Air borne diseases

Wegene J. (MSc)
 Introduction

• The organisms causing the diseases in the airborne

group enter the body via the respiratory tract.
• When a patient or carrier of pathogens talks, coughs,
laughs, or sneezes, he/she discharges fluid droplets.
• The smallest of these remain up in the air for some
time and may be inhaled by a new host.
• Droplets with a size of 1-5 microns are quite easily
drawn into the lungs and retained there.
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 Introduction cont…
• Droplets which are bigger in size will not remain air
borne for long but will fall to the ground. Here,
however, they dry and mix with dust.
• When they contain pathogens which are able to
survive drying these may become air bone again by
wind or something stirring up the dust, and they can
then be inhaled.

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 Introduction cont…
 Air borne diseases, obviously, will spread more easily
when there is overcrowding as in overcrowded class
rooms, public transport, canteens, dance halls, and
cinemas.
 Good ventilation can do much to counteract the
effects of overcrowding.
 Air borne diseases are mostly acquired through the
respiratory tract.
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 Leprosy

• Chronic infectious disease affecting the skin,

peripheral nerves, mucosa of the upper respiratory
tract and eyes
Infectious agent
Mycobacterium Leprae
Epidemiology
Occurrence - Globally, 213,989 new cases of leprosy
were detected during 2019.
• In 2019, Ethiopia reported a total of 3426 leprosy
cases.

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 Epidemiology…
Reservoir- Humans
• Mode of transmission- Transmitted mainly through
air‑borne spread of droplets
Primarily as a nasal droplet infection
• Untreated leprosy patients are source of infection
• Incubation period
 Has a long incubation period, averaging 3 to 5
years;
 May vary from 6 months to more than 20 years

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 Epidemiology…
Period of communicability – As long as the patient is
untreated but the patient become non-infectious
within a few days of treatment.
Susceptibility and resistance - Leprosy is not highly
infectious
 95% of the population has a natural immunity
against leprosy
 Over 85% of the leprosy cases are non-infectious
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 Clinical manifestation
• The most common and early symptom of Leprosy is
pale or reddish discoloration of the skin

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 Clinical manifestation cont.…
• Painless swelling or lumps in the face & earlobes.
 Clinical manifestation cont.…
• Painful and/or tender nerves
• Loss of feeling in the skin
• Painless wounds or burns on the hands or feet
 Clinical manifestation cont.…
• The cardinal signs of leprosy are:

1. Definite loss of sensation in a pale (hypo-

pigmented) or reddish skin lesion.
2. Thickened or enlarged peripheral nerve with or
without tenderness
3. The presence of acid-fast bacilli in a slit skin smear.
 Diagnosis
Leprosy diagnosed on clinical grounds in 95%
• Taking proper history
• Examination of the skin, including Sensation
testing
• Examination of the nerves – palpation
• Acid-fast bacilli in a slit skin smear

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 Treatment
• Leprosy is treated with Multi Drug Therapy (MDT)
• Three drugs used in MDT: Rifampicin, Dapsone and
Clofazimine.
• Patients are considered no longer infectious after
taking the first dose of MDT.
 Prevention and control

• Timely detection of new cases and provision of

effective chemotherapy with MDT
• Immunization of infants with BCG
• Educate patients about leprosy mode of
transmission

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 Measles (Rubeola)

• It is an acute highly communicable viral disease.

• Is an infection of the respiratory system, immune
system and skin.
Infectious agent
Measles virus
Epidemiology
Occurrence - Prior wide spread immunization, measles
was common in childhood so that greater than 90%
of people had been infected by age 20, few went
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through life with out any attack.
 Epidemiology…
Reservoir- Humans
Mode of transmission- Air borne by droplet spread,
direct contact with nasal or throat secretions of
infected persons and less commonly by articles
freshly solid with nose and throat secretion.
Incubation period - 7- 18 days from exposure to onset
of fever.

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 Epidemiology…
Period of communicability - slightly before the
prodromal period and to four days after the
appearance of the rash and minimal after the second
day of rash.
Susceptibility and resistance - All non vaccinated or
have not had the disease are susceptible, permanent
immunity is acquired after natural infection or
immunization.
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 Clinical manifestation
• Fever (may reach up to 40 °C) , conjunctivitis,
Coryza, cough and kopliks spots on the buccal
mucosa.
• A characteristic red rash appears on the third to
seventh day, beginning on the face, gradually
becoming generalized, lasting 4-7 days.
• Leukopenia is common
• Complications like otitis media, pneumonia,
diarrhea, encephalitis, croup (Laryngo tracheo
bronchitis) may result from viral replication or
bacterial super infection.
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 Diagnosis
• Based on clinical and epidemiological grounds (three Cs
—cough, Coryza and conjunctivitis (red eyes)—along
with fever and rashes).
Treatment
– No specific treatment (Most patients with
uncomplicated measles will recover with rest and
supportive treatment)
– Treatment of complications
– Vitamin A provision
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 Prevention and control

• Educate the public about measles immunization

• Immunization of all children (less than 5 years of age)
who had contact with infected children
• Provision of measles vaccine at nine month
• Initiate measles vaccination at 6 months of age
during epidemic and repeat at 9 month of age

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 Pertusis (whooping cough)
It is an acute bacterial disease involving the respiratory
tract.
Infectious agent
Bordetella pertusis
Epidemiology
Occurrence- An endemic disease, common to children
especially young children every where in the world.
• A marked decline has occurred in incidence and
mortality rates during the past five decades. 23
 Epidemiology..

• Out breaks occur periodically.

• Endemic in developing world and 90% of attacks occur
in under 6 years children.
Reservoir- Humans
Mode of transmission- Primarily by direct contact with
discharges from respiratory mucus membranes of
infected persons and by air borne route, probably by
droplets.
• Indirectly by handling objects freshly solid with
nasopharyngeal secretions.
Incubation period- 1-3 weeks 24
 Epidemiology..

Period of communicability- Highly communicable in

early catarrhal stage before the paroxysmal cough
stage.
• It is the most contagious disease with an attack rate of
75-90%.
• Gradually decreases and becomes negligible in about
3 weeks.
• When treated with erythromycin, infectiousness is
usually 5 days or less after onset of therapy. 25
 Epidemiology..

Susceptibility and resistance- Susceptibility to non-

immunized individuals is universal.
• One attack usually confers prolonged immunity but
may not be life long.

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 Clinical manifestation
The disease has insidious onset and 3 phases:
Catarrhal phase
• Lasts 1-2 weeks
• Cough and rhinorrhea
Paroxysmal phase
• Explosive, repetitive and prolonged cough
• Child usually vomits at the end of paroxysm
• Expulsion of clear tenacious mucus often followed by
vomiting
• Whoop (inspiratory whoop against closed glottis)
between paroxysms.
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 Clinical manifestation..
• Child looks healthy between paroxysms
• Paroxysm of cough interferes with nutrition
• Cyanosis and sub conjunctiva hemorrhage due to
violent cough.
Convalescent phase
• The cough may diminish slowly or may last long
time.
• After improvement the disease may recur.
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 Diagnosis
• Difficult to distinguish it from other URTI
• History and physical examination at phase two
(paroxysmal phase) ensure the diagnosis.
• Marked lymphocytosis.
Treatment
• Erythromycin- to treat the infection in phase one but
to decrease transmission in phase two
• Antibiotics for super infections like pneumonia
because of bacterial invasion due to damage to cilia. 30
 Prevention & control
• Educate the public about the dangers of whooping
cough and the advantages of initiating immunization
at 6 weeks of age.
• Consider protection of health workers at high risk of
exposure by using erythromycin for 14 days.

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 Diphtheria

• It is an acute bacterial disease involving primarily

tonsils, pharynx, nose, occasionally other mucus
membranes or skin and sometimes the conjunctiva or
genitalia.
Infectious agent
Corynebacterium diphtheriae

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 Epidemiology

Occurrence- Disease of colder months in temperate

zones, involving primarily non-immunized children
under 15 years of age.
• It is often found among adult population groups
whose immunization was neglected.
• Cutaneous and wound diphtheria cases are much
more common in the tropics.
Reservoir- Humans
Mode of transmission- contact with a patient of carrier.
i.e. with oral or nasal secretions or infected skin.

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 Epidemiology..

Incubation period- usually 2-5 days

Period of communicability- variable, until virulent
bacilli have disappeared from discharges and lesion,
usually 2 weeks or less.
Susceptibility and resistance- Susceptibility is universal.
• Infants borne to immune mothers are relatively
immune, protection is passive and usually lost before
6 months.
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 Epidemiology..
• Recovery from clinical a disease is not always
followed by lasting immunity.
• Immunity is often acquired through inapparent
infection.
• Prolonged active immunity can be induced by
diphtheria toxoid.

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 Clinical manifestation

• Characteristic lesion marked by a patch or patches of

an adherent grayish membrane with a surrounding
inflammation (pseudo membrane)
• Throat is moderately soar in pharyngo tonsillar
diphtheria, with cervical lymph nodes some what
enlarged and tender; in severe cases, there is marked
swelling and edema of neck.

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 Clinical manifestation cont.…
• Late effects of absorption of toxin appearing after 2-6
weeks, include cranial, peripheral, motor and sensory
nerve palsies and myocarditis (which may occur
early) and are often severe.
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 Diagnosis
• Based on clinical and epidemiological grounds
• Bacteriologic examination of discharges from lesions
Treatment
– Diphtheria antitoxin
– Metronidazole
– Erythromycin for 2 weeks but 1 week for Cutaneous
form or
– Procaine penicillin for 14 days
N:B Primary goal of antibiotic therapy for patients or
carriers is to eradicate C. diphtheriae and prevent
transmission from the patient to susceptible contacts.
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 Prevention and control

• Educate the public, and particularly the parents of young

children, of the hazards of diphtheria and the necessity
for active immunization
• Immunization of infants with diphtheria toxoid
• Concurrent and terminal disinfection of articles in
contact with patient and soiled by discharges of patient
• Single dose of penicillin (IM) or 7-10 days course of
Erythromycin (PO) is recommended for all persons
exposed to diphtheria • 41
 Influenza
• It is commonly known as "the flu", and it is acute viral
disease of the respiratory tract.
Infectious agent
Three types of influenza virus (A,B and C)
Epidemiology
Occurrence - In pandemics, epidemics and localized out
breaks.

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 Epidemiology..

• Influenza spreads around the world in

seasonal epidemics, resulting in about three to five
million yearly cases of severe illness and about
250,000 to 500,000 yearly deaths.
• Reservoir- Humans are the primary reservoirs for
human infection (Wild aquatic birds, dog, pig, seal…)
 Epidemiology..
Mode of transmission- Air borne spread predominates
among crowded populations in closed places E.G. school
buses.
Incubation period- short, usually 1-3 days
Period of communicability- 3-5 days from clinical onset in
adults, up to 7 days in young children
Susceptibility and resistance- when a new sub type
appears all children and adults are equally susceptible.
Infection produces immunity to the specific infecting
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 Clinical manifestation
• Fever, chills, head ache, myalgia , runny nose, soar
throat and cough.
• Cough is often sever and protracted, but other
manifestations are self limited with recovery in 2-
7days.
Diagnosis
• Based on clinical ground

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 Treatment
• Anti pain and antipyretic
• High fluid intake
• Bed rest
• Balanced diet intake

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 Prevention and control

– Educate the public in basic personal hygiene (As the

virus can be inactivated by soap, frequent hand
washing reduces the risk of infection), especially the
danger of unprotected coughs and sneezes and hand
to mucus membrane transmission.
– Immunization with available killed virus vaccines, may
provide 70-80% protection
– Amantadine hydrochloride is effective
chemoprophylaxis for type A virus but not to others.47
 Tuberculosis

• It is a chronic and infectious mycobacterial disease

important as a major cause of illness and death in
many parts of the world.
Infectious agent
• Mycobacterium tuberculosis - human tubercle bacilli
(commonest cause)
• Mycobacterium bovis - cattle and man infection

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 Epidemiology

Occurrence- World wide, however underdeveloped

areas are more affected.
• Affects all ages and both sexes.
• Age groups between 15-45 years are mainly affected.
• According to the WHO Global TB Report, in 2019, an
estimated 10 million people have fallen ill from TB,
and it has claimed the lives of 1.2million people

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 Epidemiology..

• Ethiopia is among the 30 high TB and TB/HIV burden

countries globally with an estimated TB incidence rate
of 140/100,000 populations; and (19/100,000
population) TB deaths in 2018 (WHO, 2019).

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 Epidemiology..

Mode of transmission - Through droplet nuclei mainly

from persons with active disease of lung expelled
during talking, sneezing, singing, or coughing
directly.
• Untreated pulmonary smear positive tuberculosis
(PTB+) cases are the source of infection.
• Most important is the length of time of contact an
individual shares and volume of droplet nuclei with
an infectious case. • 51
 Epidemiology..

• Prolonged or frequent contact is required.

• Transmission through contaminated fomites (clothes,
personal articles) is rare.
• Ingestion of unpasteurized milk transmits bovine
tuberculosis.
• Over crowding and poor housing conditions favor
the disease transmission.

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 Epidemiology..

Incubation period - 4-12 weeks

Period of communicability- as far as the bacilli is present
in the sputum, but 2 weeks after treatment started.
Susceptibility and resistance - under 3 years old children,
adolescents, young adults, the very old and the
immuno- suppressed are susceptible.
• HIV infection has been identified as a major risk factor
for developing tuberculosis.

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 Epidemiology..

N:B HIV is an important risk factor for the

development of HIV associated tuberculosis by
facilitating:
• Reactivation or
• Progression of recent infection or
• Reinfection

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 Clinical manifestation

Pulmonary tuberculosis
• Persistent cough for 2 weeks or more
• Productive cough with or with out blood stained
sputum
• Shortness of breath and chest pain
• Intermittent fevers, night sweats, loss of weight, loss
of appetite, fatigue & malaise.

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 C lin ica lm a n ifesta ti o n .

TB lymph adenitis
• Slowly developing and painless enlargement of lymph
nodes followed by matting and drainage of pus.
Tuberculosis pleurisy
• Pain while breathing in, dull lower chest pain, slight
cough, breathlessness on exertion.
TB of bones and joints
• Localized pain, swelling, discharging of pus, muscle
weakness, paralysis and stiffness of joints.
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 Clinical manifestation..

Intestinal TB
• Loss of weight and appetite
• Abdominal pain, diarrhea and constipation
• Mass in the abdomen
• Fluid in the abdominal cavity (ascites)
TB meningitis
• Headache, fever, vomiting, neck stiffness and mental
confusion of insidious onset.
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 Diagnosis

A. Clinical manifestations
B. Bacteriological Methods
• Sputum smears for acid-fast bacilli (AFB).
• Tuberculin skin test (mantoux) - Helpful in non BCG
vaccinated under 6 years of age children
• Culture
• Xpert MTB/RIF Assay
• Line prob assay • 58
 Diagnosis..
.

C. Radiological examination. This is unreliable because

it can be caused by a variety of conditions.
D. Histopathological examination
- Fine needle aspiration from enlarged lymph nodes
- Aspiration of effusions from serous membranes
- Tissue biopsy from any body tissues such as bone
E. Ultrasonography studies (abdominal and pericardial
TB)
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 Treatment

The following drugs are being used for a first line

treatment of TB in Ethiopia.
• Ethambutol (E)
• Rifampin (R)
• Isoniazid (H)
• Pyrazinamide (Z)

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 Treatment..

Drug regimens (prescribed course of therapy)

• (DOTS) intensive phase : 2(RHZE)
• Continuation phase : 4(RH)

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 Prevention and control

• Active case finding and treatment

• Chemoprophylaxis for contacts
• Immunization of infants with BCG
• Educate patients with TB about the mode of disease
transmission and how to dispose their sputum and
covering of their mouth while coughing, sneezing,
etc.

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 Prevention and control..

• Public health education about the modes of disease

transmission and methods of control
 Improved standard of living
 Adequate nutrition
 Health housing etc.

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Thank you!

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