COMMUNICABLE

DISEASES
 Introduction

• In this unit, you will explore the

common communicable diseases
found in this country.
 This eight units are as follows:

• Unit One: Patterns of Communicable

Diseases
• Unit Two: Principles of
Communicable Disease Control
• Unit Three: Contact Diseases
• Unit Four: Vector-borne Diseases
• Unit Five: Diseases Caused by Faecal-
oral Contamination
• Unit Six: Airborne Diseases
• Unit Seven: Helminthic Diseases
• Unit Eight: Diseases of Contact With
Animals or Animal Products
 Unit Objectives

By the end of this unit you will be able

to:
• Describe the pattern of
communicable diseases in a
community
• Explain the principles of
communicable diseases
 Unit Objectives Cont;

• Describe the causative factors of

communicable diseases
• Explain the mode of transmission of
communicable diseases
 Unit Objectives Cont;

• Describe the management

approaches for communicable
diseases
• Describe the preventive measures for

communicable diseases
 COMMUNICABLE DISEASE
Definition
A disease that is passed from one
person to another person is called a
communicable or transmissible
disease.
 2ND DEFINITION

Is an illness due to an infectious agent

transmitted directly or indirectly from
an infected person or animal through
the urgency of an intermediate animal
host, vector or inanimate
environment.
 communicable diseases are among
the most important diseases
because;

• Some of them are very serious and

cause death and disability.
• Some of them cause widespread
outbreak of disease-epidemics.
• Most of them can be prevented by
fairly simple means.
 Terminologies

1. Epidemic
A disease outbreak that affect more
individuals than expected in a
population.
2. Endemic
A disease which is always present in a
community at a roughly constant
3. Sporadic
A disease which occurs in various
and scattered places e.g plague
4. Pandemic
An epidemic which is becoming
world wide e.g. HIV/AIDS

5. Incubation period
Period between date of infection
and appearance of symptoms.
6. Quarantine
Period of isolation of an infectious or
suspected case to prevent spread of
the disease.

7. Isolation
The separation of a patient with an
infectious disease from those non-
8. Epidemiology
• Is the study of the distribution and
determinants of disease in human
population.
• Is also the study of “how and why”
diseases and other conditions are
distributed with in the population.
• Incidence: Refers to the number of new
infections recorded in a given population
within a specific period of time

• Prevalence: Refers to the total number of

people with a certain disease in a given
population within a specific period of time
 UNIT 1: PATTERNS OF
COMMUNICABLE DISEASES
 Objectives
• By the end of this section you will be
able to:
Describe the patterns of diseases
in the community.
Describe the interaction between
the host and the infecting agent.
Describe a typical transmission
cycle.
 PATTERNS OF COMMUNICABLE
DISEASES IN THE COMMUNITY

• Different diseases are common in

different places and at different
times.
• When the balance between the
agent, the host and the environment
is fairly constant.
• You tend to see approximately the
same number of cases of the disease
every month.
• When this happens the disease is
said to be endemic.
• When the balance is shifted in favour
of the agent (organism).
• For example, when many non-
immune children have been born in
an area since the last measles
epidemic.
• A large number of cases of measles
may occur in a short time.
• This is called an epidemic.

• Epidemic diseases occur during

certain periods or seasons.
• Causing sudden deaths and much
suffering in the community.
Some Common Epidemic Diseases in
Kenya
Cholera
Typhoid fever
Highland malaria
Acute bacterial meningitis
• What happens once an infecting
organism enters a persons body and
causes disease?
 The Host and Infection
• A person who is invaded by a disease-
causing micro-organism is called a
host.
• An infection occurs when this micro-
organism begins to reproduce
(multiply) and grow.
 Incubation Period
• The incubation period is the time
between infection and the
appearance of symptoms and signs of
an illness.
• During the incubation period the host
does not realise that they have an
infection.
• Until several days later when
detectable symptoms and signs of the
illness occur.
 Sub-clinical Infection
• At this stage, infection does not
produce clear signs and symptoms.
• The host's immune system is trying to
fight off the agent.
• In some cases, the organism is
overcome by the host immune cells.
• Hence no signs and symptoms are
felt and the infection process is
terminated.
 Clinical Infection
• This is the period when the host
develops detectable symptoms and
signs of an illness.
• Causing abnormal functioning of
some body cells and tissues.
• An individual who is suffering from a
sub-clinical infection (Carrier) is also
likely to infect others.
• As in the case of HIV infection which
leads to AIDS after a long period.
• A susceptible individual is one whose
body lacks resistance to the disease.
• Resistance of the body to a disease
occurs due to various immunity
mechanisms.
THE TRANSMISSION CYCLE
 The parts of the transmission cycle
include:
a. Source
b. Transmission
c. Susceptible host
 Transmission cycle

Source

host transmission
 a) Source

• This is where the disease-causing

organisms spreads from.
• It could be an infected person,
animal, place, or object.
• The reservoir is the source of
infection(Where microorganisms
live)
 b) Transmission Route

• The main routes of transmission

are:
Direct contact, for example
sexual contact, contact with skin
or mucous membranes.
Vectors( an organism that carries
and transmits a pathogen)
Faecal-oral (ingesting
contaminated food and water).
Airborne
Transplacental (mother to foetus).
Blood contact (transfusion,
surgery, injection).
Contact with animals or their
products.
 c) Susceptible host

• An individual who has low

resistance to a particular disease is
said to be a susceptible host for
that disease.
 People with AIDS have a high
risk of developing tuberculosis.
 Malnutrition
 Certain drugs such as those
used to treat cancer can lower a
person’s resistance to disease.
 UNIT 2: PRINCIPLES OF
COMMUNICABLE DISEASE CONTROL

• The main Principles (also known as

methods).
• That are used to control the
occurrence and spread of
communicable diseases.
 Methods of Communicable Disease
Control

• The control and eradication of

communicable diseases can be done by:
Attacking the source of the
disease-causing organism.
Interrupting the transmission
route.
Protecting the susceptible host.
 1. Attacking the source,

• Involves treating the sick patients and

the carriers.
• Isolating those persons who are
infected.
Treating sick animals such as
cattle.
 Cont.. attacking the source

• Mass treatment of persons at risk.

• Immunizing animals such as dogs
and cattle.
• Killing animal reservoir such as rats.
• Separating human and animals.
Treating
sick animals such as cattle.
 2. Interrupting transmission cycle.

• Involves:

 Personal hygiene.
Environmental health.
Water and Sanitation.
Cont.. Interrupting the Transmission
Cycle.
Vector control.
Good and adequate housing.
Effective food handling.
 Adequate nutrition.
Behaviour change.
Protecting the host involves;

Immunization.
Chemoprophylaxis.
Better nutrition.
• There are various specific and
general measures for protecting
the host.

Specific Measures
• Immunisation using vaccines such
as the KEPI vaccine.
• Chemoprophylaxis using for
example:
- Proguanil (PaludrineR)
to suppress malaria parasites.
- Tetracycline during cholera
outbreaks.
- Cotrimoxazole during plague
outbreaks.
 General Measures
Use of barriers such as bed
nets, gowns, gloves to prevent
insect bites
(especially mosquitoes).
Use of chemicals for
example insect repellents to
prevent mosquito bites.
• Wearing shoes to prevent
penetration by hookworms
from the soil.
• Adequate housing to reduce
overcrowding.
• Improved nutrition.
• Adequate ventilation.
• Health education.
 Other Control Measures
• Notification of disease.
• Notification requires you to keep
watch (surveillance) on the number
of new cases of communicable
diseases in your area of work.
• Immediately inform the local health
authority when you come across a
patient suffering from an infectious
disease.
• Reasons for notification is to help
the health authorities take
measures to confirm your suspicion.
To control the spread of the
• Notification of infectious
communicable diseases is the
responsibility of all health care
workers.
• It is also a legal requirement
according to the Public Health Act,
Chapter (cap) 242, section eight of
the laws of Kenya.
 THE THREE LEVELS OF DISEASE
PREVENTION
Disease prevention is the deferral or elimination
of specific illnesses and conditions by one or
more interventions of proven efficacy.
Three Levels of prevention have been
identified as;
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention
 THE THREE LEVELS OF DISEASE
PREVENTION CONT…
Primary Prevention.
• Measures are aimed at individuals in the
susceptibility stage.
• It refers to activities or measures, both
individual and communal, that are directed at
reducing the risk of exposure to a risk factor in
an individual or the population.
• Measles immunization is an example of Primary
Preventive measure.
 THE THREE LEVELS OF DISEASE
PREVENTION CONT…
Secondary Prevention.
• Measures focus on the subclinical stage and
early clinical stage.
• These measures enable early detection and
prompt effective intervention to correct
departures from a state of health.
 THE THREE LEVELS OF DISEASE
PREVENTION CONT…
Examples of secondary prevention measures
are;
• Papanicolou smear for early diagnosis of
cancer of the cervix.
• The detection of asymptomatic HIV patients
and their subsequent treatment with antiviral
drugs to delay the onset of AIDS.
• Mammography for early diagnosis of breast
cancer.
 THE THREE LEVELS OF DISEASE
PREVENTION CONT…
Tertiary Prevention.
• Measures are directed primarily at the
recovery, disability or death stage, although
they are used to some extent at the Clinical
Stage.
• Their purpose is to reduce or eliminate long-
term impairments and disabilities, minimise
suffering, optimize function and sometimes
extend survival.
 THE THREE LEVELS OF DISEASE PREVENTION CONT…

Tertiary Prevention cont…

• Recovery and disability are the endpoints
focus of rehabilitation, and increasingly
important where chronic disease condition are
dominant.
• An example of tertiary prevention would be
Speech, Physio and Occupational therapy and
associated Medical therapy following
Cerebrovascular Accident (C.V.A.)
 THE THREE LEVELS OF DISEASE
PREVENTION CONT…
Cerebrovascular Accident (C.V.A.)
• The sudden death of some brain cells due to
lack of oxygen, when the blood flow to the
brain is impaired by blockage or rupture of an
artery to the brain.
• A C.V.A is also referred to as a Stroke.
 Notifiable Diseases in Kenya
• Plague
• Cholera
• Measles
• Poliomyelitis
• Diphtheria
• Tuberculosis
• Anthrax
• Trypanasomiasis
• Typhoid fever
• Whooping cough
• Meningococcal meningitis
• Rabies
• It is your responsibility to notify
your local health authority
immediately should you suspect
the presence of an infectious
disease.
 Control Measures at Individual and
Village Level

• At this level, each person and

indeed every member of the village
is responsible for:
Completing the immunisation.
Personal and environmental hygiene
Food hygiene and adequate nutrition
Using bed nets and protective wear
Abstaining from casual sex, being
faithful to one sexual partner or using
condoms
Protecting water supply and using
clean water
Digging and using pit latrines
Controlling vectors
Healthy habits, for example not
smoking, consuming alcohol and
abuse of drugs
 Control Measures at Dispensary and
Health Centre Level

• The health care workers should

support and encourage their clients
and community to establish and
sustain community based disease
control programs.
 In addition, the health care workers
should:
• Increase immunisation coverage.
• Participate in vector and reservoir
control.
• Emphasise water protection and
purification
• Inspect food, markets and eating
places.
• Encourage sanitation and refuse
disposal.
• Promote health and prevent diseases
using Information, Education and
Communication (IEC).
• Notify diseases.
 Control Measures at District,
Regional &National Level

At these higher levels, health care

workers are responsible for:
• Vector control schemes.
• Mass immunisation campaigns.
• Mass treatment and
chemoprophylaxis.
• Mass media IEC programmes.
• Health statistics registration.
• Research on disease control methods.
• Emergency, epidemiology and control
teams.
• Manpower training and continuing
education for staff.
 UNIT 3:
CONTACT DISEASES
 Introduction

• This is a group of communicable

diseases that are transmitted through
direct or indirect contact between
susceptible and infected persons.
 Objectives

By the end of this section you will be

able to:
• List factors that favor the transmission
of contact (contagious) diseases
• Identify signs and symptoms of
infections, namely; scabies, fungal skin
infections and trachoma
 Objectives cont;

• Describe the management of

contagious diseases
• Describe the control measures of
contagious diseases
 Transmission of Contact Diseases

• Contact diseases tend to occur in clusters

within households, children’s play groups,
schools and workplaces.
• They are passed from one person to
another either directly by skin-to-skin
contact.
• Indirectly by handling contaminated
objects such as clothing, bedding or
Transmission of Contact Diseases
cont;
 Factors Increasing Transmission of
Contact Diseases.

• Close personal contact (for example:

sexual intercourse)
• Inadequate housing leading to
overcrowding
 Factors Increasing Transmission of
Contact Diseases cont;

• Poor personal hygiene usually due to

inadequate water supply
• High population density as in urban
(slums) areas
 SCABIES

• This is a parasitic infection of the

superficial layer of the skin
characterized by severe itching.
• It is caused by the female of an insect
called Sarcoptes Scabiei (itch mite).
• The female mite burrows in to the
skin and makes a small tunnel.
• Within the tunnel, the insect deposits
its eggs and faeces.
• The eggs hatch in four to five days
and the larvae leave the mother's
tunnel.
• They bury themselves in the skin and
in other places.
• The larvae do not make tunnels.
 Mode of Transmission
• Scabies is spread through direct close
body contact, as in bed.
• Or through contact between parents
and children.
• Also among children playing together
in schools.
 Mode of Transmission cont;
• Transmission of scabies can also
occur indirectly through clothing or
bedclothes.
• Poor living conditions and poor
hygiene promotes the spread of
scabies.
 Clinical Picture
• The patient presents with intense
itching, especially at night.
• With eczema-like signs.
• Itchy rash with typical distribution
especially where the skin is curved
(between fingers, elbows, buttocks,
etc).
 Clinical Picture cont;
• Due to itching, the skin is torn with
scratches leading to secondary
infection.
 Management
• The whole family should be treated
together with the patient to
prevent re-infection.
 Management cont;
The management of scabies is as
follows:
• The patient should take a warm bath.
• Rub a handful of 10% Benzyl
Benzoate Emulsion (BBE) all over the
body.
 Management cont;
• After 24 hours, the patient should
bathe again and put on clean clothes.
• BBE does not kill the eggs of Sarcoptes
Scabiei.
• Therefore the treatment must be
repeated after four to seven days.
• To kill those larvae which have
 Management cont;
• If itching is severe treat it
symptomatically with calamine lotion.
 Prevention of Scabies
• The best way of preventing and
treating scabies is good personal
hygiene.
• Regular firm bathing, washing of
clothes and frequent use of soap will
control scabies.
 DERMATOMYCOSIS

• The term dermatomycosis means

fungal infections of the skin and
mucous membranes.
• Fungal skin infections are mainly a
problem of personal appearance
rather than illness.
• Fungal skin and mucous membrane
infections are sometimes indicators
of immunosuppression.
• As occurs in AIDS, cancer and
tuberculosis.
 Mode of Transmission
• Fungal infections are usually spread
by direct and indirect contact.
• Genital infections such as vulvo-
vaginitis may be spread during
sexual intercourse.
 Clinical Picture
• A fungal infection typically produces a
flat patch on the human skin.
• This patch may be found on the head.
• On dry exposed body skin.
• Between the toes.
• In moist places like the mouth or
private parts.
 Clinical Picture cont;
• Each of these patches looks slightly
different and has a different name,
but they are all fungi.
• Fungal infections can be divided
into two groups;
• Ringworms and candiadiasis.
 RINGWORMS
Ringworm manifestations are
described in Latin after the areas of
the body they commonly affect:
• Tinea capitis (ringworm of the scalp)
• Tinea corporis (ringworm of the
body)
• Tinea pedis (ringworm of the foot)
• Tinea unguium (ringworm of the
nails)
• Tinea versicolor or pityriasis
Characteristic of Ringworm Diseases.

Tinea capitis
Risk Factor.
Children under 10
 Main symptoms
• Brittle hair, areas of broken hair on
scalp.
Treatment
• Whitefield’s ointment b.i.d for 3
weeks.
• Candid cream bid for 3 weeks.
 Tinea corporis

Risk factors
• Excessive sweating; hot and humid
areas.
 Main symptoms
• Ring-shaped lesions; central healing.

Treatment
• Keep dry and clean.
 Tinea pedis (athlete’s foot)

Risk factors
• AIDS
 Main symptoms
• Scaling and cracking of skin between
toes.

Treatment
• Apply whitefield’s ointment or candid
cream daily.
 Tinea unguium

Risk factors
• Nail injuries; corticosteroids
 Main symptoms
• Thickening, discoloration or
brittleness of nails.

Treatment
• Surgical removal of nails plus
whitefield’s ointment or candid
cream daily for 16 weeks.
 Tinea versicolor

Risk factors
• AIDS; excessive sweating; hot humid
areas.
 Main symptoms
• Superficial small round light coloured
areas.

Treatment
• Personal hygiene.
 CANDIDIASIS
• Candidiasis which is also known
moniliasis or yeast infection
manifests in the following ways:
• Oral thrush – patchy white dots
which appear on the mucous
membrane of the mouth
• Vulvo-vaginitis
• Balanitis
• Intertrigo ( dermititis that affects skin
folds)
 Characteristic of Candidiasis Diseases.

Oral thrush

Risk factors
• Measles; Newborn; Vulvo-vaginitis of mother
after antibiotics; AIDS.
 Main symptoms
• Pseudomembranes on mucous
membranes.

Treatment
• G.V or Candid mouth paint.
 Vulvo-vaginitis

Risk factors
• Pregnancy; Diabetes; AIDS; Post-
antibiotics.
 Main symptoms
• Thick white vaginal discharge and
itching of vagina and vulva.

Treatment
• Nystatin vaginal Pessaries, G.V Paint.
 Balanitis

Risk factors
• Lack of personal hygiene (acquired by
sexual intercourse).
 Main symptoms
• Itching and redness of the head &
foreskin of the penis.

Treatment
• Hygiene, G.V paint.
 Intertrigo

Risk factors
• Fatness; Diabetes; Humid areas
(armpits, breast folds, between toes).
 Main symptoms
• Intertriginous areas of redness (like
eczema) irritant dermatitis.

Treatment
• G.V paint; Candid paint;Keep areas
dry by exposure and talcum powder.
 TRACHOMA

• This is a chronic inflammation of

the conjunctiva and the cornea of
the eye.
• It is caused by an organism called
Chlamydia trachomatis of the
Chlamydiae group.
• Other organisms of the Chlamydiae
group cause non-gonococcal
ophthalmia neonatorum.
• Non-gonococcal urethritis.
• Cervicitis and salpingitis.
• Trachoma is a major cause of
blindness.
• Especially in those parts of East
Africa where water is scarce.
• Such as among the pastoralist
communities who inhabit the drier
grasslands.
 Mode of Transmission

• Transmission of trachoma is by
direct contact with the eye
discharge of an infected person.
 Mode of Transmission cont;
• Flies and fingers are important in
the transmission of the disease.
• After infection, the disease
progresses very slowly destroying
the cornea and the conjunctiva.
• Leading to permanent blindness in
one or both eyes.
 Mode of Transmission cont;
• The early stages of the diseases are
the most infective.
• Transmission is high among children.
 Clinical Picture
• Trachoma develops in four stages.
 Stage 1: Early Trachoma
• Initially the eyes are red and watery
(as in ordinary conjunctivitis).
• After 30 or more days, follicles (small
pinkish-grey lumps) form inside the
upper eyelids.
• To see these you would have to turn
back the lid.
 Stage 1: Early Trachoma cont;
• Usually there is a little pus in the eye.
• If the pus is copious this may indicate
a secondary infection by bacteria.
• Examination of scrapings from the
conjunctiva show the cells with a
characteristic dark object in the
cytoplasm.
 Stage 1: Early Trachoma cont;
• The dark object is called an inclusion
body.
• Its presence in the cell helps to
confirm the diagnosis of trachoma.
 Stage 2: Pannus Formation
• Normally, the cornea has no blood
capillaries on it.
• But during this stage.
• Many tiny blood vessels are found to
be growing towards the edge of the
cornea.
 Stage 2: Pannus Formation Cont;
• These tiny blood vessels which grow
in the cornea are called pannus.
• You can see the pannus by using an
ordinary magnifying glass.
• The presence of both the follicles and
the pannus strongly suggests the
diagnosis of trachoma.
 Stage 3: Scarring of the Conjunctiva
• After several years the follicles on
the conjunctiva slowly begin to
disappear.
• Leaving behind whitish scars on the
conjunctiva.
• In the cornea, the small blood vessels
degenerate.
 Stage 3: Scarring of the Conjunctiva
cont;
• The vision becomes hazy and
remains so for many years.
• Unless there is rupture of the cornea
scars, in which case blindness occurs.
 Stage 4: Entropion and Trichiasis
Formation
• Scars form causing damage.
• Due to this scarring, the scar tissue
retracts (shortens).
• Causing the eyelids to become thick
and to turn inwards (Entropion).
 Stage 4: Entropion and Trichiasis
Formation cont;
• As the thick, rough eyelids turn
inwards, the eyelashes point inwards
and rub against the cornea
(Trichiasis).
• This adds to the damage already
done to the eye and results in
• The combination of entropion and
trichiasis completely destroy the
cornea leading to blindness
 Management
• The drug of choice for the first three
stages is 3% tetracycline topical eye
ointment.
• Given twice a day for five days every
month for six months.
• Stage four of the disease with
entropion must be treated surgically.
 Management cont;
• To be done as soon as possible
because every time the patient blinks
it increases corneal damage.
• If it is not possible to perform surgery
in your health facility.
• Remove the in-turned eyelashes by
pulling them out with sterile forceps.
 Management cont;
• This should be done before you refer
the patient.
• Entropion operations can be carried
out at the health centre level.
• Pannus and opacity of the cornea
have to be done by eye specialists.
 Prevention and Control of Trachoma

• The most effective way of controlling

and eradicating trachoma is through
supply of adequate water.
 Prevention and Control of Trachoma
cont;
• Regular bathing and washing of
children's faces with water and soap
should be encouraged.
 Prevention and Control of Trachoma
cont;
• Other additional measures include:
Where water is scarce, the
community should be taught how
to use the ‘leaky tin’.
It minimises wastage of precious
water.
 Prevention and Control of Trachoma
cont;
• Reducing the fly population through
proper disposal of refuse and waste.
• Early treatment of infected
individuals.
 Prevention and Control of Trachoma
cont;
• Mass treatment especially of school
children who live in trachoma
endemic areas
• Using 3% tetracycline eye ointment
twice a day for three to five days each
month for six months.
 UNIT 4:
VECTOR-BORNE
DISEASES
 Introduction

• Communicable diseases are

transmitted by invertebrate hosts,
that is organisms without a
backbone.
 Objectives

By the end of this section you will be

able to:
• List at least nine common vector-
borne diseases
• Describe the clinical features of
vector-borne diseases
 Objectives cont;

• Explain the management of vector-

borne diseases
• Discuss the preventive measures of
vector-borne diseases namely:
- Malaria
- Filariasis
- Yellowfever
 Objectives cont;

- Trypanosomiasis
- Schistosomiasis
- Leishmaniasis
- Plague
- Relapsing fever
- Onchocerciasis
 Vector-borne Diseases
• The organisms which cause vector-
borne diseases usually undergo part
of their development inside the
vectors.
• The time taken by the disease-
causing organism to develop inside
the vector is called the extrinsic
 Vector-borne Diseases cont;
• Although the housefly is an insect
that is known to carry bacteria and
chlamydia, it is not considered a
vector.
• This is because it is merely a
mechanical transmitter of disease.
 Vector-borne Diseases cont;
• Insect vectors usually acquire disease
organisms by sucking blood from
infected persons.
• They then transmit the infection by
depositing infected faeces or body
fluids in skin cracks or abrasions.
 Vector-borne Diseases cont;
• As a result, vector-borne diseases are
endemic in a given geographical area
or population.
• Many of the diseases transmitted by
vectors can also become epidemic.
 Vector-borne Diseases cont;
Some serious epidemics which have
occurred in Africa have been as
follows:
• Yellow fever: Ethiopia, Sudan,
Nigeria, Ghana
• Trypanosomiasis: Uganda
 Vector-borne Diseases cont;
• Kala Azar: Kenya, Sudan
• Plague: Uganda, Kenya, Tanzania
• Typhus fever: Burundi, Rwanda,
Ethiopia
 • When communicable diseases are
present in animals all the time.
• The disease is said to be enzootic
(epidemic in animals).
• Such as the case of yellow fever in
monkeys.
• Plague in rats.
Disease
Yellow fever
Causative organism
Flavivirus
Vector
Aedes aegypti (mosquito)
MALARIA
 MALARIA

• Malaria is an acute infection of the

blood caused by protozoa of the
genus plasmodium.
• Malaria is directly or indirectly
responsible for much ill-health and
death, especially of children.
• Transmission of malaria is by
anopheline mosquito (anopheles
gambiae and anopheles funestus).
 Malaria Epidemology
• Transmitted to human beings by the
bite of the infected female anopheles
mosquito.
• There are four plasmodium species
and any of them can cause malaria.
 Malaria Epidemology cont;
• They are:
• Plasmodium falciparum
• Plasmodium malariae
• Plasmodium ovale
• Plasmodium vivax
 Malaria Epidemology cont;
• In Kenya 98% of malaria is caused by
plasmodium falciparum.
• The other 2% of the cases are caused
by plasmodium malariae and
plasmodium ovale.
• Malaria caused by plasmodium vivax
is very rare.
 Malaria Epidemology cont;
• Malaria due to plasmodium
falciparum is usually the most severe
form of malaria.
• It is called malignant malaria.
 Malaria Epidemology cont;
• In Kenya, malaria occurs in two
patterns:

Endemic Malaria
• Endemic malaria (also called ‘stable
malaria’) is transmitted all the year
round.
 Epidemic Malaria
• Epidemic malaria (‘unstable malaria’)
occurs seasonally and affects people
of all ages.
 Epidemic Malaria cont;
• This type of malaria is called highland
malaria.
• Seen seasonally and affects all people
severely.
 Transmission and Life Cycle of
Malaria
• Malaria parasites develop in two
cycles:
 Transmission and Life Cycle of
Malaria cont;
• The first cycle which takes place in
the mosquito is called the sexual
cycle.
• While that which takes place in the
human being is called the asexual
cycle.
 Asexual Cycle
• The asexual cycle of transmission takes
place in the body of the infected human
being.
• Starts when the infected female
anopheles mosquito bites a person.
• The infected female mosquito injects
sporozoites( the motile and infective
form) via its proboscis into the blood
 Asexual Cycle Cont;
1. The sporozoites circulate in the
blood for about one hour and then
they enter the liver cells.
2. In 10 - 14 days the sporozoites
develop into liver schizonts while
still in the liver.
 Asexual Cycle Cont;
3. The liver schizonts later burst
releasing large numbers of
merozoites.
• The merozoites leave the liver and
enter the blood stream.
 Asexual Cycle Cont;
4. Where they penetrate the red
blood cells.
• Inside the red blood cells, the
merozoites develop into
trophozoites.
• The trophozoites then develop into
erythrocytic schizonts.
 Asexual Cycle Cont;
• These erythrocytic schizonts burst
releasing a shower of merozoites,
which invade fresh erythrocytes.

5. Some of the released erythrocytic

merozoites form male and female
gametocytes, which are sucked by
 Sexual Cycle
• The sexual cycle of the malaria
parasite takes place in the body of
the female anopheles mosquito.
• This cycle begins when the feeding
mosquito sucks blood containing the
male and female gametocytes.
 Sexual Cycle Cont;
• In the stomach of the mosquito, the
male gametocytes mate with the
female gametocytes.

6. The ookinete stays in the stomach of

a mosquito for about 12 - 18 hours
after which it penetrates the
 Sexual Cycle Cont;
• Upon reaching the outer surface of the
stomach wall, the ookinete changes
into an oocyst.

7. The oocysts grow rapidly and burst

releasing large numbers of
sporozoites into the body cavity of
 Sexual Cycle Cont;
• Many of the sporozoites move to the
salivary glands of the mosquito.

8. From where they are injected into

the body of the next human being
when the mosquito feeds.
 Clinical Features of Malaria
• The incubation period of malaria is
about 10 - 14 days after the infection.
• The symptoms appear once the
invaded erythrocytes rupture to
release new merozoites.
 Clinical Features of Malaria Cont;
• This stimulates the body's immune
system and the signs and symptoms
of malaria then appear:
• Headache and dizziness
• Joint pains
• Backache
• Nausea and vomiting
Clinical Features of Malaria Cont;
• Fever and chills (high body
temperature, rigors)
• Nausea and vomiting
• Diarrhoea
• Excessive sweating
• Jaundice
 Clinical Features of Malaria Cont;
• Enlargement of spleen
• Convulsions
• Anaemia

• A typical attack of malaria progresses

through the following three stages:
 The Cold Stage
• This stage starts suddenly and lasts
for fifteen minutes to one hour.
• The patient's body temperature rises
and they shiver.
• The infected erythrocytes rupture
releasing merozoites in the blood
circulation.
 The Hot Stage
• The hot stage last for two to six
hours.
• The body temperature is high (40 -
41°C) with severe headache, nausea
and vomiting.
• The skin is hot and dry.
 The Sweating Stage
• The fever drops rapidly and the
patient sweats profusely.
• This stage last for two to four hours.
 Complications of Malaria
• Brain-mental disturbance appearing
as acute psychosis, meningitis
like symptoms and coma.

• Shock- Development of shock

syndrome caused probably by
the amount of toxin produced (toxic
• Liver:Malaria hepatitis with
hepatomegaly and jaundice.
• Kidney: Acute tubular necrosis due
to anoxia. Result- anuria with
consequent uraemia.
• Spleen: Spleen enlargement is a
common finding in acute Malaria.
 Diagnosis of Malaria
• Diagnosis is made through:
• Clinical symptoms
• Laboratory examination of thick
and thin peripheral blood
films/slides (smears).
• Which demonstrate the parasites
(Trophozoites)
 Management of Malaria
• The treatment of malaria depends
on.
• Whether the disease is complicated
malaria(severe malaria).
• Or uncomplicated malaria.
• Uncomplicated malaria is usually
treated on an outpatient basis.
 Treatment of Uncomplicated
Malaria
• Dosage of tablets of sulfadoxine
(500mg) plus pyramethamine (25mg)
and paracetamol for all age groups.
• Artemether Lumefantrine(AL)
Treatment of Uncomplicated Malaria
 Complicated Malaria treatment
cont… .
• Patients presenting with coma,
convulsions, respiratory distress,
acute renal failure, jaundice, shock,
hypoglycaemia.
• Or acidosis due to malaria should be
admitted into the ward for
 Treatment of Complicated Malaria

• Intravenous quinine in dextrose is

used in severe complicated Malaria
where the patient presents with
vomiting and coma.
• Intravenous artesunate.
Treatment of Complicated Malaria
• The treatment of malaria keeps
changing depending on current
research findings. Please check on
the current treatment and adjust
your notes accordingly.
 Prevention and Control of Malaria

Chemoprophylaxis
• Antimalarial chemoprophylaxis using
oral proguanil (PaludrineR) may be
given according to the national
guidelines for diagnosis, treatment
and prevention of malaria for health
workers.
 Chemoprophylaxis cont;
• Individuals who will benefit from
chemoprophylaxis include:
• Patients with leukaemia
(lowered immunity)
• Patients with sickle cell disease
• Patients with tropical
splenomegally
• Non-immune visitors to malaria
 Intermittent Preventive Treatment
(IPT)
• IPT is based on the assumption that
the pregnant woman is infected with
malaria.
• According to the Ministry of Health
(MoH) guidelines.
 Intermittent Preventive Treatment
(IPT) cont;
• The drugs used for IPT are the ones
that contain Sulfadoxine and
Pyrimethamine (SP).
• Such as FansidarR, MalaraxinR,
FansidinR, MetakelfinR, OrodarR, and
FalcidinR.
 Intermittent Preventive Treatment
(IPT) cont;
• The first single dose of three tablets
of SP is given to the pregnant woman
between 16 and 24 weeks of
gestation.
• The second and last dose of three
tablets of SP is given between 24 and
 Vector Control
• Actions to reduce mosquito-breeding
areas include:
• Using insecticide-treated bed nets
• Using mosquito screens in houses
• Using chemical mosquito
repellents
 Vector Control Cont;
• Cleaning drainages and water
disposal systems
• Clearing bushes and burying or
burning rubbish heaps
• Use of larvicides and insecticides
 Health Education
• You should encourage community
members to seek early diagnosis and
prompt treatment for malaria.
• Use insecticide treated bed nets
every night.
 FILARIASIS
(ELEPHANTIASIS)
 FILARIASIS (ELEPHANTIASIS)
• This is a disfiguring disease caused by
a tiny worm (nematode) called
wuchereria bancrofti characterized
with swelling especially in the legs,
genitals or breasts.
• It is mainly transmitted by
mosquitoes;
 The aedes mosquitos and
 The anopheles mosquitoes in rural
areas.
• These mosquitoes transmit the worm
from person to person in the same
way as malaria.
• The parasitic worm lives in the
lymphatic system of the patient.
• Causing inflammation of the
lymphatic vessels and lymph glands
(lymphangitis, lymphadenitis).
• Filarial fever, and eventually
elephantiasis of the arms, legs and
genitals.
• The disease is most frequent in the
tropical coastal belts and the lake
region.
 Mode of Transmission
• The microfilariae ingested by the
feeding mosquito exsheath in the
stomach.
• Become first stage larva.
• They then penetrate the mosquito
stomach wall and migrate to the
thorax muscles.
 Mode of Transmission Cont;
• Where they moult twice and develop
into the infective stage.
• Mature infective microfilariae
migrate to the mouthparts of
the mosquito.
• The extrinsic incubation period takes
10 -12 days.
 Clinical Features
• Filarial worms in the lymphatic
vessels triggers an inflammatory
reaction in the walls of these vessels.
• When the worms die, more foreign
proteins are released.
 Clinical Features Cont;
• Causing calcification of the lymphatic
walls which eventually leads to
obstruction of the flow of lymph
fluid.
• If the obstruction of the lymph flow is
extensive.
 Clinical Features Cont;
• Chronic oedema develops in the
affected areas of the body.
• Filariasis progresses through three
stages.
 Acute Phase
• Fever
• Eosinophilia
• Enlarged lymph nodes
• Inflamed lymph vessels
(lymphangitis)
 Sub Acute Phase
• Fever
• Eosinophilia (severe)
• Attacks of dyspnoea (asthma-like)
• Funiculitis (pain and swelling of
the spermatic cord/s)
• Epididymitis
 Sub Acute Phase Cont;
• Hydrocele
• Lymphadenitis (tender lymph
nodes)
 Chronic Phase
• Lymphoedema
• Elephantiasis
• Chyluria
• Hydrocele
 Diagnosis
• Fluid aspirated from swollen
lymph glands or hydrocele can
show the microfilariae.
• Thick blood slides for microfilariae
should be taken between
10:00pm and 2:00am.
 Diagnosis cont;
• This is because microfilariae are
not present in the peripheral
blood during the day.
• Blood slides for microfilariae may
be taken 45 mins after
administration of a provocative
dose of diethylcarbamazine
100mg.
 Management
• The drug of choice for filariasis (adult
worms and microfilariae).
• Diethylcarbamazine 6mg/kg body
weight daily in divided doses (150mg)
eight hourly for 12 days for an adult.
 Management Cont;
• Diethylcarbamazine may be
combined with levamisole.
• This combination kills microfilariae
and reduces the parasite worm count
in the body more rapidly.
 Prevention and Control
• The prevention and control of
filiariasis includes:
• Anti-mosquito measures; the
same as those used for control
and prevention of malaria.
 Prevention and Control Cont;
• Use of larvicides such as
polystyrene powder in the pit
latrine
• Reduction of human-mosquito
contact including the use of
insecticide treated bed nets and
screening of houses
YELLOW FEVER
 YELLOW FEVER

• Yellow fever is an acute viral disease

transmitted to human being by the
aedes aegypti mosquito.
• Yellow fever can spread rapidly.
• Yellow fever is a disease of forest
monkeys (zoonoses).
• Is transmitted among them by the
aedes africanus mosquito.
• Humans may be bitten outside the
forest by mosquitoes which have
acquired the disease from monkeys
feeding on bananas and other
agricultural plantations.
• In urban areas, yellow fever is
transmitted by the aedes aegypti.
 Mode of Transmission
• The mosquito becomes infected after
feeding on the blood of an infected
monkey or person on the third day of
fever.
• The incubation period takes 18 days
at a daily temperature of 18°C and
four days at 37°C.
 Mode of Transmission Cont;
• The cycle takes four days.
• Once infected, the mosquito remains
infected and infective for its entire life
(about two to four months).
• A person may also become infected
with yellow fever.
 Mode of Transmission Cont;
• Through handling of blood from an
infected individual in the first three
days of the disease.
• Handling infected monkeys in the
early stages of viraemia.
• Laboratory staff may become infected
when working on infected monkeys
or infected mosquitoes.
 Clinical menifestation.
• It has five distinct stages through
which the infection evolves.
• These have been termed the period
of incubation, invasion, remission,
intoxication and convalescence.
• In incubation period is three to six
days.
 Invasion stage
• Last for 2-5 days.
• Begins with abrupt onset of fever and
chills, intense headache.
• Lower backache, muscle aches,
nausea and extreme exhaustion.
 Invasion stage cont…
• The patients tongue shows a
characteristic white, furry coating in
the centre, surrounded by a swollen,
reddened margin.
• There is the simultaneous occurrence
of a high fever with a flowed heart
rate (called the fagets’ sign).
 Remission period
• The fever falls and symptoms
decrease in severity for several hours
to several days.
• In some patients, this proves only to
be the calm before the storm.
 The period of intoxication
• It represents the most severe and
potentially fatal phase of the illness.
• During this time lasting 3-9 days, a
type of degeneration of the internal
organs occur.
• Specifically the kidney, liver and heat
occurs.
 The period of intoxication cont…
• This degeneration results in what is
considered the classic triad of yellow
fever symptoms.
• Jaundice, black vomit and protein in
urine, and accumulation of bilirubin.
 The period of intoxication cont…
• Jaundice is due to liver damage.
• The liver damage results in a
tendancy towards bleeding.
• The patients vomit appears black due
to presence of blood.
• Protein is found in urine due to
disruption of the kidney.
 The period of intoxication cont…
• Patients who survive the period of
intoxication enter into a relatively
short period of convalescence.
• Infection with YFV results to lifelong
immunity against repeated infection
with the virus.
 Supportive treatment
• Fever and pain give antipyretic and
analgesics.
• Dehydration due to fluid loss from
fever and bleeding, give fluids.
• Antacid for GIT bleeding and other
medication.
 Supportive treatment cont…
• Blood transfusion due to
haemorrhage.
• Kidney failure may require dialysis.
 Prognosis
• 5-10% of all diagnosed cases of
yellow fever is fatal.
• Jaundice occuring during a yellow
fever infection is an extremely grave
predictor.
• 20-50% of these patients die of
infection.
 Prognosis cont….
• Death may occur due to massive
bleeding, often following a lapse into
a comatose state.
 Management
• Yellow fever like most other viral
haemorrhagic diseases has no
specific drug for treatment.
• You only give supportive treatment
and ensure that the patient is nursed
in strict isolation.
 Management Cont;
• Use ordinary barrier nursing
techniques.
• You also ensure that the patient has
no further contact with the
mosquitoes through the use of
insecticide treated bed nets.
 Management Cont;
• This is to prevent further spread of
the disease from the patient to other
healthy people.
 Prevention and Control
• Administering yellow fever
vaccine to all travellers.
• Coming from or going to yellow
fever endemic areas.
• Spraying aircraft coming in from
yellow fever endemic areas with
insecticides.
 Prevention and Control Cont;
• Isolating all persons who have
been in contact with the infected
persons.
• Quarantin infected persons in
screened houses for seven days.
 Prevention and Control Cont;
• Mass immunisation campaign for
the community in areas infested
with the aedes aegypti mosquito.
• Spraying of larvicides in all
possible mosquito breeding
places.
TRYPANOSOMIASIS
(SLEEPING SICKNESS)
 TRYPANOSOMIASIS (SLEEPING
SICKNESS)

• Trypanosomiasis is a tropical disease

caused by protozoa called
Trypanosoma brucei gambiense (Tbg)
and Trypanosoma brucei rhodesiense
(Tbr).
• The important reservoir of Tbr in the
wild is the bushbuck.
• Trypanosomiasis affects both humans
and cattle.
• It is invariably fatal over varying
periods of time if not treated.
• Trypanosoma brucei gambiense
causes an acute, rapidly progressive
illness.
• With death from cardiac
complications within several weeks or
months.
• Reservoirs include antelope and pigs.
• Tbr is found in eastern Africa, now
mostly in south-east Uganda.
• Trypanasomiasis spreads very rapidly.
• Unless the source (the very first case)
is identified early.
 Mode of Transmission
• Trypanosomiasis is transmitted by
tsetse flies.
• Which live in areas of wooded
vegetation.
 Mode of Transmission Cont;
• Closely cultivated areas or areas
densely inhabited by people.
• There are two important types of
tsetse flies known to transmit the
disease to humans.
 Mode of Transmission Cont;
• There is glossina palpalis, a riverine
type which breeds along rivers and
lakes.
• Glossina morsitans the woodland
type which lives away from water.
• Glossina palpalis is the main vector of
Tb gambiense. Main vector in E.Africa
 Mode of Transmission Cont;
• Glossina morsitans is the main vector
for Tb rhodesiense and it prefers to
bite cattle and game but will also bite
humans.
 Mode of Transmission Cont;
• Tsetse flies become infected with
sleeping sickness parasites, when
they take a blood meal from infected
persons or animals.
• After a period of time, the
trypanosomes undergo development
changes.
 Mode of Transmission Cont;
• The fly is able to transmit the
infection when it bites another
susceptible animal or person.
 Clinical Features
• Trypanosomiasis presents in the
following three stages:

Primary Stage (chancre stage)

• Within a few days of the tsetse bite.
 Primary Stage (chancre stage) Cont;
• A painful indurated erythematous
nodule may appear at the site of the
bite.
• This chancre may last for one to two
weeks.
• Then resolve spontaneously.
 Primary Stage (chancre stage) Cont;
• The chancre occurs in 70% of cases in
Europeans but is rare in Africans.

Blood Stage (systemic illness)

• The trypanosomes spread to the
blood, lymph and lymph nodes.
 Blood Stage (systemic illness) Cont;
• There is fever, which does not follow
any typical pattern.
• Recurs at intervals of days or weeks.
• After the fever resolves, the patient
develops anaemia.
• Debilitation and general body
weakness.
 Blood Stage (systemic illness) Cont;
• The spleen becomes enlarged as well
as the lymph nodes.
• The cervical lymph nodes of the
lower back of neck become visibly
enlarged in 80% of patients.
• This is called Winterbottom's sign.
 Blood Stage (systemic illness) Cont;
• The other signs and symptoms of
trypanosomiasis include:
• Pruritic rash (beginning six to
eight weeks after infection).
• Hepatosplenomegaly.
Blood Stage (systemic illness) Cont;
• Poor appetite resulting in weight
loss, debility, pitting oedema of
face and lower legs.
• Impotence and menstrual
irregularities.
• Heart failure.
 Cerebral Stage (Sleeping sickness
stage)
• This is the terminal stage of
trypanosomiasis.
• The parasites invade the brain leading
to mental deterioration and coma.
• Convulsions hemiplegia, and facial
palsy may occur.
 Cerebral Stage (Sleeping sickness
stage) Cont;
• Patients are very weak.
• They sleep during the day but are
restless at night.
• As the disease progresses, the
patients become severely ill.
• Die if not treated.
 Diagnosis
• Microscopic examination of the
chancre fluid to demonstrate the
trypanosomes.
• Examination of blood for
trypanosomes.
• Wet blood smear for microscopy.
 Diagnosis Cont;
• Thick blood smear for microscopy.
• Serological test .
• Lymph node aspiration
(microscopy).
 Common Side Effects of
Trypanosomiasis Drugs
Drug
Suramin
• Dose-20mgs/kg iv on days
1,3,5,14,&21.
Toxicity
• Mild proteinuria, arthralgia, severe
dermatitis, diarrhoea, nephritis.
 Drug
• Pentamidine
• Dose-4mgs/kg/day I.M or I.V X 7-10
Days.
Toxicity
• Hypoglycaemia, nephritis, diabetes
mellitus, injection abscess, collapse if
injected intravenously.
 Drug
Melarsoprol
• Dose- 3.6mgs/kgs/day IVX3days. After 7
days repeat the dose for 3days. 3rd series
of Rx after 7 days for 3 days.
Toxicity
• Jarisch-herxsheimer reaction (short term
immunologic reaction seen following
drug treatment).
 Encephalopathy, mortality up 100%.
Drug
• Difluoromethyl Ornithine.
• Dose-200-400mgs/kgs daily for 6
weeks.
Toxicity
• Diarrhoea, abdominal pain.
 Drug
• Nitrofurazone
• Dose-500mgsTID orally for 10 days.

Toxicity
• Haemolytic anaemia and neuropathy.
• The drugs used for the treatment of
trypanosomes are highly toxic. As
such the patient should be
monitored carefully and the drugs
administered very carefully.
 Prevention and Control
• The following measures are effective
in the prevention and control of
sleeping sickness.
• Chemoprophylaxis; IM
pentamidine 250mg single dose
protects against Tb gambiense
infection.
 Prevention and Control Cont;
• For six months in those working in
endemic bush land areas such as
wildlife personnel.
• Bush clearing and establishment
of agricultural settlement will in
the long run destroy tsetse fly
breeding areas.
 Prevention and Control Cont;
• Use of baited flytraps which have
an efficacy of 95% at reducing the
tsetse fly population.
• Other general measures.