LYMPHATIC FILARIASIS

Introduction:
 Lymphatic means (relating to lymph or its secretion). A tropical, parasitic disease that
affects the lymph nodes and lymph vessels.( Lymph nodes and lymph vessels are part of the
lymphatic system, which helps the body fight infection and maintain fluid levels
 Filariasis (Filariasis is a parasitic disease caused by an infection with round worms of
the filoriadea type).
 Filariasis is a tropical disease caused by the presence of filarial worms, especially in
the lymph vessel where heavy infection can result in elephantiasis.( Enlargement if
body parts)
 Lymphatic filariasis, also known as elephantiasis, is a human disease caused by
parasitic
 worms known as filarial worms.
 The worst symptoms of chronic disease generally appear in adults, in men more often
than in woman, and include damage to the lymphatic system arms, legs or genitals,
which causes significant pain, wide-scale loss of productivity and social exclusion.
 Research during the past 20 years had led to new treatment regimens, strategies and
diagnostic tools, which have dramatically changed the prospects of lymphatic
filariasis control and led to the launch of the Global Programme to Eliminate
Lymphatic Filariasis in (2000).
 The core objective of (GPELF) Global Programme Eliminate Lymphatic Filariasis.
 Lymphatic filariasis is public health problem in India. The disease is a endemic all
over India, except in Jammu and Kashmir, Himachal Pradesh, Punjab, Haryana,
Delhi, Chandigarh, Rajasthan, Nagaland, Manipur, Tripura, Meghalaya, Sikkim,
Arunachal Pradesh, Mizoram and Dadra and Nagar Haveli.
 However, surveys carried out during the past two decades indicate that areas
previously known to be free from filariasis are showing evidence of low degrees of
transmission. Heavily infected areas are found in Uttar Pradesh, Bihar, Jharkhand,
Andhra Pradesh, Orissa, Tamil Nadu, Kerala and Gujarat.

Epidemiological Determinate :
Lymphatic Filariasis is caused by infection with nematodes of the family Filariaoidea
(फिलॅरीओइङीआ): 90% of infections are caused by Wucheresia bancrofti ( वुकेरीझीआ
बॅनक्रोफ्टी)and most of the remainder by Brugia malayi.( बुरजीया मेलाई)

Humans are the exclusive host of infection with W.bancrofti).

Agents:
There are at least 8 species of filarial parasites that are specific to man.
They are Wucheresia bancrofti, Brugia malayi, Brugia timose.
They are causing lymphatic filariasis.
Host Factor:
Man is a natural host
a) Age
All ages are susceptible to infection
The infection rates rise with age up to 20-30 years
b) Gender
• In most endemic areas, MF ( macrofilaria ) rate is higher in men.
c) Migration
Migration led to the extension of filariasis into non-endemic areas.
• Environmental Factors:
1) Climate
2) Drainage
1. Climate: It influences the breeding of mosquitoes, their longevity and the development of
parasite in insect nectar.
2. Drainage
Vectors breed profusely in polluted water.
The common breeding places are open ditches, septic tanks, ill maintained drains.
Mode of Transmission:
Lymphatic Filariasis is transmitted through mosquito bites.
Incubation Period: Most commonly 8 to 16 months, but may be longer than this.
Signs and Symptoms Lymphatic filariasis infection involves asymptomatic, acute and chronic
conditions.

Asymptomatic:
Although the parasite damages the lymph system, majority of infected people are
asymptomatic and will never develop clinical symptoms.
These people do not know they have lymphatic filariasis unless tested.
These asymptomatic infections still cause damage to the lymphatic system and the kidney.
They also alter the body's immune system.
Acute:
Acute episodes of local inflammation involve
 Skin
 Lymph nodes
 Lymphatic vessels
Some of these episodes are caused by the body's immune response to the parasite.
Early Symptoms:
 Red expanding target rash
 Feeling unwell or 'Flu-like'
 Headache, stiff neck
 Swollen lymph nodes
 Sound or light sensitivity
Prevention and Control:
Even after the adult worms die, lymph oedema can develop.
You can ask your physician for a referral to see lymphedema therapists for specialised care.
Prevent the lymph oedema from getting worse by following several basic principles:
1. Carefully wash the swollen area with soap and water every day.
2. Elevate and exercise the swollen arm or leg to move the fluid and improve the lymph flow.
3. Disinfect any wounds. Use antibacterial or anti-fungal cream if necessary.
4. Prevention centres or mass treatment with antifilariasis drugs to prevent ingestion of larvae
by mosquitoes, public health action to control mosquitoes, public health action to control
mosquitoes and individual action to avoid mosquito bites.
5. If possible, stay inside during dusk and dark, this is when mosquitoes are most active in
their search for food.
6. When outside, wear long pants and long-sleeved shirts.
7. Spray exposed skin with insects repellent.

8. Vector control.
9. Destruction of breeding sites of vectors.
10. Using bed nets while sleeping.
11. Good hygiene with help reduce the spread of the parasites.
12. Hand washing after handling things with infective pinworm eggs.
13. Cleaning under the fingernails and not biting the finger nails.
14. Clothes, especially underwear, should be changed and washed daily to help prevent
spreading the disease.
15. Treating every infected in a household at the same time.
Prevention & Control depends upon :
1) Mosquito control
2) Chemotherapeutic control
1) Mosquito control:
a) Clinical control
b) Biological control
c) Environmental control
d) Reduction of non vector contact
a) Clinical control: By spraying insecticides like DDT, Malathion etc.
b) Biological control: By the use of carnivorous bacteria (Bacillus sphaer strain 1593),
carnivorous fish (Poecilia reticulata molliensis) and spore forming bacterium (Bacillus
thuringenesis serotype 11-14)
c) Environmental control: By efficient drainage & sewage system to eliminate the mosquito
breeding places.
d) Reduction of non vector contact : By use of mosquito nets and house screens.
2) Chemotherapeutic control :
It is base on the mass or selective treatment of the cases by administering DEC or use of DEC
medicated salt in the populations exposed to filarial infections.
DEC (Diethyl Carbamazine) against filarial worms

PNEUMOΝΙΑ
Introduction:
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs
known as alveoli.
Synonyms: Pneumonitis, Bronchopneumonia
1. Pneumonia is a common lung infection characterised by collection of pus and other
fluids in the lung air sacs (alveoli).
2. Lung air sacs are structures that help in the exchange of oxygen and carbon dioxide.
Collection of pus in them makes breathing difficult.
3. Pneumonia can be caused by many kinds of micro organisms (germs) including
bacteria, viruses, fungi or parasites.
4. When an infected individual coughs or sneezes, these organisms get into the air and
breathing in of this air leads to contraction of the illness.
5. Pneumonia affects approximately 450 million people globally (7% of the population)
and results in about 4 million deaths per year.
6. Pneumonia was regarded by William Orler in the 19th century as "the captain of the
men of death". With the introduction of antibiotics and vaccines in the 20th century,
survival improved.
7. Nevertheless, in developing countries, and among the very old, the very young, and
the chronically ill, pneumonia remains a leading cause of death. Pneumonia often
shortens suffering among those already close to death and has thus been called "the
old man's friend".

TRANSMISSION OF PNEUMONIA
 Pneumonia can be spread by way of someone sneezing or coughing.
 When a person sneezes or coughs, little droplets spread throughout the air.
 These droplets contain the infectious organism.
 They are then inhaled and may, in some instances, cause pneumonia.
 This is especially true for people who are already sick as a result of something like the
flu or worse, AIDS.
 However, you can actually get pneumonia in ways other than someone sneezing in
your face. Pneumonia can be cured by bacteria or viruses that are already in your nose
and throat. If these organisms spread to the lungs from there, they may cause
pneumonia. Pneumonia is caused by transmissible organisms.
For example: Aspiration pneumonia can occur when someone inhales an unwanted
substance into their lungs.

Transmission can happen in a variety of ways, including:

1) Inhaling the infection
2) Through the mouth or eyes

1) Inhaling the infection: This can occur when a person with pneumonia coughs or sneezes
and another person inhales the infected particles. This is more likely between people in close
contact with each other, such as parents and children or in poorly ventilated spaces, such as
Airplanes.
2) Through the mouth or eyes:
This can happen when a person touches a surface that an infected person has coughed or
sneezed on.
When a person with an infection coughs into their hand and then shakes another person's
hand, the second person can become infected if they touch their mouth or eyes without
washing their hands.
Fungal pneumonia typically develops when people inhale microscopic particles of fungus
from the environment.
People with weaken immune systems are more likely to develop this type of pneumonia.
Symptoms of Pneumonia: Pneumonia symptoms can be mild to life threatening. The most
common symptoms of pneumonia can include:
 Coughing that may produce phlegm (mucus)
 Fever, sweating, and chills
 Shortness of breath
 Chest pain
SYMPTOMS:
Viral pneumonia: Viral pneumonia may start with flu like symptoms, such as wheezing. A
high fever may occur after 12-36 hours.
Bacterial pneumonia: May cause a fever as high as 105°F along with profuse sweating,
bluish lips and nails, and confusion.
• Symptoms by age:
1. Children under 5 years of age may have fast breathing.
2. Infants may vomit, lack energy, or have trouble drinking or eating.
3. Older people may have a lower than normal body temperature.

DIAGNOSIS BY PNEUMONIA
1. A blood test
2. A sputum test
3. Pulse oximetry
4. A urine test
5. A CT scan
6. A Fluid sample
1) A Blood test: This test can confirm an infection, but it may not be able to identify what's
causing it.
2) A sputum test: This test can provide a sample from your lungs that may identify the cause
of the infection.
3. Pulse oximetry: An oxygen sensor placed on one of your fingers can indicate whether
your lungs are moving enough oxygen through your blood stream.
4. A urine test: This test can identify the bacteria streptococcus pneumonia and legionella
pneumophila.
5. A CT scan: This test provides a clear and more detailed picture of your lung
6. A Fluid sample : If your doctor suspects there is fluid in the pleural space of your chest,
they may take fluid using a needle placed between your ribs. This test can help identify the
cause of your infection.

TREATMENT
• Home Treatment:
1. Taking your drugs as prescribed
2. Getting a lot of rest
3. Drinking plenty of fluids
4. Not overdoing it by going back to school or work to school
5. Hospitalisation:
If symptoms are very severe or you have other health problems, you may need to be
hospitalised. At the hospital, doctors can keep track of your heart rate, temperature, and
breathing. Treatment may include:

1. Intravenous antibiotics:These are injected into your vein.

2. Respiratory therapy:This therapy uses a variety of techniques, including delivering specific
medications, directly into the lungs.
The respiratory therapist may also teach you or help you to perform breathing exericses to
maximize your oxygenation.
3. Oxygen therapy: This treatment helps maintain the oxygen level in your blood stream. You
may receive oxygen through a nasal tube or a facemask. If your case is extreme, you may
need a ventilator (a machine that supports breathing).
PREVENTION:
In many cases, pneumonia can be prevented by:
Pneumonia vaccine
1) Prevnar 13
2) Pneumovax 23
Pneumonia vaccine: The first line of defence against pneumonia is to get vaccinated.
Two types of pneumonia vaccines are available:
1) Prevnar 13
2) Pneumonax 23
Other Prevention tips:
In addition to vaccination, there are other things you can follow to avoid pneumonia:
1. If you smoke, try to quit. Smoking makes you more susceptible to respiratory
infections, especially pneumonia.
2. Wash your hands regularly with soap and water.
3. Cover your coughs and sneezes, and dispose of used tissues promptly.
4. Maintain a healthy life style to strengthen your immune system. Get enough rest, eat a
healthy diet, and get regular exercise.

DRUG ADDICTION- DRUG SUBSTANCE ABUSE

Introduction:
The problem of non-medical use of drugs is largely a social one with profound impact
upon the families of the addicts and the society.
The drugs like opium, caffeine, nicotine, cocaine, caffeine are usual to relax get pleasure
and satisfaction which cause serious in our contemporary culture.
It is a responsibility of everyone who cares for civilisation and welfare of the mankind.
Few terminologies related to drug abuse and drug dependence.
1) Drug Abuse :Drug abuse is defined as 'the consumption of a drug apart from medical
need or in unnecessary quantities' ( The harmful effects of drug abuse include drug
dependence, antisocial behaviour and traffic accidents).
Majority of drug abuse are the agents that act on central nervous system to produce
profound effects on mood, feeling and behaviour.
Broad definition of drug abuse also includes the habitual use by laymen of drugs like
laxatives, headache remedies, antacids and vitamins.
2) Drug Addiction :It is state of chronic intoxication produced by the repeated
consumption of drug. Its characteristics include:
(i) An overpowering desire or need (compulsion) to continue the drug and to obtain it by
any means.
(ii) A tendency to increase the dose
3) Drug misuse: Drug misuse can be defined as the use of drugs for purposes or
conditions for which they are unsuited or even their appropriate use but in improper
dosage.
4) Drug dependence: Drug dependence is a state, psychic and sometime physical in
which the user has compelling desire a to continue taking the drug either to
experience its effect or to avoid the discomfort of its absence. The drug has two
independent components viz.
1) Psychological drug dependence
2) Physical drug dependence
1) Psychological dependence:
A condition in which a drug produces "a feeling of satisfaction and a psychic drive that
require continuous administration of the drug to produce pleasure or to avoid discomfort"
is called psychic dependence.
2) Physical drug dependence:
It is a condition in which withdrawal symptoms are manifested by physical disturbances.
Physical dependence cannot occur without tolerance. It is an altered or adaptive
physiological state of body.
5) Drug Tolerance: Drug tolerance is a state of decreased responsiveness to the
pharmacologic effect of a drug resulting from a prior exposure to that drug or to a related
drug. When exposure to drug A produces tolerance to it and also to drug B, the organism
is said to be cross tolerant to drug B.
Reasons for drug addiction: The drug addict continue taking drug for the following
reasons:
1. for its medicinal use
2. To satisfy curiosity about drug effect
3. To have a new dangerous experience
4. To relax from stress and strength
5. To except from reality and have a dreamy state
Some important drugs of abuse and their treatment are discussed below:
1) Narcotic Analgesics (Opiates):
For example: Morphine, opium, heroin, codeine.
The addicts commonly use heroin, morphine, pethidine, methadone etc. Heroin is a drug
of preference; chronic opiate abuse results in physical dependence which increases with
increase in dose and development of tolerant state manifested by decreased sensitivity to
opiate agonist and increased sensitivity to antagonists, Psychological dependence
develops rapidly and severe.
Symptoms:
The abuse of narcotic result in syndrome include drowsiness and relaxed feeling,
restlessness excitement, pinpoint pupil, malnutrition, vitamin deficiency, constipation,
Withdrawal symptoms are as below:
1. After eight hours: Sweating, anxiety, tearing
2. After twenty hours: Chills, sweating, panic
3. After 24-48 hours- nausea, vomiting, diarrhoea, fever and hypertension.
4. Up to one week- muscle cramps
5. Up to several month- Insomnia
Treatment:
1. Morphine should not be prescribed readily for chronic pain except in cases of
compelling situation.
For example: Cancer pain
Gradual withdrawal of morphine with substitution of author narcotic analgesic to
decrease the severity of withdrawal syndrome.
The symptoms can be suppressed by substitution of another narcotic for opium. For
example: Methadone.
Dose: 20mg in dividend dosage for first 3 days and 10mg for 3 days.
1-d acetyl methanol (LAAM) is a longer acting drug used for narcotic addiction. This
drug is superior to methadone as it is not to be administrated daily.
5. Naltrexone is another long acting antagonist used for treatment of narcotic addition.
2) CNS Depressants:
a) Alcohol
Acute alcoholism: Alcoholism is a behavioural disorder and a chronic disease state
resulting due to persistent and excessive use of alcohol. It causes physical disability and
impaired emotional, occupational and interpersonal adjustment.
Alcohol addiction may include both tolerance and physical dependence. As tolerance
develops, a person consume progressively increasing amount of alcohol to achieve the
same state of psychological reinforcement previously induced by smaller closes of
alcohol. The dependences develop slowly.
Medical complications: Medical complications of alcohol abuse include malabsorption,
gastritis, cirrhosis, alcoholic hepatitis, fatty lever, chronic diarrhoea, beri beri, cutaneous
ulcers, delirium tremens, convulsive disorders, alcoholic myopathy, pellagra and hyper or
hypoglycaemia.
Withdrawal symptoms are as below: The habitual consumption of large quantities of
alcoholic drinks induces a state of physical dependence. Sudden withdrawal of alcohol
results in withdrawal syndrome. Shortly after alcoholic drinking, there is tremor, nausea,
vomiting and profuse perspiration.
After cessation of alcohol ingestion, withdrawal symptoms vary from hangover to
delirium tremens. After around 6-8 hours of stopping the alcohol, withdrawal symptoms
start with sweating, insomnia, headache, muscle twitching, cramps, diarrhea, vomiting
and agitation in more severe cares. These symptoms reduce after 40 to 50 hours of
cessation.
After 2 to 3 days hallucinations, disorientation, seizures occur followed by delirium
tremens.
Treatment: The treatment is sup-positive to maintain the respiration, blood pressure and
body temperature until the ethanol is removed from the body by metabolism or
haemodialysis. If intra cranial pressure is increased hypertonic mannitol solution is
administered intravenously. Phenothiazine is used to control psychotic behaviour.
Artificial respiration and electrolytes are given for balance.
Chronic Alcoholism It results in development of tolerance and then physical dependence.
The withdrawal of alcohol result in tremors, if its anxiety, insomnia, confusion,
gastrointestinal disturbances like chronic gastritis, peptic ulcer cirrhosis, pancreatitis,
hepatitis bone marrow suppression and gout.
Treatment: It consist of counselling and attention to society and behaviour factor
supportive social literature. It also requires pharmacotherapy with anti anxiety agents and
aversion therapy using Disulphuram.
Diazepam is given I.V. supplemented with haloperidol 2-4 mg every 4-6 hours. Dose of
diazepam - 40mg daily for 4 days.
30 mg daily for 3 days
20 mg daily for 2 days
10 mg daily for 1 day
3) Barbiturate: The chronic abuse of barbiturates result in drowsiness, ataxia, reduce
quality and quantity of work increase appetite, impaired instability and poor judgment.
Pentobarbitone which must be given to prevent withdrawal syndrome.
Medical Complications: Medical complications of chronic abuse of barbiturates include
impairment of psychomotor functions, altered sleep pattern, impaired psychomotor skills,
folate deficiency, rickets in children and osteomalacia in adults.
Withdrawal symptoms are as below:
Withdrawal symptoms starts after around 36 hour. It includes
 Nausea
 Vomiting
 Weakness
 Dizziness
 Visual hallucinations
 Insomnia
 Weight loss
 Hypotension
 Anxiety
 Muscle twitching
 EEG abnormalities etc. Recovery occurs after several weeks.
4) Hallucinogens: Hallucinogen is a drug that acts on the central nervous system to
produce a state of perception of objects with no reality or of sensations with no external
cause.
Lysergic acid diethyl-amide (LSD), Mescaline, Psilocybin and Marihuna are
hallucinogens.
Lysergic acid diethyl-amide (LSD) is a most common hallucinogen of abuse 20-25 g of
LSD may produce the effects in susceptible individuals and may last for 8-12 hrs.
Withdrawal symptoms are given as below :
The major effect of LSD abuse include blurred vision, altered shapes and colours, great
heightening of colour intensity, colours are heard, sounds may be seen, distortion of
space, hallucinations.
Dizziness muscular weakness, increased heart rate, dry mouth, nausea, vomiting, tremors
are seen. Psychological changes show altered mood, euphoria, deceased ability to
concentrate, tension anxiety etc.
Treatment: It includes following therapy :
1) Psychotherapy
2) Ant anxiety and sedative drugs can be used.
3) Psychotic reaction like schizophrenia may be treated with drug like Chlorpromazine.
 DENGUE
 Dengue fever is the most common among arthropod borne diseases.
 It is a disease of tropical and subtropical regions affecting urban and peri-urban
areas.
 According to World Health Report (1999), the increase of dengue and dengue
hemorrhagic fever occurs due to increased population, urbanisation, inappropriate
water management, travel & trade.
 Dengue fever is endemic in India.
 It is widely prevalent. During 2003, 217 deaths occurred due to dengue. Dengue is
caused by any one of four serotype of this flavivirus DEN-1, DEN-2, DEN-3 &
DEN-4).
 It causes 50 millions infection world-wide.
 The man gets dengue virus infection from the bite of an infected aedes mosquito.
 Mosquito becomes infected when they bite infected humans and later transmit
infections to other people, when they bite.
 Two main species of mosquito are: Aedes Aegypti and Aedes albopictus.

A study conducted on "The changing epidemiology of dengue in Delhi, India" by Ekta

Gupta has shown that out of 1820 serum sample received from suspected cases during the
years 2003, 2004 & 2005, Forty four point fifty six percent (811) were confirmed as
having dengue infection serologically.
Out of these confirmed cases, maximum cases were seen in the age group 21-30 years.

Epidemiological Triad:

Agent:
Agent (flavivirus of four serotype) (Den-1, Den-2, Den-3 & Den-4)
Host (All ages, both sexes)
Environment (Rainy season)
 Dengue fever is caused by flavivirus (DEN-I, DEN-II, DEN-2 & DEN
4) serotypes.
 Dengue fever is an acute viral infection and occurs in epidemic or
endemic forms in India.
 Aedes mosquito becomes infective after feeding on infective patient.
 The incubation period for development of infection in aedes mosquito
is 8-10 days And once the aedes mosquito is infective, it remains
infective for life.
Mode of Transmission:
Vector borne transmission
Reservoir of Infection: Man and mosquito
Incubation period: 3-10 days
Clinical Manifestations:
(A) Classical Dengue Fever
High fever with chills (39°C to 90°C)
 Intense headache
 Muscle & joint pain
 Photophobia
 Weakness
 Anorexia
 Constipation
 Altered taste sensation
 Pain in Inguinal region
 Sore throat
 Rash-diffuse flushing and mottling
(B) Dengue Hemorrhagic fever (DHF):
It includes all the symptoms of classical dengue fever plus
 Damage to blood and lymph vessels
 Bleeding from nose, gums or under the skin
(C) Dengue shock syndrome:
It includes all symptoms of dengue fever like-
 Fluids leaking outside the vessels
 Massive bleeding
 Shock
Laboratory Diagnosis:
Blood test for platelets & haematocrit. ( volume percentage of red
blood cells in blood, measured as part of a blood test
Platelets less than 100,000/mm³ will be in dengue Hemorrhagic Fever and
haematocrit increased by 20% or more.

PREVENTION & CONTROL

(1) Active surveillance :

It is an important component of a dengue prevention programme.
The goal should be to provide an early warning or predictive capability for
epidemic transmission, the rationale that emergency mosquito control
programmes can be initiated.
Hospitals used as sentinel sites should include all those upon the patients
who have severe infectious disease in the community.
(2) Mosquito control:
Prevention and control depends on the control of the mosquito
vector in and around home, where most transmission occurs.
The most effective way to control the mosquito that transmits dengue is
larval source reduction i.e., elimination or cleaning of water holding
containers that serves as the larval habitat in domestic environment.
(3) Community participation:
Now days, emphasis is on the community based approaches.
Prevention programmes require extensive health education to achieve
community participation.
(4) Prevention of dengue in travellers:
It is difficult to achieve effective prevention of dengue fever in travellers
visiting tropical areas. But the risk of infection can be significantly
decreased.
Precautions include :-
 Staying in screened or air conditioned rooms
 Spraying the rooms with aerosol bound insecticides to kill adult
mosquitoes indoor.
 Using a repellent containing DEET (dimethyl-metatoluamide) on
exposed skin
 Wearing protective clothing
(5) Early diagnosis and treatment:
The cases of dengue should be diagnosed. The criteria given by WHO for
diagnosis of dengue hemorrhagic fever is-
Acute onset of high grade fever continuously lasting for 2-7 days