Year: 2015

Definition:- Typhoid fever is an acute communicable disease caused by Salmonella typhi . The disease is marked by prolonged fever, toxic symptoms& constitutional disturbances.
The term “enteric fever” includes both typhoid & paratyphoid fevers.
Epidemiological factors:-
(1) Agent:- Salmonella typhi is responsible for 95% of cases. S. para A is responsible for about 5% of cases.
(2) Source of infection:- patients & carriers of typhoid fever
(3) Infective material:- Faeces and urine of infected persons.
(4) Age:-The diseases affects all age groups, but more commonly between 5 and 19 years.
(5) Immunity:- An attack of typhoid fever gives a fairly lasting immunity. Second attacks may also occur.
(6) Poor sanitation:- Lack of sanitation and safe water are involved in transmission.
(7) Unhygienic habits:- Open air defecation , urination, low standards of food hygiene, illiteracy & health ignorance are responsible for the endemicity of typhoid fever in India.
(8) Mode of transmission:- Faecal –oral & urine- oral routes.
(9) Incubation period:- 7 to 28 days.
Control of typhoid fever:-
Several control measures are common to all gastro-intestinal diseases. These are discussed in the section on “Control of Cholera”
The principles of control of typhoid fever are given below:-
(1)Patients
• Notification
• Isolation
• Treatment:-Fluroquinolone e.g.ofoxacin or ciprofloxacin, cefixime, azithromycinetc.
• Proper disposal of feaces urine.
• Disinfection of clothing , linen and fomites.
• Immunization of contents with typhoid fever
(2) Community
• Immunization with typhoid fever vaccine
• Provision of safe water & improvement of sanitation.
• Food sanitation:- protection of food from flies dust, preventing from carriers.
• Detection of typhoid carriers and treating them.
• Health education in matters of food & personal hygiene.
Anti typhoid vaccines:- The anti- typhoid vaccine currently manufactured in India is –
— monovalent & bivalent
— Heat killed
–Phenol-preserved vaccine

Description:-POLIOMYLITIS
Definition:-Poliomyelitis is a virus infection. It is primarily an infectious disease of the human alimentary tract, but may affect the brain, spinal cord & nerves resulting in paralysis.
Polio does not always cause paralysis.
Epidemiological factors:-
(1)Agents:- The causative agents is polio virus which has 3 serotypes designated as type1, type2& type 3. Type 1 is responsible for all major epidemics.
(2) Sources of infection:– Faeces mostly in young children
–Pharyngeal secretions
(3)Age:- The majority of cases contract polio between 1&2 years.
(4) Environmental conditions:– Overcrowding , poor sanitation,
rainy season, rural& urban areas.
(5) Mode of transmission:– Faecal-oral route by contaminated
Water,food or flies.
–Droplet infection from nasopharynx
(6)Incubation period:- 7-21 days (range 3-35 days)

Clinical Features:- 90% of cases are asymptomatic , about 8 % suffer from mild illness ,& 1-2 % are severely affected.
Other symptoms:-
• Fever
• Headache
• Diarrhea& vomiting
• Drowsiness
• Pain, weakness & stiffness of neck & back
• Paralysis of affected limb
Diagnosis Investigations:-
• Serological testing for polio viral antibiotics.
• X-ray
• Physical examination
Prevention:-
(1)Polio can be prevented by active immunization of all infects & children.
(2) The vaccine widely used is oral polio vaccine (OPV) which is a Sabin type of vaccine.
(3)It can also be administered soon after birth.
(4)Hot milk & hot fluids should not be given for at least half an hour after the administration.
(5)Recent studies indicate that breast feeding does not impede the effectiveness of OPV.
(6) Breast milk can be given whenever the child Hungary.
(7) A point of great importance is that polio vaccine should be stored at sub – zero temperature in a deep freeze to prevent inactivation.
Strategies for polio eradication in India:-
(1) Conduct pulse polio immunization days every year until poliomyelitis is eradicated.
(2)Sustain high levels of routine immunization coverage.
(3)Monitor OPV coverage at district level & below
Key Words:-
(1) Pulse polio
(2) Vaccine
(3)Paralysis
(4)sign & symptoms
(5)faecal route

DESCRIPTION:-
INTRODUCTION- plague epidemic had been a cause of many deaths in the world. In Bhagwat Purana and Bible also, plague is described as an epidemic.
This is also called ‘black death’. The bacteria’s are responsible for the disease pasteurella pastis. This spreads through the bite of fleas which gets the infection from sick rates. Fleas are found on rates and rodents.
EPIDEMIOLOGICAL FACTORS –
• Bacteria are found on wild rodents like rates, carnivorous animals, and in other smaller animals.
• In India source of plague is wild rodents. But the fleas living on rates are the fleas living on rates are the main source of plague against the disease.
• Along with infected rates and fleas, pneumonic plague patients are also responsible for the spread of the disease.
• Plague is transmitted by direct contact with the tissues of infected animals.
• Disease spreads more in winter. During heavy rain the rat holes are destroyed and the chances of spreading of plague becomes less.
INCUBATION PERIOD- This depends upon the type of plague and may range from 1 to 7 days.
CLINICAL MENIFESTATION- Three types of plague are found in humans:
 Bubonic plague
 Pneumonic plague
 Septicaemic plague
The beginning of bubonic plague is sudden with fever, shivering and headache. Face and eyes turn red and person feels extremely tired. Pain and swelling develop in all the lymph glands especially in the thigh.
This plague does not spread from one person to another because infection is locked in buboes and they cannot get out.
DIAGNOSISTIC TESTS-
• Smear examination of secretion of glands, fluids and sputum.
• Blood culture.
• Serum examination
COMPLICATION-
Intensive bleeding, pneumonia, toxicity, death
MANAGEMENT-
 Controlling the disease through early diagnosis, notification and isolation is the primary necessity in the management.
 Streptomycin is given.
 Tetracycline is also given.
 Control of fleas.
 Use plague vaccines.
 Health education.
 Prevention.

DESCRPITION
DEFINITION
The inflammation of meninges (membranes surrounding the brain and spinal cord) which is caused by viral, bacterial or fungal organisms.
Classification
There are three classifications –
1. Aseptic – viral or causes or meningeal irritation from other causes such as brain abscess, encephalitis, leukaemia etc.
2. Septic — bacterial origin ex. Meningococcus, Neisseria meningitides, Staphylococcus, Influenza Bacillus.
3. Tuberculous – Tubercle Bacillus

Pathophysiology
The causative organisms enter the blood stream, cross the blood brain barrier, and trigger an inflammatory reaction in the meninges. Independent of the causative agents, inflammation of the subarachnoid and piamater occurs. Increased intra cranial pressure results. Meningeal infections generally originate in one of two ways: either through the blood stream from other infections or by direct extensions. In a few cases, the cause is iatrogenic or secondary to invasive procedures or devices.
Bacterial meningitis is the most significant form. The common bacterial pathogens are Neisseria meningitides, Streptococcus, Pneumoniae and Haemophylus Influenzae.
Clinical signs
Headache, Neck stiffness, Photophobia (intolerance to bright light), Irritability
Changes in level of consciousness, disorientation, memory impairment
Behavioural changes, coma
Positive Kernig’s sign
Vomiting bradycardia, increased ICP (intra cranial pressure)
Phonophobia (intolerance to loud noises)
Abnormal skin colour, cold extremities
Petechial rash
Morphology
• Grossly, pyogenic meningitis shows a thick layer of supportive exudates covers the leptomenings over the surface of the brain.
Diagnosis
• Culture of CSF
• Blood culture
• Urine specimen
• MRI
• CT-Scan

Management
1. Medical management
• Antimicrobial therapy- penicillin, ampicillin chloramphenicol
• Vancomycin, along with refampin is given for bacterial infection
• For dehydration or shock, fluid volume expenders are given
• Seizures are controlled by diazepam or phentoin
• Osmotic diuretics used to treat cerebral edema ex. Mannitol

2. Nursing management
• Management resolve around, prevention of dehydration, electrolytes imbalance and edema and fever.
• Body weight, serum electrolyte and urine volume are closely monitored.
• Arterial pressure is monitored to asses cardiac or respiratory failure and risk of shock
• Asses the patient neurologic status.
• Watch for cyanosis, cold extremities.
• Administer I.V. (intra venous) fluids and medications.
• Monitor vital signs and neurological status.
• Provide basic patients need care.
Complications
The complications of meningitis can be severe. The longer persistent in a human and child without treatment, the greater the risk of seizures permanent neurological damage including-
• Hearing loss
• Memory difficulty
• Learning disabilities
• Brain damage
• Gait problems
• Seizures
• Kidney failure