team_
# sub-Community Medicine**
**Topic- protozoal communicable disease....
The two main protozoal communicable diseases are Malaria and Kala-azar. Today I will discuss these two. AlaMalaria🖋🖋 PEpidemiology: CcOccurance: Endemic through most of the tropical & subtropical area mainly Chattogram, Rangamati, Bandarban, Khagrachari, Mymensingh, Cox’s Bazar, Sylhet. CoEcological triad: #Agent: - Plasmodium Falciporum (Malignant Malaria) - Plasmodium malariae (Quartern Malaria) - Plasmodium ovale (Mild tersion) - Plasmodium vivax (Benign) #age: all groups are equally affected. # sex: Male> female. # Social & Economic factor: More in poor socioeconomic country. # Imminity: Influenced by status of immune population. # Housing: More in ill ventilated & ill lighted house. # Pregnancy: Increase risk & fatality # Human Habit: sleeping out of doors, refusal of spraying, refusal to take bed rest # Occupation: Closely related to agricultural practice. # Race: duty (+ ve) persons are resistant to p.vivax infection. 👉🏻 Environment: # Season: July to November (Mainly rainy season) #Humidity: 60% # Rainfall: Necessary for breading # Altitude: They are mostly found at altitude above 2000-2500 meters. # Temperature: For the development of malaria parasite in anopheles mosquitos 20 • - 30 C Made Man made malaria: • Burrow pits Pod Natural History: # Reservoir: Human ⬇️ Granulocytes # Vector: Female Anopheles Mosquitoes - Anopheles Phillipinensis (In plane area) - Anopheles Sundica (In sundarban area) -Anopheles Minimus (In mountain area) -Anopheles Balbasensis (In hilly jungle area) -Anopheles Stephonsis (In hilly / urban area) #Mode Of Transmission: 1. Vector transmission . 2. Direct transmission by blood # Root of entry: skin Incubation Period: Las Plasmodium falciporum (9-14 days) Las Plasmodium malariae (18-40 days) • Plasmodium vivax (8-17 days) • Plasmodium ovale (16-18 days) (# Which type of anemia: hemolytic anemia # Which type of fever: Intermittent fever as base line touches. Not continuous or reminant.)
NInvestigation: 1. Microscopic examination of blood: Using both thick & thin leishman or giemsa stained smears. Thick: To ensure the presence of organisms Thin: For species identification 2. Antigen detection: mun Immunochromatographic test • Dipstick test 3. Serological test: ICT- For malariae • ELISA (enzyme linked immunk servant assay) • Haemagglutination test 4. Indirect: • Leukopenia • HB% - <8 gm / dl <8% BC RBC - <3 million / cubic mm RePrevention: AnManagement of malaria case: 1.case detection 2.treatment: presumptive treatment, radical treatment, mass drugs treatment, chemoprophylaxis. CtiveActive intervention measures: 1. Stratification of the problem 2. Vector control strategies: a.antilarval measures: environment control, chemical control, biological control, b.anti-adult measures c.Protection against mosquito bite ⏩ Treatment: 1. Chemoprophylaxis: Chloroquine sensitive area- Chloroquine 150 mg (2 tablets weekly) E Moderate degree chloroquine resistant area- Chloroquine 150 mg 2 tablet weekly + Proguanil 100 mg 2 tablet daily Degree High degree chloroquine resistant area- Doxycycline / Fansider 300 mg 100 mg Weekly Weekly Drugs: Chloroquinone- Commonly used • Primaquinone • Mefloquinone Proguanil Fansider OmpComplication: 1. Pernicious malaria- ere Cerebral Fatal (99%) Algid • Septicaemia Cerebral fatal- Merozoyate➡️blood➡️cerebral artery ⬇️ Sticky➡️blood vessel➡️stroke / ishchemia➡️death 2. Black water fever 3. Hypoglycaemia (due to quinone intake) 4. Spontaneous bleeding 5. Multiple organ damage: pulmonary, hepatic, renal dysfunction 6. In pregnancy: chance of abortion, still birth, low birth weight child, intrauterine death 7. Rupture of spleen 8. Hypotensive shock 9. Prolonged hypothermia 10. Lactic acidosis 11. Immunological disorder Kala-azar PEpidemiology CcOccurance: worldwide distribution. Endemic in BD (mainly jamalpur, mymensingh, tangail, vnetrokona, gazipur etc.): 👉Ecologically triad Agent: leishmaniadonovani Host: age: all Sex: male> female Socioeconomic condition: people of poor socioeconomic states NEnvironment: season: 3 months after the onset of raining Area: confined rural areas Altitude: doesn’t occur above 2000 ft Humidity: 70% Temperature: 18-35 C 👉Natural history Reservoir: humN (patient) Vector: Phlebotomus argentipes (female sand fly) Mode of transmission: bite of female sand fly Incubation period: 1-4 months may vary from 10 days to 2 years. ⏩Type of leishmaniasis: Leishmaniasis 1. Visceral 2.cutenous> post kalaazar dermal leishmaniasis (by leishmania donovani) 3.muco - cutenous (caused by leishmania brazialensis) /C / F: fever, hepatomegaly, anemia, darkening of skin, face, hands, melanocyte formation Spleenomegaly NInvestigation: 1. Leishman skin test 2.microscopic examination of collected species (specimen collected from liverv, spleen, bonemarrow, lymphnode,) *** findings: amastigate form is found. (Another form is promastigate) *** 3. Isolation & identification from culture media: . temperature: 20 c Time: 1-2 weeks findings: amastigate form converted into promastigate Controlling measures: Restbed rest ➡nutritional support ➡disease surveillance Drugs: 1. Sodium stibogluconateb iv or im for 30 days . 20mg / kg body weught> adult & children 2.miltefosine:> 25kg: 100 mg daily for 28 days <25kg: 50mgdaily for 28 days 3. Amphotericin-B: 1mg / kg body weight / day for 20 days 4. Pantamine: 3mg / kg body weight / day iv for 10 days. Andsand fly control ➡Personal protective measures: use fine mash net, avoiding sleeping on the floor, use of repellent.