Brucellosis, Tetanus

1
Brucellosis, Tetanus Plague

• By
• Dr. Riaz Ahmed

2
Brucellosis

• Also known as undulant fever / malta fever /
  mediterranean fever.
• Bacterial zoonosis which is transmitted to man by
  direct / indirect contact with animals.
• Caused by different species of brucella- group of
  organisms and characterized by
• Intermittent / irregular febrile attacks
• Arthritis / enlarged spleen etc.

3
Epidemiology

• Agent factors
• Brucella abortus in bovine abortus fever
• B.Suis Pigs Swine F or Porcine
• B.Canis Canines Canine fever
• B.Melitensis Goats Caprine fever
• Host factors predominantly disease of males.
• Farmers
• Shepherds
• Butchers
• Slaughter house men
• Veterinarians
• Lab-workers are at special risk because of
  occupational exposure.

4

• Environmental factors
• Most prevalent under conditions of advanced
  domestication in the absence of corresponding
  advanced S.O. Hygiene () where there is
• Overcrowding of herds
• Increased rain fall
• Lack of exposure to sunlight
• Unhygienic practice of milking/ heat production

5

• M.O.T
• Ingestion milk / milk products
• - meat even of camel
• Contact absorption from skin
• Inhalation
• Inoculation 02mm throat or oral cavity
• Source / Reservoir
• S milk, lochial secretions, placenta, urine,
  feces meat.
• R farm animals e.g., cattle, goats, swine etc.
• I.P highly variable usually 1-3 weeks.

6

• Lab diagnosis
• Bacteriological
• Serological / allergic test
• Control
• in animals
• Test / slaughter
• Vacc B.Abortus strain 19
• Hygienic measures
• In humans
• At individual level
• At community level

7
Tetanus

• An acute disease caused by exotoxins of
  clostridium tetani clinically characterized by
• Muscular rigidity
• Painful paraoxysmal spasms of voluntary muscles
  esp.
• Masseters ( trismus / lock-jaw )
• Facial (risus sardonicus)
• Back / neck (opisthotonus)
• And those of lower limbs and abdomen
• Mortality 40-80

8

• Agent factors
• Clostridium tetani
• Reservoir of infection
• Source soil / dust
• Exotoxin
• P.O.C None
• Host factors
• Age / sex
• Occupation
• Rural / urban differences
• Immunity
• Environmental factors
• Tetanus is a positive environmental hazard.
• M.O.T contamination of wounds with tetanus
  spores.

9

• I.P 6 10 days
• Types
• Traumatic
• Puerperal
• Otogenic
• Idopathic
• Tetanus Neonatorum (8th day syndrome)
• Prevention
• Active immunization DPT
• Passive ATS
• Both
• Antibiotics
• Observe tetanus schedule for pregnant women

10
Plague (Black Death)

• Basically primarily a zoonotic disease caused
  by Yersinia pestis involving rodents fleas.
• It exists in natural foci is transmitted by
  infected flea bites to humans living or intruding
  into the same ecological environment.
• Occurrence many forms e.g.,
• Epizootic
• Enzootic
• Sporadic
• And in epidemics of all forms including
  anthroporotic primarily pnemonic.

11
History

• Epidemics of plague are mentioned in Bible
• Association of plague with rats is known to be
  ancient.
• 1st out-break 1320 B.C.
• 1st Pandemic 542 A.D. called Justinian plague,
  which lasted for 50 years estimated mortality
  was 100 deaths.
• 2nd Pandemic 1346 B.C. lasted for 30 years
  claimed one forth world mortality.
• In 1840 B.C. Pandemic of pneumonic type
• In 1930 6 million deaths in India.
• In 1994 - out-break in India, then subsided
  gradually.

12
Plague

• Def Highly fatal disease characterized by high
  fever, progressive heart failure nervous
  symptoms.
• Conjunctiva is injected with reddish appearance.
• Skin hemorrhage pustular eruptions.
• Clinical forms
• Bubonic
• Pnemonic
• Septicemic
• sylvatic

13
Bubonic plague

• Onset sudden, most common type
• High temperature, prostration
• Painful buboos
• Vesicular / pustular skin lesions
• Complications
• secondary terminal pneumonia

14
Pneumonic plague

• Primary P. Plague is rare. Generally follows as a
  complication of bubonic - septicemic plague.
• Incidence decreased 1
• Highly infectious
• Symptoms acute bacterial infection
• Sputum hemorrhagic
• Most deadly form of plague

15

• Septicemic
• Rare
• Buboes absent
• Fever low
• Hemorrhages into skin
• Sylvatic
• Endemic in rodents in jungles
• Man is affected accidentally while doing
  activities like hunting etc.

16

• Source of infection
• In bubonic plague by bite of inf. Rat fleas
• Xenophsylla cheopis
• Xenophsylla actia
• Xenophsylla braziliensis
• In pneumonic plague
• exhaled droplets of saliva
• sputum of patients
• Reservoir rats wild rodents, out of 1700
  species 200 associated with plague.

17

• I.P
• Bubonic 2-7 days
• Septicemic 2-7 days
• Pneumonic 1-3 days
• P.O.C pneumonic is very communicable from
  person to person, bubonic if terminal inf. is
  there.
• M.O.T
• Bubonic plague bite of infected rat flea
• Pneumonic plague droplets

18
Epidemiology

• Agent factors yersinia pestis, occur in blood,
  buboes, spleen, liver, other viscera of infected
  persons.
• Host factors
• Age / sex all ages both sexes
• Activities of man e.g., hunting, cultivation,
  grazing, harvesting, construction etc.
• Movements ship, land, cargo
• Immunity no natural immunity
• Environmental factors
• Season september May
• Temp 20-25 C
• Humidity less than 60, Rain fall
• Rural / urban, Human dwellings

19

• Population at risk
• Geologists, Biologists
• Anthropologists
• Hunters, agriculturists etc.
• Vector of plague Pulex irritants (human fleas)
• Blocked / Partially blocked flea
• Flea Indices
• Total flea index
• Specific index if gt1
• Sp. of fleas
• Burrow index

20
Prevention Control

• Control of cases
• Early diagnosis
• Notification
• Isolation
• Treatment
• Disinfection
• Control of fleas/ rodents
• Application of insecticides, rodenticides and
  other preventive measures to be adopted.
• Vaccination 0.5-1ml SC after 7-10 days.

21

• Chemoprophylaxis
• Surveillance
• Health education

22
Thank You