Zoonotic Diseases: by Rita Nkirote

ZOONOTIC DISEASES
By RITA NKIROTE
Introduction
 Zoonotic diseases are illnesses that can spread between animals and people
 Infectious agents are spread from animals to humans
 Diseases and infections which are naturally transmitted between vertebrate
animals and humans-WHO
 Common zoonotic illnesses include
 Rabies
 Tetanus
 Anthrax
 Brucellosis
 Hydatid disease
RABIES
 It is an acute viral disease of the central nervous system that is transmitted to

humans by infected animals
 Caused by the rabies virus of the genus lyssavirus and family rhabdoviridae
MODE OF TRANSMISSION
 It is a zoonoses that is transmitted to humans by bite of animal with rabies

virus.
 Dogs are primary reservoirs and vector of rabies.
 Source of infection is saliva of rabid animals
 It can also be found in wildlife such as raccoons skunks foxes bats
 Incubation period is usually 1 to 3 months but in rare cases it is as short as 2
weeks or more than a year
EPIDERMIOLOGY
 Rabies is estimated to cause 59000 human death annually in over 150

countries with 95 per cent occurring in Africa and Asia.
 An estimated 21476 human deaths occur each year in Africa due to dog
mediated rabies.
 In Kenya, rabies is ranked among the top five priority diseases and an
estimated 1000 to 2000 cases of human rabies occur annually.
LIFECYCLE
CLINICAL FEATURES
PHASES SIGNS AND SYMPTOMS

Incubation period (1-3 months) No signs and symptoms
Prodromal stage (onset of disease) Fever,malaise,headache,nausea,vomiti
ng,agitation,focal paraesthesias,pain
Acute neurologic phase
Encephalitic (1-7 days) Fever,confusion,hallucinations,hyperac
tivity,pharyngeal spasms,seizures
Paralytic (2-10 days) Ascending flaccid paralysis
Coma and death phase (1-14 days) Coma and death
DAIGNOSIS
 History of animal bite

 Signs and symptoms – should be considered in any case of unexplained encephalitis
or flaccid paralysis accompanied by fever.
 LAB INVESTIGATIONS
 Useful specimen include serum, cerebral spinal fluid, fresh saliva, brain tissue, skin
biopsy
 Complete blood count
 CSF analysis-mild mononuclear cell pleocytosis with mildly elevated protein level
 Rabies specific tests Rabies virus specific antibody
 Reverse transcription polymerase chain reaction
 Direct fluorescent Antibody testing
 Head CT scan
 MRI signal abnormalities in brainstem or other areas
 EEG electroencephalogram
MANAGEMENT
 TREATMENT
 Fatal disease
 Palliative care is necessary when disease symptoms appear
 Heavily sedated diazepam 10mg 4-6 hrly and chlorpromazine 50-100mg if
necessary
 IV nutrition and fluids
 Post exposure prophylaxis
 Cleaning of wound with ammonium detergent or soap with excision of
damaged tissues. Wound should remain unsutured .Prophylaxis includes
human rabies immunoglobulin 20. u/kg body weight injected IM
 Human diploid cell strain vaccine can also be given IM at day 0,3,7,14,30,90
 Or intradermal at 8 sites on day 1 with single boosters on day 7 and 28
PREVENTION
 PRE EXPOSURE PROPHYLAXIS

 For those who professionally handle infected animals lab personnel and those
that live in rabies endemic areas
 Injections of diploid cell strain vaccine which may be given IM 4 weeks apart
followed by yearly boosters.
 Proper immunization of dogs
 Reducing number of stray dogs
TETANUS
 Tetanus is a neurologic disorder characterized by increased muscle tone and

spasms.It is caused by Clostridium Tetani.
 The organism is found worldwide in soil,inanimate environment,in animal
faeces and occasionally human faeces
EPIDERMIOLOGY
 Tetanus is common in areas where soil is cultivated in rural areas in warm

climates during summer months
MODES OF TRANSMISSION
 Most cases of tetanus follow an acute injury puncture wound laceration

abrasion or other trauma
 Also acquired through activities such as farming,gardening
 Tetanus may affect skin ulcers abscesses,frost bite surgery body piercing drug
abuse abortion
 Direct contact where wounds are contaminated with spores of clostridium
tetani.
 It releases toxins in wound/portal of entry
 This toxin travels through axons and results in abnormal muscle and
brainstem functions
 Can also spread through blood to distant nerve terminals
Mechanism of Action
of Tetanus Toxin
CLINICAL MANIFESTATIONS
 Symptoms appear from 2 days to several weeks after injury

 GENERALIZED TETANUS
 Increased muscle tone
 Generalized spasms
 Trismus/lock jaw
 Dysphagia
 Neck stiffness
 Pain in shoulder and back
 Rigid abdomen and stiff proximal limb muscles
 Contraction of facial muscles leading to grimace/sneer
 Contraction of back muscles leading to arched back/opisthotonos
 Paroxysmal violent painful generalized muscle spasms leading to poor
ventilation hence cyanosis
 Fever
 Hypertension
 Tachycardia
 Profuse sweating
 Dysarrythmia
 NEONATAL TETANUS
 Generalised tetanus in neonates born to mothers who are not immunized
/inadequately immunized.
 Usually after unsterile treatment of umbilical cord
 LOCAL TETANUS
 Spasm of muscles near wound infection
 CEPHALIC TETANUS
 Rare form of local tetanus which involves one or more facial nerves
Opisthotonos in Tetanus Patient
The contractions by the muscles of the back and extremities may become
so violent and strong that bone fractures may occur
DIAGNOSIS
 History
 Lack/inadequate immunization
 Culture of wound discharge/tissue for c.tetani difficult and cannot be
detected
 Blood tests CBC –elevated leukocyte count and raised muscle enzyme level
 Electromyogram-continuing discharge of motor units
MANAGEMENT
 TREATMENT
 Patient should be admitted to a quiet room with an intensive care unit where observation and
cardiopulmonary monitoring can be maintained continuously
 Protection of airway
 Wound exploration and cleaning
 ANTIBIOTIC THERAPY
 Use of penicillins or metronidazole
 ANTITOXINS
 Human tetanus immunoglobulin 3000-6000 units IM in divided doses
 Equine tetanus antitoxin
 Pooled IVIG

 CONTROLLED MUSCLE SPASM
 Nurse in a quiet room
 Avoid unnecessary stimuli
 IV diazepam if spasm continues \
 Ensure adequate ventilation of patient
 RESPIRATORY CARE
 Intubation and tracheostomy in case of hypoventilation
 AUTONOMIC DYSFUNCTION/SYMPATHETIC OVERACTIVITY
 Labetalol,Esmolol,Clonidine Magnesium sulphate
 VACCINATION
 Patients recovering from tetanus should be adequately immunized
 ADEQUATE IV HYDRATION
 PHYSIOTHERAPY
 PROPHYLACTIC ANTICOAGULATION
 TREATMENT OF INTERCURRENT INFECTION
 PREVENTION
 Active immunization
 Wound management
TT IMMUNIZATION FOR WOMEN OF CHILD BEARING AGE AND
PREGNANT WOMAN WITHOUT PREVIOS EXPOSURE TO TT
DOSE OF TT WHEN TO GIVE EXPECTED DURATION OF

PROTECTION
1 At first contact or as early as possible in None

pregnancy
2 4 weeks after TT1 1-3years
3 5months after TT2 or during subsequent At least 5years

pregnancy.
4 1year after TT3 or during subsequent At least 10years

pregnancy
5 1year after TT4 or during For all child bearing age years and possible
longer.
subsequent pregnancy
BRUCELLOSIS
 It is a bacterial zoonoses transmitted directly /indirectly to humans from

infected animals(sheep,goats,camels)
 It is caused by strains of brucella; brucella melitensis,B.abortus,SB.suis
 Most severe disease is caused by Brucella melitensis
EPIDERMIOLOGY
 Brucellosis causes more than 500000 infections per year worldwide

 Heaviest disease burden lies in countries of the Mediterranean basin and
Arabian peninsula.
 Endemic areas for brucellosis include Mediterranean basin, middle east,
central Asia, china, Indian subcontinent, sub Saharan Africa and parts of
Mexico and central and south America
MODE OF TRANSMISSION
 Human brucellosis is usually associated with occupation or domestic exposure

to infected animals or their products.
 Brucellosis may be acquired by ingestion,inhalation,mucosal or percutaneous
exposure
 Accidental of strains may lead to diseases(in labs)
CLINICAL FEATURES
 Incubation period varies from one week to several months

 Fever/sweats
 Fatigue
 Loss of weight and appetite
 Myalgia
 Headache
 Chills
 Monoarthritis of hip and knee
 Lower back and hip pain in older men
 Musculoskeletal pain
 Other features such as dry cough,hepatospleenomegally,endocarditis,meningoencephalitis
DIAGNOSIS
 History of potential exposure

 Blood tests such as CBC liver function tests show mild anemia and thrombocytopenia
 Erythrocyte sedimentation rate
 C-reactive protein
 Serologic tests –standard agglutination test
 Cerebral spinal fluid biochemistry-lymphocytosis,low glucose levels, elevated
adenosine deaminase
 Tissue biopsy-non caseating granulomas
 Isolation of brucellae in fluids such as blood,CSF,bone marrow or joint fluid is
definitive.
 Culture and sensitivity
MANAGEMENT
TREATMENT
Antimicrobial therapy
IM Streptomycin 0.75-1gm daily for 14-21 days plus doxycycline 100mg BD for 6
weeks
Rifampicin and doxycycline for 6 months
Gentamycin for children
In complicated cases add ceftriaxone and regimen should continue for 6 months
PREVENTION
 Active immunization on animals

 Control of animal movement
 Pasteurization of all milk products before consumption
 Proper cooking of meat
 All cases of brucellosis in animals and humans should be reported to adequate
public health authorities

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ZOONOTIC DISEASES

 It is an acute viral disease of the central nervous system that is transmitted to

 It is a zoonoses that is transmitted to humans by bite of animal with rabies

 Rabies is estimated to cause 59000 human death annually in over 150

PHASES SIGNS AND SYMPTOMS

 History of animal bite

 PRE EXPOSURE PROPHYLAXIS

 Tetanus is a neurologic disorder characterized by increased muscle tone and

 Tetanus is common in areas where soil is cultivated in rural areas in warm

 Most cases of tetanus follow an acute injury puncture wound laceration

 Symptoms appear from 2 days to several weeks after injury

DOSE OF TT WHEN TO GIVE EXPECTED DURATION OF

1 At first contact or as early as possible in None

2 4 weeks after TT1 1-3years

3 5months after TT2 or during subsequent At least 5years

4 1year after TT3 or during subsequent At least 10years

 It is a bacterial zoonoses transmitted directly /indirectly to humans from

 Brucellosis causes more than 500000 infections per year worldwide

 Human brucellosis is usually associated with occupation or domestic exposure

 Incubation period varies from one week to several months

 History of potential exposure

 Active immunization on animals

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