Paediatrics – Infectious diseases Part 1

Paediatrics – Infectious Diseases –
Part 1
• Presented By –
Prof.Dr.R.R.Deshpande
(M.D in Ayurvdic
Medicine & M.D. in
Ayurvedic Physiology)
• www.ayurvedicfriend.c
om
• Mobile – 922 68 10 630
• professordeshpande@g
mail.com
12/5/2016 1Prof.Dr.R.R.Deshpande

Part 1
• Third BAMS –Paper 1 Part B
• 10. Aupasargika Vyadhi (Infectious Diseases):--
• 1) Karnamula Shotha (Mumps)
• 2) Romantika (Measles)
• 3) Rubella
• 4) Masurika (Chicken Pox)
• 5) Rohini (Diphtheria)
• 6) Kukkura-Kasa (Whooping Cough)
12/5/2016 Prof.Dr.R.R.Deshpande 2

Part 1
• 7) Dhanurvata (Tetanus)
• 8) Krimiroga (Worm Infestations)
• 9) Antrika Jwara (Typhoid)
• 10) Mastisakavarnashotha (Meningitis)
• 11) AIDS
• 12) Dengue
• 13) Malaria
• 14) Rajayakshma (Tuberculosis)
• 15) Jivanujanya Yakrit Shotha (Hepatitis)

1) Mumps ( Epidemic Parotitis)
• Cause – Virus .Spread by droplet infection
• Involves one or both parotid glands
• Sometimes Submandibular or sublingual
glands may be involved
• Testis ,Ovary ,Pancreas ,brain etc may be
involved
• Seen in young children & young adults
• Incubation period – 3 weeks

Mumps – Clinical features
• Fever – 100 to 101 degree F with chill & little
rigor
• Weakness ,malaise
• Stiffness of jaw ,Inability to open the mouth
• Dryness of mouth with foul smell
• Pain & swelling over Parotid region
• Parotid glands are enlarged one after another
at an interval of 24 to 36 hours

Salivary Glands

Mumps

Mumps – Clinical features
• Sometimes both glands are enlarged at the same
time
• The hollow or groove between the angle of jaw & the
mastoid process is filled up
• Tenderness over the posterior ramus of mandible
• Some times ,upper abdominal pain due to
Pancreatitis or pain in the testis or lower abdomen
due to Oophoritis or headache due to meningitis
• Fever & glandular swelling subside within few days

Mumps – Complications
• Orchitis – Commonest complication .Usually
unilateral .But when bilateral ,may produce
Sterility ,due to Testicular atrophy
• Oophoritis ,Prostatitis
• Mastitis
• Pancreatitis – severe abdominal pain
,vomitting, fever ,collapse
• Encephalitis, Meningitis, Thyroiditis

Mumps -- Investigations
• Complement Fixation Test – Positive
• Serum Amylase – Raised ( even without
Pancreatic involvement )

Mumps – Treatment
• Patient should be isolated
• Oral Hygiene
• Liquid diet
• Symptomatic Treatment like Tab Combiflam
1 TDS
• For Orchitis – Steroids may be used

Mumps
• After the age of 3 years
• It can affect people up to the age of 40 or more
• Pain behind the ear while chewing
• Pain is also increased on opening the mouth
• Pain accompanied by fever and malaise
• One or both parotid glands may be involved
• DD of the swelling of parotid gland & enlarged
lymph glands -- swelling of parotid has ill defined
margins.

Mumps
• Usually lasts for about 7 days
• Common complication  ---
• Orchitis  ,which is more common in grown up
people  & lead to atrophy of testis and
sterility

Mumps – Treatment
• Non-specific
• Bed rest
• Analgesics, local warmth and saline mouth
wash may
• Avoid sour drinks or food
• For orchitis -- large doses of Prednisolone ,
Analgesics, cold compresses, resting the
scrotum on a support also help

2) Romantika (Measles)
• Acute Contagious viral Infection
• Epidemics occur in winter
• Young children are affected due to droplet
spread of Infection
• Incubation period is 12-14 days.

Romantika (Measles)
• 3 Stages
• A) Prodromal or Catarrhal stage (first 4 days) --
Sudden onset
• of Acute fever, nasal catarrh, sneezing,
conjunctivitis, photophobia, cough, hoarseness of
voice
• On 2nd day -- Pathognomonic - Kopliks spots appear
in mucous membrane of mouth. (Tiny whitish or
bluish white spots, against a reddish background, at
level of upper 2nd molar teeth.)

Measles – Koplik’s spots

Romantika (Measles)
• B) Exanthematous stage (4th to 7th day)
• High rise of Temp. face puffy; Headache, cough,
photophobia, myalgia; lymph nodes may enlarge;
spleen-may be palpable.
• Rash - on 4th day. Maculo papular. Appear first, on
forehead & behind the ears, at the junction of skin &
hair. Spread downwards to whole of trunk & limbs
up to palms & soles.
• Initially - Discrete, pink, blanch on pressure. Later
Confluent.

Measles

Romantika (Measles)
• C) Recovery Stage - Rapid, Rashes fade away,
leaving brownish discolouration of skin &
areas of desquamation
• Complications - Laryngitis, bronchitis, broncho
pneumonia, conjunctivitis, otitis media,
Albuminuria

Romantika (Measles)
• Treatment -- Isolation of patient , Liquid diet ,Care
of mouth, eyes, bowels.
• Symptomatic
• Sy. Crocin 1 tst x 4 hrly.
• Sy Avil expectorant 2 1 tsf TDS.
• for conjunctivitis - Genticyn eye drops 1 drop x QID
• Preventive - Measles vaccine (Live attenuated
vaccine - 0.5 ml S/C, gluteal. Given between 9 to 15
months)

Measles
• very infectious
• Occur up to the age of 14 years
• Fever is first symptom
• sore throat, nasal discharge, non-purulent
conjunctivitis, photophobia and dry cough.
• With even one child of Measles in the locality ,
can spread the infection to other many
children .So History of contact is very
important

Measles
• On examination --- throat looks fiery red
,fever is high and the nose is running
• Fine white spots surrounded by red areas
appear in the buccal mucosa-opposite molar
teeth

Measles – Rash
• Rash usually appears on 4th or 5th day but can be
delayed even up to 10 days --- if broad spectrum
antibiotics have been given to the child (which
always delay the appearance of rash)
• The rash appears first behind the ears, then on
face, chest abdomen and lastly on the limbs
• The rash is irregularly pink and erythematous
skin is stretched between two thumbs this rash
fades due to pressure

Measles –Rash
• Measles rash lasts from four to seven days and
leaves behind black spots
• True measles occurs once in life time.
• Confusion of ‘Measles’ is created many times,
because there are many viral fevers, which can
cause a rash just like measles. But in which, the
rash disappears within a day or two and does not
leave behind black spots and pigmentation
• German measles can cause second attack of true
measles

Measles
• Complications -- Bronchiolitis and
bronchopneumonia
• Avoid broad spectrum antibiotics --  which  will
delay the onset of rash and  increase the
duration of illness
• Do not give injection till the rash is seen
• Antibiotics can be given , if respiratory
complications occur
• Tab Paracetamol  --- To reduce the fever

3) Rubella ( German Measles)
• Less infectious than Measles
• Spreads by droplet infection
• Severe in adults than children
• When occurs in women ,in first 4 months of
pregnancy – Developmental defects in foetus like
• Cataract ,Glaucoma, Congenital heart diseases,
disorders of retinal pigmentation, deaf, mutism &
also
• Abortion, miscarriage,stillbirth

Rubella ( German Measles)
• Incubation period – 2 to 3 weeks
• Symptoms –
• Not prominent & sometimes absent
• Fever – 99 to 101 degree F
• Headache,Bodyache
• Anorexia,Nausea,vomiting
• Weakness ,lassitude
• Arthralgia

Rubella –Signs
• Temp – raised
• Pulse – Relative bradycardia
Face – flushed
• Rash – appears on 1st or 2nd day .Small pink
macules or papules –remains as distinct units
& do not run together ,as in true measles
• No Koplik’s spots are seen in mouth
• Generalized lymph node enlargement –
posterior cervical group .Tender on palpation

Rubella

Rubella – course & complications
• Whole illness ends in 2 to 3 days
• No staining or desquamation of skin
• Complications – Purpura, encephalo
myelitis,arthritis

Rubella – Treatment
• Preventive – Inj Gamma Globulins 1.5 gms –
Protection for 3 weeks .Helpful during
pregnancy
• Curative –
• No curative Treatment .Only symptomatic

4) Laghu Masurika (Chicken pox)
• Causative virus is identical to the virus of
Herpes zoster
• Incubation period - 14 to 18 days
• C/F ( Clinical Feature)
• Onset is Acute.
• Malaise, headache, weakness, fever,
prodromal rash.
• Rash appears on first day.

Chicken pox

Laghu Masurika (Chicken pox)
• Vesicular. With each fresh crops of rash,
temperature rises. Chicken pox rash is centripetal in
appearance but centrifugal in progress. (Rash first
appears on central part of body - trunk)
• Another feature of Rash is Pleomorphism (At the
same time,all types of rashes are seen - i.e. macule,
Papules, Vesicles & Pustules) .After separation of
crusts, no scars

Chicken Pox – Pleomorphism

• Treatment
• Symptomatic -- Tab crocin 1/2 Q I D, or Sy
crocin 1 tsf TDS
• For Itching - Sy Avil 2 1 tsf TDS. & Caladryl
lotion externally
• If complication, like pustule.
• Sy. Erythrocin 1 tsf QID

• Prevention
• Inj. Varilix 0.5 ml S/C, 12 mcntns to 12 yrs.
• 2 doses at the Interual of 6 to 12 wks

5) Diphtheria
• Look  at the throat with Torch and a tongue
depressor of every child who comes with fever
– even if throat pain is absent
• Uncommon below 6 months of age.
• Fever and pain in the throat – common
symptoms of Diphtheria. But are not very
severe
• Common causes of these  symptoms  --
Tonsillitis or Pharyngitis

Diphtheria
• white patches are present as in ‘Follicular
Tonsillitis’, which can be differential diagnosis
of diphtheria.
• The fever is usually very high in follicular
tonsillitis.

Diphtheria
• Pulse in any fever is 100 when the
temperature is 100 degree F, and it rises by
about 10 beats for every 1 degree rise in
temperature, ( So pulse will be 130 /min
when temp will be 103 degree F )
• But in diphtheria even with fever of 100
degree F or 1010F -- the pulse may be 130 +
• General look of illness and toxaemia is more
marked.

Diphtheria
• Diphtheria in early stage, affects only one tonsil,
while follicular tonsillitis is always bilateral.
• The white patches in tonsillitis, usually do not
spread on the anterior pillar of uvula, and if a
cotton swab is used, the patch can be easily
removed from the tonsil without any bleeding.
• Patch of Diphtheria ,extends to uvula or anterior
pillar & bleed ,if try to remove patch
• Swab –should be sent for smear & culture

Diphtheria Patch

Other Types of Diphtheria
• Nasal Diphtheria – fever and blood stained
discharge from the nostril
• Common cause of a blood stained discharge
from the nostril is a foreign body & also fever
is absent in a foreign body .Some times history
can be obtained ,regarding foreign body
insertion

Other Types of Diphtheria
• Laryngeal Diphtheria
• Difficult to differentiate from Viral Laryngitis
• Symptoms --  Hoarseness of voice while crying,
cough with a ‘croup’, inspiratory dyspnoea and
fever
• Usually no membrane is visible in the throat
• Oedema of neck  -- can make confusion for
Mumps.
• Refer these children to Hospital ,because
Tracheostomy  my require

Treatment of Diphtheria
• A.D. serum is the specific treatment
• Anaphylactic shock ,after this inj is possible .So
better do “sensitivity test”
• Give 0.05 cc of 1:10 dilution of serum in normal
saline ,intra dermally ,on the flexor surface of
forearm
• If within 20 min ,erythema or redness occurs
,larger than 1.5 cm in diameter ,child is sensitive
.Apply local Hydrocortisone ointment ,to treat
redness & itching

Desensitization
• First give a few injections of diluted 1:10
serum  s/c .
• Give 0.1 cc. of serum in the beginning
• Every 20 minutes -- double the dose e.g. 0.2,
0.4, 0.8, 1.6 cc
• Then start few injections of serum I/M ,with
same dose .Double dose ,every 20 min
• Keep Inj Adrenaline, Hydrocortisone –as
Emergency of Anaphylactic Shock

Dose of Anti Diphtheria Serum
Sr.No Type of Diphtheria Dose of A D Serum in
Units
1 Tonsillar ( Unilateral) 20,000
2 Tonsillar ( Bilateral) 40,000
3 Laryngeal 40,000
4 Nasal 20,000

Anti Diphtheria Serum
• If no improvement is seen within 24 hours, the
dose of 20,000 can be repeated
• After the patient recovers, give 2 doses of
Diphtheria toxoid with interval of six weeks.

Diphtheria - Treatment
• Erythromycin is the best antibiotic be 2 Gm. per
day continued for 5 days or
• Penicillin -- 10 lacs I/M, twice a day (Crystalline
Penicillin)
• Complete rest in bed should be advised period of
four weeks ( Complication of Myocarditis can
occur during period of 4 weeks)
• Contacts at home should be given 2,000 units of
A.D.S. ( After AST) .Those who have not received
Triple Antigen should be given that as well.
• A.D. Serum is quite costly.

6) Whooping Cough
• Type of catarrh of the entire respiratory tract
• Produces paroxysmal cough & a typical stridor
or whoop caused by H. Pertusis
• Causes – Haemophilus pertussis organism
• This is Gram negative anaerobic bacilli
• Spreads by droplet infection
• Age – 2 to 5 years
• Incubation period – 7 to 14 days

Whooping Cough – Pathology
• Necrotizing inflammation – whole respiratory
tract from naso pharynx up to bronchi
• Inflammation of peribronchial & tracheo
bronchial lymphoid tissue
• Stickiness of exudate causes – obstruction of
bronchioles & atelectasis

Whooping Cough– Clinical features
• 3 stages ---Catarrhal + Paroxysmal +
Convalescent
• Catarrhal stage –
• Like common cold
• Nasal discharge ,conjunctivitis ,mild cough
• Fever
• Disease is most infectious at this stage

Whooping Cough – Paroxysmal stage
• Paroxysms of cough ,without any apparent
inspiration between them
• Ending in a crowing inspiratory sound ( the
whoop)
• Expulsion of large quantities of thick mucoid
sputum & vomiting
• Cough is more prominent at night
• Increased on crying & during feeding
• Episodes of cough as many as 40 to 50 times a
day

Whoop – Whoop

Whooping Cough – Paroxysmal stage
• Fever is not present
• Vomiting ,occur at the end of bouts
• Tetany may occur due to severe vomiting
• Bleeding tendency ( Haemoptysis, Epistaxis,
purpura, subconjunctival or intestinal
haemorrhage )
• Auscultation – Fine cracking rales

Whooping Cough – Convalescent period
• Cough –Less frequent
• Sputum –Less tenacious
• Immunity after illness lasts long

Whooping Cough – Investigations
• Leucocytosis ( 1 lakh /cmm)
• Lymphocytes – 90 %
• Culture – Naso pharyngeal swab or Sputum
exam – shows – H.Pertussis
• X ray – Enlarged Hilar glands
• Isolation of H Pertussis with Fluorescent
antibody technique

Whooping Cough- Complications
• Pneumonia
• Atelectasis
• Electrolyte imbalance
• Encephalopathy
• Spontaneous Pneumothorax
• Development of Herniae

Whooping Cough- Treatment
• Prophylactic – DPT vaccination
• Curative – Feeding child ,immediately after
vomiting or paroxysms
• Fluid balance
• Broad spectrum Antibiotics
• Cough suppressants – Ephedrine, Noscapaine

Whooping Cough
• Very infectious disease
• Occurs up to the age of 2-3 years
• Disease is rare after the age of 5 years
• lf one child is affected in the family or even in
waiting room of Doctor’s consulting room –it
can affect many other children

Whooping Cough
• It is infectious one week before and two
weeks after the onset of “whoop”
• Disease should not be diagnosed until the
appearance of “whoop”  ( Loud inspiratory
whistling sound in between the paroxysm )
• Many Doctors can get confusion   for other
cough of Bronchitis etc .Because whoop starts
after a few days of illness

Complications of Whooping Cough
• Bronchopneumonia
• Convulsions
• Sub –conjunctival haemorrhage, etc.
• Fortunately due to vaccines like DPT ,
(Diphtheria ,Pertussis & Tetanus)– Now cases
of Diphtheria or Pertussis or whooping cough
are nearly obsolete i.e seen very rarely

3) Tetanus
• Tetanus is a serious bacterial disease
• Affects nervous system ---
• Leading to painful muscle contractions,
particularly of your jaw and neck muscles
• Tetanus can interfere with ability to breathe
and ultimately threaten your life.
• known as “Lock Jaw."

Tetanus occurrence
• Rare in the United States and the developed
world.
• The incidence of tetanus is much higher in less
developed countries.
• Around a million cases occur worldwide each
year.

Tetanus – No cure
• There's no cure for tetanus

• Treatment focuses on managing complications
until the effects of the tetanus toxin resolve
• Fatality is highest in individuals who haven't
been immunized and in older adults with
inadequate immunization

Tetanus – Symptoms
• Appear anytime from a few days to several
weeks after tetanus bacteria enter your body
through a wound.
• The average incubation period is seven to
eight days.

Tetanus Symptoms
• Spasms and stiffness in your jaw
• Muscles Stiffness of your neck muscles
• Difficulty in swallowing
• Stiffness of your abdominal muscles
• Painful body spasms lasting for several
minutes, typically triggered by minor
stimulus , such as a draft, loud noise, physical
touch or light

Tetanus

Tetanus Signs
• Fever
• Sweating
• Elevated blood pressure
• Rapid heart rate

Tetanus -- Causes
• The bacteria that cause tetanus, Clostridium
tetani, are found in soil, dust and animal
feces
• When they enter a deep flesh wound, spores
of the bacteria may produce a powerful toxin,
tetano spasmin, which actively impairs your
motor neurons, nerves that control your
muscles

Tetanus -- Causes
• The effect of the toxin on your motor neurons
------
• Cause muscle stiffness and spasms — the
major signs of tetanus

Tetanus -- Risk Factors
• Certain factors are necessary for tetanus
bacteria to proliferate in your body. These
include ---Lack of immunization or inadequate
immunization
• failure to receive timely booster shots against
tetanus
• A penetrating injury that results in tetanus
spores being introduced to the wound site

Tetanus -- Risk Factors
• The presence of other infective bacteria
• Injured tissue
• A foreign body, such as a nail or splinter
• Swelling around the injury

Types of Injuries – Can cause Tetanus
• Puncture wounds including from splinters
• Body piercings
• Tattoos
• Injection drugs
• Gunshot wounds
• Compound fractures , Crush injuries
• Burns

Types of Injuries – Can cause Tetanus
• Surgical wounds ,Injection drug use
• Ear infections
• Animal bites
• Infected foot
• Ulcers
• Infected umbilical stumps
• In newborns born of inadequately immunized
mothers

Tetanus – Complications
• Once tetanus toxin has bonded to your nerve
endings it is impossible to remove
• Complete recovery from a tetanus infection
requires the growth of new nerve endings
and can take up to several months.

• Broken bones -- The severity of spasms may
cause the spine and other bones to break.
• Disability ---
• Treatment for tetanus typically involves the
use of powerful sedatives to control muscle
spasms.
• Prolonged immobility due to the use of these
drugs can lead to permanent disability

• In infants, tetanus infections may cause lasting brain
damage, ranging from minor mental deficits to
cerebral palsy
• Death -- Severe tetanus-induced (tetanic) muscle
spasms can interfere with your breathing, causing
periods in which you can't breathe at all
• Respiratory failure is the most common cause of
death
• Lack of oxygen may also induce cardiac arrest and
death. Pneumonia is another cause of death

Tetanus – Tests
• Doctors diagnose tetanus based on a physical
exam, medical and immunization history, and
the signs and symptoms of muscle spasms,
stiffness and pain.
• Laboratory tests generally aren't helpful for
diagnosing tetanus

Tetanus – Treatment
• Since there's no cure for tetanus ---
• Treatment consists of wound care
• Medications to ease symptoms and
• Supportive care.

Tetanus – wound care
• Cleaning the wound is essential to preventing
growth of tetanus spores.
• This involves removing dirt, foreign objects
and dead tissue from the wound.

Tetanus – Vaccine
• Inj TT --- As a preventive measure
• If a child has taken 5 doses of TT ,in the form
of DPT & a TT at 10 years of age ,then a
booster dose ,every 10 years is enough
• In an adult ,with no history of childhood
immunization ,then 2 doses of TT at 2 months
apart with a third dose at 7 months after 1st
dose –Gives protection for next 10 years

Tetanus – Vaccine
• When patient with an injury –
• For Tetanus prone wounds i.e contaminated
,penetrating with significant tissue damage –
only 1 dose of Inj TT is required if patient has
taken booster within 10 years
• If more than 10 years – Give Human Tetanus
Immunoglobulins – 250 to 500 IU

Tetanus – Vaccine
• If Immunization status of the patient is not known –
Give complete course of Inj TT + HTI ( Human
Tetanus Globulin)
• Side effects of Inj TT – Local pain ,redness, swelling –
lasting for 10 days .Also there may be fever, Myalgia,
headache
• In Pregnancy – 2 doses of TT after first Trimester ,at
one month interval .Second dose ,atleast 15 days
prior to Expected date of Delivery ( EDD)

Tetanus Medicines
• Sedatives -- Doctors generally use powerful
sedatives to control muscle spasms.
• Other medications, such as magnesium
sulfate and certain beta blockers, may be
used to help regulate involuntary muscle
activity, such as your heartbeat and breathing
• Morphine may be used for this purpose as
well as sedation

Tetanus Management
• Supportive therapies
• Tetanus infection often requires a long period
of treatment in an ICU
• Since sedatives may result in shallow
breathing, you may need to be supported
temporarily by a ventilator.

Ascariasis ( Round worm)
• Infection by Ascaris Lumbricoides
• Pathogenesis -Ascaris ova are passed along with
faeces
• The ova are not infective to man
• Fertilized ova undergo maturation in the soil
,giving rise to rhabditiform larvae
• These embryonated eggs are infective to man
• They are swallowed with contaminated food or
inhaled from dust .

Round worm

Round worm – Pathogenesis
• The ova hatch out in duodenum from where
larvae pierce the wall of the gut & are carried
into portal circulation & then to lungs
• In lungs they pierce into alveolar space
• The larvae then migrate into upper intestinal
tract by climbing up the respiratory tract & are
being swallowed from the pharynx
• Larvae then grow into adult worms in the
intestine

Round worm Infection

Round worms - Clinical features
• Mechanical Effect –
• Due to mechanical irritation –abdominal pain
• Nausea, vomiting
• Loose motions ,abdominal distension
• Rarely mechanical obstruction of the gut or
appendix or biliary tract ,which can give rise to
colic & jaundice

Round worm - Clinical features
• Toxic Effects – From the body of the worm
aalegen is liberated ,which is called as Ascaron
• There is a toxic substance in the body fluid of
worm
• This gives rise to allergic reactions like
urticaria ,fever ,symptoms of Pneumonia ,
Loefler’s syndrome or bronchitis

• Nutritional effect – These worms swim against
the intestinal peristalsis .For this considerable
energy is required ,which is taken from food
,ingested by host
• So Anaemia ,puffiness of face ,oedema is seen
in the patient
• Reflex effect – Grinding of teeth at night ,
sometimes convulsive seizure

• Abdominal colic, vomiting or Diarrhoea
• Common cause of intestinal obstruction
• During larval stage, round worms can cause a
picture of frequent night coughs simulating
Allergic Bronchitis, which is quite common in
children.

Round worm - Investigations
• Haemogram – Slight Leucocytosis with
Eosinophilia
• Stool Exam – Macroscopically – adult worm &
Microscopic – Typical ova ( fertilized or
unfertilized )
• X ray chest – may show localized patch of
Pneumonia ( Loeffler’s syndrome)
• Ba meal --- Filling defect ,due to worm

Round worm- Complications
• Obstruction of Intestine ,biliary tract ,
respiratory tract ; Pneumonia ,perforation,
peritonitis, Appendicitis, Intussusception
• Treartment – Piperazine phosphate – 4 gm
single dose

Hook worm Infestation
• 4 types of Hook worm –
• Ancylostoma duodenale
• Necator americanus
• Ancylostoma braziliensis ( This is parasite of
cats & dogs )
• Ancylostoma canium ( This is parasite of dog )

Hook worm Infestation
• Hook worm disease in man is produced due to
Ancylostoma duodenale & Necator amercanus
• They live in small intestine –Jejunum

Hook worm - Life Cycle
• Ova are passed in faeces
• Ova hatch out into hadaitiform larvae in the
soil
• Then transform into filariform larvae ,which
are infectious to man .

Hook worm - Life cycle
• The Filariform larvae enter through skin & foot into the
lymphatic system of host
• From there they enter the venous circulation
• After reaching at pulmonary circulation ,they break
through alveolo – capillary wall & reach alveolar space
• Then they traverse the whole respiratory tract
• Ultimately reach pharynx ,from where they are
swallowed
• Finally they settle down in the upper part of small
intestine

Hook worm Life Cycle

Hook worm - Clinical Features
• During migration of Larvae – Creeping
eruption is produced ,when the larva wanders
through the skin in aimless manner ,producing
a reddish itchy papule ( More common in
Ancylostoma braziliensis & Ancylostoma
canium)

• Cough, dyspnoea ,rusty sputum due to
bronchitis & broncopneumonia ( Which may
occur when larvae reach alveolar space &
travel upwards )
• This gives Eosinophilia
• When larvae reach stomach & intestine –
vomiting ,diarrhoea ,epigastric pain occur

• In ill nourished person or if infestation is too
heavy – Iron deficiency occurs due to –
sucking of blood from intestinal wall by
parasites ,haemorrhage from punctured sites
depression of bone marrow by toxin ,Gastro –
intestinal upsets
• Dyspnoea on exertion ,Oedema, Anasarca,
Palpable liver & spleen , Tongue becomes pale
& like blotting paper

• Severe anaemia or cases of atypical pain of
peptic ulcer
• In any case of severe anaemia where there is
no history of bleeding piles and excessive
menstruation in female -- then it is 99 per
cent sure, that patient is having Hook worm
infection

• These worms suck the blood constantly from
the duodenum,where they are maximum in
number
• Worms also cause Duodenitis, which gives
epigastic pain
• Differential diagnosis of a peptic ulcer in
India may be hook worms
•

Hook worm – Diagnosis
• Examination of stool is necessary for diagnosis
• But Stool examination better to be done with
salt floatation method.
• Remember ,Malignancy of G.I. tract or
Anaemia due to other causes should be ruled
out

Hook worm - Investigations
• Haemogram – Hypochromic Anaemia
Eosinophilia
• Stool R – Microscopic – Ova ,Occult blood test
may be positive
• Aspiration from duodenum – may show ova or
adult worms

Hook worm - Treatment
• In Hb is too low – BT is given .High protein diet ,Iron
supplements either orally or parenterally ,vitamins
• Drugs act better when upper bowel is empty .So dugs
are given ,early morning on empty stomach
• In olden days drug used was – Bephenium
Hydroxynaphtholate ( Alcopar) – 5 gm powder with a
syrupy liquid ( Because drug was very bitter)

Hook worm - Prophylaxis
• People must wear shoes or gloves while
working in the field
• Use of latrines ,instead of fields ,along with
proper disposal of night soil

Oxyuriasis ( Thread worm)
• This occurs due to ingestion of Thread worm (
Enterobius vermicularis)

Thread worm

Thread worm - Pathogenesis
• Infection occurs due to ingestion of eggs ,which
contain tadpole like larvae
• After egg shells are dissolved ,the larvae escape into
upper intestine & become mature
• The male fertilizes the female & dies when the gravid
female migrates to the large intestine .

Thread worm - Pathogenesis
• During the night ,female worm lays down the
eggs at the perianal region
• The movement of these worms at this region
causes severe itching .
• They can also invade the female genitalia

Thread worm – Life Cycle

Thread worm - Clinical Features
• Diarrhoea
• Itching of the perianal skin
• Urethral irritation
• Vaginal discharge
• Nocturia

Thread worm – Peri anal

Thread worm - Diagnosis
• Naked eye demonstration of adult worms in
the stool
• Microscopic examination – Eggs ,either from
stool sample or perianal scraping

Thread worm- Clinical features
• Itching round the anus.
• In children sleeplessness and rarely grinding of
the teeth
• Many members of the family are harboring at
the same time
• stool examination or by scraping the perianal
area, is used for microscopic examination

Thread worm –Diagnosis
• Ideally , “scotch-tape method” should be used
• But these facilities are not available in many
places
• But then ,point should be kept in mind is that
stools may not show ova of thread worm
because usually they are sticking around the
anus
• So Therapeutic Test” should be relied upon

Thread worm –Treatment
• All the family members should be treated at  the
same time.
• General   advice --  must be  given to the mother
or the patient  ------ proper cleanliness, cutting of
the nails regularly’
• In children, tying cotton gloves on the hands to
prevent scratching of the anus at night and local
application of the antihistaminic cream or Ung.
Hydrargyri around the anus
• Continuous reinfection is common  due to auto
infection

Thread worm - Treatment
• Piperazine saly as single dose
• For perianal itching ,local application of anti
histaminic or hydrocortisone cream or
Gentian violet
• Personal cleanliness --- like washing of hands
with soap ,cutting of nails

Taeniasis( Tape worm)
• Due to infestation of ---
• Taenia solium & Taenia saginata
• After ingestion of undercooked pork
( T.Solium) or Beef ( T.Saginata)

Tape worm

Tape worm - Life cycle
• Eggs of these Tape worms are passed by
human beings in stool
• These eggs are swallowed by pigs or cows or
buffaloes
• In alimentary tract the onchospheres are
liberated ,after rupturing the wall of the eggs
• The onchospheres penetrate intestinal wall &
reach portal & systemic circulation

Tape worm – Life Cycle

Tape worm -Life cycle
• The onchospheres ,settle down in the muscles
.Here they form a vesicle & larva at the
bottom ( future head of the Tapeworm ,called
as Cysticercus )
• The cysticerus are capable of further
development if they reach human alimentary
tract
• The eggs & segments of adult worms are
passed in the faeces

Tape worm -Clinical Features
• Mostly symptomless
• Some times pain in abdomen
• loose motions
• The knowledge of it’s presence in the intestine
& passing of segments in stool are distressing

Tape worm – Pork eater
• This infection is not seen in Hindus because
beef or the pig’s meat is not eaten
Infection is common people who have been
eating the Pork or Beef meat for a very long
time

Tape worm –Segment passing
• Symptom is the passing of the segment of
tape worm in the stool
• It is the most difficult This infestation is very
difficult to treat

Tape worm Treatment
• Failure in the treatment is due to incomplete
preparation of patient to administer the drug
• Aim of this preparation is to keep G.I. tract
empty and free of any mucus and food ,so
that the dugs can act better

Tape worm Treatment
• Advice the patient for fasting for 2-3 days and
by taking sodabicarb 30 gms. 4  times a day to
dissolve the mucus
• During these 2-3 days, a saline purgative can
be given every morning and the patient
instructed not to take   milk or starchy food.
• Then One morning on an empty stomach


Tape worm - Diagnosis
• Demonstration of typical ova or the adult
segments in the stool

Tape worm -Treatment
• Taenia Saginata – Niclosamide 500 mg – 2 tab
for chewing & 2 tablets after 1 hour
• Bowel preparation – By liquid diet,saline
purgative BD for 2 days
• Cysticercosis of brain is treated with Anti
Epileptic drugs .Operation may not be
necessary

Anti Helminthic Medicines
• Mebendazole – For Round,Hook,Whip –100
mg BD for 3 days .For Pin worm -100 mg Single
dose & repeated after 3 weeks .Children of 1
to 2 years –Half dose
• Tab Mebex 100 mg chewable tablet ,100 mg
/5 ml syrup

• Albendazole – For Round, Hook,
Pinworm,Whipworm –400 mg Single dose .For
children 1 to 2 years – Half dose. For Tape
worm -400 mg daily for 3 days
• Tab Zentel -400 mg tab,200 mg /5 ml syrup

• Pyrantel pamoate – For Round worm
Ancylostoma ,Pinworm – 10 mg /kg single
dose
• Tab Nemocid 250 mg tab ,500 mg /10 ml
syrup

• Piperazine --- For Round worm -4 Gm once a
day for 2 consecutive days.Children –0.75 gm
m/year of age
• Piperazine citrate – 0.75 gm /5 ml Elixir in 30
ml ,115 ml bottle ;500 mg Piperazine
Phosphate tablet


• Levamizole – For round worm – 150 mg for
adults .110 mg for children having weight 20
to 39 kg .50 mg for children having weight 10
to 19 kg .single dose
• Vermisol tab of 50 & 150 mg ;50 mg /5 ml
syrup

• Diethyl carbamazine citrate – For Filariasis 2
mg /kg TDS for 12 to 21 days .For Tropical
Eosinophilia 2 to 4 mg /Kg TDS for 2 to 3
weeks
• Hetrazan -50 ,100 mg tablet ,120 mg/5 ml
syrup .50 mg /5 ml paediatric syrup

• Ivermectin – 10 to 15 mg ( 0.15 to 0.2 mg/kg )
orally single dose for Strongyloidosis
,enterobiasis ,ascariasis
• Tab Vermin – 3,6 mg –to be taken on empty
stomach

• Niclosamide – For Tapeworm ( T.Solium
T.Saginata ) 2 gm taken in 2 doses ,one hour
apart .Children of 2 to 6 years – 1 gm total
dose .This is followed by saline purge after 2
hours .For H .nana -2 gm repeated daily for 5
days
• Tab Niclosan 500 mg ( To be chewed &
swallowed by water

• Praziquantel – For Tape worm (T.Solium
,T.Saginata ) 10 mg /kg single dose in the
morning
• Tab Distocide 600 mg

Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved

Paediatrics – Infectious diseases Part 1

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