia saginata (beef tapeworm)
• Taenia solium (Pig tapeworm)
• Hymenolepis nana (Dwarf tapeworm or dog
tapeworm)
• Diphyllobothriasis (fish tape worm):-

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 Taeniasis…
1. Taenia saginata- Beef tapeworm
• T. saginata infection is caused by the presence of the adult
beef tapeworm, in the intestine of humans.
• It is found all over the world in all countries where raw
meat is ingested.
• Ethiopia is one of the heavily affected countries.
• A large tapeworm usually 5-10 meters in length.
• Human is the only definitive host.
• Eggs from human excreta deposited on vegetation can
persist for months or years, until ingested by cattle.
• Embryo from cattle intestine migrates to the muscle and
transform into cysticercus.
• When eaten raw or undercooked, it infects humans
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Taeniasis…
Clinical manifestation:
• Usually asymptomatic.
• Often patients pass motile proglottids with stool or alone.
• Perianal discomfort during proglottids discharge.
• Mild abdominal pain, nausea, anorexia and weight loss can
occur.
Diagnosis: S/E- the eggs seen in stool or
- proglottids in the stool.
Treatment:
• Prazequantel 5 -10 mg/kg in a single dose.
• Niclosamide as a 2 g single morning dose before breakfast

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 Taeniasis Solium (pig tapeworm)
• It is caused by eating raw or undercooked pork(pig).
• The adult tapeworm resides in the upper jejunum,
similar to taenia saginata.
• Life cycle is similar to beef tapeworm.
• However, both the adult tapeworm and the larvae
(Cysticerca) infect people.
• Clinical manifestation :
• Mostly asymptomatic; but could have epigastric
discomfort, nausea and weight loss.
• Patients may note passage of proglottids
• The major manifestations in CNS with seizures,
headache, raised intracranial pressure, mental changes
etc.
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 Taeniasis Solium…

• Diagnosis: The diagnosis of intestinal T.solium infection

is made by the detection of eggs or proglottides.
Diagnosis is difficult in cysticercosis, which is done by
different clinical and laboratory criteria.

• Treatment: a single dose of prazequantel 5-10 mg/kg.

• If patients develop CNS symptoms, refer them to a

hospital

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 Hymenolepis nana (Dwarf tapeworm)
• Dwarf tapeworm is 25-40mm in length by 1mm in breadth and the
scolex bears four small suckers.
• It is distributed all over the world.
• This tapeworm doesn't require intermediate host.
• Hatching of eggs occurs in the small intestine where they penetrate
the villus and become cysticercoid.
• Eventually the parasites breakout in to the lumen of the gut and
reach maturity.
• Infection is prevalent in children.
Clinical manifestation
• Mostly asymptomatic
• Severe infections may manifest with abdominal pain, anorexia and
diarrhea.
• Diagnosis: based upon demonstration of the eggs in the stool.
• Treatment:
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- Praziquantel 25 mg/kg
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as single dose.
KGY 2024 171
 Diphyllobothriasis (fish tape worm):-
• Fish tape worm):- caused by adult Diphyllobothrium latum.
• It is acquired from eating raw fish.
• It is mostly found in Europe and Northern hemisphere.
• It is the longest tapeworm reaching up to 25 meters.
Clinical manifestation:
• Many people are asymptomatic.
• abdominal pain, loss of appetite, anorexia, nausea, diarrhea or loss
of weight.
• The tapeworm consumes a lot of vitamin B12 and cause deficiency
(megaloblastic anemia)
Diagnosis: S/E –eggs seen in the stool.
Treatment:
• Praziquantel 5-10 mg/kg once is very effective.
• Vitamin
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 7.Foodborne diseases
• Foodborne diseases- result from eating foods that contain
substances which are either infectious or toxic in nature
Transmission of foodborne diseases
 Raw or undercooked meat and meat products
 Raw milk ( unpasteurized or unsterilized)
 Food items contaminated with human faeces
(directly/indirectly)
 Raw vegetables contaminated with soil
 Food contaminated by chemicals, e.g. pesticides ,malathion
 Food prepared using contaminated water
 Food kept in an unsuitable condition for a long time after
preparation
 Poisonous plants
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 Classification of foodborne diseases
• Two broad categories:
1. food poisoning 2. food infections.

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 Food borne…
1. Food poisoning
• From chemical or biological sources.

• Food that contains harmful chemicals, or biological

toxins (poisons) from plants, animals or microorganisms

• Some common sources of food poisoning are

contaminants already in the food when the raw
materials are harvested

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 Food borne…
 Bacterial toxins- by Clostridium botulinum and Clostridium
perfringens, commonly found in the natural
environment, e.g. in soil.
 Chemical toxins ; insecticides sprayed onto growing crops.
 Heavy metals ;lead and mercury, particularly in fish caught
near chemical processing facilities.
 Certain toxic plant tissues ; poisonous mushrooms,
 Toxic animal tissues ; the poison glands of certain fish,
crabs, etc.

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 Food borne…
2. Food infection

• Occurs as a result of ingestion of pathogenic mos like

bacteria, Virus, parasite, fungus with food.

• The ingested microorganisms multiply in the gut and can

cause diseases like diarrhea, e.g typhoid fever, cholera
and Ips etc.

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 Food borne…
Incubation period- may begin from 1 to 72 hours after
eating the food.
Clinical Manifestation
• Range from mild headache to severe flulike symptoms.
• Most common S/S are nausea, stomach cramps,
diarrhea, fever, chills and vomiting depending on the
cause or the agent involved.
Diagnosis
Clinical and history
Lab. investigation of the specific causatitve agent

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 Food borne…
Treatment

• Fluid replacement in case of diarrhea

• Antibiotics for those caused by bacteria( Ciprofloxacin or

cotrimoxazole)

• Antitoxin, or other antidote to neutralize in case of food

poisoning

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 Food borne…
Prevention and control

• Promoting and monitoring the personal hygiene of food

handlers

• Safe and hygienic conditions in food storage and

preparation areas

• Keeping cooked or processed foods covered and in cool

conditions until consumed.

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 Neglected Tropical Diseases
Scabies
 A parasite infestation of the skin caused by microscopic mites,
(Sarcoptes scabiei)
 Spread principally by direct skin-to-skin contact
 very common in poor communities and severely impair the
quality of life of affected children
 Incubation period- 4-6 weeks
• Clinical manifestations of scabies
• severe itching of the skin, particularly at night, raised red
pimples on the skin, the palms, soles, face and scalp of infants
and in older children and adults the rash is most often found in
the spaces between fingers and toes, wrist, armpits, ankles,
navel, ‘belt line’, groin, buttocks, genitals in men and breasts in
women.
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 Scabies…
Treatment -benzyl benzoate lotion (BBL, 25 % solution)
• Treat other people who have been in close contact with
scabies should also be treated with BBL to avoid re-
infection
Prevention and control
• Early diagnosis and treatment of patients and contacts.
• All clothes and bedding should be thoroughly washed
with hot water and dried in sunlight
• Education about good personal hygiene and prevention
of scabies.

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 Schistosomiasis (bilharzia)
 A chronic communicable disease caused by parasitic flatworms of
three species of blood flukes called schistosomiasis:
Schistosoma mansoni -causes intestinal schistosomiasis;
S. haematobium -causes urinary schistosomiasis;
S. intercalatum - also causes intestinal schistosomiasis.
 Two species of Schistosoma parasites (S. mansoni and S.
haematobium are common in Ethiopia:
• Schistosoma mansoni is widespread in several parts of Ethiopia,
usually Ziway, Hawassa, Bishoftu, Wonji,Haromaya, Jimma, Bahir
Dar, and some places in Gojam, Dessie and Tigray.
• More than 60% of schoolchildren are infected with Schistosoma
mansoni.
• S. haematobium - lowland areas, swampy land and floodplains of
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KGY 2024
 Bilharzia…
• Reservoir -humans (primary hosts)
• Freshwater snails (intermediate hosts).
• Mode of transmission
• The immature form of the parasite penetrates the skin of
a new host when he or she is swimming, washing or
standing in infected water.
• They pass to the liver, where they mature into adult
worms. Male and female adult worms mate and deposit
their eggs in the blood vessels of either the intestine or
bladder.
• The eggs pass out into the water in either the faeces or
urine, to continue the infection cycle
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 Bilharzia…
Clinical features:
• Dermatitis (itching) where a parasite has penetrated the
person’s skin (swimmer's itch) in S. mansoni, 2-3 days
after invasion
• S. mansoni - abdominal pain and bloody diarrhea,
swollen abdomen due to enlargement of the liver if
untreated it can lead to permanent liver damage
• S. haematobium- pain during urination, frequent need
to urinate, and blood in the urine.
If remains untreated it can lead to chronic bladder
diseases, like cancer, permanent kidney damage.
Infertility in men, and pain during sexual intercourse
and vaginal bleeding in women.
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 Bilharzia…
• Clinical features….
Intestinal Schistosomiasis -fever, headache, chills,
myalgias malaise, profuse diarrhea, nausea and vomiting.
• Patient may have generalized lymphadenopathy, urticaria
hepatosplenomegaly, and cachexia (wasting and weakness).
• Up to 90% of untreated cases eventually die due to organ
failure, anemia or secondary infections.
Urinary Schistosomiasis
• dribbling, incontinence, frequency, dysuria and hematuria.
• Chronic infection leads to obstructive uropathy, hydronephrosis,
chronic pyelonephritis, renal failure and contraction of the
bladder.
• In rare instances gonads, CNS (brain, spinal cord), lungs and
endocrine organs can be involved.
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Bilharzia…
Diagnosis-Urine analysis and stool exam-observation of the
parasite eggs
Treatment-praziquantel
Prevention and control
• Integrated vector control (IVC)- reducing the number of vectors;
in areas affected by schistosomiasis( using Endod)
 Parasite control measures -treating water for washing with
chlorine or iodine
• Personal protection -against exposure to the parasites, e.g.
farmers, Fishermen
• Rapid case detection and referral to the nearest health centre for
effective treatment;
• Education in the community about the causes and modes of
transmission of schistosomiasis
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 Leishmaniasis
• It is a chronic protozoal parasitic disease exists in
two forms:
Visceral leishmaniasis ( kala-azar)- affects the
internal organs such as the liver and spleen
Cutaneous leishmaniasis- affects the skin.
• There are four major species of Leishmania protozoa
in Ethiopia:
• Leishmania donovani- causes visceral leishmaniasis
• Leishmania aethiopica
• Leishmania major all cause cutaneous leishmaniasis
• Leishmania tropica

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 Leishmaniasis…
• Infection is transmitted by the bite of phlebotomies
sandflies and results in cutaneous, mucosal or visceral
manifestations
• Epidemiology- Distribution is world wide where
appropriate snails are present, Much burden due to the
leishmaniases in Africa is concentrated in East Africa;
Uganda, Sudan, Ethiopia and Kenya
• Life cycle
• Man is the definitive host where sexual reproduction takes
place and snails are intermediate hosts in which asexual
regeneration continues.
• It is transmitted by cercarial skin penetration when in
contact with water bodies containing cercaria escaping from
appropriate snail host
• Each species of Schistosoma has a specific snail host
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 Leishmaniasis…
Clinical Manifestation
1. Visceral leishmaniasis ( kala-azar)
• Emaciated patient with hepatosplenomegally,
• Generalized peripheral lymphadenopathy
• Marked pallor in the late stage .
• Edema of the legs, brittle dry hair, hemorrhages from any
site (gum, skin etc)
• Purpura and petechiae of the skin may occur.
2. Cutaneous leishmaniasis
• Single or multiple painless nodules mainly the face
• Enlarge and ulcerate and raised border forms crust which
may spontaneously heal over months to years
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3/31/2025 CD and NTD KGY 2024 191
 Leishmaniasis…
Diagnosis
• Identification of the characteristic ova in stool or urine
• Seroimmunological diagnosis (ELISA)
• Ultrasound of liver and spleen or biopsy
Treatment
• Praziquantel : has wide spectrum, effective against all
species of Schistosoma, single oral dose, has high cure
rate

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 Leishmaniasis…
• Prevention and control

• Environmental sanitation avoidance of pollution of surface

water

• Elimination of the disease in the reservoir by

chemotherapy

• Snail control (Physical, Chemical control (moluscicides,

Biological control)

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 Onchocerciasis
• Onchocerciasis ("river blindness") is caused by the filarial
nematode Onchocerca volvulus.
• It is transmitted to humans by the bite of blackflies which
breed in fast-flowing streams and rivers in the inter-
tropical zones.

• Epidemiology:-Infection in humans begins with

deposition infective larvae on the skin by the bite of an
infected black fly. The larvae develop into adult in
subcutaneous tissue and form nodules. About
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 Onchocerciasis…
Clinical features:
• Following the bite of an infected fly, there is an incubation
period of several months before nodules appear.
• Subcutaneous nodules, onchocercomata, usually appear on
coccyx, sacrum, thigh and bony prominences.
• The most frequent manifestations are pruritus and rash,
Eczematous dermatitis and pigmentary changes are more
common in the lower extremities.
complication of onchocerciasis
• Visual impairment is the most serious
• Patients could have enlarged inguinal lymph nodes (hanging
groin).
• Heavily infected patients could have severe wasting
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 Onchocerciasis…
• Diagnosis:-
• Demonstration of the microfilariae in the skin snip or
nodules.
• Microfilariae are rarely found in blood smear, but may
be seen in urine
Treatment:
• Ivermectin orally
• Antihistamines for the pruritus
Prevention and control
• Personal exposure reduced by avoiding black fly localities
and by protective clothing or repellents
• Vector control program
• Large scale Ivermectin chemotherapy
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 Podoconiosis
• Podoconiosis is a type of elephantiasis (swelling of the limbs) that
is common in highland Ethiopia (woina dega or dega) in areas of
red clay soil, usually at high altitudes.
• Great deal of misunderstanding about the disease in affected
communities.
• Some people think it is caused by treading on a snake or frog,
others that it is a curse or form of punishment.
• In reality, podoconiosis is a reaction in the body to very small soil
particles that have passed through the skin of the feet.
• The swelling begins in the feet and progresses up the legs, and
both feet are usually affected.
• Unlike other types of elephantiasis, podoconiosis is not caused by
any bacteria, viruses or parasites.
• It cannot be transmitted between people, so close contact with
someone who has podoconiosis is totally safe
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 Podoconiosis…
Distinguishing podoconiosis from lymphatic filariasis
• The outward appearance of legs and feet affected by
podoconiosis and lymphatic filariasis is very similar and can’t
be differentiated just by looking
• But there are some questions you can ask the patient that
can help you to decide which diagnosis is most likely to be
correct
Where does the patient live?
Where did the disease start and what body parts are
affected?
Podoconiosis started in the feet and both feet/legs are
affected
 lymphatic filariasis began in the groin and spread
downwards and only one leg is affected2
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 Podoconiosis…

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 Podoconiosis…
Treatment of podoconiosis
• 9/10 leg swelling from podoconiosis can be treated –Using
• simple foot hygiene, ointment, Bandages, socks and shoes
1 Foot hygiene. First soak the feet for 20 minutes in a
basin of cold water into which half a capful (about 10 drops)
of berekina (bleach) have been added.
2. Then wash the feet carefully using soap and clean cold
water, Dry between the toes with a clean cotton cloth.
3. Rub a small amount of ointment or oil into the skin after
drying.
4. For patients with softer swelling of the legs, elastic
bandages are useful. Show the patient how to apply the
bandage from the toe to the knee, with the leg raised
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 Podoconiosis…
5. Encourage the patient to perform exercises to improve
their circulation, such as toe points, ankle circles and calf
raises, two or three times per day.

6. Raise the affected legs whenever possible by raising the

foot end of the bed, or resting the foot on a stool when
sitting.

7. Clean socks and closed shoes are vital in preventing

further exposure to the soil. If local houses have floors
made of earth the floor should be covered with mats.
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 Podoconiosis…

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 Podoconiosis…
Podoconiosis-plus: problems that need urgent
referral
Red hot leg.
Open wounds
Deep fungal infection
Skin cancer
Prevention of podoconiosis
• Wearing shoes every day to protect the feet from
the soil will prevent it completely!
• So if children wear shoes all the time, the next
generation will not suffer from podoconiosis.
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 Guinea Worm (Dracunculiasis)-GWD
Caused by the parasite Dracunculus medinensis.
Affects poor communities that do not have safe water
(drinking stagnant water containing copepods -tiny
“water fleas)
Can occur by consuming raw or undercooked aquatic
animals
 Incubation period -about 2 weeks
 Diagnosis-
White filamentous worm appears at cutaneous ulcer
X –ray if worms calcified in the skin

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Symptoms
People with Guinea worm
disease (GWD) have no
symptoms for about 1 year.
 Slight fever
 Nausea
 Vomiting
 Diarrhea
 Dizziness
 Itchy rash –worm can be
pulled out after blister bursts

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 Dracunculiasis…
Treatment
• No medical treatment
• Pulling out the worm a few cm each day
• Anti inflammatory and antibiotic for super infection
Prevention and control
 Surveillance (case detection) and case containment
(preventing contamination of drinking water sources by
infected persons or animals)
 Provision of safe drinking water
Filtering, boiling, or chlorinating drinking water
 Health education and community mobilization.
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 Trachoma – the ‘quiet blindness’
• Trachoma is an infectious eye disease that can eventually
cause blindness if left untreated.
• Usually occurs in childhood
• Infected people generally do not develop severe sight
problems until adulthood
• Infectious agent -the bacteria Chlamydia trachomatis
• Mode of transmission
• Transmitted mainly by direct contact with the discharge
(pus) coming from an infected person's eyes by flies,
towels, clothes or contaminated hands
• Direct mother-to-newborn transmission during birth if the
mother has Chlamydia bacteria in her birth canal.
• Bacteria can live in the genitals of males and females,
causing a sexually transmitted infection
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 Trachoma…

Clinical manifestations

The five grades of trachoma progression

1st grade = Trachomatous follicles (TF)

2nd grade = Trachomatous inflammation (TI) or (TF+TI)

3rd grade = Trachomatous scarring (TS)

4th grade = Trachomatous trichiasis (TT)

5th grade = Corneal opacity (CO)

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 Trachoma…
1st grade = Trachomatous follicles (TF)
• Redness and swelling of the conjunctiva
• Presence of five or more trachomatous follicles in the
conjunctiva

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 Trachoma…
2nd grade = Trachomatous inflammation (TI) or (TF+TI)
• Red, thick and swollen upper conjunctiva and has many
trachomatous follicles
• In severe cases, eyelids may not be visible due to the swelling of
the conjunctiva.

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 Trachoma…
3rd grade = Trachomatous scarring (TS)
• Inflammation resolves and the follicles are replaced by scars
on the conjunctiva
• Appear as small glistening lines or stars, and later may
become flat, thick, white bands

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 Trachoma…
4th grade = Trachomatous trichiasis (TT)
• The eyelashes to turn inwards, and at least one eyelash rubs
on the cornea called trichiasis
• Severe and the inward turned eyelash rub the cornea and
causes painful and distressing for the person and it gradually
damages the cornea.

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 Trachoma…
5th grade = Corneal opacity (CO)
• The most severe grade of trachoma
• The cornea becomes white and opaque (not transparent)-corneal
opacity- complete blindness

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 Trachoma…
Prevention and control
• There are four major components for the prevention and
control of trachoma at community level, which are
represented by the letters SAFE
• S = Surgical treatment for trichiasis to stop eyelashes
rubbing the cornea
• A = Antibiotic treatment of active cases (Grade 1&2) of
trachoma by TTC 1% ointment applied to the eyes
• F = Faces and hands washed regularly to prevent
spreading of infection
• E = Environmental sanitation and safe water supply.

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Designing strategies to resolve health problems
The roles of nurse in public health/community
health
1. Role in Health Promotion
 Encourages the adoption of health beliefs, attitudes, and
behaviors that contribute to the overall health of the
population.
 Supports public policy changes to modify physical and
social environments that contribute to risk.
 Assists communities, families, and individuals to take
responsibility for establishing, maintaining, and/or
improving their health.
 Works with others and leads processes to enhance
community, group, or individual plans.
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 Designing strategies…
2. Role in Disease and Injury Prevention
• Reduces the risk of infectious disease outbreaks
• Applies epidemiological principles to manage and control
communicable diseases
• Uses appropriate technology for reporting and follow-up.
• Uses effective strategies to reduce risk factors that may
contribute to chronic disease and disability
• Helps individuals and families to adopt health behaviors
that reduce the likelihood of disease, injury, and/or
disability.
• Encourages behavior changes to improve health
outcomes
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 Designing strategies…
3. Role in Health Protection
 Acts in partnership with public health colleagues, government, and
other agencies to:
ensure safe water, air, and food
control infectious diseases

provide protection from environmental threats

Takes the lead in identifying issues that may need attention and
offers public health advice

Works with individuals, families, and communities to create or

maintain
3/31/2025
a safe environmentCDwhere
and NTD
people may live, work, and 217play
KGY 2024
 Designing strategies…
4. Role in Health Surveillance
 Is aware of health surveillance data and trends; applies
this knowledge to day-to-day work.
 Integrates eco-social surveillance that focuses on
broad, multi-level conditions that contribute to health
inequalities.
 Systematically and routinely collect and report health
data for tracking and forecasting health events or health
determinants.
 Collects and stores data within confidential data
systems; integrates, analyzes, and interprets this data.
 Provides expertise to those who develop and/or
contribute to surveillance systems, including risk
surveillance
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 Designing strategies…
5. Role in Population Health Assessment
 Uses health surveillance data to launch new services or
revise those that exist.
 Contributes to population health assessments and
includes community viewpoints.
 Plays a key role in producing and using knowledge
about the health of communities (or certain populations
or aggregates) and the factors that support good health
or pose potential risks (determinants of health), to
produce better policies and services

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 Designing strategies…
6. Role in Emergency Preparedness and Response
 Contributes to and is aware of public health’s role in
responding to a public health emergency.
 Plans for, is part of, and evaluates the response to both
natural disasters and man-made disasters

 Communicates details of risk to population subgroups at

higher risk and intervenes on their behalf during public
health emergencies

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 Designing strategies…
7. Care/Counseling
 Establishes a therapeutic relationship based on trust,
respect, caring, and listening.
 Uses clinical skills to assess, plan, implement, and evaluation
of nursing interventions.
 Uses health promotion, illness, and injury prevention
techniques that are client centred, client-driven, and
strengths-based
 Helps clients to accept their share of responsibility for
health.
 Sets and maintains boundaries, monitors the counseling
relationship, and effectively plans and manages the process
until the relationship ends.
 Promotes client self-care and/or avoidance of harm to self
and others.
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 Designing strategies…
8. Case Management
 Actively engages with individuals, case-finding, identifying
groups at risk and who meet the agency’s criteria for case
management.
 Assesses the resources and services that needed to improved
quality of life.
 Develops, implements, and evaluates an agreed-upon plan
with the client
 Links individuals and/or families with needed services and
resources.
 Uses an inter-disciplinary approach and cooperates with other
organizations as needed, based on how complex the
circumstances are.
 Coordinates services and applies plans in a logical sequence
together with individuals and/or families.
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 Designing strategies…
9. Communication
 Uses oral and written skills, along with visual, print, and
others
 Negotiates or contracts with health care, social services, or
resource agencies
 Uses effective communication with team members.
 Effectively addresses and manages conflict.
 Contributes to and plays an active role in providing quality
and equitable health services.
 Works to achieve inter-agency and inter-governmental
cooperation.
 Acts as a spokesperson and uses effective risk
communication approaches.
 Uses appropriate technology to manage, mitigate public
health events; this includes good record keeping
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 Designing strategies…

• Health Education

 Assesses the knowledge, attitudes, values, beliefs, behaviors,

practices, stage of change, and skills of the learner.

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Identifying most at risk population (MARPS)
• Sometimes called ‘as at-risk groups or high-risk groups’
• Members of most-at-risk populations (MARPs) are at increased
risk of passing HIV to others or contracting HIV
• They often establish, accelerate, or sustain the HIV epidemic.
• Sex workers , injecting drug users and men who have sex
with men are populations most at risk.
• Other MARPS include, but are not limited to,
 Mobile populations (such as migrants, refugees, and internally
displaced persons)
 Street children
 Prisoners
 uniformed personnel
 Out-of-school youth
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 Perform disease Surveillance
• Public health surveillance of communicable diseases is
continuous data collection, data analysis, interpretation of
the data, and dissemination of the information to
concerned bodies.

• The higher authorities, can take appropriate disease

control measures.

• Surveillance activities are information loops that start

with data collection and end with appropriate disease
control measures
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 Types of public health surveillance
• Three basic types of surveillance systems

• Passive surveillance

• Active surveillance

• Mixed surveillance

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 Passive surveillance
• Passive surveillance;- is the collection of data by health
facilities as part of their routine work of diagnosis and
treatment
• It is called ‘passive’ because the data is obtained only
from the people who seek help from the health services
• In Ethiopia, there is a passive surveillance system based
on monthly activity reports and weekly reporting of
notifiable diseases.
• Most communicable disease outbreaks should be
reported by telephone or radio to concerned body
• Passive surveillance is cheap to operate, because it takes
place as part of routine health-service work
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 Active surveillance
• The second type of surveillance is called active surveillance, in
which the health professionals actively seek to collect data
from all possible cases in their area, under instruction to do
so from a higher level in the health system.
• Active surveillance is usually conducted in relation to a
specific disease or disorder, or it seeks to assess the take up
of a particular health service (e.g. FP, immunization..)
• Active surveillance data are collected because the higher
health authorities request a specific surveillance report,
instead of waiting for routine reports.
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 Mixed surveillance
• Mixed surveillance means combining passive and active
surveillance systems.

• This can work well, leading to better monitoring of

communicable diseases and other health problems.

• Disease control programmes for HIV/AIDS, polio and

malaria use a combination of passive and active
surveillance systems.

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Features of good public health surveillance
A high-quality public health surveillance system:
Involves and encourages the community to report all
cases of diseases and other health problems
Uses both active and passive surveillance for effective
disease control and prevention
Collects only useful data, using a simple data collection
method
Uses laboratory services to confirm clinical diagnosis of
disease
Reports data to the higher level when required and
without delay
After data are reported, the right actions are taken
quickly to improve services or programs.
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 Integrated disease surveillance-IDSR
• IDSR- Collecting, analyzing and reporting priority
diseases quickly and accurately to the proper authorities

• IDSR is a cost-effective surveillance system which

addresses the major health problems of Ethiopia.

• IDSR is a passive surveillance system as the data used

are collected during routine health work

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 IDSR…
Advantages:
• It is cheap, since the same health personnel and
reporting formats are used as are also used for routine
reports of health-related data.
• It creates an opportunity to computerize all the available
data at the central level.
• It provides training and capacity building opportunities
for health personnel to develop new skills.
• It encourages community participation to detect and
respond to disease epidemics.

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 Priority diseases for IDSR in Ethiopia

Priority diseases are diseases that fulfil one or more of

the following criteria

Have a high potential for causing epidemics

Have been targeted for eradication or elimination

Have significant public health importance (causing many

illnesses and deaths)

Can be effectively controlled and prevented

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 Case definitions of priority diseases
• Standard case definitions- confirmed or suspected case.
• A confirmed case shows all the typical S/S of a disease and the
infectious agent or other cause has been positively identified in a
laboratory investigation. Eg. in a confirmed case of malaria, the
patient shows symptoms typical of malaria, the RDT) is positive
• A suspected case of malaria means that the person shows
symptoms of malaria, but a laboratory test either has not been
conducted yet, or has failed to find evidence of the parasite that
causes malaria.
• A community case definition is a simplified version of the
standard case definition, adapted to suit the needs and resources
of practitioners, community health volunteers, community
members, traditional healers and birth attendants.
• It is useful to make a poster showing these definitions in the local
language.
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List of reportable priority diseases and conditions in Ethiopia in 2010
(International calendar).
A. Immediately Reportable Diseases
1. Acute flaccid paralysis(AFP)
2. Anthrax
3. Avian human influenza
4. Cholera
5. Dracunculiasis/Guinea worm disease
6. Measles
7. Neonatal tetanus
8. Pandemic influenza A (H1N1)
9. Rabies
10.Smallpox
11.Severe acute respiratory syndrome (SARS)
12.Viral hemorrhagic fever(VHF)
13.Yellow fever
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 B. Weekly reportable diseases

1. Dysentery
2. Malaria
3. Meningococcal Meningitis
4. Relapsing fever
5. Severe malnutrition
6. Typhoid fever
7. Typhus
3/31/2025

CD and NTD KGY 2024 237

Reporting of priority diseases
1.Immediately reportable diseases- within 30 minutes to higher
authority
2.Weekly reportable diseases

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Epidemic Investigation and Management

• Outbreak –is an increase in cases of a disease compared

with the expected number, occurs only in a limited area and
lasts for only a short time.

• Epidemic -is an excess of cases compared with the

number expected; however, it is the increase in the number
of cases continues far longer (possibly months or even
years), and the cases are distributed across a wider area.

• It is more general than an outbreak

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 Types of epidemics
1. Common source outbreaks- infection occurs after a group of people all came into
contact with the same unsafe source of infection (the common source), such as
contaminated food or water.
2. Propagated or progressive epidemics occur when the infection spreads from person
to person.
• The infectious agents causing the disease pass from one host to another, either directly
from person to person
3.Mixed epidemics -show characteristics of both common source and propagated
epidemics.
 start with a common source and be followed by a propagated spread.
 Mixed epidemics are often caused by foodborne infectious agents.

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 Epidemic investigation
It is a set of procedures used to identify
the cause responsible for the disease.
the people affected
the circumstances and mode of spread of the disease
other relevant factors involved in propagating the
epidemic
The main purpose of epidemic investigation is to control
the spread of the disease before it causes more deaths
and illness

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 Management of epidemics
• It is taking appropriate control measures such as
Report the occurrence of an epidemic to health
authorities as early as possible
Treating those who are ill to reduce the reservoir of
infection
Providing health education to limit the transmission of
the disease to others.
Health professionals at higher levels will require your
help in putting into operation any measures needed to
control the spread of the disease, such as giving drugs
to people in the community and providing health
education
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• Reading assignment
• Refer your Basic health statistics and Survey module

Thank You
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