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Air borne diseases

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air borne diseases
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Air borne diseases

  1. 1. AIR BORNE DISEASES & CASES APPLICATIONS By Doaa Habib Under supervision of Prof dr Mona Aboserea Zagazig university
  2. 2. CONTENT  Infectious chain  Mode of transmission  Definitions  Classification  Viral infections  Emerging airborne infections  Bacterial infections  Questions
  3. 3. INFECTIOUS CHAIN  Air borne or droplet or respiratory tract infections:  Agent : virus, bacteria, fungi.  Reservoir: mainly man, animal.  Exit: respiratory secretion.  Mode of transmission: inhalation  Inlet: nose, mouth.  Host: susceptible individual.
  4. 4. MODE OF TRANSMISSION  Direct Droplet spread  Indirect Airborne Indirect contact
  5. 5. DEFINITIONS  Air borne transmission :  occurs when infectious agents are carried by dust or droplet nuclei suspended in air.  Droplet nuclei are dried residue of less than 5 microns in size.  Droplet nuclei may remain suspended in the air for long periods of time and may be blown over great distances.  for example, Measles and TB .
  6. 6. DEFINITIONS  Droplet spread :  Refers to spray with relatively large, short-range aerosols produced by sneezing, coughing, or even talking.  Droplet spread is classified as direct because transmission is by direct spray over a few feet, before the droplets fall to the ground.  Examples, Pertussis and meningococcal infection.
  7. 7. CLASSIFICATION
  8. 8. CLASSIFICATION Less common infections: Viral: herpes simplex, Epstein-bar, hand, foot and mouth disease. Bacterial: chlamydia pneumonia, legionella, mycoplasma Fungal: Candida , Coccidioidomycosis, Cryptococcosis, Histoplasmosis, Pneumocystis carinii pneumonia.
  9. 9. VIRAL: INFECTIOUS MONONUCLEOSIS AND HERPES SIMPLEX  Caused by Epstein Bar virus in case of infectious mononucleosis and Herpes simplex virus in case of Herpes simplex.  Infectious Mononucleosis is manifested by sore throat, lymphadenopathy, splenomegaly, skin rash and stomatitis.  Herpes Simplex usually produce vesicular stomatitis. The illness may starts acutely with fever and oral pain, followed by appearance of lesions on lips, gums, mucosa, tongue, palate. Management  Symptomatic  IV fluid in case of severe difficulty in swallowing.  Gentian violet helps to prevent secondary infection in Herpes simplex.  If secondary bacterial infection occurs, penicillin or metronidazole should be prescribed
  10. 10. VIRAL: HAND, FOOT, AND MOUTH DISEASE  Hand, Foot, and Mouth Disease, or HFMD, is a viral contagious illness caused by coxsackie virus common in infants and children younger than 5 years old. Transmission: Close contact, droplet, contact with blister fluid  c/p: fever, mouth sores, and a rash, HFMD is usually not serious, and nearly all people recover in 7 to 10 days without medical treatment.  Complication: Rarely, viral meningitis polio-like paralysis, or encephalitis HFMD spreads from an infected person to others from: Management: symptomatic
  11. 11. BACTERIAL: CHLAMYDIA PNEUMONIA  Agent: C. pneumoniae  IP: 3 to 4 weeks  Transmission: close contact , respiratory droplets, contact with contaminated surfaces.  c/p: cough, fever, headache, malaise and can develop:  Laryngitis, Pharyngitis, Pneumonia  Complication: Exacerbation of asthma, Encephalitis, Myocarditis  Diagnosis: 1. culture 2. Serology: CF, Micro immunofluorescence (MIF) is the serological method of choice 3. PCR  Management: 1) Macrolides (azithromycin) — first-line therapy 2) Tetracyclines (tetracycline and doxycycline): not for children 3) Fluoroquionolones
  12. 12. LEGIONNAIRES’ DISEASE  Agent: Legionella bacteria (L. pneumophila)  Reservoir: natural, freshwater environments, human-made water systems (e.g., plumbing system of large buildings, cooling towers, decorative fountains, hot tubs)  IP: 3 to 4 weeks  Transmission: inhaling aerosolized water droplets, aspiration of contaminated drinking water. Legionella is usually not transmitted from person to person. however, a single episode of person-to person  Risk Factors  Age ≥50 years  Smoking (current or historical)  Chronic lung disease, such as emphysema or COPD  Immune system disorders due to disease or medication  Systemic malignancy  Underlying illness, such as diabetes, renal failure, or hepatic failure
  13. 13. Legionnaires’ disease Pontiac fever Pontiac fever Clinical features Fever, myalgia, and cough shortness of breath, headache, confusion, nausea, diarrhea may be present flu-like illness, often with fever, chills, headache, myalgia, fatigue, malaise; less often with symptoms such as cough or nausea Pneumonia (clinical or radiographic) Yes No Pathogenesis Replication of organism Possibly an inflammatory response to endotoxin Incubation period 2 to 10** days after exposure 24 to 72 hours after exposure occuracce Less than 5% of people exposed to the source of Legionella Greater than 90% 3 Treatment Antibiotics Supportive care (because illness is self-limited) Isolation of the organism Possible Never demonstrated Outcome Hospitalization common Case-fatality rate: 10% (25% for healthcare-associated) Hospitalization uncommon Case fatality rate: extremely low
  14. 14. LEGIONNAIRE DISEASE  Diagnosis: Best practice is to obtain both sputum culture and the urinary antigen test Indications for Legionnaires’ Disease Testing:  Patients who have failed outpatient antibiotic treatment for community-acquired pneumonia  Patients with severe pneumonia, in particular those requiring intensive care  Immunocompromised patients with pneumonia*  Patients with a travel history (patients who have traveled away from their home within 10 days before the onset of illness)  All patients with pneumonia in the setting of a Legionnaires’ disease outbreak  Patients at risk for Legionnaires’ disease with healthcare-associated pneumonia (pneumonia with onset ≥ 481 hours after admission)  Management: Macrolides and respiratory fluoroquinolones
  15. 15. MYCOPLASMA PNEUMONIA  Agent: M. pneumoniae  IP: 1 to 4 weeks  Transmission: airborne droplets from person to person and is exclusively a human pathogen.  c/p: cough, fever, headache, malaise and can develop: Tracheobronchitis, Pharyngitis Pneumonia  Complication: Exacerbation of asthma, Encephalitis, Myocarditis, Hemolytic anemia, Renal dysfunction, Erythema multiforme, Stevens- Johnson syndrome, or toxic epidermal necrolysis  Diagnosis: 1. culture 2. Serology: enzyme immunoassay (EIA) testing 3. PCR  Management: it does not respond to sulfonamides or penicillin (beta- lactams). 1) Macrolides (azithromycin) — first-line therapy 2) Tetracyclines (tetracycline and doxycycline): not for children 3) Fluoroquionolones
  16. 16. FUNGAL INFECTION Candidiasis This illness is caused by Candida. Candidiasis, can affect the skin, nails, and mucous membranes throughout the body. Persons with HIV infection often have trouble with Candida, especially in the mouth and vagina. However, candidiasis is only considered an OI when it infects the esophagus (swallowing tube) or lower respiratory tract, such as the trachea and bronchi (breathing tube), or deeper lung tissue. Coccidioidom ycosis This illness is caused by the fungus Coccidioides immitis. It most commonly acquired by inhaling fungal spores, which can lead to a pneumonia that is sometimes called desert fever, San Joaquin Valley fever, or valley fever. Cryptococcos is This illness is caused by infection with the fungus Cryptococcus neoformans. The fungus typically enters the body through the lungs and can cause pneumonia. Histoplasmosi s This illness is caused by the fungus Histoplasma capsulatum. Histoplasma most often infects the lungs and produces symptoms that are similar to those of influenza or pneumonia. People with severely damaged immune systems can get a very serious form of the disease called progressive disseminated histoplasmosis.
  17. 17. PNEUMOCYSTIS PNEUMONIA  Agent: fungus Pneumocystis jirovecii (carinii)  IP: 1 to 4 weeks  Risk: HIV, Solid organ transplant, Blood cancer, Inflammatory diseases or autoimmune diseases, Stem cell transplant  Transmission: airborne droplets from case or carrier.  c/p: cough, fever, headache, Difficulty breathing, Chest pain, Chills Pneumonia  Complication: highly fatal.  Diagnosis: 1. sputum or bronchoalveolar lavage Or lung tissue biopsy is examination under a microscope. 2. PCR 3. A blood test to detect β-D-glucan  Management: trimethoprim/sulfamethoxazole also known as co-trimoxazole  Prevention: co-trimoxazole for patients at risk.
  18. 18. German measles “Rubella” Measles “Rubeola” Cases & incubatory Carriers. Congenitally Infected infants act as reservoir for 1 year"in respiratory secretion, blood, urine, & stool” Man only case or contact healthy carrier (inresp. secretion) Source of infection 14-18 days10 daysIP 1 week before & 7 days after rash In prodromal stage & 5 days after rash Period of infectivity
  19. 19. German measles “Rubella” Measles “Rubeola” C/P - 1 day - Mild symptom - Cervical lymph adenopathy. - 3-4 days Fever, cough, Catarrh, Conjunctivitis - Koplik's spots on 2nd day “Tiny bluish white spots on buccal mucosa”. Prodroma lstage - Lasts for 3 days. - Maculo-papular or uniform red all over body. On 4th day red blotchy appears on face, root of hair then generalized. Branny desquamation after 1 week. Rash - Congenital rubella syndrome “CRS”: infection during 1st trimester(16 weeks). Causes cataract, deafness, heart anomaly, mental retardation. - Otitis media, cervical adenitis - Encephalitis - Pneumonia - Otitis media Complication
  20. 20. German measles “Rubella” Measles “Rubeola” Pre vent ion Rubella alone or MMR live attenuated, single dose 0.5ml SC. given at 12-15th month. Given to adolescent girls or females at any age before pregnancy. MMRV:12M - 12 years of age. The minimum interval is 3 months Life long immunity. Type: live attenuated virus Preparations: MMR, MMRV Administration: 0.5 ML subcutaneous injection. Schedule: MMR: 2 doses, 1st at 12-15 months and booster dose( at least 28 day after 1st dose) at 4-6 years before school entry. Life long immunity Vaccination Vaccine and IGS are not effective Pregnant exposed to infection & refuse abortion. Vaccine within 3days of exposure is protective Within 6 days of exposure Sero-prevention: Human Ig. Sero-attenuation: smaller dose to give mild C/P. PEP
  21. 21. ZosterChicken poxSmall pox Preparation, type: Zostavax: live attenuated virus. Shingrix :recombinant zoster vaccine Administration: 0.5ml SC injection in arm Schedule: Zostavax: single dose. Shingrix : IM two doses separated by 2 to 6months. Type: live attenuated virus Preparation: varivax (varicella alone), MMRV Administration: 0.5 ML subcutaneous injection Schedule: First dose at 12 -15 months old, Second dose at 4 -6 years Calf lymph vaccine: vaccinia virus ACAM2000 Aventis Pasteur Smallpox Vaccine (APSV): Imvamune: attenuated live vaccine, underdevelopment. Administration, Schedule : Calf lymph vaccine: single dose by scratching. ACAM2000, Aventis Pasteur Smallpox Vaccine (APSV): single dose by the percutaneous route using the multiple puncture technique. Vaccination varicella vaccine: within 3 daysup to 5 days, of exposure to rash. zoster immune globulin (ZIG): within 72 to 96 hours after exposure Vaccination Within 3 days prevent, 5-7 days mild symptoms PEP
  22. 22. VIRAL INFECTIONS WITHOUT RASH MumpsCommon coldinfluenza VirusRhino v.Virus types A:mutation &pandemics B:epidemic C:outbreaks Agent Cases & incubatory carriers (saliva & in utero) CasesHuman cases only “may be Avian, swine, horses” Source of infection 18 days1-3 daysIP 1 week before parotitis till disappearance of swelling. All course of diseasePeriod of infectivity
  23. 23. MumpsCommon cold influenza Prodroma: 1-2 days fever, malaise, headache, body aches. Enlarged painful salivary gland (parotid, sublingual, submaxillary) Sudden onset catarrh, running nose, sneezing, sore throat, cough. Usually no fever Sudden high fever, body aches, arthralgia, sore throat, cough. C/P Orchitis, oophritis, aseptic meningitis, pancreatitis, mastitis, nephritis, neuritis Rare.Pneumonia, otitis media, sinusitis, pericarditis, bronchitis Complication
  24. 24. Mumps C.C influenzaVaccination MMR 0.5ml SC or mumps vaccine alone. Must be before puberty. Life long immunity. No 1- Inactivated : Trivalent: 5 years – 65 years, high dose, adjuvant vaccine > 65 years Quadrivalent: 6months – 64 years 2- Live attenuated: Trivalent, Quadrivalent: 2 years – 64 years 3- Quadrivalent Recombinant: > 18 years Administration, Schedule : Inactivated:0.5 ml IM, 2 doses separated by 4 weeks. Live attenuated: 0.2 ml intranasal, one dose. PEP booster dose of MMR within 5 days Chemoprophylaxis: Oseltamivir, Zanamivir
  25. 25. EMERGING VIRAL AIR BORNE INFECTIONS  Avian flu( H5N1)  Swine flu (H1N1)  SARS  MERS- COV
  26. 26. Swine fluAvian flu H1N1H5N1, H7N9(Asian form) Ag en t pigsPoultry, wild birds, pigs S. INF 2 - 14 days (internationally 7 days) 14 days (internationally 7 days) IP All coarse of diseaseMan to man transmission Is very rare infec tivity mild to severe and included conjunctivitis, influenza-like illness (e.g., fever, cough, sore throat, muscle aches), pneumonia sometimes accompanied by nausea, abdominal pain, diarrhea, and vomiting C/P Fatality is lowacute respiratory distress, respiratory failure), neurologic changes (altered mental status, seizures), and the involvement of other organ systems. Complicati on The H1N1 Inactivated Vaccine (2 dose, IM) The H1N1 Live Attenuated Intranasal Vaccine Vaccine for birds Vaccination Like flu P E P
  27. 27. CLASSIFICATION
  28. 28. Scarlet feverStrpt. Pharyngi tis Diphteria NoUnder trial Type: Diphtheria: toxoid Preparation: 1- Diphtheria and Tetanus (DT and Td) 2- Diphtheria, Tetanus, acellular Pertussis (DTaP) Vaccines 3- Tetanus, Diphtheria, acellular Pertussis (Tdap) Vaccines IM injection on 2, 4, 6 months, 15 -18 months, and 4 through 6 years Vaccination Chemoprophylaxis is not recommended Antibiotics: benzathine penicillin G, erythromycin. Diphtheria antitoxin is not indicated for prophylaxis of contacts of diphtheria patients. PEP
  29. 29. TBPertussisMeningitis Preparation, type: Live attenuated bovine strain. Administration, Schedule : 0.1 ml intradermal injection in deltoid of lt arm, single dose Type: Pertussis; killed bacteria in DPT Preparation: 1- Diphtheria and Tetanus (DT and Td) 2- Diphtheria, Tetanus, acellular Pertussis (DTaP) Vaccines 3- Tetanus, Diphtheria, acellular Pertussis (Tdap) Vaccines IM injection on 2, 4, 6 months, 15 -18 months, and 4 through 6 years Capsular polysaccharide vaccine: quadrivalent, capsular polysaccharide Meningococcal conjugate: quadrivalent, meningococcal A, C, W, and Y polysaccharides conjugated to protein adjuvant. serogroup B meningococcal vaccines: monovalent, recombinant protein vaccines Administration, Schedule : Capsular polysaccharide vaccine: 0.5 ml IM, 2 doses 3months apart Meningococcal conjugate: 0.5 ml IM, 2 doses 2 months apart serogroup B meningococcal vaccines:0.5 ml IM, 2 doses 1months apart Vaccination INH orally for 1 year .Oral erythromycin in 4 divided doses for 10 days Rifampin 600mg twice 2 days International certificate to endemic area, ciprofloxacin, and ceftriaxone may be used PEP
  30. 30. DPT VACCINE Preparation: 1- for children < 7 years (DTaP and DT) 2- for persons > 7 years (Tdap and Td) They differ in concentrations of diphtheria and tetanus concentrations 1- for children < 7 years: concentration of DT toxoid (25 Lf of diphtheria toxoid, 10 Lf of tetanus toxoid) is higher than td and D toxoid concentration is higher than T toxoid. 2- for persons > 7 years: concentration of td toxoid (5 Lf tetanus toxoid, 2 Lf diphtheria toxoid) is lower than TD and t toxoid concentration is higher than d toxoid. Contraindications to acellular pertussis-containing vaccines: 1. Patients who developed encephalopathy within 7 days of administration of a previous dose of DTP, DTaP, or Tdap 2. Progressive or unstable neurologic disorder (including infantile spasms for DTaP) 3. Uncontrolled seizures 4. Progressive encephalopathy 5. Had Guillain-Barré syndrome within 6 weeks after a previous dose of tetanus toxoid-containing vaccine
  31. 31. Pneumococcal diseaseHib disease lancet-shaped, gram-positive capsulatedgram-negative coccobacillus. Mostly encapsulated Ag nasopharyngeal carrier or case patientnasopharyngeal carrier or case patient. aspiration of amniotic fluid or contact with genital tract secretions S.inf 1 to 3 days2-4 days Ip transmission can occur as long as the organism appears in respiratory secretions. Secondary attack rate is 2-6% p.If Ear infections, Sinus infections, Pneumonia, Meningitis, Bacteremia Pneumonia, Bacteremia, Meningitis, Epiglotittis, Cellulitis, Infectious arthritis C/P Preparation, type: pneumococcal conjugate vaccine (PCV7): IM Pneumococcal Conjugate Vaccine (PCV13); Pneumococcal Polysaccharide Vaccine (PPSV23): IM or SC Administration, Schedule: (2 doses, 8 weeks apart) Routine: at 2, 4, and 6 months of age, Booster dose at 12 through 15 months of age. Preparation, type: a polysaccharide conjugate vaccine. Monovalent: Hib Combined: pentacel ( DTaP + Hib + IPV) Administration, Schedule: IM injection at 2,4,6 months OR 2,4 months and booster 12 - 15 months Vacc Not recommendedRifampicin 600mg twice daily pep
  32. 32. CASE STUDY A "5" years old girl was bought to the outpatient clinic because of rash covering the girl's face, it was preceded by fever, malaise for 3 days. a)What is the differential diagnosis? On examination, the rash was red blotchy maculopapular rash and there was bluish spot on the girl’s buccal mucosa. b) What is the provisional diagnosis? c) How to confirm? d)What are the preventive and control measures that should be done for the case, house hold contact including 10 months brother and her school contacts .
  33. 33. CASE 1 a) Differential diagnosis:  Measles (maculopapular, first on face, on 4th day of high fever)  Rubella (maculopapular, after 1 day of low fever , cervical lymph nodes)  Varicella ( pleomorphic, after 2-3 days of low fever, first on trunk centripetal)  smallpox ( monomorphic, high fever, first on extremities) Less likely  Scarlet fever (no rash in the face)  Meningitis (high fever, convulsions)  Drug or food allergy (history of exposure)
  34. 34. CASE 1 b) the provisional diagnosis: probable case of measles c) Confirm diagnosis:  Isolation of measles virus from a clinical specimen; or  Detection of measles-virus specific nucleic acid from a clinical specimen using polymerase chain reaction; or  IgG seroconversion or a significant rise in measles immunoglobulin G antibody using any evaluated and validated method; or  A positive serologic test for measles immunoglobulin M antibody; or  Direct epidemiologic linkage to a case confirmed by one of the methods above.
  35. 35. CASE 1 Case: notification to LHU- isolation (4 days after rash in measles)- concurrent disinfection-ttt- release after rash disappearance. Treatment  There is no specific antiviral therapy. Symptomatic, address complications such as bacterial infections.  Severe measles cases among children should be treated with vitamin A. Contact: enlistment- surveillance - HE Segregation: from school, child care, health care setting MMR vaccine: within 72 hours of initial measles exposure to those without evidence of immunity Immunoglobulin (IG) : People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women and immuno compromised people Its recommended to give vaccine rather than IGS to the baby and later on he take the routine 2 doses of MMR School contacts If sure of immunization (document 2 doses): survillance- HE to avoid further exposure. If not sure of previous immunization, or child have fever or respiratory catarrah before or the child is immunocompromised: seroprevention, seroattenuation Outbreak measures: booster dose MMR
  36. 36. CASE 2 A student 7 years old complaining of fever, sore throat, headache and malaise was detected by school nurse. a)What is the provisional diagnosis? b)What is the differential diagnosis? c)What are the preventive measures that should be done in school according to the type of disease identified? d)What are the measures taken for the sick child? His house hold contacts?
  37. 37. CASE 2  provisional diagnosis: Streptococcal pharyngitis.  differential diagnosis:  Strept. Pharyngitis  Diphtheria  Influenza :short I.P(1-3 days), sudden onset of fever, constitutional manifestation  Common cold: mild fever, running nose  Less likely: Meningitis: high fever, convulsions  Prodroma of measles, rubella
  38. 38. CASE 2 preventive Measures done in school General preventive measures: good ventilation, HE, notification if get ill In strept: chemoprophylaxis is not recommended In diphtheria: close survillence and administer antitoxin with the first sign of disease.  if immunized before: booster dose of D toxoid, not immunized 2 doses of vaccine.  prophylaxis by antibiotics to all contacts  benzathine penicillin G Single dose. or  a 7- to 10-day course of oral erythromycin (40 mg/kg/day for children and 1 g/day for adults).
  39. 39. CASE 2 measures taken for the sick child? His house contact ? Child: Penicillin or amoxicillin is the antibiotic of choice to treat group A strep pharyngitis. for 10 days Diphtheria:  Respiratory support and airway maintenance should also be administered as needed. Diphtheria Antitoxin  Diphtheria antitoxin, 20,000 - 80,000 I.U. (or even 100,000 in severe cases) I.M. or I.V.  The patient must be tested for sensitivity before antitoxin is given. Antibiotics: The antibiotics of choice are  erythromycin (500 mg four times daily for 14 days) or  procaine penicillin G (600,000 units every 12 hours intramuscularly) until the patient can take oral medicine, followed by oral penicillin V (250 mg four times daily) for a total treatment course of 14 days.  Elimination of the organism should be documented by two consecutive negative cultures after therapy is completed at least 24 hours apart .  Maintain isolation until elimination of the organism .  Vaccination is required because clinical diphtheria does not necessarily confer immunity
  40. 40. CASE 2 House contacts: Strept. Pharyngitis: HE, SURVIELLENCE FOR 3 DAYS Diphtheria:  close surveillance and begin antitoxin at the first signs of illness.  a diphtheria booster if vaccinated before, 2 doses if not vaccinated. AND  Antibiotics:  benzathine penicillin G Single dose (600,000 units for persons younger than 6 years old and 1,200,000 units for those 6 years old and older) or  a 7- to 10-day course of oral erythromycin (40 mg/kg/day for children and 1 g/day for adults).  Identified carriers should also receive antibiotics.  Adult with occupational contact with children —» allow to go to work only after 2 more -ve swabs.  If the swab is positive —» Segregate (exclude) from school or work until 3 consecutive negative swabs 24 hours apart is obtained.  Diphtheria antitoxin is not indicated for prophylaxis of contacts of diphtheria patients
  41. 41. CASE 3 A male adult aged 50 years old working as public bus driver, complaining of low fever, loss of weight, night sweating, cough and anorexia. Symptoms began since 2 weeks. a) What is the provisional diagnosis? b) How can you verify your diagnosis? c) What are the preventive measures that must be done for that case, wife, 1 and 18 years old children and his old father 70 years?
  42. 42. CASE 3 the provisional diagnosis: Probable Pulmonary tuberculosis - history: elderly-male patient - c/p: low grade fever, loss of wt, anorexia, night sweating, cough Confirm diagnosis: A) Bacteriology: 1) Detection of TB bacilli ( Direct smear microscopy, laryngeal swabs, culture). 2) Tuberculin test ( immune response to TB). 3) Histo-pathological diagnosis. 4) BACTEC ( detection of metabolic end products of bacilli). 5) PCR ( detection of DNA of TB bacilli). B) Radiology: sensitive but not specific
  43. 43. CASE 3 Measures for case: case finding, notification to LHU, isolation for 4-8 ws, disinfection, ttt, follow 5 years Treatment: DOTS  first 2 months: isoniazid + rifampicin + pyrazinamide + ethambutol  following 4 months: isoniazid + rifampicin Measures for Contacts: enlistment- HE  tuberculin testing  tuberculin -ve give BCG vaccine and prevent contact with the case till 3 months  tuberculin +ve do chest x ray, if suspicious do smear exam. Give INH. Chemoprophylaxis: INH (isonicotinic acid hydrazid) orally for 1 year. Year: BCG in first 3 months, so TST is +ve > 15mm Sputum exam (+ve: DOTS), (-Ve: chemoprophylaxis) 18 years: TST test, sputum exam If both +ve (DOTS)- IF both –ve ( BCG) IF TB +ve and sputum –ve: chemoprophylaxis Father (70 ys), Pregnant: immunocompromised C.I of BCG>35ys, INH risk of induce hepatitis
  44. 44. CASE 4 A 15 years old girl came to the out patient clinic complaining from high fever, vomiting, neck rigidity and convulsion. a) What is the differential diagnosis? On examination there was dark red petechial eruption on extremities. b) What is the provisional diagnosis? c) How to confirm? d) What is the measures taken to the case and her contacts?
  45. 45. CASE 4 a) Meningitis for differential diagnosis Bacterial:  Neisseria meningitides  haemophilus influenza  Streptococcus pneumoniae  Group B Streptococcus  Listeria monocytogenes Viral:  Non-polio enteroviruses, the most common  Mumps virus  Herpesviruses, including , herpes simplex viruses, and varicella- zoster virus.  Measles virus  Influenza virus  Arboviruses, such as West Nile virus Fungal: in immunocompromised Cryptococcus, Histoplasma Non infectious: autoimmune, injury, tumors
  46. 46. CASE 4
  47. 47. CASE 4 b) Provisional diagnosis: suspected meningococcal meningitis due to presence of purpura fulminans. c) Confirm diagnosis:  Detection of N. meningitidis-specific nucleic acid in blood or CSF), using a valudated polymerase chain reaction (PCR) assay; or  Isolation of N. meningitidis From blood or CSF, or less commonly or purpuric lesions.
  48. 48. CASE 4 d) Measures to case, contact. Case:  effective antibiotics should be administered promptly to patients suspected of having meningococcal disease.  treatment with penicillin G, ampicillin, or an extended-spectrum cephalosporin (cefotaxime or ceftriaxone) .  if antimicrobial agents other than ceftriaxone or cefotaxime are used for treatment, eradication of nasopharyngeal carriage with rifampin (4 doses over 2 days) or single doses of ciprofloxacin or ceftriaxone are recommended prior to discharge from the hospital. Contact:  Antibiotic chemoprophylaxis: ideally should be initiated within 24 hours after the index patient is identified; prophylaxis given >2 weeks after exposure has little value.  Antibiotics used ciprofloxacin, rifampin, and ceftriaxone.  Ceftriaxone is recommended for pregnant women.  Rifampin 600mg twice daily.
  49. 49. CASE 5 A 35 years old man come to out patient clinic complaining from chest pain, productive Cough, Dyspnea and high fever The patient is smoker for 5 years. a) What is provisional diagnosis? b) What is the causative agent of the disease? c) The gram stain shows gram positive cocci, How to confirm diagnosis? d) What are measures taken for the patient and his contacts?
  50. 50. CASE 5 a) provisional diagnosis: pneumonia b) Causative organism: Viral: influenza and respiratory syncytial virus (RSV) Bacterial: pneumococcus, legionella, mycoplasma, H. influenza Fungal: pneumocystis pneumonia. c) pneumococcal pneumonia confirmed by:  Supportive: Identification of S. pneumonia from a normally sterile body site by a CIDT(culture independent diagnostic tests like PCR ) without isolation of the bacteria.  Detect capsular polysaccharide antigen in body fluids or in urine by immunochromatographic membrane technique.  Confirmatory: Isolation of S. pneumonia from a normally sterile body site by culture.
  51. 51. CASE 5 d) Measures taken for the patient and his contacts: Patient: notification, isolation, disinfection, treatment General: support respiration, symptomatic. Specific: S. pneumonia are resistant to one or more clinically relevant antibiotics so treatment depend on culuture and sensitivity. Contacts: enlistment, HE, surveillance for 3 days Chemoprophylaxis The American Academy of Pediatrics typically recommends daily antimicrobial prophylaxis with oral penicillin V or G for children with functional or anatomic asplenia, especially those with sickle-cell disease. Because secondary cases of invasive pneumococcal infection are uncommon, chemoprophylaxis is not indicated for contacts of patients with such infection. Vaccination: pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23)  Are recommended for all children, old age, adults with certain diseases  It is also recommended after infection because infection doesnot prevent future attacks.
  52. 52. CASE 6 5 years girl was brought to your office by her mother complaining from pruritic vesicular rash covering her body and preceded by fever. a) What is your diagnosis? b) How to confirm it? c) What are the measures taken for the girl and her contacts?
  53. 53. CASE 6 a) Diagnosis: probable case of chicken pox (varicella infection) b) Confirm diagnosis:  Epidemiologic linkage to another probable or confirmed case, OR  Laboratory confirmation by any of the following:  Isolation of varicella virus from a clinical specimen, OR  Varicella antigen detected by direct fluorescent antibody test, OR  Varicella-specific nucleic acid detected by polymerase chain reaction (PCR), OR  Significant rise in serum anti-varicella immunoglobulin G (IgG) antibody level by any standard serologic assay
  54. 54. CASE 6 c) Measures to girl & contacts : The girl: notification, isolation 7 days, disinfection ,ttt  symptomatic, analgesics, calamine lotion and antihistaminic  treatment with antivirals is not routinely recommended for otherwise healthy children with varicella. Contacts: Previous Varicella infection or 2 doses of vaccine give life long immunity, no need to PEP. varicella vaccine: is effective in preventing illness or modifying varicella severity if administered to unvaccinated children within 3 days, and possibly up to 5 days, of exposure to rash. zoster immune globulin (ZIG): within 72 hours of exposure , 96 hours after exposure in Immuno compromised patients but may be effective if administered as late as 10 days .
  55. 55. CASE 7 11 years old boy come to your office complaining from fever and swelling behind his ear. a) What is the possible diagnosis? b) What are the complications of such case? c) What are the measures taken for the boy and his contacts?
  56. 56. CASE 7 a) Diagnosis: suspected mumps case b) Complication :  Orchitis, usually unilateral in 20-30% of post pubertal males (rarely may induce sterility)  CNS involvement (aseptic meningitis, Encephalitis).  Pancreatitis.  Neuritis, arthritis, mastitis, nephritis, thyroiditis and pericarditis may occur.  Permanent nerve deafness (usually unilateral) is a rare complication.
  57. 57. CASE 7 c) Measures for the boy & contacts: The boy: notification, isolation, disinfection, ttt. Isolation: relieve of swelling (9 days). Treatment: symptomatic Contacts: enlistment, segregation, HE, surveillance for 2 weeks.  2nd dose of MMR within 5 days.  third MMR dose administered as PEP did not have a significant effect, it may offer some benefits in specific outbreak contexts.  Immune globulin (IG) is not effective postexposure prophylaxis.
  58. 58. CASE 8 10 months baby boy brought by his mother to your office complaining from attacks of productive cough which increase at night and end with vomiting. The mother also complained from strange cough sound. a) What is the provisional diagnosis? b) What are the complication of this disease? c) What are the measures taken to the baby and his contacts?
  59. 59. CASE 8 a) Diagnosis: whooping cough ( pertussis infection). b) Complications: 1- Increasing pressure during paroxysmal coughing: * Hernia (especially umbilical) and prolapse of rectum. * Convulsions in infants due to cerebral anoxia. * Hemorrhage: skin, nasal, conjunctiva and C.N.S. *Encephalopathy in severe cases from cerebral anoxia or hemorrhage. 2- Secondary bacterial infection: may cause otitis media, diarrheal disease, pneumonia and bronchopneumonia. 3- Malnutrition: due to repeated vomiting for long time in untreated cases. 4- Long term complications which include neurological deficits ranging from gross mental retardation to behavior disorders.
  60. 60. CASE 8 c) Measures for baby & contact: Baby: Case finding, Notification, Isolation , disinfection. Treatment:  Specific: - erythromycin : administered in 4 divided daily doses for 14 days  symptomatic: - Proper feeding. - Prevention and management of complications. - Release: pupils can return to school after 3 weeks from start of whooping stage and improvement of the case clinically or one week from beginning of effective treatment. Contacts: enlistment, HE, surveillance 2 weeks Chemoprophylaxis: Oral erythromycin 50 mg/kg/day in 4 divided doses for 10 days. Providing PEP to all household contacts of a pertussis case.
  61. 61. CASE 9 65 years old man visit the out patient clinic complaining from painful rash on his shoulder for 3 days? a) What is the provisional diagnosis? b) What is the complication? c) What are the measures taken for the patient and his contacts, wife, pregnant daughter , and 10 years grandson?
  62. 62. CASE 9 a) Diagnosis: zoster infection (VZV ) b) Complications:  post-herpetic neuralgia  cranial or peripheral nerve palsies  sensory loss, deafness  ocular complications.  bacterial infection of the lesions, usually due to Staphylococcus aureus.  visceral involvement, meningoencephalitis, pneumonitis, hepatitis, and acute retinal necrosis.
  63. 63. CASE 9 c) Patient: notification, isolation, disinfection  Antiviral drugs: acyclovir, valacyclovir, and famciclovir  Analgesics  Wet compresses, calamine lotion to relieve some of the itching.  Vaccination (Shingrix ) after acute attack to prevent coming episodes. Contacts: enlistment, HE, surveillance Wife:  Evidence of varicella immunity: nothing  No Evidence of immunity and immunocompromised: VZIG during 72 – 96 Hours OR acyclovir for 7 days after 7 -10 days post exposure.  Shingrix should be offered
  64. 64. CASE 9 Pregnant daughter:  Evidence of varicella immunity: nothing  No Evidence of immunity:  VZIG during 72 – 96 Hours.  if she has signs and symptoms of varicella around the time of delivery 5 days before to 2 days after delivery, VZIG should be given to her neonate. 10 years grandson:  Evidence of varicella immunity: nothing  No Evidence of immunity: varicella vaccine: within 3 days, and possibly up to 5 days, of exposure to rash. zoster immune globulin (ZIG): within 72 hours of exposure , 96 hours after exposure in Immuno compromised patients
  65. 65. CASE 10 6 months baby girl was brought to the out patient clinic suffering of fever, running nose and fast breathing .Her mother has fever, body aches, cough and sore throat for 2 days. a) What is the differential diagnosis? b) How to confirm diagnosis? c) What are the measures taken for the girl and her contacts?
  66. 66. CASE 10 a) Differential Diagnosis:
  67. 67. CASE 10 Other less possible diagnosis: 1. otitis media: fever, ear pain, irritability, crying. 2. sinusitis: postnasal discharge, high fever, cough, headache. 3. Strept. Pharyngitis: high fever- sore throat-red oedmatous pharynx, tonsil 4. Catarrhal stage of measles, rubella 5. Pertussis: upper respiratory catarrh for 10 days, paroxysmal attack of spasmodic cough (whooping cough) b) Confirm diagnosis: Clinically, the girl has influenza infection and early sign of pneumonia The diagnosis base on symptoms, history of contact with flu patient and fast breathing as early sign of pneumonia. o A case definition of fever 100°F or greater and cough and/or sore throat is used by CDC in Influenza-like Illness Surveillance Network (ILINet). o Individual cases of influenza typically are not investigated. Exceptions to this are severe, unusual complications. Or o suspected or confirmed to be of animal origin (most frequently swine or avian). o Definitive diagnosis of influenza requires laboratory confirmation in addition to signs and symptoms.
  68. 68. CASE 10 Measures to girl & contacts: Girl: notification, isolation, disinfection, ttt Treatment: Oseltamivir 3mg/kg twice daily for 5 days. Contacts: Chemo prophylaxis:  Antiviral chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the first exposure to a person with influenza.  once daily for 7 -14 days  Oseltamivir:75 mg, oral, used for 3months and older.  Zanamivir: 10 mg, inhaled , recommended from age 7 years and older. Indication:  people at high risk for complications who cannot receive influenza vaccine.  people at high risk of influenza complications during the first two weeks following vaccination.  people with severe immune deficiencies or others who might not respond to influenza vaccination. 2- vaccine: no post exposure prevention but still recommended if still in flu season.
  69. 69. CASE 11 3 years old boy visited the outpatient clinic with his mother complaining from generalized rash first appear on face and preceded by mild fever, on examination there was enlarged cervical lymph node. a) What is the possible diagnosis? b) How to confirm? c) What are measures taken for the child and house hold contacts including pregnant sister?
  70. 70. CASE 11 a) diagnosis: probable rubella infection b) Confirm diagnosis:  Isolation of rubella virus; or  Detection of rubella-virus specific nucleic acid by polymerase chain reaction; or  IgG seroconversion or a significant rise between acute- and convalescent-phase titers in serum rubella IgG antibody level by any standard serologic assay; or  Positive serologic test for rubella IgM antibody†* OR  Epidemiologic linkage to a laboratory-confirmed case of rubella.
  71. 71. CASE 11 Case: Isolation: for 5--7 days after rash onset. Treatment : There is no specific antiviral therapy. Symptomatic, address complications such as bacterial infections. Contact: Rubella vaccine and IG are not effective as PEP MEASURES taken to prevent spread of infection:  Identify and vaccinate susceptible persons who have no contraindications to rubella vaccine.  Ensure that pregnant women who are exposed to rubella are serologically evaluated for rubella-specific IgM and IgG antibodies.  Infection indicated by +ve IgM or rising titre of IgG or IgG seroconversion.  Counsel susceptible pregnant women regarding the risks for intrauterine rubella infection and recommend that they restrict their contact with persons with confirmed, probable, or suspected rubella for >6 weeks (two incubation periods) after rash onset in the last identified patient.  Abortion is recommended, IG in high dose if the mother refuse abortion.
  72. 72. MCQ There are reports of an outbreak of mumps in your community. As you prepare to see patients who may be infected, what should you consider regarding mumps? A. Two doses of the measles-mumps-rubella (MMR) vaccine provides over 99% protection against mumps B. Mumps is only communicable after the onset of parotitis C. Up to one-quarter of individuals infected with mumps virus may be asymptomatic D. Public health policies in schools effectively eliminate the risk of the spread of mumps Key: C
  73. 73. MCQ 2. As regard a third dose of MMR as post exposure prophylaxis. What is the policy of the Advisory Committee on Immunization Practices (ACIP)? A. It should be administered to household contacts only B. It should be administered to children between the ages of 5 and 12 years only C. It should be applied broadly in affected communities D. It should not be used at all KEY: A
  74. 74. MCQ What was the main result of using 3rd dose MMR as post exposure prophylaxis against mumps? A. MMR was not associated with a numerical or statistical benefit B. MMR was associated with a lower rate of secondary cases of mumps, but the result was not statistically significant C. MMR significantly reduced the risk of secondary cases of mumps D. MMR caused more cases of mumps than it prevented Key: B
  75. 75. MCQ 4. The commonest cause of bacterial meningitis in newborns is: A. Group B Streptococcus B. Streptococcus pneumoniae C. Listeria monocytogenes D. Escherichia coli KEY: A
  76. 76. MCQ 4. The commonest cause of bacterial meningitis in children is: A. Streptococcus pneumoniae B. Neisseria meningitidis C. Haemophilus influenzae type b (Hib) D. group B Streptococcus KEY: A
  77. 77. MCQ The most incriminated organism in causing bacterial meningitis in Teens and young adults is: A. Neisseria meningitidis B. Streptococcus pneumoniae C. Listeria monocytogenes D. Haemophilus influenzae type b (Hib) KEY: A
  78. 78. MCQ The main causative organism of viral meningitis is: A. Non polio enterovirus B. Mumps virus C. Measles virus D. Influenza virus KEY: A
  79. 79. MCQ A presumptive case of pulmonary TB in which there is only 2 of 3 smears are positive for AFB. What is the most appropriate action? A. Do a third confirmatory smear B. Initiate treatment C. Ask for x ray D. Ask for TB culture KEY: B
  80. 80. MCQ 50 years old man complain from cough for 1 month, anorexia, night sweat and fatigue. On sputum analysis, only one of three smears was positive for AFB, what is the suitable action? A. Repeat sputum analysis B. Begin treatment immediately C. Ask for x ray D. Consider another diagnosis Key: c
  81. 81. MCQ Tuberculin test is considered positive in previously immunized person with BCG if induration is: A. ≥ 5 mm B. ≥ 10 mm C. ≥ 15 mm D. 10 – 15 mm Key: c
  82. 82. MCQ All the following statements are wrong about tuberculin test results except: A. Indurations of ≥ 15 mm is positive in HIV positive non immunized patient B. Indurations of ≥ 15 mm is positive in healthy non immunized individual. C. Indurations of ≥ 10 mm is positive in children before age of 5 years D. Indurations of ≥ 10mm is positive in children after age of 6 years Key: D
  83. 83. MCQ A 5 year old child comes to the immunization centre without BCG scar on his arm; what would you prefer? a) Give BCG vaccine b) Perform mantoux if positive then give BCG c) No need of BCG d) Chemoprophylaxis e) Perform mantoux if negative then given BCG Key: e
  84. 84. A mother brought her six weeks old child to an EPI centre for routine immunization. She was enquired about history of Epilepsy in the family and febrile fits. The doctor took this history to avoid complication with: a) Diphtheria toxoid b) Tetanus toxoid c) Hepatitis B vaccine d) Pertussis vaccine e) OPV Key: True: d
  85. 85. A 6 weeks old boy came for DPT, polio & HBV vaccination. He was given initial doses of all and was called after 4 weeks to have the next doses. The likely reason for calling him again was: a) Loss of immune memory b) Stimulation of macrophages c) Summation of immune responses d) Replication of lymphocytes e) Immune tolerance Key: True: c
  86. 86. A mother brought her four year old child to the doctor. She gave the history that her child was in close contact with a case of diphtheria in school. She was very anxious about her child and gave history of booster dose of DT 2 years ago. What would be line of management for such a child? a) Booster dose of DT with penicillin b) Active and passive immunization c) Active and passive immunization with chemoprophylaxis d) Only keep under surveillance for 1 week e) Nothing more required Key: a
  87. 87. In Sir-Syed Model School a student of class 3 developed measles. The child was isolated from rest of the class. The school medical officer advised for the contacts of this child: a) Active immunization within 3 days b) Passive immunization c) Chemoprophylaxis d) Isolation e) Anti-viral therapy Key: b
  88. 88. A woman brought her child with congenital anomalies of heart and cataract. She gave history of mild fever and rash in the first trimester of pregnancy, which settled with mild antipyretics. The possible gestational condition that resulted in these anomalies was: a) Measles b) Herpes c) Rubella d) Drugs taken in pregnancy e) Streptococcal scarlet fever Key: True: c
  89. 89. A 22 years old man presented with painful, vesicular and postulate eruption on his back. He gave history of chicken pox infection at ten years of age. The likely diagnosis was: a) Measles b) Meningococcemia c) Herpes simplex d) Scarlet fever e) Herpes zoster Key: True: e
  90. 90. There is an epidemic of Meningococcal Meningitis among jail prisoners. The best chemoprophylaxis for the protection of contacts is by giving: a) Rifampicin b) Chloramphenicol c) Chloroquine d) Doxycycline e) Penicillin Key: True: a
  91. 91. A 5 years old boy developed fever with typical “dew drop rash” over his body. It appeared first on the trunk and spread to arms and legs later; there were no signs of neck stiffness and rigidity. What could be likely diagnosis? a) Small pox b) Measles c) Tanapox d) Meningococcal meningitis e) Chicken pox Key: True: e
  92. 92. A school child is diagnosed to have chicken pox. He should be isolated from other school children till: a) The scabs fall off b) Two days after the scabs are formed c) Three days after the fever develops d) Five days after the development of pustules e) Seven days after the development of pustules Key: True: a
  93. 93. A mother brought her 4 years old child with complaint of sore throat, difficulty in swallowing and low grade fever. On examination mild erythema and whitish membrane was found on the posterior pharynx. The doctor diagnosed him as a case of Diphtheric Mother gave history of complete course of immunization. In addition to penicillin what would be your line of management? a) Supportive treatment b) Passive immunization c) Active immunization d) Active plus passive immunization e) Active and passive immunization plus Tracheostomy Key: True: b
  94. 94. In Pediatric OPD the physician examined a 3 years old child with low grade fever, mild erythema in the throat and whitish membrane on the left side tonsil. The cervical lymph node was palpable. The doctor advised the mother to isolate the child for 7 days from other contacts of less than 5 years old. The most probable diagnosis is a) Pharyngitis b) Tonsillitis c) Diphtheria d) Acute Laryngitis e) Whooping cough Key: True: c
  95. 95. A student of nursery class developed mild fever along with irritating cough gradually becoming paroxysmal along with characteristic whoop. What you suggest for how long the student should be isolated from the class? a) I week b) 2 weeks c) 3 weeks d) 4 weeks e) 6 weeks Key: True: d
  96. 96. A 30 years old man presented in emergency in POF hospital with complaint of severe headache, fever and vomiting. On examination neck stiffness was found. He has just returned from hajj and gives no history of preceding ailment or injury. The most probable diagnosis is a) Meningitis b) Tetanus c) Brain abscess d) Cerebral Malaria e) Ischemic stroke Key: True: a
  97. 97. If you being a field doctor in department of public health, are given a task to visit a low socioeconomic community of a slum and to give report about the immunization status of the community against Tuberculosis. The single most important clue to this immunization is a) Monteux test b) Tuberculosis patients c) BCG scar d) X-ray chest e) Sputum for AFB Key: True: c
  98. 98. An epidemiologist was assigned to find out all the cases, both new and old of T.B, in a slum located near Islamabad during year 2007.Prevelance of tuberculosis is confirmed by: a) Mass miniature radiography b) Sputum examination c) Sputum culture d) Tuberculin test e) BCG scar mark Key: True: c
  99. 99. A 10 years old boy was brought to a doctor in a hospital with history of moderate fever with shivering and abundant rash on the trunk and buccal mucosa. On examination there were vesicles filled with clear fluid on the trunk and legs. The physician told the mother that child is suffering from a) Herpes b) Chicken pox c) Rubella d) German measles e) Tanapox Key: True: b
  100. 100. A pregnant lady reported to ante natal clinic with signs and symptoms of Rubella during 28th week of gestation. She was insisting for the induction of labor because of fear of congenital malformations of fetus. She was told by the doctor that Rubella does not cause major abnormalities of fetus after a) 8th week of pregnancy b) 12th week of pregnancy c) 16th week of pregnancy d) 20th week of pregnancy e) 24th week of pregnancy Key: True: c
  101. 101. A 7 years old child presented with sore throat low grade fever rash on face and posterior auricular and cervical lymphadenopathy. The most probable diagnosis is a) Chicken pox b) Small pox c) Measles d) Rubella e) Mumps Key: True: d
  102. 102. A 3rd year MBBS student of FJMC presented in ENT OPD with complaint of sore throat, pain of swallowing & low grade fever examination revealed erythema on the pharynx and a whitish membrane on the pharynx extending to the left tonsil. The doctor diagnosed her as a case of diphtheria. What do you suggest minimum isolation period: a) Six daily negative throat and nasal swabs report b) Till the signs & symptoms settle down c) One week course of antibiotic d) For days e) Till complete blood picture becomes normal Key: True: a
  103. 103. A mother brought her child with history of paroxysmal cough and restlessness. On examination he showed a loud inspiratory sound and sub-conjuctival haemorrhagic On the basis of clinical presentation what should be the drug of choice: a) Erythromycin b) Ampicillin c) Tetracycline d) Sulphadiazine e) Co- trimoxazole Key: a
  104. 104. A 40 year old tuberculosis patient on ATT for the last two months presented to his physician with complaints of tingling, numbness and loss of peripheral sensation. The likely anti tuberculosis drug to have caused these symptoms is: a) Isoniazid b) Rifampicin c) Streptomycin d) Pyrazinamide e) Ethambutol Key: a
  105. 105. 10 years old boy presented with high grade fever, chills, aches, cough and generalized weakness. He was diagnosed as a case of influenza. The most dreaded complication is: a) Encephalitis b) Pneumonia c) Toxic shock syndrome d) Reye’s syndrome e) Sub-Conjunctival hemorrhages Key: b
  106. 106. A 22 years old married non pregnant woman developed rubella infection. In order to avoid congenital rubella syndrome in her pregnancy she should be given: a) Antibiotics b) Active immunization c) Nonspecific immunization d) Advice to avoid conception for 12 weeks e) Anti viral therapy Key: d
  107. 107. A 40 years old man was diagnosed as a case of TB 4 weeks ago. He has been taking ATT for the last 3 weeks. His sputum analysis showed AFB on follow up investigation. Such a case of TB is known as: a) Failure case b) Newer case c) Defaulter d) Transfer out e) Resistant Key: b
  108. 108. A primigravida presented in Medical OPD at 39 weeks of gestation with dew drop rash on the body for 1 day she was diagnosed as having chicken pox she was told that her baby is at higher risk of having: a) Low birth weight b) Microcephaly c) Atrophied limbs d) Varicella infections e) Cutaneous scars Key: d
  109. 109. A 17 year old boy was brought in emergency department with symptoms of acute encephalopathy. He was admitted in ICU, initial investigation revealed that his liver had undergone fatly degeneration. His father gave history of rash on his body. Most likely he suffered from: a) Measles b) Rubella c) Chicken pox d) Mumps e) Cutaneous diphtheria Key: c
  110. 110. After serial sonography it was told to the apparently healthy pregnant woman that her baby is microcephalic and of low birth weight she gave no important medical history of note except mild febrile illness with rapidly disappearing rash in 2nd month of pregnancy. Most likely she suffered from: a) Chicken pox b) German measles c) Measles d) Cutaneous diphtheria e) Malaria Key: b
  111. 111. 4 years old girl was having fever, cough with a characteristic whoop. She was diagnosed as a case of whooping cough several antibodies are effective they are important as they: a) Reduce the frequency of spasm b) Control severity of disease c) Shorten the illness d) Control secondary bacterial infection e) Prevent carrier state Key: d
  112. 112. A child of 6 presented to school medical officer with complains of fever, malaise and painful swallowing. On examination a diffuse swelling was observed on the sides of the face below and in-front of the ears. The doctor diagnosed him as a case of mumps. What is the most appropriate management for him? a) Analgesics only b) Active and passive immunization c) Passive immunization d) Antibiotics only e) Rest, analgesics and balanced diet Key: e
  113. 113. 50 years old Bank officer was told to be suffering from illeocecal Tuberculosis. Nobody suffered tuberculosis in the family, but he still got infected, probably due to: A. Infected milk B. Infected clients C. Contaminated vessel D. Stressful work E. Advancing age Key: a
  114. 114. 44 years old man presented with fever, cough, night sweats and weight loss. He is HIV positive , has crackles on both lungs and chest x ray shows bilateral lower lobe infiltrate. All the following are correct except: A. Evaluation should include sputum gram stain and culture B. Sputum should be stained and cultured for M. tuberculosis C. Patient require pneumocystis pneumonia prophylaxis D. Infiltrates in lower lobes exclude diagnosis of TB KEY: D
  115. 115. Which of the following groups should not receive live attenuated influenza vaccine: A. Adults with mild to moderate illness B. Healthy children 2- 5 years C. Healthy pregnant D. Penicillin allergic adults Key: c
  116. 116. Which statements about Tdap vaccine is false: A. Tdap is contraindicated in pregnancy B. Tdap should replace a single dose of td vaccine for adults who don’t receive a dose of Tdap and require a booster of TD C. Tdap is not licensed for use among adults aged 65 and more D. Tdap is contraindicated in adults allergic to formaldehyde Key: A
  117. 117. A 20 month old child sent to your office with mild viral infection . Result of examination was normal except for temperature 37.2 c and clear nasal discharge. She received 2 doses of DTap, OPV and she did not take MMR vaccine. The mother is 20 week pregnant and her brother undergoing chemotherapy for leukemia. Which is more appropriate intervention. A. Scheduale a visit in two weeks for DTaP B. Administer inactivated polio (IPV) and DTaP C. Administer DTaP, opv amd MMR D. Administer DTaP, IPV amd MMR E. Administer DTaP, opv amd MMR after 3 months Key: D
  118. 118. Immunization of preschool children with diphtheria toxoid result in: A. Protection against the diphtheria carrier state B. Lifelong immunity against diphtheria C. Detectable antitoxin or immunologic memory for 10 years D. Frequent adverse effects E. Protection against infection with C. diphtheria Key: c
  119. 119. What is the recommended interval in months between the administration of whole blood transfusion and MMR vaccine? A. 0 B. 1 C. 3 D. 6 E. 10 Key: D
  120. 120. The most common opportunistic infections occuring in HIV patients is: A. Tuberculosis B. Pneumocystis pneumonia C. Amoebic encephalitis D. Fungal pneumonia Key: A
  121. 121. A 2 years old boy is brought to ER with sever prostration, temperature 40 c and few petechial lesions around the ankle. A gram stian of blood showed gram negative diplococci , what is the case fatality rate of this disease? A. 5 – 15 % B. 20 – 30 % C. 40 – 50 % D. More than 50% Key: A
  122. 122. CONTINUE Compare to general population the risk of developing infection in household contacts is: A. the same B. 10 – 20 time more C. 50 -100 time more D. 200 -400 time more E. 500 – 800 time more key: E
  123. 123. CONTINUE The child had been to child day care center, in addition to close surveillance, which of the following is most appropriate intervention? A. No further action B. Vaccination of children only C. Vaccination of children and adults D. Antibiotic prophylaxis for children only E. Antibiotic prophylaxis for children and adults Key: E
  124. 124. A 7 years old girl brought to your office because of a rash that appeared 3 days ago. Her temp. was 37.2 c and her face has intense rash with a slapped cheek appearance. The most likely etiological factor is: A. Adenovirus B. Rotavirus C. Parvovirus D. Coxsackie virus E. Echovirus Key: c
  125. 125. To which patient MMR would be safe to administer? A. A 15 months old HIV infected child with CD4 cell count 700 B. A 25 years old pregnant woman C. A 12 years old asthmatic on 20 mg of oral prednisone daily for the last 20 days D. A 18 years old leukemia in remission whose chemotherapy was terminated 1 month ago E. A 17 years old with life threatening anaphylactic reaction to egg Key: A
  126. 126. A 19 years old colleague student complaining of sever coughing spells for the last 4 days following initial symptoms of coryza and malaise. She is afebrile. In weekends she baby sits a 10 month and 2 years old children, in term of controlling contacts , What is the most important etiological factor to be included in D.D? A. Streptococcus pneumoniae B. Mycoplasma pneumoniae C. Bordetella pertussis D. Influenza virus E. Legionella Key: c
  127. 127. Which of the following infections is transmitted mainly from person to person? A. California encephalitis B. St. louis encephalitis C. West Nile viral encephalitis D. Meningococcal meningitis E. Eastern equine encephalitis Key: D
  128. 128. In investigation about influenza outbreak, you found out that a large number of persons who developed mild symptoms, have been vaccinated with trivalent vaccine containing the appropriate strain for the current year. The isolated strain is the same strain in the trivalent vaccine. What is the most likely explanation? A. Vaccine failure B. Antigenic drift C. Antigenic shift D. Herd immunity E. Incomplete immunity due to rhinovirus infection Key: B
  129. 129. A 5 years old preschool child presented with fever, malaise and vesicular rash that started 24 h ago. He has a sibling 3 months old and pregnant mother 38 week both are susceptible. What is the most common complication? A. Pneumonia B. Reyes syndrome C. Encephalitis D. Orchitis E. Thrombocytopenia Key: A
  130. 130. CONTINUE What is the most appropriate management for contacts? A. Observation only for all contacts B. Vaccination for the mother, sibling and class mates C. Immune globulins for mother, sibling and class mates D. Immune globulins for mother and vaccination for sibling and class mates E. Immune globulins for mother and sibling and vaccination for class mates Key: E
  131. 131. Under which condition should chemoprophylaxis for influenza be considered? A. All nursing home residents and unvaccinated staff during an influenza A outbreak B. All nursing home residents and unvaccinated staff during an influenza B outbreak C. Only unvaccinated nursing home residents and staff during an influenza A outbreak D. Only unvaccinated nursing home residents and staff during an influenza B outbreak E. All nursing home residents and staff during an influenza B outbreak Key: A
  132. 132. For which patient pneumococcal vaccine PPV23 is not beneficial? A. A 15 month old HIV infected child B. A 20 years old about to undergo splenectomy for ITP C. A 70 years old healthy female D. A 5 years old child with sickle cell disease E. A 10 years old boy with nephrotic syndrome who received the vaccine 5 years ago. Key: A
  133. 133. A 32 years old HIV infected patient, has 5 mm induration after tuberculin test. His chest x ray is normal, he is currently on protease inhibitors antiretroviral treatment. He did not receive anti tuberculosis treatment nor he had been in contact with tuberculosis patient. What is the most appropriate intervention? A. No preventive therapy for TB B. Isoniazid for 9 months C. Rifampicin for 9 months D. Rifampicin and pyrazinamide for 2 months E. Streptomycin for 6 months Key: B
  134. 134. HIV infected patients have high risk of developing active TB resistant to: A. Isoniazid B. Rifampicin C. Streptomycin D. Pyrazinamide E. Ethambutole Key: A
  135. 135. Four drug therapy is recommended as initial approach to HIV infected active TB patient: A. Always B. When multidrug resistant TB exceed 4% in community C. When the patient had anti tuberculosis treatment before D. When the patient has contact with multidrug resistant TB E. When CD4 count is under 200 Key: A
  136. 136. A 30 years old farmer suffering from fever, coughing, night sweats and malaise. He received BCG when he was child and his skin test is 15 mm, the most likely diagnosis; A. Influenza B. Brucellosis C. Aspergillosis D. Mycobacterium tuberculosis E. Mycobacterium bovis Key: E
  137. 137. A 4 years old girl suffering from sore throat, fever, hoarseness and drolling. What is the most likely diagnosis? A. Poliovirus B. C. Tetani C. C. Diphtheria D. H. Influenza E. Streptococci Key: D
  • ZohaAtique

    Jul. 16, 2020
  • KamranGilani2

    Jun. 3, 2020
  • DEEPAKARANDURAI

    Apr. 27, 2020

air borne diseases cases applications MCQS APPLICATION

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