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COMMUNICABLE DISEASES THAT AFFECTS OUR NERVOUS SYSTEM

MENINGITIS
Also known as cerebrospinal fever Meningitis is the inflammation of the meninges of the brain and spinal cord as a result of viral and bacterial infection. Such inflammation may involve the three meningeal membranes the dura matter, the arachnoid, and the pia matter.

WHAT CAUSES MENINGITIS?

The disease can be caused by several kinds of organisms which include the pneumococcus, staphylococcus, and tubercle bacillus. The specie Neisseria meningitides (meningococcus) is the organism causing most epidemics of meningitis

MENINGOCCCUS
Human pathogen Non-motile diplococci Small, kidney-bean Shaped cells Non-spore forming Optimum growth in Warm, moist environment Aerobic Gram-negative Strongly oxidase positive Oxidative metabolism

Neisseria minigitides

MENINGOCOCCUS CONT
Energy obtained by Fermentation of various sugars (N. meningitidis ferments glucose & maltose) No Gas is Produced Intracellular Growth Habit Fastidious ( growth is inhibited by free fatty acids ) Susceptible to Drying Several of Neisseria are found in aquatic environments Incubation period varies, the extreme limit being set from 1-10 days

BACTERIA ACTION

Neisseria meningitidis is often transferred from person to person in aerosol form as from a sneeze. Upon infection, it first takes residence on the muscosal membrane surface as in the nose, throat, and respiratory tract by attaching with its pili. It then gradually infects deeper into the tissue until it gains access to the bloodstream where it then travels to infect the meninges of the brain.

HOW CAN IT BE TRANSFERRED?


By respiratory droplets through nasopharyngeal mucosa ( droplet transmission) By direct invasion through otitis media (vehicle transmission, Cotton buds) May result after a skull fructure, a penetrating head wound, lumbar puncture or ventricular shunting preocedures

SIGNS AND SYMPTOMS

Symptoms usually come on quickly, and may include:


Fever

and chills Mental status changes Nausea and vomiting Sensitivity to light (photophobia) Severe headache Stiff neck (meningismus)

S/S CONT

Other symptoms that can occur with this disease:


Agitation Bulging

fontanels Decreased consciousness

S/S CONT
Poor

feeding or irritability in children Rapid breathing Unusual posture, with the head and neck arched backwards (opisthotonos)

DIAGNOSTIC PROCEDURES

Lumbar puncture
diagnostic
To

purposes

obtain specimen, the CSF To take x-ray of the spinal canal and cord
Therapeutic

purposes

to reduce intra-cranial pressure to introduce serum and other medications To inject an anesthetic agent

DIAGNOSTIC PROCEDURES CONT


Gram staining Smear and blood culture Smear for petechiae Urine culture

MANAGEMENT AND TREATMENT


1. If meningitis is left untreated it has a mortality rate of 70 to 100 per cent. 2. Treatment includes appropriate antibiotic therapy and vigorous supportive care. 3. Usually IV antibiotics are given for 2wks. and are followed by oral antibiotics such as: ampicillin, cephalosporin (ceftriaxone), aminoglycosides. 4. Digitalis glycoside (digoxin) is administered to control arrhythmias. 5. Mannitol is given to decrease cerebral edema 6. anticonvulsant or sedative is needed to reduce restlessness and convulsions. 7. Acetaminophen is helpful to relieve headache and fever. 8. Asses neurologic sign often. Observe the patients level of consciousness and check for increase intra-cranial pressure.

MANAGEMENT & TREATMENT CONT


9. Monitor fluid balance. Maintain adequate fluid intake to avoid dehydration, but avoid fluid overload because of the danger of cerebral edema. Measure central venous pressure and intake and output. 10. Position the patient carefully to prevent joint stiffness and neck pain. Turn the patient often to avoid pressure sores and respiratory complications. Assist with ROM. Tests that may be done include: Blood culture Chest x-ray CSF examination for cell count, glucose, and protein CT scan of the head Gram stain, other special stains, and culture of CSF

PREVENTION

Haemophilus vaccine (HiB vaccine) in children will help prevent one type of meningitis. The pneumococcal conjugate vaccine is now a routine childhood immunization and is very effective at preventing pneumococcal meningitis. Household members and others in close contact with people who have meningococcal meningitis should receive preventive antibiotics to avoid becoming infected themselves. The meningococcal vaccination is recommended for: Adolescents ages 11 - 12 and adolescents entering high school (about age 15) who have not already received the vaccination. All college freshmen who have not been vaccinated and are living in dorms. Children age 2 and older who do not have their spleen or who have other problems with their immune system.

TETANUS

Tetanus is an infectious disease caused by Clostridium tetani which produces potent exotoxin with prominent systemic neuromuscular efforts manifested by generalized spasmodic contractions of the skeletal musculator

TETANUS CONT

Tetanus is fatal up to 66% of unimmunized persons, usually within 10 days onset. When symptoms develop within three days, the prognosis is poor.

WHAT CAUSES TETANUS?


The causative organism of the disease is Clostridium tetani. Sources of infection are:

animal

and human feces. The organisms are found in the intestinal wall of herbivorous animals, including man. Soil and dust Plaster of paris, unsterile sutures, pins, rusty materials, scissors.

CLOSTRIDIUM TETANI

Anaerobic, gram positive with round terminal spore with slender body giving a drumstick appearance. The organism comes in 2 forms, spore forming and the vegetative form. Clostridium tetani reproduces via an asexual reproduction process known as binary fission. In this process a single bacterium cell that has reached its maximal growth stage divides into two smaller identical clone bacteria cells. Due to this process, C.

CONT
Incubation period is within 3 days to 3 weeks. The organism releases 2 types of toxin:

Tetanospasmin

that is responsible for muscle

spasm Tetanolysin that is responsiblefor destruction of RBC.

ACTION

Spores of the bacteria C. tetani live in the soil and are found around the world. In the spore form, C. tetani may remain inactive in the soil, but it can remain infectious for more than 40 years. Infection begins when the spores enter the body through an injury or wound. The spores release bacteria that spread and make a poison called tetanospasmin. This poison blocks nerve signals from the spinal cord to the muscles, causing severe muscle spasms. The spasms can be so powerful that they tear the muscles or cause fractures of the spine.

ACTION
The time between infection and the first sign of symptoms is typically 7 to 21 days The toxin (tetanospasmin) has a great affinity to the central nervous system tissues and the spinal motor ganglia, inducing hyperexcitability of the motor neurons by interfering with the release of inhibitory transmitter.

HOW CAN IT BE TRANSFERRED?


Normally, the mode of transmission is through punctured wound that is contaminated by dust, soil, or animal excreta containing Cl. Tetani 1. Rugged traumatic wounds and burns 2. Umbilical stump in newborn especially for babies delivered at home with faulty cord dressing; babies delivered without tetanus toxoid immunization 3. Unrecognized wounds (cleansing of the ears with sharp materials) 4. Dental extraction, circumcision, ear piercing.

SIGNS AND SYMPTOMS

Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affect the chest, neck, back, and abdominal muscles. Back muscle spasms often cause arching, called opisthotonos. Sometimes the spasms affect muscles that help with breathing, which can lead to breathing problems.

S/S CONT

Polronged muscular action causes sudden, powerful, and painful contractions of muscle groups. This is called tetany. These episodes can cause fractures and muscle tears.

S/S CONT
Other symptoms include: Drooling Excessive sweating Fever Hand or foot spasms Irritability Swallowing difficulty Uncontrolled urination or defecation

MANAGEMENT AND TREATMENT

Antibiotics, including penicillin, clindamycin, erythromycin, or metronidazole (metronidazole has been most successful) Bedrest with a nonstimulating environment (dim light, reduced noise, and stable temperature) Medicine to reverse the poison (tetanus immune globulin) Muscle relaxers such as diazepam Sedatives Surgery to clean the wound and remove the source of the poison (debridement) Breathing support with oxygen, a breathing tube, and a breathing machine may be necessary.

PREVENTION

1. Active immunization with tetanus toxoid for adults 2. DPT for babies and children. Tetanus is completely preventable by active tetanus immunization. Immunization is thought to provide protection for 10 years. Studies of soldiers suggest that good protection persists up to 12 years after the last immunization. Immunizations begin in infancy with the DTaP series of shots. The DTaP vaccine is a "3-in-1" vaccine that protects against diphtheria, pertussis, and tetanus. It is a safer version of an older vaccine known as DTP, which is no longer used in the U.S.

PREVENTION CONT
Td vaccine or Tdap vaccine is used to maintain immunity in those age 11 and older. Tdap vaccine should be given once, prior to age 65, as a substitute for Td for those who have not had Tdap. Td boosters are recommended every 10 years starting at age 19. Older teenagers and adults who have sustained injuries, especially puncture-type wounds, should receive booster immunization for tetanus if more than 10 years have passed since the last booster.

PREVENTION CONT

Thorough cleaning of all injuries and wounds and the removal of dead or severely injured tissue (debridement), when appropriate, may reduce the risk of developing tetanus. If you have been injured outside or in any way that makes contact with soil likely, contact your health care provider regarding the possible risk for tetanus. Many people believe injuries caused by rusty nails are the most dangerous. This is true only if the nail is dirty as well as rusty, as is usually the case. It is the dirt on the nail, not the rust, that carries the risk for tetanus.

LEPROSY
Also known as Hansens disease Leprosy is a disease that has been known since biblical times. It causes skin sores, nerve damage, and muscle weakness that gets worse over time.

WHAT CAUSES LEPROSY?

Leprosy is caused by the bacterium Mycobacterium leprae. It is not very contagious and it has a long incubation period (time before symptoms appear), which makes it hard to know where or when someone caught the disease. Children are more likely than adults to get the disease.

MYCOBACTERIUM LEPRAE
Mycobacterium leprae acid fast Gram-positive bacterium. straight or slightly curved rod-shaped organism with parallel sized and rounded ends It is an obligate intracellular organism and grows and divides inside macrophages and Schwann cells

MYCOBACTERIUM LEPRAE CONT


. It is further characterised by an extremely slow doubling time of 12-14 days, favouring temperatures of around 30 degrees C. M. leprae is the only species of mycobacteria to infect peripheral nerves. Incubation period of leprosy ranges from 5 and months to 8 years.

ACTION
Mycobacterium leprae attacks the peripheral nerves, especially the ulnar, radial, posteriorpopliteal, anterior-tibial and facial nerves. when the bacilli damage the skins fine nerves, they cause paralysis and dryness. If they attack a large nerve trunk, motor nerve damage, weakness and pain occur, followed by peripheral paralysis, muscle paralysis and atrophy.

HOW IS IT TRANSFERRED?
1. Mycobacterium leprae is transmitted through respiratory droplets (droplets transmission) 2. inoculation breaks in the skin and possibly through environmental contacts.

SIGNS AND SYMPTOMS


Skin lesions that are lighter than your normal skin color Lesions have decreased sensation to touch, heat, or pain Lesions do not heal after several weeks to months Muscle weakness Numbness or lack of feeling in the hands, arms, feet, and legs

MANAGEMENT AND TREATMENT

A number of different antibiotics (including dapsone, rifampin, clofazamine, fluoroquinolones, macrolides, and minocycline) are used to kill the bacteria that cause the disease. More than one antibiotic is often given together. Aspirin, prednisone, or thalidomide is used to control inflammation. Tests done are: Lepromin skin test can be used to tell the two different forms of leprosy apart, but it is not used to diagnose the disease Skin lesion biopsy Skin scraping examination

PREVENTION

Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease).

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