Invasion of the skin or mucous membranes by a pathogenic organism or parasite. Infection in which entrance of the pathogenic organism (or the parasite) occurs through the skin or mucus membranes. Some infectious agents can invade the intact (undamaged) skin or mucous membranes, but the majority needs injured surfaces in the form of abrasions, scratches, wounds or ulcers.

1. CONTACT
INFECTIONS
Dr. Dalia El-Shafei
Lecturer, Community Medicine Department,
Zagazig University

2. Invasion of the skin or mucous membranes by a
pathogenic organism or parasite.
Infection in which entrance of the pathogenic organism
(or the parasite) occurs through the skin or mucus
membranes.
Some infectious agents can invade the intact
(undamaged) skin or mucous membranes, but the
majority needs injured surfaces in the form of
abrasions, scratches, wounds or ulcers.

3. Viral
AIDS
HBV
HCV
Rabies “Dog”
Bacterial
Anthrax
Gas gangrene
Gonorrhea
Leprosy
Tetanus
Parasitic
Ancylostomiasis
Bilaharziasis
Fungal
Vaginal thrush
Valvovaginitis.
Balanitis

4. The infectious cycle of contact infection
Agent:
Reservoir:
Exit: skin-mucous membrane
Mode of transmission:
(Direct: infected person skin, mm
(Indirect: fomites, cloths, brushes, combs, animal bite,
injections, surgical instruments)
Inlet: intact or wounded skin, mm
Host: all specially with bad sanitary habits & hygiene
Incubation period-C/P
Preventive measures

5. Mode of transmission
1- Directly
2- Indirectly
from infected person skin or mucous
membrane to new host.
through fomites, clothes, commonly
shared brushed, combs, eye liners,
handkerchief, animal bite, injections
and surgical instruments.

6. HOST
In some occupation: as animal
guards, medical personnel,
veterinary care workers and
butchers.
All individuals are susceptible
specially with bad sanitary
habits and hygiene.

7. Incubation period: important for period
of communicability and supervision of
contacts. e.g. Hepatitis B (average 3
months, syphilis 3 week, leprosy 6 months
-12 months, anthrax 2-7 d.).
Clinical picture: cardinal symptoms and
signs which characterize as loss of
appetite, Aerophobia, hydrophobia,
difficult swallowing. Also, muscle spasm
in tetanus.

8. Primary Prevention
A) Environmental sanitation:
• Water sanitation: provide safe water supply to all
houses, for personal hygiene, bathing.
• Insect and rodent control (insects transmit
infection mechanically and rodents transmit
infection by bite).
• Control of animal reservoirs by vaccination,
sanitary animal breading areas, veterinary care or
killing/ segregation of diseased animals.

9. B) Protection of susceptible host (health
promotion):
• Empowering laws for environmental sanitation.
• Health education to cover the different aspects
of health habits.
• Improving immunity by proper nutrition,
physical exercise.
• Specific preventive measures for prevention of
certain diseases by vaccination, seroprophylaxis
and chemoprophylaxis.

10. C) International measures:
• Notification of local health authority for
complicated diseases as anthrax, leprosy, rabies.
Notification to WHO for AIDS.
• Quarantine measures for imported animals to
prevent entrance of zoonotic diseases as rabies.
• Fumigation and de-rating of ships to control
rodents.
• Vaccination certificate for travelers coming from
endemic areas.
• Supervision of travelers coming from infected
areas.

11. Secondary Prevention
Measures for cases (reservoir)
• Case finding.
• Notification.
• Isolation: to separate cases from
contact with others to prevent more
transmission of infection.

12. • Disinfection: concurrent disinfection of
clothes, excreta, discharge, spoiled articles
of the patient. Terminal disinfection by
cleaning room, formaldehyde or chlorine
use, or by burning disposable things.
• Treatment.
• Release: the time of release of cases
depends on infectivity, presence of carrier
state, general condition, complete clinical
cure and laboratory free test result.

13. Measures for contacts (susceptible)
• If the disease is serious or highly
infective all contacts of cases in the period
prior to clinical signs are listed and
investigated for carrier state.
• Surveillance: put contacts under medical
observation for maximum time of
incubation period to detect any sign early
and begin treatment.

14. • Segregation: exclude from work or school
in highly infectious diseases, till investi-
gation for carrier state is done or for
passing incubation period of the disease.
Segregation may be at home.
• Isolation: in hospital for fatal infectious
diseases as AIDS.
• Immunization: by vaccination or seropro-
phylaxis or chemo prophylaxis if available.

15. Tertiary Prevention
Care of handicapped cases.
Prevent more complications for cases.

17. Definition: acute viral zoonosis, transmitted to man by
bite of an infected animal & causing acute
encephalomyelitis illness.
Causative organism: Rabies virus, RNA rhabdovirus
with 5 genetically related viruses.

18. Reservoir: Domestic & wild animals “dog, cat, fox,
wolf, rats, bat, etc”.
Exit: in saliva of rabid animals.
Modes of transmission: Infection is transmitted with
saliva through the bite of an infected animal usually or
when saliva gets on an injured skin by lick. No man
to man infection.

20. •IP: depends
on the
distance
between the
site of bite &
brain.
•It is usually
2-8 ws, but up
to 1 year.

21. Clinical picture:
History of animal bite.
Non-specific manifestation: e.g. FHMA.
Specific manifestations: paraesthesia, aerophobia,
hydrophobia, difficult swallowing, convulsions.
4.Death within 1-2 weeks during a convulsive stage or
due to respiratory paralysis

23. Diagnosis:
C/P following a history of an animal bite.
Detection of virus particles in saliva, C.S.F or urine
Detection of viral antigen in skin biopsy using direct fluorescent
antibody technique.
Rising antibody titers in blood or C.S.F.

24. Control:
Measures for animals:
Destruction of stray dogs.
Vaccination of domestic animals by an inactivated rabies
vaccine every 2 years and giving license.
Quarantine of imported animals to prevent introduction of
rabies to countries where rabies has been eradicated.

25. (A) Pre-exposure vaccination: vaccination of at risk e.g.
night guards & zoo workers. 3 inactivated types of rabies
vaccines are used:
Human diploid cell vaccine (HDCV)
Rabies vaccine adsorbed (RVA)
Duck embryo vaccine (DEV).
Any one available is given I.M., 3 doses, 1 ml each, in
deltoid region on days 0, 7, and 21 or 28. Booster dose
every 2 years if risk of exposure continues.

30. *Immediate local treatment of animal bite & scratches through
repeated flushing & cleaning of wound with soap & water.
*A rabies immunoglobulin (20 IU/kg) or antiserum (40 IU/kg) is
infiltrated locally around the wound (half the dose). The other half
is given I.M.
*Wound should not be sutured then wound is dressed.
*Give tetanus prophylaxis & antibacterial treatment.

35. V. Measures for cases
*Notification to the local health authority.
*Isolation.
*Disinfection of saliva & soiled articles.
*Treatment: no effective treatment, only symptomatic.
V. Measures of contacts:
*No specific measures, as there is no man to man
transmission; however, avoid contamination of skin
wound or mucous membrane by patient's saliva.

37. 1-Epidemiology of viral hepatitis
*Viral hepatitis: liver infection with one of hepato-tropic viruses:
A, B, C, D, E, F, & G.
* Usually disease is self-limited, however some cases show massive
or chronic hepatic necrosis & chronic hepatitis.
* Virus B & C may be complicated by liver cirrhosis &
hepatocellular carcinoma. HCV is a major health problem in
Egypt.

38. 1. HBV, HCV and HDV are transmitted mainly percutaneous,
so they are considered as contact infections.
2. HAV is transmitted mainly by faeco-oral transmission, so it
is considered as food borne disease.
3. HDV and HFV are similar to HBV.
4. HEV is similar to HAV.
5. HGV is similar to HCV.
6. There are many other viruses that can cause acute hepatitis
e.g. cytomegalovirus, Epstein-Barr virus.

40. Hepatitis B Hepatitis C Hepatitis DCausativeAgent:
 Hepatitis B Virus
(HBV)
 DNA virus
 Contains: HBsAg,
HBcAg, HBeAg
 It is more resistant
than HAV to heat &
disinfectants & can
retain infectivity
for at least 1 month
at room
temperature.
 Hepatitis C Virus
(HCV).
 RNA virus,
 6 known genotypes
&50 or more
subtypes.
 Types 1,2&3
worldwide, type 4 in
North Africa & Middle
East, type 5 in south
Africa, 6 in Asia
 90% of HCV in Egypt
belongs to subtype 4b
“less response to
interferon therapy”.
Hepatitis D virus
(HDV)
 RNA virus
 In blood it is
surrounded by
HBsAg
envelope
 So, HDV must
occur on top of
HBV and
cannot occur
alone.

41. HDVHCVHBV
CasesCases, carrier “incubatory &
chronic for years or life long”
Cases, carriers “chronic
carrier for years or life long”
Reservoir
“man
only”
During
course of
disease
1-2 w before onset of symptoms
through acute clinical course &
persists in most persons in
chronic carriers.
So long is HBs Ag (+ve)
“appear 30-60 days after
infection& persists for
variable period”
Periodof
communicability
1- Percutaneous exposure to infective body fluid “
blood transfusion, hemodialysis, sharing needling during injection”.
2-insufficient sterilized needles, syringes, razors, toothbrushes
3- Maternal fetal transmission
4- Organ transplantation
5- Sexual transmission
6- Tattooing, Endoscopy, commercial barbering, beauty treatment, endoscopy,
intranasal cocaine use.
Modeof
transmission

43. From infected mother to her infant occurs in less than 10% of
pregnancies.
There are no measures that alter this risk.
It is not clear when during pregnancy transmission occurs, but it
may occur both during gestation and at delivery.
A long labor is associated with a greater risk of transmission.
There is no evidence that spreads HCV; however, to be cautious, an
infected mother is advised to avoid breastfeeding if her nipples
are cracked and bleeding, or her viral loads are high.
Maternal fetal transmission (vertical
transmission).

44. HDVHCVHBV
2-8 weeks2-12 weeks (average 6 weeks)60-150 days (average 90
days)
IP
•No specific symptoms
•The most important
character is rapid
progress to cirrhosis,
liver failure and
severe liver damage in
children.
1-Asymptomatic or mild
symptoms.
2.Low grade fever, fatigue, N,V ,
right sided abdominal pain,
3.Jaundice.
4.Self-limiting infection after 3-6
months. No jaundice,
5.Chronic infection occurs in
80% of cases presented by feeling
of weakness, pain in right upper
abdomen.
1-Nonspecific prodroma of
FHMA, myalgia.
2- Dark urine, jaundice.
3- At least 50% are
asymptomatic or have
illness not specific for
HBV.
Clinicalpicture
Liver cirrhosis, failure,
Severe liver damage
in children.
Liver cirrhosis in 25% of cases
followed by failure, Cancer liver,
Renal disorders, formation of
auto-antibodies, DM
Fulminant hepatitis,
Chronic hepatitis, Liver
cirrhosis, Causes up to
80% of hepatocellular
carcinoma.
Complications

47. HDVHCVHBV
Detection of Ab
to HDV by
serologic tests.
C/P + elevated liver
enzymes, detection of Ab
by ELISA
+VE ELISA: PCR test
-Liver biopsy
- Genotyping of HCV
-Serum fibrosis markers
C/P + elevated liver enzymes,
markers:
HBsAb: active or past
infection
HBsAg: disease or chronic
carrier
HBcAb: recent infection
Diagnosis
1- Screening and testing blood, plasma and organ tissue donors.
2- Health education about modes of transmission to reduce exposure to infection.
3- Sterilization of surgical instruments and use of disposable syringes.
4- Prevention of drug abuse & needle shared injections.
5- Prevention of tattooing, prevention of use of common razors or scissors.
6- Surgeons should use thick protective gloves.
7- Proper handling and disposal of sharp instruments and needles.
8- Quarantine measures: some countries prevent hepatitis C patients from
entrance. All passengers should have certificate denoting absence of infection.
Prevention:1ry
General

50. HDVHCVHBV
No vaccines
Prevention of
HBV prevent
infection with
HDV
No specific preventive
measures
1- HBV, 3 Doses,0.5 ml each at 0,
1,6 months (for who?). Give 95%
protection for 7 years.
2- Ig, 0.1ml/kg, 2 doses 1 month
apart given at once after exposure
(for who?) not more than 48hs
3- Combined vaccine+ Ig
Prevention:1ry
Cases: case finding- notification-isolation-disinfection-HE-treatment (antiviral,
antioxidants).
Contact: enlistment- examination-HE-specific protection in case of HBV (vaccination,
seroprophylaxis)
2ry
Rehabilitation of liver failure or cancer liver cases.
3ry

51. 1- Vaccination: 2 vaccines:
• Plasma derived HB Vaccine: purified inactivated HBsAg
prepared from healthy carriers.
• Recombinant DNA vaccine: prepared on yeast by genetic
engineering.
3 doses, 0.5 ml each, at 0, 1, 6 months.
It gives 95% protection for 7 years.
• Compulsory to all infants at 2, 4, 6 months.
• Medical & paramedical staff & students
• Patients who need repeated blood transfusion or hemodialysis
• Contacts of carriers
• Drug abusers

52. 2.Seroprophylaxis: immunoglobulins, 0.1 ml/kg, 2
doses 1 month apart, given at once after exposure
not after 48 hs.
• High risk persons.
• Exposure to infected blood.
• After sexual exposure to infected person.
• Infants born to infected mothers: within 12 hs
after births, then after 1 & 6 ms.

53. 3- Combination of vaccination & seroprophylaxis:
• Infants born to infected mothers: 1st dose of vaccine is
given within 12 hs after births with immuno-globulins but
at different sites. The 2nd & 3rd doses of vaccine are given
after 1 & 6 months. This will prevent carrier state in 90%.
• After recent exposure:
Vaccinated before: Igs, then booster dose of vaccine
Not vaccinated before: Igs & 1st dose of vaccine at
once, then 2nd & 3rd doses are given 1 & 6 months later.
• Contacts of cases.

55. 2- Secondary prevention: (for early detection of the infection and early management
which will prevent liver complications)
1. Cases:
• Case finding: early detection of infection by screening of: medical staff, lab
technicians, renal dialysis patients, cases that need frequent blood or plasma
transfusion, patients treated by tartar emetic for schistosomiasis, before surgery and
premarital.
• Notification to the local health authority.
• Isolation: universal precautions to prevent exposures to blood and body fluids.
• Disinfection of patient's discharges & blood contaminated articles.
• Health education for: modes of transmission, early treatment, prevent infection of
others, not to donate blood to others, follow treatment strictly, no alcohol drinks.
• Treatment: antiviral therapy, antioxidants, bile acids, herbal medicines. Treatment
should begin early and frequently checked by lab results. Liver transplantation for
cancer liver or liver cirrhosis.
• Cover cuts and sores on skin to prevent spread of infectious blood.
• No shared brushes, razors or personal articles.

56. Viral Diseases transmitted by contact (bite, injection,
surgical instruments, Blood transfusion, sexual)
Disease Agent
Source of
infection
IP
Clinical
picture
Period of
infectivity
Specific prevention
Rabies
Virus Bit of
infected
dog, cat,
bat, fox,
wolf bite
(in saliva)
Virus can
contaminat
e wounds
by licking or
feces of
bats in
contact
with
conjunctiva
2-8
week
up to 1
year
History of
bite
malaise,
fever, loss
of appetite,
paraesthesi
a
aerophobia
difficult
swallowing,
convulsion,
death
within 1-2
weeks due
to resp.
paralysis.
No man to
man
infection
Destruction of stray dogs, vaccination
of animals. Quarantine of imported
animals vaccination of at risk before
bite by human diploid vaccine, duck
embryo or rabies vaccine adsorbed.
1ml IM at 0,7,21, 28 days and booster
every 2 years. For night guards, zoo
workers.
After bite: clean wound by soap &
water. Use immune globulin locally
injected around wound, no suture.
Give antibiotic + antitetanus.
Immediate IMinj of immune globulin
and 1st dose of human diploid vaccine
then at 3,7,14,28 days. Booster 2 doses
if person is bitten again within 3 years.
If the animal escape or the wound in
head or neck begin vaccination
immediately if animal is captured,
observe it for 10 days, if died begin
vaccine

57. Viral Diseases transmitted by contact (bite, injection,
surgical instruments, Blood transfusion, sexual)
Disease Agent
Source
of
infection
IP
Clinical
picture
Period of
infectivit
y
Specific prevention
Hepat-
itis
B,C,D
Viruse
s
Case,
carrier
in
Blood,
body
fluids
2-3
mon
th
Low fever,
anorexia,
vomiting,
dark urine,
jaundice.
Liver
cirrhosis,
liver
failure,
cancer
liver.
All + ve
HBsAg
person
are
infective
Testing blood donor, proper
sterilization, use disposable
syringe no tattoo or
acupuncture.
Vaccination: by inactivated
HBsAg 3 doses 0.5ml Im 95%
immunity for 7 years given
at 2,4, 6 months for
infants, at risk medical
staff, renal dialysis cases,
drug abuser.
Seroproph: immunoglobulin
alone or with vaccine in
infants of infected mother,
for postexposure.

58. Viral Diseases transmitted by contact (bite, injection,
surgical instruments, Blood transfusion, sexual)
Diseas
e
Agent
Source of
infection
IP
Clinical
picture
Period of
infectivity
Specific prevention
AIDS
LAV
HTLVI
III
virus
Case,
incubato
ry carrier
in blood,
body
fluids
congenit
al
6
month
s to 5
years
Malaise, low
fever, loss of
appetite,
loss weight
enlarged
lymph
nodes,
deficient
immunity to
all
infections.
Malignancy,
death.
All
patient
life
Health education of
youth, social welfare,
increase religion roots,
control of drug abuse,
control prostitute. Early
case finding. Testing
blood donor, proper
sterilization, use
disposable syringe no
tattoo, acupuncture no
vaccination or
chemoprophylaxis.

60. It is a parasitic disease caused by a
trematode infecting the venous system
and transmitted by water contact.
It is an endemic disease in Egypt.

61. Schistosoma
hematobium
• Urinary tract
• Bullinus trancutus snail
• Egypt
Schistosoma
mansoni
• Large intestine
• Biomphilaria alexandrina snail
• Egypt
Schistosoma
japonicum
• Large intestine
• Oncomelania snails e.g. Oncomelaniahupensis
• China

64. Spreadof schistosomiasis in Egypt:
• Before construction of High Dam:
S. hematobium: was prevalent all over Egypt with low
prevalence south of Assuit.
S. mansoni: was prevalent in Nile delta and Giza Gov.
• After construction of High Dam:
Upper Egypt: S. hematobium is more prevalent (5-14%)
& increased south of Assuit.
Lower Egypt: S. mansoni is more prevalent (18-43%) &
almost totally replaced S. hematobium.

65. Change of basin irrigation to perennial irrigation
……...change in velocity & volume of water flow +
decreased silt in water……….affected the distribution
of snail vector.

66. Life cycle of schistosomiasis:

68. Infective stage: Cercaria “lives 24-72 hs (1-
3 ds) in water then dies”.
Mode of transmission: Cercaria in polluted
water penetrates the skin of new host during
bathing or irrigating lands.
IP.: 5-8 ws (1-2 ms) from penetration of
skin by cercaria till appearance of eggs in
stool or urine.

69. Clinical picture:
1- Itching & dermatitis: cercaria penetration.
2- General weakness & anemia.
3-Terminal hematuria or blood on faeces.
4- Cystitis, urethritis, stone formation, colitis.
5- Liver cirrhosis, portal hypertension,
esophageal varices & bleeding.
6-Cancer.

70. Diagnosis:
 C/P: (e.g. terminal haematuria or dysentery) may be suggestive in
endemic areas.
 Laboratory examination:
(a) Microscopic exam.: Demonstration of ova in urine & stools.
(b) Immunologic tests:
Complement fixation test: +ve few ws after infection & persists for
many ys.
Intradermal test: injection of Ag. prepared from adult worms.
Reading is taken within 15 min. +ve reaction signifies infection (past
or present).

71. Environment
• Unsanitary
environment.
• Lack of safe
water supply for
bathing &
washing.
• Unavailable
latrines.
• Suitable climate
(temperature &
humidity) for
development of
cercaria & snails.
Agent
• Continuous flow of
snail intermediate
host from Nile
resources.
• Perennial irrigation
favors development
of snails.
• Cercaria
characteristics (big
No., survive 2-3 ds,
thermotropic, have
great affinity to man).
Host
• Age: 10-20 years
(swimming in infected
canals in summer).
• Sex: males (more exposure
during farming &
irrigation).
• Education: less in
educated persons (avoid
polluted water & seek
medical care early).
• Occupation: affects those
exposed to water e.g.
farmers & fishermen.
• Habits & Behavior:
defecation & urination in
canal water make
infectious cycle completed
and infection is endemic.
• Underutilization or
reluctance to seek
medical care for diagnosis
& early treatment.

72. Control:
I. 1ry prevention:
1. Sanitary water supply &waste disposal e.g. sanitary latrines.
2. Mechanization of agriculture, irrigation & drainage system.
4. Provision of recreation places in rural areas.
5. Snail control:
- Periodic drying of canals.
- Clearance from vegetation.
- Trapping snails.
- Manual collection of snails.
- Molluscicides to kill snails.

73. II. Protection of susceptible host:
Health education for:
1. Mode of transmission.
2. Role of defecation & urination in canal water.
3.Drying of skin after water contact to kill cercaria before
entering skin.
4.Wearing PPE on water contact e.g. gloves & boots.
5. Seek medical ttt early when infected.

74. III. Secondary prevention:
A- Measures for cases:
1. Early case finding by routine stool & urine examination for S. eggs
at any occasion of health appraisal, such as:
(a) Health appraisal of school children.
(b) Examination of army recruits.
(c) Periodic checkup.
(d) Pre-placement examination.
(e) All attendants of health services.
2. ttt of discovered cases.
3. Re-examination to be sure of cure.
4. Health education for preventing re-infection.

75. B- Measures for contacts:
No special measures as there is no man to man infection;
but the following are recommended:
1. Stool & urine examination for early detection of cases.
2. Health education to avoid infection.
3. Mass treatment controls reservoir of infection & limits
spread of disease. Praziquantel (non-antimonial drug)
“orally in a single dose, 30 mg/Kg BW with a max. of
2400 mg (4 tablets)”.

76. Treatment of Schistosomiasis
1. Praziquantel (non-antimonial drug): orally in a single
dose, 30 mg/Kg BW with a max. of 2400 mg (4 tablets). It
is available as:
- Tablets 600 mg as: Distocide tab., Biltricide tab.,
Praziquantel tab.
- Suspension 600 mg/5 ml as: epiquantel susp.
2. Commiphoramukul extract: as Mirazid 300 mg, 2
caps daily on an empty stomach.

78. o Endemic parasitic helminthic disease which is prevalent
in underdeveloped countries.
o More prevalent in Upper than in Lower Egypt.
o Declining due to community development of rural areas
& availability of health services.

79. Contact of bare skin with
moist contaminated soil
Attached to mucosa
by mouth capsule.
continuously sucking
blood & laying eggs
Ancylostoma duodenale

82. Reservoir of infection: Man: infected person who
discharges eggs in faeces
Period of communicability: untreated cases remain
infective for years.
IP: 6 ws from penetration of skin to appearance of
eggs in stool.

83. Clinical picture:
- May be asymptomatic.
1 - Ground itch: local dermatitis at site of entry of larvae.
2- Respiratory manifestations “migrating larvae”: Patchy
lung consolidation, Upper respiratory catarrh.
3- Anaemia: microcytic hypochromic anaemia due to
chronic blood loss by worm sucking blood.
4- General manifestations: retarded physical growth &
mental development of children.

84. Diagnosis:
1- C/P: suggestive but not diagnostic.
2- Laboratory: Stool exam. to detect the 4-cell eggs.

85. Environment
• Unsanitary
environment.
• Lack of safe water
supply for bathing &
washing.
• Unavailable latrines.
• Suitable climate (temp.
& humidity) for eggs to
hatch & continue life
cycle.
Host
• Age: children of
underdeveloped areas.
• Occupation: farmers &
agriculture workers.
• Habits & behaviour:
Promiscuous defecation in
field & vicinity of houses.
• Bare foot & getting in
contact with contaminated
soil.
• Reluctance of cases to seek
medical treatment &
repeated exposure.

86. Control:
I- Prevention:
1- Community development: safe water supply &
sanitary latrines.
2- Health education: Avoid promiscuous defecation
& contamination of soil. Not to walk bare footed or
sit on the soil.
3- Upgrading of health services.

87. II. Measures for cases:
1 - Case finding by different methods:
Comprehensive medical exam. e.g. school children, pre-placement
& periodic exam of workers, military camps, etc.
Routine medical exam. in rural health units & outpatient clinics.
Survey studies.
2 - Treatment of cases to eliminate reservoir of infection.
3 - Re-examination to be sure of cure.
4 - Treatment of associated conditions such as anaemia.
5 - Health education to prevent re-infection.
III. Measures for contacts: non as there is no man to man
transmission.

88. Parasitic diseases transmitted by contact
(infective stage pierces skin)
Disease Agent
Source
of
infection
IP Clinical picture
Period of
infectivity
Specific prevention
Schistosoma
hematobium
mansoni
Cerca-
ria in
canal
water
Case
5-8
weeks
Itching dermatitis on
cercaria penetrating skin
weakness, anemia,
hematuria, blood in
stool.
Complication: cystitis,
stone, colitis, liver
cirrhosis, failure,
osphageal varices.
As long as
patient defecate
or urinate in
water containing
snails
Health education, mechanical use
in irrigation, no contact with
infected canals, sanitary water
supply, recreation club for children
in rural areas. No defecation in
canals. Snail control. Use
praziquantel, bilarcid or ambilhar
as mass treatment.
Accylosto-
miasis
Filarifor
m larva
Case
6
weeks
Ground itch, cough,
catarrh anemia, retarded
growth of children
As long as
patient pass
eggs
Sanitary latrines, health education,
no bare foot, no defecation in soil,