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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5990_Библиотеки_им_академика_М_И_Перельмана.pdf
183Introduction to Microbiology
Prevention and control:
1. Isolation of the patients.
2. Quarantine of contacts.
3. Disinfection of articles soiled with discharges of
infected person.
4. Immunization with measles vaccine, e.g. measles,
rumps, and rubella (MMR) Vaccine and measles-
mumps-rubella-varicella (MMRV).
Treatment: Most patients of measles recover without specific
treatment. Drugs are required only when complaints occur.
The children need care during the acute stage of the disease.
Malnourished children need special care. Vitamin A
supplements and extra fluids are given to the infected person.
c. Rubella/German measles
Rubella, also known as German measles, is a contagious viral
infection of short duration (3 days).
Causative agent: RNA Rubivirus (RV) of the family
Togaviridae
Incubation period: 2 to 3 weeks
Epidemiology: Rubella occurs worldwide, most often in
children.
Epidemiological determinants:
Agent factors:
1. Source of infection in clinical or subclinical cases of
rubella.
2. Rubella is much less communicable than measles.
3. The period of communicability extends from a week
before the symptoms to about a week after the rash.
Host factors: It affects children mainly between 3 and
10 years in developing countries and adolescents in developing
countries.
Environmental factors: Rubella usually occurs in a seasonal
pattern. In temperate zones, it occurs during the late winter
and spring.
184 Social Pharmacy
Mode of transmission:
1. A virus is transmitted directly from an infected person
to a healthy person by droplets from the nose and
throat and droplet nuclei.
2. It can also spread by direct contact with an infected
person’s respiratory secretions, such as mucus.
3. It can also be passed on from pregnant women to
unborn children via the placenta.
Clinical features:
1. Mild fever of 38.9°C (102°F) or lower,
2. Headache,
3. Sore throat,
4. Aching joints,
5. Stuffy or runny nose,
6. Inflamed, red-eyes,
7. Enlarged, postauricular and posterior cervical lymph
nodes,
8. A pink rash that begins on the face and quickly spreads
to the rest of the body.
Prevention and control: The best protection against rubella
is the MMR (measles-mumps-rubella) vaccine.
Treatment: There is no specific medicine to treat rubella.
Symptoms are usually mild and can be managed with bedrest
and medicines such as acetaminophen.
d. Mumps
Mumps is a contagious viral infection of the salivary glands
that most commonly affects children.
Causative agents: Myxovirus parotiditis and Paramyxo-
viridae family.
Incubation period: 16–18 days.
Epidemiology: Mumps is prevalent worldwide.
Epidemiological determinants:
Agent factors:
1. The source of infection is usually a clinical case or
subclinical case of mumps. 30 to 40% of cases are
subclinical.
185Introduction to Microbiology
2. The period of communicability is 4 to 6 days before the
onset of the disease and seven days after the onset
(10–14 days).
Host factors:
1. Age: It occurs mostly in children aged 5–9 years.
Mumps is the most common cause of deafness in
children.
2. Immunity: The disease confers lifelong immunity.
Mumps shows a seasonal trend and mostly occurs in winter
and spring.
Mode of transmission: The virus is transmitted from an
infected person via droplets or through contact with contagious
saliva/nasal secretion.
Clinical features:
1. Puffy cheeks
2. Parotitis
3. Swollen jaw
4. High-grade fever
5. Headache
6. Muscle aches
7. Tiredness
8. Loss of appetite
Prevention and control: The MMR vaccine is a safe and
effective preventive measure. The first dose is at 13 months of
age, and the second dose is at 4–6 years of age.
Treatment: No specific antiviral treatment is available.
Symptomatic treatment includes antipyretics and analgesics
(acetaminophen, paracetamol), and non-steroidal anti-
inflammatory drugs). Adequate hydration is useful.
e. Influenza (Flu)
Influenza is an acute and specific infection of the respiratory
tract.
Causative organism: It is caused by RNA viruses influenza
type A, type B, and type C belonging to the family Orthomyxo-
viridae (the influenza viruses).
186 Social Pharmacy
The incubation period is 8 to 72 hours.
Epidemiology: It is a highly infectious disease that is
distributed worldwide. Major epidemics occur at intervals of
2–3 years. The morbidity rate varies from 15 to 40% of the
population. The epidemic lasts for 6 to 8 weeks and its peak is
reached in 3 to 4 weeks.
Epidemiological determinants:
Agent factors:
1. Influenza A and B viruses are responsible for epidemics
of disease throughout the world.
2. A major reservoir of influenza virus exists in animals
and birds (e.g. swine, horses, cats, domestic poultry,
horses, wild birds, etc.).
3. The source of infection is usually a clinical case or
subclinical case of influenza.
4. The secretions of the respiratory tract in the case of
influenza are infective.
5. The period of communicability is 1 to 2 days before the
onset of the disease and 1 to 2 after the onset of
symptoms.
6. The secondary attack rate is 50 to 60%.
Host factors:
1. Age: It affects all ages and both sexes.
2. Immunity: The disease does not confer lifelong
immunity. Re-infection with the same virus can occur.
Environmental factors: Influenza shows seasonal trend and
epidemics mostly occurs in winter and rainy seasons.
Mode of transmission: Influenza spreads from person to
person mainly by tiny droplets created by sneezing, coughing,
or talking. The portal of entry of the virus is the respiratory
tract.
Clinical presentations:
1. Fever
2. Headache
3. Chills
4. Sore throat
5. Cough without much sputum
6. Weakness and severe pain in the back and limbs.
187Introduction to Microbiology
Prevention and control:
1. Cover mouth and nose with a handkerchief while
coughing or sneezing.
2. Frequently wash hands with soap and water or alcohol-
based hand cleaners.
3. Disinfect the patient’s excreta, saliva, and linen.
4. Good ventilation of houses and public buildings.
5. Sanitize rooms with diluted chlorine bleach.
6. Practice good health habits (including adequate sleep,
nutritious food, and physical exercise).
7. Avoid touching the eyes, nose, or mouth to stop the
spread of germs.
8. Compulsory and prompt notification of cases and
isolation of patients.
9. Avoidance of overcrowded places during epidemics.
10. Prophylactic vaccination: Vaccines available against the
influenza virus are (a) trivalent inactivated influenza
vaccine (e.g. agriflu, fluzone), (b) quadrivalent
inactivated influenza vaccine (e.g. Flulaval tetra), and
c) live attenuated influenza vaccines (e.g. FluMist).
Treatment: Persons suffering from influenza infections
should be advised to:
1. Take bed rest.
2. Drink plenty of liquids.
3. Do not smoke or drink alcohol.
4. Take medications to relieve flu symptoms like
antipyretics (paracetamol or acetaminophen, for fever
or pain; cough suppressants).
5. Stay alert for emergency warning signs like shortness
of breath, chest pain, dizziness, confusion, and
vomiting.
6. Take antiviral medications (amantadine, rimantadine,
zanamivir, and oseltamivir) to reduce the severity and
duration of the illness.
f. Avian-Flu
It is also known as bird flu.
188 Social Pharmacy
Causative agent: Avian influenza Type A viruses.
Incubation period: 2 to 8 days.
Epidemiology: Avian–Fluviruses naturally spread among
wild aquatic birds worldwide and can infect domestic poultry
and other bird and animal species. Bird flu viruses do not
normally infect humans. The disease can carry a high mortality
in humans.
Mode of transmission: This type of flu is most often
contracted by contact with sick birds or bird droppings. It can
also be passed from person to person.
Clinical features: Cough, fever, sore throat, muscle aches,
headache, runny nose, and shortness of breath.
Prevention and control:
1. Wash hands before and after handling raw meat.
2. Use different utensils for cooked and raw meat.
3. Make sure meat is cooked until steaming hot.
4. Avoid direct contact with wild birds.
5. Avoid unprotected contact with poultry.
6. Avoid contact with surfaces contaminated with saliva,
mucous, or feces from wild or domestic birds.
Treatment: Antiviral medicines Oseltamivir (Tamiflu) or
Zanamivir (Relenza) may reduce the severity of the condition,
prevent complications and improve the chances of survival.
g. H1N1
In April 2009, a novel flu disease emerged in Mexico, the United
States, and several other countries. The causative agent of this
disease contains genes from all three flus, namely human, pig,
and bird. Initially, it was called swine flu but later named
influenza A/H1N1.
h. Severe Acute Respiratory Syndrome (SARS)
Introduction: Severe acute respiratory syndrome (SARS) is
a communicable viral respiratory illness. It is a contagious and
potentially fatal respiratory illness.
Causative agent: SARS is caused by Coronavirus, called
SARS-associated Coronavirus (SARS-CoV).
189Introduction to Microbiology
Incubation period: 2–7 days.
Epidemiology: SARS first appeared in China in November
2002 and was identified in February 2003. SARS spread to over
24 countries before it was contained. No new cases have been
reported since May 2004, except for the recent outbreak of
COVID-19. The overall mortality rate of SARS is about 14%
and mortality is age-related. Children are rarely affected by
SARS. There is no evidence of transmission of SARS from the
infected mother to the fetus.
Mode of Transmission: A person with the virus can transmit
the infection through droplets formed on cough and sneezing
and by close human contact. It may also spread through
hugging and kissing, sharing utensils for eating and drinking,
speaking to someone within a distance of 3 feet, or touching
someone directly. The virus is likely to remain active in the
environment for several days.
Clinical Features:
1. High fever above 38°C
2. Muscle pain
3. Aches
4. Chills
5. Headache
6. Diarrhea
7. Sore throat
8. Cough
9. Running nose
10. Difficulty in breathing and shortness of breath.
SARS may eventually lead to pneumonia. Serious
complications include respiratory failure, heart failure, and
liver failure.
Prevention and Control:
1. Early identification and quantitation of SARS cases and
their close contacts.
2. Proper screening of travelers at airports, bus stands,
and stations.
3. Frequent hand washing. Avoid touching the eyes,
mouth, or nose with unclean hands. Cover the mouth
190 Social Pharmacy
and nose with a tissue when coughing or sneezing.
Proper use of appropriate masks.
Treatment: There is no effective drug against SARS.
Supportive drug therapy is recommended to relieve symptoms
such as fever and cough.
i. MERS
Middle East respiratory syndrome (MERS) is a viral respiratory
disease. MERS coronavirus (also known as MERS or MERS-
CoV) is a rare but severe respiratory illness.
Causative agents: Novel coronavirus (MERS CoV)
Incubation period: 1–14 days
Epidemiology: The prevalence of MERS-CoV is significant
across the Middle East region. The fatality rate is around 35%.
The frequent occurrence of MERS is due to community spread.
MERS-CoV can survive in camel milk for more prolonged
periods; hence camels are considered intermediate hosts while
the original hosts are speculated to be bats.
Mode of transmission: The virus does not appear to pass
easily from person to person unless there is close contact, such
as providing unprotected care to an infected patient. MERS is
spread between animals and people. There is evidence that
camels in the Middle East are the main source of the virus.
MERS can also be passed from person to person through
cough droplets. But it does not seem to be very contagious
between people unless they are in close contact.
Clinical features: Fever, cough and shortness of breath,
pneumonia, diarrhea, and vomiting.
Prevention and control:
1. No vaccine or specific treatment is currently available.
2. Practice general hygiene measures, including regular
hand washing before and after touching camels and
other animals.
3. Avoid contact with sick animals.
4. Consume cooked or pasteurized animal products,
including milk and meat.
191Introduction to Microbiology
Treatment: There is no specific treatment for MERS. Only
supportive therapy is given to relieve the symptoms.
j. Covid-19
Coronavirus disease (COVID-19) is an infectious disease.
Causative agent: SARS-CoV-2 virus
Incubation period: 1–14 days
Epidemiology: Most infected people experience mild to
moderate respiratory illness and recover on their own.
However, some seriously ill patients require medical attention.
Patients with underlying medical conditions like cardiovascular
disease, diabetes, chronic respiratory disease, or cancer are
more likely to develop serious illnesses.
Mode of transmission: The virus can spread from an infected
person’s mouth or nose in small liquid particles when they
cough, sneeze, speak, sing, or breathe. These droplets and
particles can be breathed in by other people. Respiratory
étiquette needs to be practiced; for example, by coughing into
a flexed elbow, and to stay home and self-isolate until recover
if feeling unwell.
Clinical features:
1. Fever or chills.
2. Cough.
3. Shortness of breath or difficulty breathing.
4. Fatigue.
5. Muscle or body aches.
6. Headache.
7. Loss of taste or smell.
8. Sore throat.
9. Congestion or runny nose.
10. Nausea or vomiting.
11. Diarrhea.
Prevention and control: Important ways to slow down the
spread of COVID-19 include:
1. Stay at least 6 feet apart from others.
2. Wear a well-fitted mask, and wash hands frequently
192 Social Pharmacy
with soap and water or use an alcohol-based hand
sanitizer.
3. Get vaccinated. Available vaccines are Covaxin,
Covishield, Sputnik, and Corbevax (for children of the
age group 12+ years).
4. Avoid crowds and poorly ventilated indoor spaces.
5. Avoid touching contaminated surfaces.
6. Avoid touching the eyes, nose, or mouth.
7. Cough into a flexed elbow
8. Stay home and self-isolate until infection recovers.
9. Avoid direct contact with the sick person’s fluids.
Treatment:
1. Drink a lot of fluids to maintain adequate hydration.
2. Stay at home; take plenty of rest and drink fluids.
3. Take acetaminophen to lower the fever.
4. Oral antiviral medications—Remdesivir, Paxlovid, and
Molnupiravir are available for outpatients with mild to
moderate COVID-19.
k. Diphtheria
It is an acute communicable disease mostly localized in the
throat, nose, and tonsils.
Causative organism: Corynebacterium diphtheria
Incubation period: 2 to 5 days.
Epidemiology: It occurs mostly in preschool children. Adults
may be occasionally affected. It is characterized by the involve-
ment of the respiratory system and the formation of a false
membrane for soluble exotoxin. Peculiar inflammation of the
surface of the membrane to the nose, throat, and tonsils occurs.
The bacteria also produce toxin, which is absorbed into the
blood and causes serious complications in the nervous system
and heart.
Epidemiological determinants:
Agent factors:
1. The source of infection may be a case or carrier.
2. Carriers are common sources of infection. Carriers may