Block-5

DNHE-2
Public Health and

Indira Gandhi National Open University
School of Continuing Education Hygiene
Block
5
COMMON INFECTIOUS DISEASES
UNIT 15
Measles, Tuberculosis and Whooping Cough 7
UNIT 16
Diphtheria, Tetanus and Poliomyelitis 22
UNIT 17
Malaria 36
UNIT 18
Skin, Eye and Ear Infections 44
COURSE DESIGN (ORIGINAL)
Prof. V.C. Kulandai Swamy Prof. H.P. Dikshit Prof. A.B. Bose
Vice Chancellor Pro-Vice-Chancellor Director
IGNOU, New Delhi IGNOU, New Delhi SOCE, IGNOU, New Delhi
Prof. P.R. Reddy Dr. Mehtab Bamji Prof. B.N. Koul
Vice-Chancellor National Institue of Executive Director
Sri Padmasvathi Mahila Nutrition STRIDE
Vishwa Vidyalyam Hyderabad New Delhi
Tirupathi
Mrs. Arvind Wadhwa Prof. Prabha Chawla
Mrs. Mary Mammen Lady Irwin College School of Continuing
CMC Hospital Vellore New Delhi Education, IGNOU
New Delhi
Dr. Mrs. S.R. Mudambi Dr. Annu J. Thoma
W-163 'A', 'S' Block School of Continuing Dr. Deeksha Kapur
MIDC Pmpri, Bhosari Education School of Continuing
Pune IGNOU, New Delhi Education, IGNOU
New Delhi
BLOCK PREPARATION (ORIGINAL)

Dr. K.V.R. Sarma Block Coordinator Course Editor
National Institue of Nutrition Dr. Annu J. Thoma Prof. P.R. Reddy
Hyderabad School of Continuing Vice-Chancellor
Education Sri Padmasvathi Mahila
IGNOU, New Delhi Vishwa Vidyalyam
Tirupathi
COURSE REVISION TEAM (2014)
Prof. Deeksha Kapur Ms. Rajshree
Discipline of Nutritional Sciences Ms. Kusum Bhatt
SOCE, IGNOU, New Delhi Consultant, SOCE
IGNOU, New Delhi
COURSE REVISION TEAM (2022)

Prof. Deeksha Kapur Dr. Namrata Singh
Discipline of Nutritional Sciences Discipline of Nutritional Sciences
SOCE, IGNOU, New Delhi SOCE, IGNOU, New Delhi
PRINT PRODUCTION
Mr. Rajiv Girdhar Mr. Hemant Pardia
Asstt. Registrar Section Officer
MPDD, IGNOU, New Delhi MPDD, IGNOU, New Delhi
March, 2022
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ISBN :
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BLOCK INTRODUCTION
After a detailed study of food borne diseases, food infections and intoxication in
Block 4, now in Block 5 our attention shifts to the common infectious diseases.
Infectious deseases, also referred to as communicable diseases are those that
spread from one person to another. This may occur by director physical contact,
by common handling of an object that has picked up infective microorganisms
through a disease carrier or by spread of infected droplets coughed or exhaled
into the air. Infectious diseases as you may be aware are caused by bacteria and
other organisms that harm the body. These diseases are preventable and the
government has initiated active immunization programmes to control them.
We begin our study of block 5 with the common infectious diseases – measles
tuberculosis, whooping cough, diphtheria, tetarus and poliomyelitis. Units 15
and 16 of this block focus on how these diseases are caused? What are the factors
which contribute to severity of the disease? How can we prevent the disease and
how to manage patients with these diseases?
Malaria is an infectious disease caused due to the presence of parasitic protozoa

(single-cell animal) within the red blood cell. How is the disease transmitted and
how to prevent/control it is the focus of Unit 17.
Diseases/infections resulting on account of not maintain food personal hygiene

are discussed in Unit 18. Skin, eye and ear infections are common public health
problem in our country. What are these infections? How to prevent them? This
unit presents handy tips on control/prevention/ management of these infections.
STUDY GUIDE
The following points will help you to organise your study of Block 5.
1) Block 5 deals with the causes, symptoms of infectious diseases like measles,
tuberculosis, whooping cough, diphtheria, tetanus, poliomyelitis, malaria,
skin, eye and ear infections. Read them carefully.
2) The preventive control measures for infectious diseases are dealt within this
block. Study them carefully. You should be in a position to undertake steps
to prevent these diseases and also arrest the spread of such diseases once
they occur.
3) Read POINTS TO REMEMBER given at the end of each section carefully,

as they briefly summarise the main points.
4) Before learning about the specific infectious diseases, it is essential for you
to understand some of the common definition of technical terms used in this
block. The glossary of words given in Block 4 would surely have helped
you in understanding difficult terms. For your reference we are including
the same glossary of terms under the heading “Understanding technical
terms” in the beginning of this block. Read them carefully once again,
understand them and then proceed.
4
UNDERSTANDING THE TECHNICAL TERMS
You should be familiar with the following terms used in this block. Read them
carefully and try to understand them.
Infection: The entry and development or multiplication of an infectious agent in

the body of man or animals. Infections need not always mean infectious disease.
The infection, sometimes, may be in apparent i.e. without any recognizable clinical
signs or symptoms. This is also known as sub clinical infections.
Infectious diseases: A disease of manor animals resulting from an infection.

The persons suffering an infectious disease exhibit clinical signs or symptoms
from which one can diagnose the disease.
Infectious agent: An organism, chiefly a microorganism, that is capable of

producing an infection or infectious disease. Most of the infections are caused
by bacteria or viruses which cannot be seen by a naked eye and require either
simple or sophisticated microscopes to see them.
Infestation: The presence of animal parasites either on the skin (for example
ticks) or inside the body (for example worms).
Incubation Period: The time interval between exposure to an infectious agent

and appearance of the first sign or symptom of the disease in questions.
You should understand that there is some lapse of time between the exposure to
an infectious agent and developing the disease. This is known as incubation
period.
Communicable disease: The time interval between exposure to an infectious

agent and appearance of the first sign or symptom of the disease in question.
You may be aware that an individual (susceptible host) when exposed to a patient
suffering from tuberculosis (TB) (infected person) is likely to contract (catch)
the disease. Similarly, malaria is transmitted by mosquitoes. In other words,
mosquitoes are the vectors for malaria.
Reservoir of infectious agents: Any human being, animals, plant, soil or

inanimate matter in which an infectious agent normally lives and multiplies, and
on which it depends primarily for survival and reproduces itself in such a manner
that it can be transmitted to a susceptible host.
In case of the infectious diseases, you will be learning, man is the reservioir.
These are like water reservoirs where water is stored to be distributed later. In
the case of reservoirs of infection, a disease agent is harboured and transmitted
to others.
Host: A man or other living animal, including birds and insects which affords
subsistence to an infectious agent under natural conditions.
Susceptible: A person or an animal is susceptible who has not acquired immunity

to a particular disease by a previous infection or vaccination and thus he is liable
to contract a disease, if exposed to such as agent.
5
Communicable period: The time or times during which an infectious agent
may be transferred directly or indirectly from an infected person to another person,
from an infected animal to man.
It is important to understand that is a person is not exposed to a patient suffering
from a communicable disease during the period, he/she will not get the disease.
In other words, if you know the communicable period of the disease, you can
take suitable steps to prevent individuals from getting an infectious disease. This
can be done either by isolating the patients from others or taking steps to see that
other persons are not exposed to these pateitns during the communicable period.
Epidemic: The occurrence in a community or a region of cases of an illness or a
disease outbreak clearly in excess of normal expectancy and arising from a
common or propagated source. Even a single case of a communicable disease
long absent from a population is to be considered sufficient evidence of a potential
epidemic.
Endemic: The constant presence of a disease or infectious agent within a given
area. In other words, patients with the disease will be present at any point of time
in a community living in endemic area. Malaria is, for example, endemic in
India.
Faecal-oral route of infections: In certain diseases the infective agent is excreted
in the faeces and enters the body via the mouth. Mechanism for transfer of the
agent from faeces to mouth vary widely and are often not known.
Fomites: These are substances capable of transmitting an infections agent after
their contamination with disease causing organisms. They include soiled clothes,
towels, linen, handkerchiefs, cups, tumbers, door handles, taps, lavatory chains
or flush system, syringes, instruments and surgical dressings.
Asymptomatic: A disease/condition without any clinical symptoms.
Clinical Manifestation: Clinical signs and symptoms based on which a disease
can be diagnosed.
Carriers: These are persons who harbor pathogenic microorganism of a specific
infectious disease without manifesting any signs and symptoms of the disease
but who are still able to infect other individuals.
Tuberculin: A protein extract from cultures of tubercle bacilli; used to test whether
a person has suffered from or been in contact with tuberculosis.
Mantoux Test: Skin test for diagnosing tuberculosis infection. In mantoux test a
quan of tulerculin is injected beneath the skin and a patch of inflammation
appearing in the next 18-24 hours is regarded as a positive reaction, meaning
that a degree of immunity is present.
Schick Text: A test to determine whether a person is susceptible to diphtheria. A
small quantity of diphtheria toxin is injected under the skin, a patch of reddening
and swelling shows that the person has no immunity and, if at particular risk
should be immunized.
Surveillance: Refers to close watch or supervision.
Susceptibility: Lack of resistance to disease.
Sickle Cell Trait: A hereditary blood disease characterized by the production of
an abnormal type of haemoglobin in the red blood cells.
6
UNIT 15 MEASLES, TUBERCULOSIS AND Measles,
Tuberculosis
WHOOPING COUGH And Whooping
Cough
Structure
15.1 Introduction
15.2 Measles
15.2.1 The Disease-What causes it? Who gets it? How and when docs it spread?
15.2.2 Symptoms and Complications
15.2.3 Prevention and Management
15.3 Tuberculosis
15.3.1 The Disease-What causes it? Who gets it? How and when does it spread?
15.4 Whooping cough

15.4.1 The Disease—What causes it? Who gets it? How and when does it spread?
15.5 Let Us Sum Up

15.6 Glossary
15.7 Answers to Check Your Progress Exercises
15.1 INTRODUCTION
You are aware that children are very prone to infections. The infections are
caused by microorganisms which are very minute and can be seen only
through a microscope. Measles, tuberculosis, whooping cough are three such
infectious diseases commonly found in children. What is the causative agent?
How does it spread? How do we identify these diseases? What can we do to
prevent our children from getting these diseases. This unit provides answer to
these crucial questions. In this unit we will learn about the causes,
complications, prevention/control measures for each of these infectious
diseases.
Objectives . After studying this unit, you will be able to :
• identify the cause and mode of spread of measles, tuberculosis and

whooping cough; enumerate the symptoms and complications of
measles, tuberculosis and whooping cough; and
• discuss the steps to manage and prevent these diseases and also educate
the community about preventive measures.
7
Common
Infectious
15.2 MEASLES
Diseases
Measles is a viral disease which generally attacks children, around one year
of age. It is one of the important and common childhood infections. Measles
is endemic in most of the countries of the world. In India, every year about 14
million children suffer from measles. After implementation of universal
immunization programme, the number of cases have come down and were
reported to be 48,181 in 2008. However, the estimates are much higher as
large number of cases go unreported.
15.2.1 The Disease - What causes it? Who gets it? How and
when does it spread?
What causes measles?
The disease is caused by the measles virus. Viruses you know are
microorganisms which can be seen only through sophisticated microscope.
Who gets the disease?

Age : The disease is common in childhood. Most of the children have an
attack of measles by the time they complete the age of 3 years. In about a
third of all cases with measles, it occurs under the age of one year.
Socio-Economic Factors : Measles is particularly severe amongst poor

communities. Of many adverse influences of poor socio-economic status on
child, poor nutrition, both before and during the attack of measles, plays a
major part in the severity and outcome of the infection. Epidemics tend to
occur at 2 to 4 year intervals in crowded large cities, particularly in the urban
slum areas. In conditions of poor environment, children get measles at an
earlier age. In middle income families, it occurs later around the school age.
Sex : Incidence of measles is equal among both the sexes.
Seasons : The disease is more prevalent in winter.
How does it Spread?

It is spread through droplets (either during coughing or sneezing) or direct
contact with secretions from nose or throat or urine of persons infected with
measles. It is one of the most readily transmissible of the communicable
diseases. Articles recently contaminated with saliva or nasal discharges may
also convey infection. An attack of measles in the case of pregnant women
may lead to abortion.
Incubation period: The disease takes, on an average, about 10 days varying

from 8 to 13 ays, to occur from the time of exposure to a patient with measles
to the onset of fever. The skin rash appears about 14 days after exposure to an
infected child.
Period of communicability: The disease is communicable from the beginning

of onset of fever to 4-6 days after appearance of the skin rash. Measles is
very infectious and about 90 per cent of susceptible family members coming
8
in contact with the patient (family contacts) acquire the disease. In other Measles,
words, other children, who had not got measles earlier, in the household of Tuberculosis
And Whooping
the patient are likely to catch the disease. Cough
Susceptibility: Practically all persons are susceptible. After an attack, a

person usually acquires permanent immunity. In otherwords, an individual
suffers from measles only once in life time. Infants born of mothers who
have had the disease are ordinarily immune (i.e. do not develop the disease)
for approximately the first 6 months of life.

Measles is an acute (short and sudden onset) communicable disease. It starts
as mild fever, cough and running nose. There will be conjunctivitis
(reddening of the eyes). If you examine the inside of mouth, you can find
characteristic greyish white spots on a red base on the mucous membrane of
the mouth (a membrane, secreting mucus, lining the mouth). A day or two
later typical skin rash (eruptions on the skin) which is dusky red in colour
appears i.e. third to seventh day after the onset of fever. The rash appears first
on the face and spreads to the body and generally lasts for 4-5 days. Measles
is rather severe among children who are malnourished.
What are the complications of measles ?

Measles is an important public health problem because it leaves the children
in a debilitated condition (very weak). Common complication after an attack
of measles is severe respiratory infection leading to broncho-pneumonia
(infection of the lungs) which may end in death. One of the commonest
complications is severe diarrhoea which quite often leads to malnutrition.
Measles and nutritional status of the child are very closely associated. If you
carefully question the mothers of the children suffering from severe forms of
malnutrition, almost always, they would tell you that the children had
measles in the recent past. Because of loss of appetite and severe diarrhoea,
the children recovering from the measles often develop severe forms of
malnutrition. You might recall reading about the effect of measles on
nutritional status of children in Unit 20, Block 5, of Course 1.
Middle ear infection, mental retardation can also occur as complications after
an attack of measles. Measles is known to contribute to the damage of the
cornea (black portion of the eye) leading to blindness. Measles also
aggravates Vitamin A deficiency in children and leads to blindness.

Prevention/control measures for measles are discussed below:
Prevention of measles through vaccination : Vaccination is the simplest and

best method to prevent measles. Normally all children at 9 months of age or
as soon thereafter as possible are given measles immunisation. A single
injection protects 95 per cent of susceptible children from the disease for over
12 years and probably for life. After vaccination majority have minimal
infection with minimal symptoms such as fevers, cough, running nose and
9
Common even rash. A single dose of 0.5 ml of reconstituted freeze-dried vaccine is
Infectious given intramuscularly (in the muscle). Normally, immunity develops 11 to 12
Diseases
days after vaccination.
Next, a word about how to treat measles ?
Management of Measles : There is no specific treatment for measles.

Antipyretics i.e. medicines to control fever, bed rest and adequate fluid intake
are the basic requirements. The important aspect in management is control of
secondary bacterial infection by using suitable antibiotics. Complications
such as pneumonia and middle ear infections require appropriate treatment
with antibiotics. The nutritional status of the child must be maintained
properly. Children who are breast-fed and unable to suck due to soreness of
mouth may be fed breast milk with a spoon after expression of the same from
the mothers breast. For those children who are not breast-fed, soft diets in the
form of porridges can be given. Children suffering from measles lose
considerable weight and during the recovery period weight gain is slow.
Children recovering from measles should be given adequate diet to stimulate
faster weight gain. The child should be fed more frequently i.e. 5-6 times a
day. The diet should include cereals like rice or wheat, pulses (dal), curd, and
green vegetables. The child should also be given atleast one glass of milk
every day. The diet should be cooked soft and preferably be fed by the
mother or elder member. Other dietary considerations for management of
measles discussed in Unit 20, Block 5 of Course I are applicable here as well.
Go through those considerations carefully.
Points to Remember: given below presents the salient features of measles:
POINTS TO REMEMBER
Measles
• Measles, an acute communicable disease is an important public health
prob
• It is caused by measles virus.
• It spreads through droplets or direct contact with secretions from nose,
throat or urine of persons infected with measles.
• The disease has an incubation period of about 10 days.
• The simplest and best method to prevent measles is vaccination.
• Treatment of secondary infections and complications is the best way to
manage measles.
• Maintain the nutritional status of the child by providing good nutritious
food.
Check Your Progress Exercise 1

1) Prepare a flow chart for the step-by-step progress of measles in a child.
……………………………………………………………………………
……………………………………………………………………………
10
2) Prepare a talk to educate mothers about prevention and management of Measles,
measles. Tuberculosis
And Whooping
Cough
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
15.3 TUBERCULOSIS (TB)

Tuberculosis is a common disease that is found almost everywhere. It is an
important cause of disability and death in many parts of the world. In
developing countries such as India, you should expect a higher prevalence of
tuberculosis in the under-five age group, as a result, of greater opportunities
of exposure to the disease. In other words, it is likely to occur more
frequently in these age group. India accounts for nearly one-fifth of global
burden of tuberclosis. Each year nearly 2 million persons develop tuberclosis.
It is estimated that there would be atleast 9-10 million cases of pulmonary
(lung) tuberculosis as well.
15.3.1 The Disease-What causes It? Who gets it? How and
Tuberculosis is caused by Mycobacterium tuberculosis, a non-motile, slender,
acid- fast bacillus. Two strains-human and bovine-are of importance to man.
Human source is responsible for the vast majority of cases of India. The
bacillus can be seen by examination of sputum or other secretions under a
microscope after using appropriate staining procedures.

Age : Tuberculosis can occur at any age. Recent surveys in India show that it
occurs more in older age groups than the younger groups.
Sex: In India, tuberculosis is more prevalent among males over 45 years of

age than among females. In females however, the peak prevalence is below
35 years.
Socio-Economic Factors: The disease occurs more frequently in families

belonging to low income groups. In Western countries a decline in death rates
due to tuberculosis has occurred with an increase in standard of living.
Communities living in substandard houses which are ill ventilated and have
inadequate floor space are likely to suffer more from the disease. Miners and
textiles workers are more prone to disease. Overcrowding as in the slum areas
of the cities helps in the rapid spread of the disease.
Certain social customs such as indiscriminate spitting, smoking of hukka,

purdah system also help in the spread of the infection. Tuberculosis has a
social stigma. This attitude leads to concealment of the disease and
11
Common consequent delay in diagnosis of cases with increased risk of spreading the
Infectious disease to others.
Diseases
How does it spread?

Tuberculosis is transmitted by droplets from sputum of infected persons
particularly during coughing. To carry infection, the droplet particles must be
fresh to carry a viable organism (organism that can thrive). Prolonged
household exposure to an active tuberculosis case may lead to infection of
those persons in contact with such cases. Tuberculosis is not transmitted by
fomites i.e. dishes and other articles used by patient. Sterilization of these
articles is of little or no value.
Bovine tuberculosis results from ingestion of unpasteurised milk or dairy

products of tuberculous cows.
Primarily man and in some areas diseased cattle also are the reservoir of
infection of tuberculosis.
Incubation Period: It takes about 4-12 weeks from the time an individual is
infected from an active case of tuberculosis to demonstrable primary lesion.
It may take years to lead to progressive pulmonary or extra-pulmonary
tuberculosis. You should remember that tuberculosis infection means entry or
development of the organism M. tuberculosis. while the disease has specific
manifestations (symptoms and signs) resulting from the infection.
Period of Communicability : The disease is communicable i.e. can spread

from a patient of tuberculosis to a non-infected individual, as long as tubercle
bacilli are discharged by the patient. Some untreated, as in the poorer
communities, or inadequately treated (discontinuing treatment) patients may
be intermittently sputum positive for years. In other words, there is a constant
danger of getting the disease from such patients. Proper treatment generally
reduces communicability within a few weeks. It only means that for control
of tuberculosis, prompt and complete treatment are essential. Extra
pulmonary tuberculosis without any discharge (secretions) is not directly
communicable.
Susceptibility: Everyone is susceptible to the disease. However, children

under the, age of 3 years are highly susceptible. In undernourished
individuals susceptibility is high. Susceptibility is lowest in later childhood
i.e. 4-10 years, but is again high in adolescents and young adults.

Tuberculosis is a chronic disease, i.e. a disease of gradual onset and long
duration. The primary infection, in young children, usually goes unnoticed
clinically. The primary tuberculosis lesions (pathological changes in tissues)
commonly become inactive leaving no residual changes. However, it may
also progress to active pulmonary (lung) tuberculosis and further spread
through lympho-haematogenous (blood) path to involve the nervous system,
particularly the meninges (membranous coverings of brain and spinal cord).
12
Pulmonary tuberculosis, is characterised by a variable and often Measles,
asymptomatic (symptomless) course with exacerabations (increase in Tuberculosis
And Whooping
severity) and remissions (abatement of symptoms). Clinically, it is confirmed Cough
by presence of tubercle bacilli in sputum (matter ejected from lungs, trachea
and bronchi through mouth). Abnormal X Ray (chest) densities indicative of
pulmonary involvement occur before clinical manifestations (clinical signs
and symptoms). The patients may have cough, easy fatiguability (gets tired
with little effort), fever, loss of weight and appetite, hoarseness of voice, and
chest pain. The patient may bring out blood in sputum, particularly in
advanced stages. Most often, the patient, usually from a low income family,
presents himself before a doctor in advanced stage.
Sputum examination by direct microscopy is now considered the method of

choice for finding out cases of tuberculosis. Under Indian Tuberculosis
control programme microscope examination of sputum is performed as a
routine on patients who attend hospitals and primary health centres with the
following chest symptoms:
1) Cough lasting for more than 4 weeks

2) Continuous fever
3) Chest pain
4) Blood in sputum
1) Tuberculin Test is undertaken to detect tuberculosis. What is the test and
how it is administered is discussed below:
Tuberculin Test: Persons infected with tuberculosis will react to a low
dose of tuberculin test. One of the tests, is Mantoux intradermal test. This
is the most widely use found satisfactory for epidemiological studies.
Into the superficial layers of the skin, 0.1 ml of a standard dilution of old
tuberculin (OT) or purified protein derivative (PPD) is injected. Special
syringes are used for the purpose. If you notice induration (slight
hardening, reddish in colour) of more than 6 mm in diameter after 72
hours, it is considered a positive test. The reaction may be negative in
critically ill tuberculosis patients and during certain infectious diseases
such as measles.
Extra-pulmonary (other than lung) tuberculosis is much less common
than the tuberculosis of the lungs. It includes tuberculous meningitis
(infection of the protective covering of the spinal cord), involvement of
bones and joints, intestines, kidneys, larynx (voice box) etc, Diagnosis is
by recovery of tubercle bacilli from lesions or secretions from these
lesions.
15.3.3 Prevention and Management of Tuberculosis

Tuberculosis can be prevented by adopting the following measures :
a) Improvement of social conditions : Conditions which increase risk of
becoming infected with tuberculosis such as overcrowding should be
removed. Housing which has proper ventilation (allowing proper light
13
Common and air) should be provided particularly to the poorer communities. You
Infectious may be aware that in every city, the Government has been undertaking
Diseases
construction of a large number of well planned low cost houses to
rehabilitate the poor like the slum dwellers. Such steps could help in the
control of tuberculosis.
b) The community should be educated about the mode of spread of the
disease (to avoid indiscriminate spitting in public places) and motivated
to seek medical advice early in case of any prolonged fever, cough, loss
of appetite etc. Early detection and treatment: You can prevent and
control tuberculosis by detecting early all the cases of tuberculosis i.e. in
the initial stages of infection and providing prompt treatment. But, for
diagnosis of the patients you require medical and laboratory facilities for
examination of the patients. It is also important that all the family
members who would have been in close contact with a tuberculosis
patient and all those suspected of having tuberculosis should also be
examined carefully. For this medical and laboratory facilities for
tuberculin test and microscopic examination of sputum should be made
available. In addition facilities for prompt treatment of all the positive
cases should be provided.
c) BCG Vaccination: Vaccination of uninfected (tuberculin negative)
confers variable protection. It is particularly recommended to prevent
infantile tuberculosis. Some controlled trials indicate that protection
against tuberculosis after BCG vaccination may last for 15-20 years.
Recent studies in India indicate that it is not very effective in preventing
adult tuberculosis. In India, BCG is given to infants at birth and at 6
weeks if not given at birth.
Elimination of tuberculosis among dairy cattle, tuberculin testing of the cattle
and slaughter of reactors to the test and pasteurisation of milk help in
preventing bovine tuberculosis.
Management of Tuberculosis : Most primary infections are often inapparent
and heal without treatment. When primary infection is diagnosed in children
anti-tuberculous therapy with the drug Isoniazid reduces the risk of the
disease progressing further.
Patients suffering from pulmonary tuberculosis should be given prompt
treatment with an appropriate combination of antimicrobial drugs for a
minimum of twelve months. Current accepted regimens include using a
combination of drugs like Isoniazid. Ethambutol, Streptomycin and
Paraamino Salicylic Acid (PAS). Rifampicin is recommended for resistant
cases i.e. those not responding to the above regimen of treatments. Drug
treatment should be strictly under medical supervision.
Proper diet plays a helping role in controlling the disease. Recent advances
encourage treatment of patients at their homes under domiciliary
inanagement of tuberculosis
Under the scheme the patients take medicines prescribed by specialists at

their houses continuously without need for hospitalisation. This reduces the
14
cost of treatment quite substantially. However, the patients should be Measles,
educated and motivated to complete the treatment and not to discontinue the Tuberculosis
And Whooping
treatment as soon as there is improvement in the general conditions of the Cough
patient.
A summary of Tuberculosis is presented in Points to Remember.
POINTS TO REMEMBER
Tuberculosis
• Tuberculosis is a chronic disease caused by Mycobacterium tuberculosis.
• It is more prevalent among males over 45 years of age belonging to low
income group.
• It is transmitted by droplets from sputum of infected persons.
• The disease has an incubation period of 4-12 weeks.
• The disease can be prevented by improving social conditions by early
detection and treatment and by BCG vaccination.

1) Fill in the blanks :
a) T.B. is caused by ……………..
b) ……………. is the primary reservoir for T.B.
c) ……………. is the most widely used tuberculin test.
d) BCG Vaccination is given to infants around the age of …………….
e) ……………. examination is the method of finding out cases of
tuberculosis.
15.4 WHOOPING COUGH (PERTUSIS)

Whooping cough is an acute highly communicable infection of the
respiratory tract. The Chinese call it a hundred day cough—because it is a
disease which lasts for about 3 months or more. In India and other developing
countries, it is still a serious disease accounting for considerable number of
deaths among children. It also leads to complications. In infants (under one
year of age) 4-15 per cent of cases of whooping cough end in deaths.
15.4.1 The Disease — What causes it? Who gets it? How and
Whooping cough is caused by micro organism Bordetella pertussis ,or the
Pertussia bacillus. In about 5 per cent of the cases B. parapertussia is the
causative organism. In such cases the disea:se is milder. Certain viruses also
can cause a similar clinical syndrome.
15
Common Who gets the disease?
Infectious
Diseases Age: It is primarily a disease of infants and children. The disease is
considered as a pediatric priority. In other words, it is considered as an
important disease of children. In countries such as India about 50 per cent of
the cases occur between 20-30 months of age. In the developed countries of
the west, however, it occurs around the age of 50 months. The death rates are
the highest below the age of one year.
Sex: The disease affects both males and females equally. But the mortality is
observed to be higher among girls as compared to boys.
Socio-economic factors : The disease takes a serious form in malnourished
children. Such children who are already weak do not have resistance to any
disease. Similarly, in communities which are poor and exposed to multiple
infections, whooping cough is a lethal disease of children. In these
communities, children who are already exposed to other infections like
diarrhoca etc. will be weak and whooping cough may take a severe form and
lead to death.
How does it spread?

The disease is spread mainly by droplet infection, like most of the respiratory
tract infections, and also by direct contact. Each time, the patient of
whooping cough talks, coughs or sneezes the causative organisms (pertusis
bacilli) are sprayed into the air. If a susceptible person is within the range of
the spray of droplets, he is likely to inhale the same. Most children contract
the infection from their playmates during the early stages of the disease.
Similarly, direct contact with discharges from respiratory tract of infected

cases (sputum, nasal discharges) can spread the disease. Indirect contact with
articles freshly soiled with the discharges of infected persons also contribute
to the transmission of the disease.
Incubation period : Normally, it takes about 7-10 days for a child to get
infected from the time of exposure to an infected person. It is never beyond 3
weeks.
Period of Communicability: The disease is highly communicable during the

initial catarrhal stage (during the stage of slight cough with running nose)
before the child develops typical paroxysmal cough. The communicability of
the disease become negligible in about 3 weeks. The period of infectiousness
extends only 5-7 days after starting of treatment with appropriate antibiotics.
In other words, prompt treatment reduces the infectivity of the disease and
reduces spread of the disease.
Susceptibility: Every individual, particularly under the age of 7 years of age is
susceptible to the disease. Numerous cases of infection without any clinical
manifestations or a typical case can occur. This means that in several children
the disease is mild and passes off as an ordinary respiratory infection.
16
15.4.2 Symptoms and Complications Measles,
Tuberculosis
Whooping cough begins with a slight cough, usually accompanied by And Whooping
Cough
running nose. The cough then assumes a frequency which is out of proportion
with the thin discharge from the nose. Usually, coughs associated with colds
with thin discharge from the nose are of milder nature. In the case of
whooping cough, however, you would notice that it is of severe degree.
Within 1-2 weeks, the cough comes in bursts and the child with whooping
cough, unlike the child with bronchitis, does not take a breath in anticipation
of the burrst of coughing. At the end of the second week, the coughing
spasms increase in speed. rise in pitch, and the paroxysms become longer and
more intense. The cough is characterised by high pitched crowing or
inspiratory whoop (a peculiar sound while breathing in). Hence, it is called
whooping cough. The rapid spasmodic cough is generally associąted with
choking and vomitting, with the production of sticky sputum. In the case of
young infants and adults the typical whoop may be absent.
The chief complications are broncho-pneumonia and severe bronchitis. The
severe paroxysmal cough may sometimes lead to bleeding under the
conjunctiva (white portion) of the eye or bleeding through nose. The children
may develop convulsions (fits) and go into coma (deep unconsciousness).
There is considerable evidence that whooping cough may lead to severe

malnutrition. The children are liable to poor weight gain and end up in
marasmus- a nutritional disorder due to protein-energy malnutrition
characterised by extreme muscular wasting. Hence, proper nutritional care is
necessary during convalescence.

The following measures can prevent whooping cough:
a) Active Immunisation : An effective vaccine is now available for

protection against the disease. The vaccine is generally given along with
diphtheria and tetanus toxoids as a triple vaccine or DPT vaccine. Three
doses (each dose 0.5 ml) of DPT vaccine are administered
instramuscularly at 1-2 months interval, starting when the infant is about
6 weeks old. A booster dose of DPT is adminstered at the age of 18-24
months.
b) Education: The parents of the infants should be educated about the
dangers of the disease, particularly in young children, and encouraged to
get their infants immunised. The Government of India have now
launched a massive education programme through mass media such as
Doordarshan and All India Radio to educate the communities about the
importance of immunisation.
c) Isolation of Cases : Known cases of whooping cough should be isolated
and wherever possible susceptible children (not immunised and not
affected by the disease so far) should be excluded and exempted from
schools and public places for 14 days after last exposure to a household
17
Common case of whooping cough. This would help in reducing the spread of the
Infectious disease by them if they also get infected.
Diseases
Management of Whooping cough is simple. The measures adopted are
discussed below:
Management of whooping cough : Erythromycin or Ampicillin drug is used

in infants and children as the specific treatment for whooping cough.
Points to Remember given below lists the salient features of whooping

cough.
POINTS TO REMEMBER
Whooping cough
• Whooping cough is an acute highly communicable infection of the
respiratory tract.
• It is caused by microorganism Bordetella pertussis or pertussis bacillus.
• Infants and children are more prone to whooping cough.
• The infection spreads by droplet and direct contact.
• The incubation period for the disease is 7-10 days.
• Burst of cough associated with cold and thin discharge from the nose are
the symptoms of the disease.
• Complications of the disease are broncho-pneumonia and severe
bronchitis.
• The simplest and the best way to prevent whooping cough is through
active immunisation.

1) Fill in the blanks:
a) Whooping cough is caused by ………………
b) Whooping cough has an incubation period of ………………
c) ……………… and ……………… are the chief complications of
whooping cough.
2) Prepare a message to educate parents about measures to be taken to
prevent whooping cough.
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
18
15.5 LET US SUM UP Measles,
Tuberculosis
And Whooping
In this unit we have learnt that microorganisms like viruses and bacteria Cough
cause infectious diseases.
Measles is caused by the measle virus. Children under the age of three years
are most prone to it. Measles spread through droplets or direct contact with
secretions from nose, throat or urine. It takes about 10 days for the disease to
occur from the time of exposure to the disease. The disease starts as mild
fever, cough and running nose followed by skin rash on the face and on the
body. Common complication after an attack of measles is severe respiratory
infection leading to broncho-pneumonia and also diarrhoea. The simplest and
the best measure to prevent measles is vaccination.
Tuberculosis is caused by Mycobacterium tuberculosis. Recent surveys show

that it occurs more in older age group than younger group. People living
under substandard conditions are likely to suffer more from the disease.
Tuberculosis is transmitted by droplets from sputum of infected persons. The
disease has an incubation period of 4-12 weeks. The patient suffering from
tuberculosis may have cough, fever, loss of weight and appetite, hoarseness
of voice and chest pain. The disease can be prevented by improving social
conditions, by early detection and treatment and BCG vaccination.
Whooping cough is caused by Bordetella pertussis. It is primarily a disease
of infants and children. The disease is spread mainly by droplet infection and
also by direct contact. Normally it takes 7-10 days for the disease to appear.
Whooping cough begins with slight cough accompanied by running nose and
later the cough becomes severe. Bronchitis and broncho-pneumonia are the
chief complications of whooping cough. The simplest and best way to
prevent this disease is through active immunisation.
15.6 GLOSSARY
Acute (Disease) : Disease of short and sudden onset
Asymptomatic : Without any clinical symptoms
Broncho- : Infection of lungs
pneumonia
Clinical : Chinical signs and symptoms based on which a
manifestations disease can be diagnosed
Convulsions : Fits
Domiciliary : Patient takes the treatment staying at home. Drugs
management are to be collected from a dispensary/hospital
DPT : Immunisation against Diphtheria, Whooping cough
Immunisation (Pertusis) and Tetanus
Exacerbations : Symptoms increasing in severity
Fatiguability : Getting tired
Inapparent : Infection without any recognisable clinical signs or
19
Common infection symptoms
Infectious
Diseases Intradermal test : Where test material is injected into superficial layers
of the skin
Larynx : Voice box
Mantoux test : Skin test for diagnosing tuberculosis infection
Meningitis : Infection of the protective coverings of brain and
spinal cord
OPV : Oral Polio Vaccine
Paroxysmal cough : Cough recurring suddenly
Remissions : Abatement in symptoms of disease
Tuberculin : A tubercle bacilli extract used to test whether a
person has suffered from or been in contact with
tuberculosis
15.7 ANSWER TO CHECK YOUR PROGRESS

EXERCISES
1) Susceptible child
Death Exposure to disease
Complications Child develops cold, fever and

conjunctivitis
3-7 days later skin rash
Poor diet, Fever subsides

Malnutrition
Good diet normal child
2) Answer on your own. Emphasise on measles vaccination.

1) a) Mycobacterium tuberculosis
b) Man
c) Mantoux test
20
d) 3 months Measles,
Tuberculosis
e) Sputum And Whooping
Cough
1) a) Bordetella pertussis
b) 7-10 days
c) Broncho pneumonia, severe bronchitis
2) Answer based on your understanding of the unit. Emphasise on-active
immunisation, isolation of cases and awareness regarding dangers of the
disease.
21
Common
Infectious UNIT 16 DIPHTHERIA, TETANUS AND
Diseases
POLIOMYELITIS
Structure
16.1 Introduction
16.2 Diphtheria
16.2.1 The Discaso-What causes it? Who gets it? How and when does it spread?
16.3 Tetanus
16.4 Poliomyelitis
16.5 Let Us Sum Up

16.6 Glossary
16.1 INTRODUCTION
You have so far learnt about three common infectious diseases prevalent in
our country, namely measles, tuberculosis, and whooping cough. You would
note that these three diseases contribute to high morbidity (sickness) and
mortality (death) particularly among young children. In this unit, you will be
learning about three other equally important childhood diseases diphtheria,
tetanus and polio. The causes, symptoms/complications, prevention/control
measures for these three infectious diseases are discussed here.
Objectives After studying this unit, you will be able to:
• identify the cause and mode of spread of diphtheria, tetanus and

poliomyelitis;
• enumerate the symptoms and complications of diphtheria, tetanus and
poliomyelitis; and
• discuss steps to manage and prevent these diseases and also educate the
community about prevention of these diseases.
22
16.2 DIPHTHERIA Diphtheria,
Tetanus And
Poliomyelitis
Diphtheria is a common infectious disease. The available data indicates a
declining trend of diptheria in India. It is due to increasing coverage of child
population by immunization. The reported incidence of the disease in the
country during 2005 was about 10,231 whereas during the year 2008 only
6081 were reported. Unfortunately, it is difficult to obtain accurate
information about the actual extent of diphtheria in warm climate countries
like India because bacteriological confirmation of the disease is not easily
available.
16.2.1 The Disease---What causes it? Who gets it? How and
Diphtheria is caused by Cornyebacterium diphtheriae, a non-motile (not
moving) organism. The organism produces a powerful toxin. Three types of
diphtheria, bacilli are differentiated.
1) Gravis: Causing serious type of disease and generally accounts for about
a fourth of the cases of diphtheria.
2) Mitis : Causing milder type of infection contributing to about 65 per cent
of the cases.
3) Intermedius : This accounts for about 10 per cent of the cases.

Age: Diphtheria is primarily a disease of children under 15 years of age. You
would rarely come across cases of diphtheria in children below the age of 6
months. The highest number of cases are observed among preschool children
i.e. 1-5 year old children. It can also occur in adults, who have not been
immunized during their childhood.
Sex: It affects both the sexes equally.
Season : Cases of diphtheria are reported in all the seasons. But, higher
numbers of cases are reported during August to October.
How does it spread?

Diphtheria spread usually by contact with a patient or a person having
inapparent infection (without any recognisable clinical sign or symptom).
The transmission is through droplet infection or infected dust.
It can also be transmitted if raw milk contaminated with discharges from the
patients is consumed. However, in India where milk is invariably boiled
before consumption transmission by milk is not likely to occur.
It is rare to contract the disease by handling articles soiled with discharges
from lesions of infected persons. The organism can sometimes enter through
wounded skin and lead to infection.
Incubation period: Usually 2 to 5 days.
23
Common Period of Communicability: The disease can spread from an infected person
Infectious to another unimmunised person as long as the virulent bacilli are present in
Diseases
the discharges of the lesions. Generally, it is communicable for about 2
weeks but never for more than 4 weeks.
Susceptibility: Infants born to mothers who are immune do not get the disease
during the first six months of their life. Recovery from an attack of diphtheria
is not followed by long lasting immunity as in the case of measles. Prolonged
active immunity can be induced by giving diphtheria toxoid.

Diphtheria is an acute communicable disease which affects the nose, throat
and tonsils. The bacilli multiply at the site of implantation (insertion into the
body), be it throat, nose or tonsils. It produces local lesions at the site of
implantation. This lesion is characterised by formation of a patch or patches
of greyish false-membrane on the affected parts such as tonsils or larynx
(voice box). It also produces an offensive and strong odour. There will be
reddening and swelling ofthe surrounding tissues.
The throat is moderately sore when diphtheria affects tonsils, with swelling
of the cervical lymph glands (lymph glands in the neck region). This may
result in bull-neck appearance.
Diphtheria affecting larynx is serious particularly in infants and children.
Most often it leads to death of the affected children.
Nasal diphtheria (of nose) is usually a mild condition marked by one sided
discharge in the nose.
You should always suspect diphtheria whenever there are cases of sore throat
often, such cases are taken lightly and treated as mild upper respiratory
infection. Administration of antibiotics, assuming that it is ordinary sore
throat delay diagnosis, endangering the life of the patient.
Diagnosis is confirmed by examining the lesions for the presence of bacteria.

Failure to demonstrate the bacteria under microscope should not, however, be
the reason for withholding the treatnient for diphtheria.

How to prevent diphtheria? Preventive measures are simple. Read the
following section and find out for yourself:
a) Immunisation : The only effective way of preventing the disease is by

active immunisation by diphtheria toxoid to general population. It is
given as DPT or triple antigen along with immunisation for whooping
cough and tetanus. Three intramuscular injections of 0.5 ml each at
intervals of 4 weeks are given to children starting at six to ten weeks of
life. A booster is given at the age of 18-24 months. For children, at the
age of five to six years, only DT containing diphtheria and tetanus
toxoids, is given.
24
b) Identification of susceptible cases: There is a test to find out individuals Diphtheria,
who are susceptible to diphtheria. This test is known as Schick test. This Tetanus And
Poliomyelitis
test can also be used for confirmation of successful immunisation. The
test is an intradermal (injection into the layers of skin) test. A measured
amount (0.2 ml) of Schick test toxin is injected into the skin of the
forearm. Toxin inactivated by heat is injected into the opposite arm
which is called control arm. In other words the individual has enough
antitoxin to neutralise the toxin and fight the disease. The test is positive
if red flushing (colouring) of 1 to 5/42 cm diameter appears within 1 to 1
days of injection The control arm shows no change. This would mean
that the person is susceptible to diphtheria.
The community, particularly the parents of young children, should be

encouraged through education to get their children immunised against
diphtheria along with the whooping cough and tetanus.
Prevention is surely better than cure. But if an individual is suffering from

diphtheria, how do we manage such a patient, let us consider.
Management of diphtheria : In all the cases suspected of having diphtheria,

antitoxin should be administered without waiting for bacteriological
confirmation. After completion oftests for allergy to the antitoxin,
intramuscular administration of antitoxin (10,000 80,000 units or more) is
recommended depending upon the severity of the case. Penicillin and
Erythromycin are effective but should be given along with the antitoxin.
When there are cases of diphtheria, you should immediately take steps to
arrange for injections of antitoxins to the patients. In otherwords, these
patients should be taken to the nearest hospital at the taluq or district level.
The hospital authorities will arrange for laboratory investigations and
antibiotic cover. Simultaneously, the close contacts in the family should be
investigated and kept under watch thoroughly. It is a sound practice to
administer 1000-2000 units of diphtheria antitoxin to household contacts and
others who have been in recent contact with cases of diphtheria.
Read Points to Remember given below, which provides a summary of

diphtheria.
POINTS TO REMEMBER
Diphtheria
• Diphtheria is an acute communicable disease affecting the nose, throat
and tonsils.
• Diphtheria is caused by Corynebacterium diphtheria.
• Diphtheria is primarily a disease of children under 15 years of age.
• Transmission of diphtheria is through droplet infection or infected dust.
• The throat become sore when diphtheria affects tonsils and there is
swelling of the cervical lymph glands.
• Immunisation is the most effective way of preventing the disease.
25
Common Check Your Progress Exercise 1
Infectious
Diseases 1) Prepare a brief plan of action indicating the steps you would take to
organise treatment of diphtheria patients and the preventive measures
you will take.
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
16.3 TETANUS
Tetanus, commonly known as lockjaw, is an ubiquitous (common) disease
occurring in almost all the countries of the world. The rate of infection with
tetanus and consequent death rates are, however, very high in tropical
countries such as India. About 5-10 per cent of all infant deaths during the
first month of life can be attributed to tetanus infection of the new born.
During the year 2008 the reported number of cases due to tetanus neonatal in
India were 811.
16.3.1 The Disease—What causes it? Who gets it? How and
Tetanus is induced by a toxin produced by bacillus Clostridium tetani, The
organism grows at the site of injury under anaerobic (lack of oxygen)
conditions. The bacillus forms spores at its terminals which are spherical in
shape. Thus, the organism appears as a drum-stick under the microscope. The
spores germinate in anaerobic conditions and the bacillus produces a potent
toxin. The tetanus bacillus is a normal inhabitant of the intestines of animals
such as cattle, horses, goats etc. Contamination with animal dung, therefore,
is one of the important causes for tetanus.

Age: Tetanus is a disease of active age, though it affects all ages. Generally, it
is common in the age group of 5-40 years. This age group generally is
predisposed to all kinds of injuries and the risk of acquiring tetanus is higher.
In India and other tropical countries, tetanus of the new born infant is very
common due to bad hygienic practices followed during delivery particularly
for cutting the umbilical cord by the untrained traditional mid wives (dais).
You may be surprised to know that some midwives apply cowdung to the
umbilical cord after it is cut, in the belief that it will help to heal the cut. This,
as you can imagine, is a dangerous practice and is the surest way of spreading
tetanus. This practice should be stopped.
Sex: Generally, tetanus is more common in males than in females. However,

in the reproductive age group of 15-45 years, females are at a higher risk,
26
particularly after criminal abortions and deliveries conducted under primitive Diphtheria,
conditions in the rural and tribal areas. Tetanus And
Poliomyelitis
Socio-economic factors : The disease is more frequent in rural areas than in
urban areas. Agricultural workers are at a greater risk of getting the disease
because of their contact with soil and animal faeces. Wide spread poverty,
high illiteracy and consequent unhygienic practices like applying all sorts of
medications, sometimes even fine sand powder on the wound without
properly cleaning it, lead to tetanus infection in low income families.
How does it spread?

Tetanus occurs in most cases after injury. The wounds may be trivial and
often are ignored or unnoticed. This is more so among labourers. Infection
takes place due to contamination of wounds with tetanus spores. The
contamination may happen with soil, dust or animal faeces. The tetanus
bacilli are found in the soil.
Tetanus of the new born occurs through infection of umbilical cord,

particularly due to unhygienic practices, adopted by untrained birth
attendants while cutting the cord.
Tetanus may result after surgical treatment, the spores being introduced
through improperly sterilised suturing material or instruments. The tetanus
spores can be introduced through dressings of the wounds and plaster of paris
used for bandaging fractured limbs.
Incubation period : The incubation period is generally 4 to 21 days. It
depends on the character and extent of the wound. On an average, it is about
10 days. Most cases occur within 14 days of the wound, but, sometimes it
may take longer.
Period of communicability: It is not directly transmitted from man to man.
Susceptibility: Everyone is susceptible to tetanus infection. Recovery from

tetanus does not result in definite protection against the disease. Second
attacks can occur. However, prolonged immunity is induced by tetanus
toxoid injection.

Tetanus is an acute disease characterised by painful muscular contractions
mainly of jaw and neck muscles. This is usually followed by spasm
(contraction) of muscles of trunk and spine (Figure 16.1). The common first
sign suggestive of tetanus is rigidity (tightening) of abdominal muscles.
Sometimes such a rigidity is confined to the sile on injury only. It is difficult
to confirm the diagnosis through laboratory investigations since the organism
is rarely recovered from the site of infection.
27
Common
Infectious
Diseases
Figure 16.1: Spasm of muscles of trunk and spine

Tetanus has a high fatality rate. About 40-80 per cent of the patients die. You
will appreciate how important it is to prevent it.

Discussed below are the preventive measures of Tetanus :
a) Active Immunisation : The best protection against tetanus is through

routine immunisation with tetanus toxoid. Tetanus toxoid (TT) is
recommended regardless of age. It is particularly important for workers
who frequently come in contact with soil or domestic animals and all
those with greater than usual risk of traumatic injury. These include
military and police personnel. Immunisation for different individuals
include:
• For Children: Primary course (the very first course of immunisation
in children) of immunisation consists of 3 injections of tetanus
toxoid (given as DPT) with an interval ofabout 4-8 weeks between
injections, starting at 6 week of age followed by a booster dose at 18
months of age and a second booster (only DT) at five to six years of
age and a third booster (only TT) after 10 years of age. A booster is
given about one year after the third injection.
• For Pregnant Women: All the pregnant women should receive
immunisation as a protective measure against tetanus of the new
born infant. In immunized pregnant women, two doses of tetanus
toxoid should be give, the first as early as possible during pregnancy
and the second at least a month later and at least 3 weeks before
delivery. According to the National immunization schedule three
doses may be given between 16-36 weeks of pregnancy, allowing an
interval of 1-2 months between the 2 doses. In previously
immunized pregnant women, a booster dose is considered sufficient.
Temporary protection can be given to a wounded individual by an
injection of anti-tetanus serum (ATS). This should be administered only
under the supervision of a medical expert and be given after a
subcutaneous test dose is given. Human immunoglobulins against tetanus
are considered one of the best ways of protection against tetanus.
b) Education : Education of the workers, about the mode of transmission of
the disease is important. This would help them to take suitable
preventive action like immunisation after injury. The importance of
28
routine immunisation after injury should be emphasised. You should also Diphtheria,
stress on proper hygienic practices particularly after injury like avoiding Tetanus And
Poliomyelitis
contact with soil, animal faeces and keeping the wound clean would also
help in the prevention of the disease. Providing home delivery kits and
educating the dais and pregnant women about the "three cleans” — clean
hands, clean delivery surface and clean cord care is important in
preventing transmission of disease. Training of traditional birth
attendants in proper ways of cutting the cord; to use sterilised blades for
cutting the cord; to wash hands thoroughly with soap before undertaking
the delivery, not to resort to applying cowdung etc. to the cut portion of
the umbilical cord is essential to prevent tetanus in the new born infant.
Management of Tetanus : Tetanus Human Immuno globulin is given in
large doses intramuscularly to the patients. Also tetanus antitoxin should
be given intravenously with adequate precautions. Remember that
antitoxins can cause severe allergic reactions which may lead to death.
Hence these should be given after testing for such allergic reactions.
Intramuscular penicillin is also recommended. In severe cases, artificial
mechanical respiration may have to be resorted to.
Let us go through Points to Remember and recapitulate salient features of
Tetanus.
POINTS TO REMEMBER
Tetanus
• Tetanus is caused by a toxin produced by tetanus bacillus Clostridium
tetani.
• Tetanus is a disease of active age (5-40 years).
• Its incubation period is generally 4 to 21 days.
• Tetanus in most cases occur after injury.
• The first sign suggestive of tetanus is rigidity of abdominal muscles.
• Immunisation is the best protection against tetanus.

1) Indicate step-by-step the way in which a labourer working in an
agricultural field can get tetanus.
a) ………………………………………………………………………
b) ………………………………………………………………………
c) ………………………………………………………………………
2) What measures should be taken to prevent tetanus from occurring among
the labourers?
a) ………………………………………………………………………
b) ………………………………………………………………………
c) ………………………………………………………………………
29
Common
Infectious
16.4 POLIOMYELITIS
Diseases
Poliomyelitis is an acute communicable disease. It is principally an infection
of alimentary tract but affects the central nervous system leading often to
paralysis. You may have seen a number of individuals handicapped for life,
as a result of an attack of poliomyelitis in their childhood. With the
introduction of immunisation, poliomyelitis is rarely ever seen in the
developed countries where the incidence of the disease has almost
approached zero. The last reported cases of wild polio in India were in West
Bengal and Gujrat on 13 January 2011. On 27'h March 2014, World Health
Organisation (WHO) declared India a polio free country, since no cases of
wild polio had been reported in previous three years.
16.4.1 The Disease-What causes it? Who gets it? How and
Poliomyelitis is caused by a virus which can be seen only under sophisticated
microscope. Three types of polio virus type 1, type 2 and type 3 have been
found to be responsible. Type 1 virus shows preponderance both during
epidemic times and non-epidemic times. Polio viruses are resistant to
freezing and drying.

Age: In India, it is essentially a disease of childhood and infancy. About 95
per cent of the cases occur in children below the age of 5 years and, in fact,
80 per cent of the cases are seen below the age of 3 years. The most
vulnerable age is between 6 months and 3 years. In contrast, in about a
quarter of the cases it is found in the group'15 years and above.
Sex: Males are more prone to clinical attack of poliomyelitis than females.
For every case in females there will be approximately 3 cases of polio in
males.
Injury: Usually paralytic poliomyelitis is associated with some injury or
trauma such as injections, fractures and even surgical operations such as
tonsillectomy.
Season : Seasonal variations are striking. About two thirds of the cases occur
during the months of June to September. This approximately corresponds
with the monsoon season throughout most of the country.
Standard of living : In contrast to most of the diseases, paralytic poliomyelitis

is associated with improved living standards. This is illustrated by increased
incidence of the disease in regions where infant deaths are coming down.
How dose it is spread?

Direct contact with secretions from the pharynx (throat) or faeces of infected
persons is the usual method of spread of the disease to the uninfected
persons. In rare instances milk contaminated with viruses has also been a
vehicle. Epidemiologic evidence suggests that oral to oral spread (through
30
pharyngeal secretions) is more important, particularly where sanitation is Diphtheria,
good, than the spread from faeces (faecal to oral spread). Tetanus And
Poliomyelitis
Incubation period : Usually it takes 7 to 12 days for a person to develop
infection from the time of first exposure. It can vary, of course, between 3
days to 2 weeks.
Period of communicability: Polio virus can be demonstrated as early as 36

hours in throat secretions and in the faeces 72 hours after infection. This is
true not only in clinically apparent cases but also in inapparent infection
(without any clinical manifestations). The virus can persist in the throat for
about one week and in faeces for 3 to 6 weeks or even longer. The polio cases
are most infectious from one week to 10 days before and after the onset of
symptoms.
Susceptibility: Generally, every individual is susceptible to poliomyelitis.

Fortunately only a few of the infected persons develop paralysis. Second
attack of poliomyelitis are rare. Type-specific resistance of long duration is a
rule both after clinically recognisable infection or inapparent infection. In
other words, persons who are infected with type 1 polio virus are resistant to
type 1 polio reinfection. However, they can be infected with either type 2 or
type 3 virus. Infants born to mothers who are immune (protected) to
poliomyelitis have passive immunity which is, of course, temporary.
Pregnant women are known to be more susceptible to paralytic poliomyelitis
than non-pregnant women.

Poliomyelitis is an acute viral illness. Its severity varies from inapparent
infection (without any clinical manifestations) to a disease ending in
paralysis. The symptoms include fever. headache, upset of the
gastrointestinal tract, malaise and stiffness of neck and back. The disease may
also be accompanied by paralysis.
Polio virus enters the body through the alimentary canal and multiplies
initially in the pharynx and small intestine. It may enter central nervous
system through the blood stream resulting in paralysis, particularly of the
lower limbs. Sometimes paralysis of muscles of respiration and swallowing
can occur which may lead to the death of the patient.
It is important for you to remember that the number of cases of inapparent
infection may be about a hundred times that of clinical cases.
Polio virus can be isolated by carrying out sophisticated investigations such
as tissue culture from samples of faeces or throat secretions early in the
course of the infection Such facilities often are not available in the peripheral
hospitals such as pi:imary health centres, taluq or district hospitals. Under
these circumstances you have to depend mostly on clinical diagnosis.
Complications of poliomyelitis : If respiratory muscles are paralysed the

child can die. Similarly if muscles of swallowing are paralysed it may
31
Common threaten life. Non-paralytic poliomyelitis may lead to aseptic meningitis.
Infectious About 2-10 per cent of para lytic cases may die.
Diseases

Preventive measure of poliomyelitis include:
a) Active Immunisation : With the discovery of vaccines, prevention of

poliomyelitis has become possible. Active immunisation of all
susceptible persons against the 3 types of polio virus is the simplest
method of prevention. All the children, who are a higher risk of catching
the disease, should be inmunised.
Two methods of immunisation are available. These include:
Immunisation with (a) live polio vaccine and with (b) killed polio
vaccine. Let us discuss each one of them.
• Live Polio Vaccine : It is an oral polio vaccine (OPV) known as Sabin
Vaccine. It is prepared from attenuated (reduced virulence) strains of the
three types of polio virus (trivalent vaccine). In other words, it is
prepared from the virus with much less degree of pathogenicity. The
primary course of immunisation consists of 3 doses given by mouth, at
one month interval commencing the first dose when the infant is 6 weeks
old. OPV is given concurrently with DPT; BCG can be given
simultaneously with the first dose of OPV. It is important to complete
vaccination of all infants before 6 month's of age. One booster dose of
OPV is recommended 12 to 18 months later.
Booster is given about one year after the third dose.
The advantage of oral polio vaccinc (OPV) is that it produces intestinal
immunity and this prevents subsequent infection of the alimentary tract
with wild strains of polio vius. This vaccine is also relatively
inexpensive. It is useful in controlling epidemics since it produces
antibodies to fight virus quickly among the vaccinated.
• Killed Vaccine: It is inactivated vaccine given as injections. It also
contains all the three types ofpolio virus. It also provides protection but
is less effective in subsequent alimentary infection. In other words, it
does not induce local or intestinal immunity. Hence, mild polio viruses
still can multiply in the intestinal tract of the vaccinated individual and
be a source of infection to others.
For primary immunisation, four injections are required. The first three
are given at one to two months interval and the fourth 6-12 months after
the third dose. The first dose is given at the age of 6 weeks. Additional
dose are recommended prior to school entry and then every five years
until the age of 18 years. One of the major disadvantages of the killed
vaccine, particularly during epidemic of poliomyelitis, is that injections
are to be avoided in epidemic times as they are likely to precipitate
paralysis. Also, immunity is not rapidly achieved with killed vaccine as
in the case of oral live vaccine.
32
b) Education: The community should be educated adequately about the Diphtheria,
dangers of the disease, the mode of spread of the disease and the Tetanus And
Poliomyelitis
advantage of immunisation.
Management of poliomyelitis: There is no specific treatment for

poliomyelitis. During acute illness attention should be given to the
complications of paralysis. Some patients may require respiratory assistance.
The key points of the disease poliomyelitis are listed in the section ‘Points to
Remember’, read them carefully.
POINTS TO REMEMBER
Poliomyelitis
• Poliomyelitis is an acute communicable disease caused by a virus.
• It spreads by direct contact with secretions from the pharynx or faeces of
infected persons.
• The incubation period is 7-12 days.
• Fever, gastrointestinal upset, malaise, stiffness of neck and back
accompanied by paralysis are the common symptoms of poliomyelitis.
• Immunisation is the simplest method of prevention.

1) Prepare a flow chart of the progress of infection of poliomyelitis from its
onset to paralytic stage.
…………………………………………………………………………….
…………………………………………………………………………….
…………………………………………………………………………….
…………………………………………………………………………….
…………………………………………………………………………….
2) Match the following:
a) Most vulnerable age 1) Over 15 years of age in India for
poliomyelitis
b) High incidence of para 2) 6 months to 3 years
lytic poliomyelitis
c) Age of onset of poliomyelitis 3) In areas with low infant deaths
3) State true or false. Correct the false statement.
a) Paralytic poliomyelitis has no association with trauma like injections
or tonsillectomy: (True/False)
b) In westernised countries where infant mortality is very low the
incidence of paralytic poliomyelitis in unprotected children is
higher. (True/False)
33
Common c) In India, the most vulnerable age for poliomyelitis is between 5-40
Infectious years. (True False)
Diseases
16.5 LET US SUM UP

In this unit you have learnt about three infectious diseases — diphtheria,
tetanus and poliomyelitis.
Diphtheria is a common infectious disease caused by Cornybacterium

diphtheriae a microorganism. It is primarily a disease of children under 15
years of age. It spreads usually through droplet infection or infected dust. The
incubation period is 2-5 days. Diphtheria affects nose, throat and tonsils with
swelling of the cervical lymph gland. The only effective way of preventing
the disease is by active immunization.
Tetanus, commonly known as lockjaw is another acute disease characterised
by painful muscle contractions leading to rigidity of muscles. The disease is
caused by a toxin produced by tetanus bacillus. It is a disease of active age,
affecting age groups (5-40 years) who are predisposed to injuries. Tetanus in
most cases occurs after injury or through infection of umbilical cord or after
surgical treatment. Immunisation of children, pregnant women and education
of people is the best protection against tetanus toxoid.
Poliomyelitis is an acute viral illness, affecting essentially children and

infants. The disease causes paralysis and at times can also lead to death.
Direct contact with secretions of infected person is the course of spread of the
disease. Active immunisation against the polio virus is the simplest method
of prevention.
16.6 GLOSSARY
Anaerobic conditions : Conditions where oxygen is absent.
Dais : Traditional midwives helping in conducting
deliveries.
Prevalence of disease : Number of cases of a disease at a point of time
in a community.
Muscular spasm : Contraction of muscles.
Schick test : Test to find out whether an individual is
susceptible to diphtheria.
16.7 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
1) You can include the following while talking about treatment and
prevention :
a) Immunisation
34
b) Identification of the susceptible population Diphtheria,
Tetanus And
c) Injections of antitoxins to cases. Poliomyelitis

1) a) Agricultural labourer will be in contact with the soil continuously
during different types of agricultural operations. Tetanus spores are
found in soil.
b) The dangers of injuries such as cuts and wounds is more common in
the case of agricultural labourer. Office going person is not exposed
to the risk of the above by nature of his duties.
c) Contamination with animal faeces is one of the important causes of
tetanus. Cowdung is extensively used as organic fertilizer in
agriculture. When the agriculture labourer comes in touch with the
same, he is likely to be infected.
2) a) Educate the labourers about the chance of contracting the disease
because of nature of the work which includes working with the soil.
Tell them how disease is caused.
b) Emphasise the need for taking preventive immunisation with tetanus
toxoid.
c) Arrange for active immunisation with tetanus toxoid of all the
labourers with the cooperation of the officials implementing the
schemes.

1) Fever headache upset of gastro-intestinal tract malaise
and stiffness of neck and back paralysis.
2) a-3; b – 2; c-1
3) a) False; there is an association.
b) True
c) False; In India the most vulnerable age group is under 5 years.
35
Common
Infectious UNIT 17 MALARIA
Diseases
Structure
17.1 Introduction
17.2 Malaria
17.2.1 The Disease—What Causes it? Who gets it? How and when does it spread?
17.3 Let Us Sum Up

17.4 Glossary
17.1 INTRODUCTION
In the previous two units of Block 5, you have learnt some of the commonly
prevailing infectious diseases, such as measles, tuberculosis, poliomyelitis,
whooping cough, diphtheria and tetanus. You may have noticed that all the
diseases are preventable and the Governments have initiated active
immunisation programmes to control these discases. In this unit, you will
now be learning about malaria- an infectious disease transmitted by a
mosquito. What are the consequences of malaria? Is it preventable? There are
some of the aspects discussed in this unit. Unlike other infectious diseases
you should be aware that there is no immnisation programme to prevent
malaria in the comunities. So how to control/manage malaria? Read this unit
to find out.
Objectives
After studying this unit, you will be able to:
• identify the cause and mode of spread of malaria;

• enumerate the symptoms and complications of malaria; and
• discuss steps to manage and prevent malaria.
17.2 MALARIA
Malaria has been in the limelight ever since about 90 years ago when Sir
Ronald Ross showed how it was transmitted. Malaria, you might be aware is
an infectious disease caused by the presence of a parasitic protozoa of the
genus Plasmodium within the red blood cells. The disease is transmitted by a
type of female mosquito called Anopheles. The disease is mainly confined to
tropical and subtropical areas.
In India, concerted attempts have been made since 1950 to control the
problem of malaria. There have been major setback to the early success
achieved in the sixties in the control of malaria. Since 1977, with the
36
implementation of the modified plan of operation (PO) there is a consistently Malaria
declining trend in the annual malaria incidence in the country. In India the
number of cases of malaria dropped down from about 1.79 million in 2006 to
about 1.58 million in 2008, As per the provisional data, 2,71,037 cases of
malaria were reported upto April 2009.
17.2.1 The Disease-What Causes it? Who gets it? How and
The disease is caused by the Plasmodium parasite and is transmitted by the
anopheles mosquito.

The discussion below (under different headings) present a clear picture of
who are susceptible to malaria.
Age: Malaria affects all ages, though new born infants have considerable
resistance to infection with malaria.
Sex: Males are more affected than females mainly because they lead more
outdoor life and are likely to frequent areas where infected mosquitoes thrive.
Also females in India are better covered with clothes.
Socio-economic conditions : Where economic conditions are poor, malaria is
more prevalent. Houses which are ill-ventilated and poorly lighted provide
ideal resting places for mosquitoes. Malaria is commonly acquired by
mosquito bites within the house. Malaria is widely prevalent in tribal areas.
This is because the conditions in tribal areas, usually surrounded by forests,
provide favourable grounds for mosquito breeding. In addition, in view of
their inaccessibility, malaria control in these areas is often difficult.
Migrant labourers working on dams : Engineering sites and migrant

agricultural labour may import malaria and reintroduce malaria into areas
where it has been under control.
Environmental factors : Discussed below are environmental factors.
Season — In India, malaria is most prevalent during the months of July to

November. High Temperatures are detrimental to parasite development.
Rainfall — Rain in general increases mosquito breeding. However, heavy
rains may flush out breeding places.
Man-made Malaria — Man-made alterations to the environment like

extensive irrigation systems can introduce malaria into areas where mosquito
activity would have reduced during dry season. Garden pools and stagnant
cess pools of water and sewage can increase mosquito breeding and lead to
malaria.
How does it spread?

Malaria is transmitted by the bites of certain species of infected female
anopheles mosquitoes. In India, the mosquito vectors of importance are
37
Common Anopheles culicifacies and Anopheles fluviatilis. Anopheles stephensi is
Infectious considered an important vector (carrier of infective agent from one host to
Diseases
another) of malaria in the urban areas.
These female anopheles mosquitoes ingest human blood containing malarial

parasites. The male and female unite in the stomach of the mosquito and
multiply and then invade the salivary glands. When the mosquito bites the
man and takes blood meals the parasites are injected into the blood stream
and migrate to the liver and other organs where they multiply. (In the liver
the parasites penetrate into a liver cell and after considerable development the
original single infective form sub-divides into as many as several thousands
of new individual forms). The liver cell ruptures liberating the new
individuals into the blood stream. Some of these enter cells and undergo a
process of multiplication and development. Rapid multiplication of the
parasite results in destruction of the red cell and the new forms are released in
the blood stream and enter fresh red cells. Red cell destruction results in
anaemia and at this stage of the life cycle of parasite the patient experiences
periodic bouts of shivering, fever and sweating. From this stage, sexual forms
(gametocytes) of the parasite develop which on ingestion in a blood feed by
an anopheles mosquito to carry on the life cycle of the parasite in that insect.
In the susceptible individuals, after undergoing cycle, parasites usually
appear in blood within 3 to 14 days after onset of symptoms. Malaria is also
transmitted by blood transfusion.
Incubation period : The length of time between the bite of an infected
mosquito and the first attack of fever is usually not less than 10 days.
There are four types of Plasmodium species. The incubation period varies
according to the species. In the case of P. falciparum it is 12 days and in P.
vivax and P. ovale 14 to 15 days. It is about one month in the case of P.
malariae.
Period of communicability: As long as the parasite are present in the blood of
patients, mosquitoes can be infected.
Susceptibility: Susceptibility is ‘universal'. In those who were frequently

infected, the degree of susceptibility is sometimes lessened, In highly
endemic areas, adults may be more tolerant to developing malaria.
Individuals with sickle cell trait are relatively immune to malaria.

1) Draw the life cycle of the malaria parasite in mosquito and man,
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
38
2) How long does it take from the time the mosquito bites to the onset of Malaria
fever?
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
3) Prepare a list of the factors that facilitate high prevalence of malaria.
Circle all those factors which are relevant in your neighbourhood or a
slum area near your place of residence.
a) ………………………………………………………………………..
b) ………………………………………………………………………..
c) ………………………………………………………………………..
d) ………………………………………………………………………..
e) ………………………………………………………………………..
f) ………………………………………………………………………..

Malaria is characterised clinically by 3 stages:
1) Cold Stage: The patient will have fever of sudden onset with rigor
(shaking chills) and a feeling of extreme cold which is accompanied by
shivering.
2) Hot Stage: The patient complains of sensation of burning and tries to
take of all the clothes on him. The patient will have splitting headache.
3) Sweating Stage: The fever subsides accompanied by profuse sweating.
After an interval free of fever, the cycle of chills followed by fever and
sweating is repeated either daily, alternate day or every third day. If
untreated, the primary attack may last from a week to more than a month.
Relapses occur at irregular intervals for several years. Enlargement of spleen
is common in areas where malaria is persistent. The patients may also have
anaemia (reduction of haemoglobin in blood).
Actually there are 4 types of malaria. They are quite similar in their
symptoms and often it is difficult to differentiate them without laboratory
studies. The most serious is malignant tertian malaria or falciparum malaria.
Apart from the symptoms mentioned above, it can affect central nervous
system leading to loss of orientation, delirium and may even lead to coma.
The other human malarias—benign tertian or vivas, quartan and ovale - are
not dangerous as to lead to death, except perhaps in very young children.
Complications of malaria.
39
Common Cerebral malaria is an extremely dangerous complication of falciparum
Infectious malaria. The patients may have convulsions (fits) and end up in coma.
Diseases
Fatality is very high in such cases.
Diarrhoea and malnutrition are also considered to be common complications

of malaria. Chronic anaemia also is common in children with malaria.

Prevention Management of malaria is discussed below. We begin with
preventive/control measures.
Prevention/Control of malaria : Prevention and control of malaria mainly

depend on- (a) control of mosquitos through spraying of insecticides like
DDT or malathion (b) active and passive surveillance of the areas where
annual parasite incidence is more than 2 and (c) presumptive and radical
treatment of cases of malaria. Let us learn about these measures.
A) Spraying of Pesticides : The spraying of insecticides like DDT or

malathion is done twice or thrice in an year wherever the annual parasite
incidence (number of confirmed cases of malaria during one year per
1000 population) is more than 2.
B) Active Surveillance : Under active surveillance one health worker will
visit each house in his area, consisting of 1000 households, once every
fortnight. He will enquire whether anyone in the house had fever during
the previous fortnight or at the time of the visit in both the instances,
blood film is collected. He then distributes a dose of four tablets of
chloroquin (drug used for malaria treatment). This is known as
presumptive treatment
C) Radical Treatment: If the blood film is positive, appropriate radical
treatment is given. This consists of giving chloroquin along with
primaquine to kill the parasite.
In addition to the above measures other methods of prevention/control
include:
D) Protection against mosquitoes : Protection against mosquitoes can be
done by adopting the following four measures:
• to do away with the conditions which render possible the breeding of
mosquitoes.
• to destroy mosquitoes at some period of their life. This can be done
by spraying DDT or spraying kerosene oil, diesel or fuel oil on the
surface of stagnant water (this suffocates the larvae, as they cannot
breathe) or by introducing larvicidal fish into pools of water where
mosquitoes breed.
• to prevent the mosquito from biting the man. In endemic areas, the
person must be advised to sleep under mosquito nets to prevent
mosquito bites. Insect repellents (such as odomos) which are applied
to the skin may also help.
40
• to attack the parasite as it circulates in the blood of man. Anti- Malaria
malarial drugs (chloroquin, pyrimethamine) can be used for the
purpose.
E) Environmental Sanitation : Improvement of environmental sanitation
through filling of drains and stagnant pools is one of the permanent ways
of reducing mosquito breeding. In the rural areas, the household drain
water should be let into soak pits instead of letting out into open drains.
You can also help in the control of malaria to a certain extent. In areas,
where malaria is endemic, assume that all cases of fever are malaria. In
such cases, arrange for presumptive treatment after a blood film is
collected from them. Simultaneously, ensure that the health authorities
carry out spraying operations to control the mosquitoes. If the slide was
positive for malaria the patient should be educated to take radical
treatment. You can also educate the community to remove mosquito
breeding places such as stagnant pools, cess pools etc.
Management of malaria : Treatment of confirmed cases of malaria with oral

Chloroquin and Primaquine is recommended. In acute cases intramuscular
chloroquin can be given.
Points to remember given below presents an overview of malaria. Read them

carefully.
POINTS TO REMEMBER
Malaria
• Malaria is caused by a parasite of the genus Plasmodium i.e. Plasmodium
vivax, P. Malariae, P. Falciparum, P. Ovale.
• The parasite is transmitted by bites of certain species of infected female
anopheles mosquito.
• Malaria is characterised by the cycle of chills followed by fever and
sweating repeated either daily, alternate day or every third day.
• The incubation period is around 10 days.
• Prevention and control mainly depend on the control of mosquitos and
environmental sanitation.

1) Indicate the steps for carrying out malaria control in an endemic area.
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
…………………………………………………………………………… 41
Common 2) List any two complications of malaria.
Infectious
Diseases ……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
17.3 LET US SUM UP

In this unit you have learnt that malaria is caused by parasites of the genus
Plasmodium. The bite by female anopheles mosquitoes transmit the parasite.
Malaria manifests itself as a cycle of chills followed by fever and then
sweating. Anaemia is a complication of malaria. Prevention and control
depend upon the control of mosquitoes in the community and maintaining
good environmental sanitation.
17.4 GLOSSARY
Anaemia Reduction of haemoglobin in blood

Annual Parasite Number of confirmed cases of malaria in one
Incidence (APT) year per 1000 population.
Benign Tertian Malaria caused by vivax type of malarial
parasite
Gametocytes Sexual forms of malarial parasites. These
develop in man.
Malignant tertian Malaria caused by falciparam type of malarial
Malaria parasite
Presumptive Treatment Treatment of all fever cases assuming them to
of Malaria be as malarial fevers
Prophylactic Treatment Treatment taken to prevent a disease
Radical Treatment of Treatment for malaria aimed at killing
Malaria gaemetocytes of malarial parasite
Rigor Feeling of cold with body shaking vigorously
Salivary Gland A gland that produces saliva
Vector Carrier of infective agent from one host to
another e.g. mosquitoes in malaria
42
17.5 ANSWERS TO CHECK YOUR PROGRESS Malaria
EXERCISE
Skin Mosquito ingest human

blood containing parasite
Mosquito Bite
New form released in the Mosquito bites human skin

blood
Rupture blood cell Through the blood
Parasite develop and Reach liver cells multiply

multiply in RBC
Liver cell repture
Liberate
parasite in
blood
2) About 10 days
3) a) Poor economic conditions
b) The ventilated and poorly lighted houses c) Migrant agricultural
labour d) Months of July to November e) Rainfall f) Stagnant pools
of water and sewage
1) • Look for cases of fever actively

• Take blood film on a slide
• Administer tablets of chloroquine
• If the slide is positive for malarial parasite administer radical
treatment with primaquine and chloroquine
• Arrange for spraying operation
• Ensure that breeding places are closed
• Educate the community to keep the surroundings dry and clean

• Educate them to sleep under mosquito nets
2) Diarrhoea and Anaemia.
43
Common
Infectious UNIT 18 SKIN, EYE AND EAR
Diseases
INFECTIONS
Structure
18.1 Introduction
18.2 Skin Infections
18.2.1 Bacterial Infections
18.2.2 Fungal Infections
18.2.3 Insect Infestation—Scabies
18.2.4 Leprosy
18.3 Eye Infections

18.3.1 Trachoma
18.3.2 Other Conjunctival Infections
18.4 Ear Infections

18.4.1 Acute Suppurative Otitis Media
18.4.2 Chronic Discharging of Ear
18.4.3 Otitis Externa
18.5 Let Us Sum Up

18.6 Glossary
18.1 INTRODUCTION
In unit 17 we learnt about the cause, spread, symptoms, control, prevention
and management of malaria. In this unit, we shall discuss about the common
skin, eye and ear infections. These are important public health problems,
which can be attributed to poor personal hygiene. Though these infections are
not life threatening but they are important because they can adversely effect
certain vital organs. In this unit, therefore, our emphasis would be on the
prevention/control measures for these infections. A brief discussion on the
different eye, ear, skin infections is also presented.
Objectives
After studying this unit, you will be able to:
• identify the types, cause and spread of common infections of the skin,
eye and the ear;
• enumerate the symptoms of these infections; and
• discuss measures that can be adopted to manage and prevent the
occurrence of these infections.
44
18.2 SKIN INFECTIONS Skin, Eye And
Ear Infections
Skin infections are an important public health problem in our country. Most
of the skin diseases can be attributed to bad personal hygiene of the persons.
One of the reasons for this is, apart from ignorance, lack of adequate water
for washing and bathing, particularly in the rural areas and urban slums.
Though skin infections per se may not be life threatening, these are
important, since some of the skin infections can lead to infection of vital
organs such as kidneys.
Skin infections may be due to:

a) Bacterial infections for example boils, impetigo
b) Fungal infections i.e. ringworm infection
c) Insect infestations like scabies
d) Eczematous dermatitis (red patches with little blisters)
Identification or diagnosis depends on the type of infection, In this unit, we

will be learning about common skin infections caused by bacteria, fungus and
insect infestations, Leprosy is the other aspect discussed.
18.2.1 Bacterial Infections

The normal skin harbours as commensals (non parasitic, harmless, but
mutually beneficial organisms which live together) some bacteria known as
staphylococci and streptococci, though they are normally non-virulent (not
pathogenic). Of the common conditions, impetigo and furunculosis (boils)
can be considered important. Aword about each.
Impetigo: This bacicriai infection starts as a red macule (a small, smooth

circumscribed area of discolouration of skin) and becomes a blister within
hours. Later, pus accumulaies in it. The surface of the pustule (a small
circumscribed elevation on the skin containing pus) gets eroded and serous
discharge and pus ooze out. These when dried up leave yellowish honey
coloured crusts.
Furunculosis : In tropical regions like- India, it is common to come across

cases of prolonged boils. These are due to the infection of the hair follicle
(root of the hair). Usually this condition occurs more frequently in
individuals who are suffering from debilitating diseases such as anaemia or
malaria. The lesions are generally localised (confined to certain areas of the
body) and painful. There may be mild fever present in some cases. In such
cases furunculosis is usually extensive.
Why do they occur?

Streptococci (a type of bacteria) are the important causative organisms in the
case of impetigo. In the case of boils, staphylococci are the main pathogens.
45
Common Who gets the Disease?
Infectious
Diseases The skin infections are more common among children. However, any one can
get these infections. Susceptibility is greatest among the new born.
Generally, these skin infections are more frequent in low income group
families where overcrowding and lack of cleanliness are very common. In
fact, apart from ignorance water shortage contributes to higher rate of
infections. In the hot climate the moist sweaty skin favours bacterial growth.
Since, daily bathing is rare in most of the poorer communities skin infections
such as impetigo and furunculosis are common.
What are the preventive measures?

Bacterial skin infections can be called 'water washed" diseases. In other
words, provision of adequate water for the purpose of washing and bathing
would, by itself, help in reducing the prevalence of these infections. The
community should be educated to use soap for washing the skin. They should
be encouraged to have daily bath. Spread of the infection can take place
through the sharing of same towel by a number of persons. Education is
necessary to encourage protective measures. When educating the community
you should emphasise also on proper washing of clothes. Proper detergent
should be used for washing of clothes, particularly of infected individuals. It
is preferable to wash the clothes in hot water in the case of those with
extensive infections of the skin. One of the simplest ways of preventing
spread of the infection is to keep the clothes of the infected individual
separately from others.
How to manage the infection?

Application of creams or ointments consisting of antibiotics is one of the
simplest measures of management of impetigo. It is, however, important first
to remove the crusts. Wash the affected part with soap and boiled water,
gently scaling off the crusts. Systemic antibiotics either by mouth or
parenterally (other than through alimentary canal) may be necessary in severe
forms of impetigo and furunculosis.
18.2.2 Fungal Infections

Fungal infections of the skin are very common in India. The commonly
occurring fungal infections can be grouped as follows:
a) Body ringworm, and

b) Ringworm of the hair and nails (Head ringworm)
Most fungus infections grow in the form of a ring. Ringworm of the head can
produce round spots with scales and loss of hair).
How to identify the Disease?

Body ringworn. : It is a chronic infection. It is also referred to in clinical
terms as Tinea Corporis, In typical cases, the lesions mainly on the trunk or
abdomen, appear as a circular area with a clear border which is raised. The
46
border may have blisters. It is in this area that the fungus will be Skin, Eye And
proliferating. The central portion of the ring may show depigmentation Ear Infections
(paleness). A number of such lesions may fuse into large areas having a
common edge. The patient may complain of itching and burning. Because of
itching and scratching secondary bacterial infection may result.
Head ringworm : This is referred to as Tinea capitis. The typical infection
shows greyish white circular spots consisting of hairs broken off a millimetre
or so from the scalp. The skin is scaly.
Why does it occur?

Fungal skin infections are largely due to fungi belonging to the group
Tricophyton.

Fungal infections can affect all individuals. These are common particularly in
children.
Release of toxins from the fungi whose natural host is soil or animals results
in infection. Populations who come in regular contact with soil and animals
are more likely to get the disease.

Proper cleanliness of the body is the surest way of avoiding the infection.
The children should be refrained from playing with soil which you would
agree is rather a difficult task instead it would be recommended that children
should be thoroughly washed after their play.
In the case of head ringworm maintenance of barbers combs in cleaner state

will contain/check the spread of the infection. Prompt treatment of all the
diagnosed cases is also important.
How to manage fungal infections?

Washing the infected part every day with soap and water may be all that is
needed.
Antifungal agent griseofulvin is the drug of choice in the case of Tinca capitis
causing head ringworm. This drug is taken by the mouth. The treatment is
generally for about six weeks. Local application of antifungal ointment does
not clear the infection easily. 47
Common Body ringworm on the other hand, can be treated effectively by local
Infectious application of antifungal ointment. Oral griseofulvin may be required in the
Diseases
case of extensive infection.

1) Fill in the blanks :
a) Tinea capitis affects ……………… and ……………… and is
known as ……………… ringworm.
b) Tinea corporis presents as ……………… in the central portion of
which may show ……………… of the skin.
c) Oral ……………… is the drug of choice for the treatment of Tinea
……………….
2) State whether True of False. Correct the false statement.
a) In the case of hair ringworm maintenance of barbers comb in cleaner
state will contain the spread of infection. (True/False)
b) Impetigo usually occurs in individụals suffering from anaemia or
malaria. (True/False)
c) Streptococci. is the organism causing boils in children. (True/False)
d) Fungal infections are commonly referred to as water washed
diseases. (True/False)
e) Antifungal drugs are given for the treatment of body/hair ringworm.
(True/False)
18.2.3 Insect Infestations – Scabies

Scabies is perhaps the commonest of all the skin infections, caused by insect
infestations. In India, it is not uncommon to come across almost all the
members of a family suffering from scabies. In the rural areas the disease is
fairly widespread in occurrence.
How to identify scabies?

The patient generally complains of intense itching particularly at night. The
infection is commonly found around the webs of the fingers, around the
wrists, thighs, belt line and on the genitalia (relating to the reproductive
organs). On examination, you will find either papules (a small circumscribed
elevation on the skin) or vesicles (blisters). Superimposed bacterial infection
is very common and sometimes may take the appearance of impetigo,
particularly over the buttocks and back of the trunk (Figure 18.1)
Why does it occur?

Scabies is caused by little animals — similar to tiny ticks or chiggers —
which make tunnels under the skin.
It is called itch mite, scientifically known as Sarcoptes scabies. The female

mite burrows into skin and lays eggs which ultimately develop into adults.
48
The diagnosis can be confirmed by searching for the parasite in the skin Skin, Eye And
debris under the microscope. Ear Infections
Figure 18.1 : Scabies

It appears to develop more frequently in early ages. It is common in socially
backward and poor communities. Generally, whole family is affected. It is
uncommon where frequent bathing is common. In other words, communities
who lack proper personal hygiene with particular reference to bathing are
more likely to suffer from the disease.
How does it spread?

Transfer of the itch mite occurs by direct contact with an infected person.
This occurs often while sleeping in the same bed with an infected individual
or in the case of children while they are playing together. It tends to spread in
families. The disease may also be acquired from soiled and contaminated bed
clothes used by an infected individual and to a limited extent from
undergarments.

Prompt treatment of the disease is most important. All the affected and non-
affected members of the household should be treated. Undergarments, bed
linen in the affected house should be changed and properly washed. It is
preferable to wash the clothes with boiling water. The community should be
educated about the need for cleanliness particularly for frequent bathing.
Similarly, cleanliness of garments and bed clothes should be maintained. In
the case of school children, infected children should be excluded until all the
members of the affected family are treated adequately.
49
Common How to manage scabies?
Infectious
Diseases Benzyl benzoate or 1 percent gama benzene hexachloride are effective killers
of itch mite. Before the treatment the patient should have scrub bath with
soap and water. The medicinal preparation is applied to every inch of the
body below the chin. This should be repeated after about 12 hours and a bath
is taken, preferably after two or three applications of the medicine. This is
followed by complete changing of the clothing including bed linen. To
prevent reinfection it is essential to treat all the family members even if they
do not have any complaints.
Super imposed bacterial infection is treated with appropriate antibiotics.
18.2.4 Leprosy
Leprosy is a chronic communicable disease characterised by lesions of the
skin and involvement of nerves. It is a major health problem in our country.
In 2007-08 about 1,37,685 leprosy case:s were repored in India. While
leprosy is a problem in all the States, about 83 per cent of the leprosy cases
are present in the States of Andhra Pradesh, Tamil Nadu, Bihar, Maharashtra,
West Bengal, Orissa, Assam, Karnataka and Uttar Pradesh. It is, particularly
a serious problem in Andhra Pradesh and Tamil Nadu.
How to identify Leprosy?

The diagnosis of leprosy can be made if one or more of the following
important signs are present:
• Loss of sensation
• Enlargement of nerves, and
• Presence of leprosy bacilli in skin smears
On clinical examination, there may be a pale/depigmented patch of the skin

with or without loss of sensation on the patch. The patients who have no
sensation on the patch (anesthetic patch) will not be able to feel the touch
with a feather or wisp of cotton as in the normal skin (Figure 18.2). Some of
the nerves of the upper and lower extremities (limbs) may be thickened and
can be rolled between fingers. The skin on the affected part appears thickened
and shiny (coppery red). Loss of sensation may be extensive and normally
present in extremities. The skin lesions may also take the form of nodules. In
untreated cases, due to extensive involvement of nerves and skin,
disfiguration can occur.
50
Skin, Eye And
Ear Infections
Figure 18.2: Leprosy sores

The disease is divided clinically into two major types: tuberculoid and
lepromatous. Infections of intermediate character are described as border-line
type. There is also an intermediate form which corresponds to earliest
manifestations of the disease. Let us learn about these different types of
leprosy.
Types of leprosy
In the tuberculoid type the disease is mild and does not progress and the
number of hypopigmented (pale) skin patches will be a few in number. Often
only single nerve is involved. No bacilli are present in the lesions. Hair
growth is markedly diminished.
The lepromatous leprosy; however, is of more severe degree and progressive.
The skin lesions are more in number and they take the form of nodules. Hair
growth is not affected. There will be generalised symmetric involvement of
the nerves. There will be loss of sensation(anesthesia) in the extremities. In
the case of upper extremities anesthesia is present on the skin which will be
covered when a glove is worn on the hands. Similarly, in the case of lower
extremities, the area of the skin which will be covered when a stocking is
worn, will not have sensation. This is called glove and stocking type of
anesthesia. Many bacilli are present on skin smears and nasal (from nose)
smears.
Diagnosis is supported by the demonstration of leprosy bacilli in the lesions.
Why does it occur?

Leprosy is caused by Mycobacterium leprae, the leprosy bacillus. The bacilli
are similar to tubercle bacilli. They are acid-fast and characteristically occur
in clumps or bundles (called globi). Other than in man the bacilli can
multiply only in the footpads of mice and in the armadillo (ant eater). This is
an important fact for carrying out research in leprosy.
Reservoir of Infection: Man is the only known reservoir. In other words, the
leprosy bacilli normally live and multiply only in man and reproduce
themselves so that the disease can be transmitted to another individual.
51
Common Who gets the disease?
Infectious
Diseases Age: It is not a common disease of children. Studies in India indicate that it
occurs after the age of 20-25 years. However, a high incidence among
children only indicates that leprosy infection is active in the area.
Sex: In general, it is twice more common in men as compared to females.

This may be due to greater exposure to the disease in the case of men.
Socio-economic factors: It is more common in low income group families

than those of higher income groups. Factors that contribute to this are low
standards of living, overcrowding, unhygienic personal habits and certain
prejudice to the disease. Social stigma and consequent ostracism causes
patients to conceal their early lesions at the period when it is possible to
speedily control the disease.
Climate : It is more frequently seen in countries with hot and humid climate,
though it is seen in all the countries of the world.
How does it spread?

The mode of transmission of the disease is not established yet. Presumably
the leprosy bacilli from the nasal discharges of infectious patients gain
entrance through the skin or respiratory tract of the uninfected. Continued
household contact is important in the case of the lepromatous type, the attack
rate in household contacts is 6 to 8 times greater than other forms of leprosy.
Incubation period : The incubation period is rather prolonged. Average

period is 3 to 5 years. Of course, it may take much longer to recognise the
disease. Shortest known incubation period is 7 months.
Period of communicability: As long as normal leprosy bacilli are present the

disease is infectious. This is particularly so in untreated cases. With
treatment, however, it is reported that infection is lost in a majority of the
cases within 3 months.
Susceptibility: Clinical leprosy occurs in response to a massive and repeated

exposure Most adults appear to be not readily susceptible when exposed.
Subclinical and inapparent infections are common.
What are the preventive measures ?

Early diagnosis and prompt initiation of treatment are now considered
important in the control of leprosy. Active search for cases of leprosy in
endemic areas is recommended. Surveillance of household and close contacts
will help in detecting a large number of cases of leprosy. Health education
emphasising the availability of effective treatment and that with prompt
treatment, the infection can be contained is essential. There are a lot of
misconceptions that leprosy is hereditary, due to impure blood, the disease
always leads to deformities etc. There is unjustified social stigma. The
community should be encouraged to seek medical assistance in all the cases
of suspected hypopigmented skin patches.
52
Rehabilitation of treated cases of leprosy to normal life, so that they resume Skin, Eye And
their normal role in the society, is an important aspect of leprosy control. It is Ear Infections
also necessary to follow-up the patients to ensure regular intake of drugs and
evaluate the treatment. Research is being carried to develop a vaccine against
leprosy.
How to manage leprosy?

Multidrug treatment of leprosy is recommended under the National Leprosy
Eradication Programme. Depending on the type of the disease, a combination
of dapsone (DDS), Rifampicin, Clofazimine elhioramide and protionamide is
given. The treatment may last from 6 to 24 months depending on the type of
leprosy. Evaluation of treatment and a close follow up of any side effects to
the drug will help in proper compliance by the patients.
The discussion above presented a detailed account ofskin infections. For your
reference the key points under this section are listed in points to remember
below.
POINTS TO REMEMBER
Skin Infections
• Microorganisms like bacteria, fungus are the main causative agent for
skin infections (boils, ringworm, impetigo etc.). Scabies is, however,
caused by an insect - itch mite.
• Skin infections effect all individuals but they are more common in
children (except leprosy, in adults only).
• Low standard of living, unhygienic personal habits are the main causes
of skin infections.
• Direct contact with the patient in most cases helps in the spread of
infections.
• Proper cleanliness of the body helps prevent the occurrence of skin
infections.
• Drugs and skin ointments are used to treat skin infections.

1) Draw a flow chart of how scabics develops and manifests in a child
starting from the entry of the organism.
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
53
Common 2) List the differences between tuberculoid type of leprosy and lepromataus
Infectious leprosy in a tabular form.
Diseases
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
18.3 EYE INFECTIONS

Of the eye infections, those affecting the eyelids and the conjuctiva (figure
18.3) are commonest. Conjunctivitis i.e. infection of the conjunctiva is very
common, particularly among children. Common eye infections include
trachoma, bacterial conjunctivitis and viral conjuniivitis. We will deal with
each one of these eye infections separately. We began with trachoma.
Figure 18.3: Structure of the eye
18.3.1 Trachoma
Of the conjunctival infections, trachoma is one of the important causes of
blindness. In the states of Punjab, Rajasthan and Uttar Pradesh, the
prevalence of trachoma is about 75 per cent. In South India it is less common.
The individual suffering from trachoma experiences mild symptoms of

watering and irritation of both the eyes. There may be sensation of a foreign
body in the eyes. (Figure 18.4). Examination reveals reddening of the
conjunctiva, particularly of the upper eyelids, On careful examination, by
everting (turning inside out) the upper eyelids, we find small greyish
granules, generally known as follicles. Surrounded by reddish capillaries.
After many months, spontaneous healing of the lesion takes place leading to
fibrosis (formation of fibrous tissue. Contraction of the fibrous tissue of the
upper eyelid leads to inward turning of eyelid (entropion) and aberrant
growth of eye lashes. This leads to constant irritation of the cornea (black
54
portion of the eye) by the eyelashes which leads to ulcers of the cornea Skin, Eye And
ultimately leading to blindness either completely or partially, Ear Infections
Pinkish grey lumps inside the upper

lid
Figure 18.4 : Trachoma
Why does it occur?

Trachoma is due to a bacterium of the genus Chlamydia (Chlamydia
trachomatis). Previously, it was believed to be due to a large atypical virus.

Age: Trachoma occurs very early in life. In areas where trachoma is highly
prevalent, children under the age of 10 years are the main victims of active
disease.
Sex: While below the age of 10 years both sexes are equally affected, beyond
this age the females suffer more than the males. The severity of the disease
also is more in females. This is because females are always in more contact
with children and thus get infected.
Socio economic factors: The disease is more frequent, in fact, thrives in
conditions of poverty and low standards of personal hygiene.
Season: The incidence of trachoma is high between April-May and July-

September (during the house-fly season).
How does it spread?

The disease is transmitted primarily by direct contact. 'This happens when the
individuals are sleeping together. It can also spread indirectly through use of
contaminated towels and handkerchiefs. House-flies play an important role in
the transmission of the disease. House flies pick the infected bacteria when
they rest on the eyes of the infected individuals. These are transferred to the
normal eyes when they rest on them.
Incubation period: It takes about 5-12 days for a person to get infected with
trachoma since the time of first contact.
Period of communicability : It is infective as long as the active disease is

present. After fibrosis of the lesions the concentration of the agent decreases
but may increase when the disease is reactivated.
55
Common What are the preventive measures?
Infectious
Diseases Early diagnosis of the cases and prompt treatment of all the cases,
concentrating on preschool children, are important. The disease occurs in
areas of water shortage. Improvement of basic sanitation and water supply
are essential for the prevention of the disease. The community should be
educated about use of the soap and water for washing face and body. Use of
common towels should be avoided. In other words, proper personal hygiene
is absolutely essential for the control of the disease.
How to manage trachoma?

Local treatment can control the disease adequately. Tetracycline ointment
should be applied, twice a day, for five consecutive days each month or once
daily for 10 days each month for 6 consecutive months or for 60 consecutive
days. An alternative antibiotic is erythromycin. Oral sulfonamides and
tetracyclines are effective in the active stages of the disease. Since reinfection
is common the patients should be followed up for some months after the
treatment and examined carefully.
18.3.2 Other Conjunctival Infections

Conjunctivitis could be due to (i) bacterial (ü) viral or (i) fungal infections.
We will. discuss only about bacterial and viral conjunctivitis since these are
common.
A) Bacterial conjunctivitis
In bacterial conjunctivitis, the eyes will be red and the patient complains
of foreign body sensation, i.e. the patient feels as if something has fallen
in his/her eyes. There will be secretions from the eyes which may be
purulent (pus). The patient complains of sticking together of upper and
lower eyelids in the morning. However, vision is not affected.
In the case of bacterial conjunctivitis, the causative organisms are
staphylococci, pneumococci and haemolytic streptococci.
The causative organism can be identified by obtaining smears of the
secretions from the eyes of the infected individual and examining it
under the microscope.
Bacterial infections of the eye can be treated by using antibiotic eye
ointments or instillation of eye drops. These are usually self-limiting and
may not require prolonged treatment beyond a week. Proper personal
hygiene by the uninfected, avoidance of contact with secretions of an
infected eye, will help in controlling transmission of the disease.
B) Viral Conjunctivitis
Viral conjunctivitis is also common and often comes in the form of
epidemics since the spread of the disease is rapid. It is characterised by
reddening of the conjunctiva with thin watery discharge. It is caused by a
virus as the name suggests. Viral conjunctivitis lasts for 12-14 days.
There is no specific treatment. Use of sulfonamide drops or broad
56
spectrum antibiotic ointment may help in the prevention of secondary Skin, Eye And
bacterial infection. Ear Infections
We can prevent the disease only by proper personal hygiene. One should
take steps to avoid contact with eye secretions of infected individuals.
Towels used by infected individuals should not be used by others.
Sometimes, preventive use of antibiotic ointment or drops may help
prevention of conjunctivitis.
Points to remember given below presents a summary of Eye Infections,
POINTS TO REMEMBER
Eye Infections
• Of the eye infections, those affecting the eyelids and the conjunctiva are
the commonest,
• Bacteria and viruses are the common organisms causing eye infections
namely trachoma, conjunctivitis.
• All individuals, particularly children are more prone to cyc infections.
• Improvement of basic sanitation, water supply and personal hygiene are
essential for the prevention of eye infections.
• Eye infections can be treated by oral drugs and antibiotic ointments.

1) Indicate three ways in which trachoma can be transmitted from an
infected individual.
a) ..............................................................................................................
b) ..............................................................................................................
c) ..............................................................................................................
2) Suggest some measures to prevent the spread of trachoma.
…..............................................................................................................
…..............................................................................................................
…..............................................................................................................
…..............................................................................................................
…..............................................................................................................
18.4 EAR INFECTIONS

Ear infections are common, particularly among young children, in rural areas
and urban slums. It is not uncommon to come across children with ear
discharge in villages. Though ear infections do not lead to death they may
lead to complications such as loss of hearing, meningitis (inflammation of the
membranes covering brain and spinal cord), mastoiditis (inflammation of the
bony part behind the ear) etc. It is possible to protect children from these
complications with prompt treatment. 57
Common Of the commonly occurring infections of the ear, those affecting middle ear
Infectious are important. Are you aware of the structure of the ear? For your reference
Diseases
figure 18.5 illustrates the structure of the ear. The middle ear you notice is
most prone to infections. Infections of the external car also occur frequently.
Generally three types of ear infections are common:
1) Acute suppurative otitis media.

2) Chronic discharging of ear, and
3) Otitis externa
Figure 18.5: Structure of human ear

Acute suppurative otitis media and chronic discharging ear are the infections
of the middle ear. Otitis extema is an infection of external ear. Lets get to
know about these ear infections.
18.4.1 Acute Suppurative Otitis Media

Acute suppurative otitis media is an infection of the middle ear usually
following upper respiratory tract infection. The essential features for
diagnosis are : (a) Ear ache (b) fever, and (c) red bulging tympanic membrane
(ear drum).
This develops in children with remarkable rapidity. A child goes to bed

apparently in normal health and wakes up crying with pain a few hours
afterwards. He will have difficulty in sleeping. Even older children,
sometimes will be unable to point out the exact location of the pain. Tugging
at the ear is sometimes present and may be a useful sign. Fever and running
nose are usually present.
On examination of the ear, the tympanic membrane (see Figure 18.5), is
usually flaming and diffusely red. The entire ear drum bulges out in some
cases, the ear drum spontaneously ruptures and there will be cloudy discharge
in the ear. In the untreated cases, perforation of the ear drum occurs with
58
profuse discharge of pus. Some patients may develop suppurative otitis media Skin, Eye And
with every cold. This is known as recurrent acute suppurative otitis media. Ear Infections
In untreated cases it may lead to mastoiditis (inflammation of the bony part

behind the ear) and meningitis. Rarely necrosis (death of tissue) of the whole
ear can occur. These are the complications of acute ear infection.
Why does it occur?

It is the most common complication of a cold. The organisms most frequently
encountered in such cases are pneumococci, H. influenzae and haemolytic
streptococci.

Young children are most commonly affected. This may be because they are
more prone to upper respiratory tract infections. The children have shorter
eustachian tubes (tube connecting ear and nose). It may be more common in
low income group families. It is also seen even among children belonging to
affluent sections of the society.
How to manage acute ear infection?

Oral or intramuscular penicillin is the drug of choice. If the patient is allergic
to penicillin, erythromycin, another antibiotic, can be given. The treatment is
given for a period of 10 days.
Antibiotic ear drops can be instilled 3 times a day. In case of perforation with
discharge of pus, it should be removed by suction using a syringe and a short
plastic tube. Ear drops should be instilled only after cleaning the ear of the
discharge. Tablets for pain killing and control of fever will be required.
18.4.2 Chronic Discharging of Ear

Discharge from the ear is very common and wide spread problem of the ear
in rural areas and urban slums. It is often considered as an index of low
standards of living.
How to identify the problem?

The child comes with a complaint of discharge of the ear which is often of
offensive smell.
On examination, one can see a thick muco-purulent (containing both pus and
mucus) discharge (pus) from one or both the ears. In cases which are
neglected the discharge is offensive with flies and other insects lying in the
opening of the ear. Excori (superficial loss) of the skin may be present. It is
usually painless. The discharge be cleared for exarnination of the tympanic
membrane (ear drum). The drum presents a large perforation (hole).
Complications : Chronic discharging ear should be viewed seriously. If

untreated or neglected cases what complications can occur? Erosion of
mastoid bono (behind the ear) and middle ear structures are common
59
Common complications. The children may develop facial palsy (paralysis of the face),
Infectious meningitis and even brain abscess (collection of pus in the brain).
Diseases

Children are commonly affected. It is seen among children belonging to low
income group families being associated with poor nutrition, over crowding,
insanitary environment and high prevalence of respiratory infections. It can
sometimes occur in middle income group children. The children may also
have infected tonsils and sinusitis.
Why does it occur?

It is usually due to neglect of acute otitis media. Common organisms which
may be found in the discharge are pseudomonas, escherichia coli and
staphylococci.
How to manage chronic discharging ear?

Local treatment consists of thorough, regular and daily cleansing of the ear.
There may not be any need for either local instillation of antibiotics ear drops
or systemic antibiotics. Infections of the middle ear should be ruled out. If it
is present, appropriate antibiotics should be given.
Health education of the parents to keep the ears of the child clean and seek
prompt treatment is important.
Now, lets learn about the external ear infection.
18.4.3 Otitis Externa

Otitis externa is an infection of the external ear. It is very common in warm
regions. It is an inflammation of external auditory canal and the pinna of the
ear. Look at Figure 18.5 to see the part of ear infected. An inflammation can
be seen easily by the examination of the external ear under proper light. In
acute stage, examination may not be possible due to pain. The ear drum
should be examined to exclude chronic otitis media. The patient complains of
pain which is usually aggravated by pulling of the external ear.
Otitis externa is due to bacterial infection and some times due to fungal
infection. Local application of gentian violet will be of help.
Chloramphenicol ear drops are also given.
Read Points to Remember given below to get an overview of ear infections.
POINTS TO REMEMBER
Ear Infections
• Ear infections are common particularly among young children.
• Infections in the middle and external ear are common. Acute suppurative
otitis media and chronic discharging ear are the infection of the middle
ear. Otitis externa is the infection of the external ear.
• Ear infections are primarily due to bacterial and fungal infection.
60
• Ear ache, fever, bulging ear drum, discharging ear, redness in external Skin, Eye And
ear are some of the common symptoms of ear infection. Ear Infections
• Loss of hearing, meningitis, mastoiditis are the common complications

of ear infection.
• Antibiotic ear drops and oral drugs are used for the treatment of ear
infection.
• Educate parents, children to keep the ear clean and seek prompt
treatment in case of infection.

1) List out the differences between acute otitis media and chronic
discharging of ear.
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
2) How do you manage a child with acute otitis media?
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
18.5 LET US SUM UP

In this unit we learnt that skin infections may be due to bacterial or fungal
infections, insect infestations. Children are most prone to skin infections.
Direct contact with an infected person is usually the mode of spread of skin
infections. Low standard of living, poor personal hygiene are the main causes
of skin infections. Proper cleanliness of the body helps prevent the
occurrence of skin infection. The common eye infections are trachoma,
bacterial, viral or fungal conjunctivitis.
All individuals, particularly, children are susceptible to cye infections. Eye

infection can be prevented by maintaining proper personal hygiene,
improvement of basic sanitation and water supply: Oral drugs and antibiotic
ointment are used to treat eye infections.
Ear infections generally include acute suppurative otitis media, chronic

discharging of ear and otitis externa. Middle and external ear is usually
affected. Young children in rural area are more prone to infections. Earache,
discharging ear, redness of the external ear are some of the symptoms of ear
61
Common infection. When untreated ear infections can lead to loss of hearing.
Infectious Educating children and the parents to keep the ear clean is important.
Diseases
18.6 GLOSSARY
Anesthetic patch Patch on skin with no sensation

Fibrosis Formation of fibrous tissue, normally during the process
of healing
Furunculosis Multiple boils on the skin
Impetigo A type of bacterial infection of skin
Macule A small smooth circumscribed area of discolouration of
skin
Mastoid process Bony part just behind the ear
Necrosis Death of tissue
Papules A small circumscribed elevation on the skin
Parenteral Administration (of drugs) through routes other than
mouth, e.g. Intramuscular or intravenous
Pustule A small circumscribed elevation on the skin containing
pus
Trachoma Infection of eye affecting particularly conjunctiva of the
upper eyelids
Tympanic Ear drum
membrane
Virulent Pathogenic (disease causing)
18.7 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
1) a) scalp, hair, tinea capitis.
b) circular area, depigmentations.
c) griseofulvin, capitis.
2) a) True
b) False, Furunculosis usually occur in individuals suffering from
anaemia or malaria.
c) False, Staphylococci is the organism causing boils in children.
d) False, Impetigo and Furunculosis are called the water washed
diseases.
e) True.
62
Check Your Progress Exercise 2 Skin, Eye And
Ear Infections
1) Female itch mite burrows into skin
Lays eggs which develop into adults
Leads to intense itching at night
Infection seen around webs of the fingers, around the waists, thighs, belt
line and on the genitalia
Appearance of impetigo over buttocks and back of trunk
2) Tuberculoid Type Lepromiatus Type
• Mild and does not progress • Severe and progressive
• Number of hypopigmented • Skin lesions more in number

skin patches few in number and in the form of nodules
• Hair growth diminished • Hair growth not affected
• Only single nerve is • Generalised symmetric

involved involvement of the nerves
• No bacilli present in the • Many bacilli present on skin

lesions smears and nasal smears

1) a) Direct contact
b) Individual sleeping together
c) Transmission through house-fily
2) • Prevent direct contact between diseases and unaffected people
• Use individual towels and handkerchiefs
• Keep the environment clean
• Use of goggles in case of patients.
1) Acute otitis media Chronic discharging ear

• Infection of middle ear • Discharge of an offensive
with ear ache, fever and smell from the ear
red bulging tympanic
membrane
• Painful • Painless 63
Common • Perforation of ear drum • Ear drum presents a large
Infectious
Diseases perforation.
2) Child may be given oral or intramuscular penicillin for about 10 days.
Antibiotic ear drops given 3 times a day. In case of perforations with
discharge of pus, it should be removed by suction. Tablets given for pain
killing and control of fever.
64

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DNHE-2

Public Health and

BLOCK PREPARATION (ORIGINAL)

COURSE REVISION TEAM (2022)

Malaria is an infectious disease caused due to the presence of parasitic protozoa

Diseases/infections resulting on account of not maintain food personal hygiene

3) Read POINTS TO REMEMBER given at the end of each section carefully,

Infection: The entry and development or multiplication of an infectious agent in

Infectious diseases: A disease of manor animals resulting from an infection.

Infectious agent: An organism, chiefly a microorganism, that is capable of

Incubation Period: The time interval between exposure to an infectious agent

Communicable disease: The time interval between exposure to an infectious

Reservoir of infectious agents: Any human being, animals, plant, soil or

Susceptible: A person or an animal is susceptible who has not acquired immunity

15.4 Whooping cough

15.5 Let Us Sum Up

• identify the cause and mode of spread of measles, tuberculosis and

Who gets the disease?

Socio-Economic Factors : Measles is particularly severe amongst poor

Sex : Incidence of measles is equal among both the sexes.

Seasons : The disease is more prevalent in winter.

How does it Spread?

Incubation period: The disease takes, on an average, about 10 days varying

Period of communicability: The disease is communicable from the beginning

Susceptibility: Practically all persons are susceptible. After an attack, a

15.2.2 Symptoms and Complications

What are the complications of measles ?

15.2.3 Prevention and Management

Prevention of measles through vaccination : Vaccination is the simplest and

Next, a word about how to treat measles ?

Management of Measles : There is no specific treatment for measles.

Check Your Progress Exercise 1

15.3 TUBERCULOSIS (TB)

Who gets the disease?

Sex: In India, tuberculosis is more prevalent among males over 45 years of

Socio-Economic Factors: The disease occurs more frequently in families

Certain social customs such as indiscriminate spitting, smoking of hukka,

How does it spread?

Bovine tuberculosis results from ingestion of unpasteurised milk or dairy

Period of Communicability : The disease is communicable i.e. can spread

Susceptibility: Everyone is susceptible to the disease. However, children

15.3.2 Symptoms and Complications

Sputum examination by direct microscopy is now considered the method of

1) Cough lasting for more than 4 weeks

15.3.3 Prevention and Management of Tuberculosis

Under the scheme the patients take medicines prescribed by specialists at

Check Your Progress Exercise 2

15.4 WHOOPING COUGH (PERTUSIS)

How does it spread?

Similarly, direct contact with discharges from respiratory tract of infected

Period of Communicability: The disease is highly communicable during the

There is considerable evidence that whooping cough may lead to severe

15.4.3 Prevention and Management

a) Active Immunisation : An effective vaccine is now available for

Management of whooping cough : Erythromycin or Ampicillin drug is used

Points to Remember given below lists the salient features of whooping

Check Your Progress Exercise 3

Tuberculosis is caused by Mycobacterium tuberculosis. Recent surveys show

15.7 ANSWER TO CHECK YOUR PROGRESS

Death Exposure to disease