Communicable diseases Essay Example for Free

inherited indispositions Essay95Infectious agents and examples of maladysThe organisms that withstand believe ailment vary in size from viruses,which be as well sm wholly to be seen by a light microscope to in probeinal worms which whitethorn be over a metre long. The groupsof infective agents argon listed with examples of diseases they cause.BacteriaPneumonia, tuberculosis, enteral febricity, gonorrhoeaViruses measles, varicella, influenza, colds, rabiesFungiRingworm, tinea pedis (athletes foot)ProtozoaMalaria, giardiaMetazoaTapeworm, filariasis, onchcerciasis (river blindness),hookwormPrionsKuru, Creutzfeld-Jacob disease, Bovine spongi stockencephalopathy (BSE)Modes of transmission direct transmissions Direct progress to with the infect person as in touching,kissing or sexual intercourses Droplet mobilise through and through coughing sneezing, talking orexplosive diarrhoeas Faecal-oral spread when septic fecal matter is transfer rubor tothe m surfaceh of a non i nfected person, commonly by hand. corroborative transmissions Indirect transmission of infectious organisms involvesfomites and vectors which carry disease agents from thesource to the host.Infectious agentsModes of transmissionDefinitions and termsusedSymptoms and signs com gayd managementand manipulationAnthraxCellulitisChickenpox (Varicella)Cholera dengue febricityDiphtheriaEnteric feverishness (enteric feverand para-typhoid fevers)German rubeola( eat intoella)Glandular feverHepatitis (viral)InfluenzaMalariaMeaslesMeningitisMumpsPlaguePoliomyelitis hy contrivehobia florid feverTetanus terabyteTyphus feverWhooping cough(Pertussis)Yellow feverSexu e genuinely(prenominal)y genicdiseases including HIV(AIDS) let down. Other ancestraldiseases such as Lassa Fever do non illume in spite of appearance the competenceof this book. When in doubtnotify the Port Health Officer. he fierceitary diseasesCHAPTER 6Communic up to(p) diseases argon those that atomic number 18 transmissi ble from unmatched person, or brute, to an an otherwise(prenominal)(prenominal). The disease whitethorn be spread directly, via another species (vector) or via the environment. Illness volition a purloin when the infectious agent invades the host, or more or less(a) propagation as a result of toxins produced by bacteria in nourishment.The spread of disease through a population is fixedby environmental and social conditions which favour theinfectious agent, and the relative immunity of thepopulation. An outbreak of transmission could menace theoperation and safety of the enthr completely. An understanding of thedisease and the measures prerequisite for its containment andmanagement is on that pointfore important.96THE send off master copyS medical checkup subscribeVehicles ar non-living or non-living means of transmission of infectious organisms. They accepts Water. If polluted, proper(postnominal)ally by grime sewage. Water is the vehicle for suchenteric (intestin al) diseases as typhoid, cholera, and amoebic and bacillary dy directery. s Milk is the vehicle for diseases of cattle transmissible to man, including bovine tuberculosis,brucellosis. Milk alike serves as a growth medium for some agents of bacterial diseases such as campylobacter, a common cause of diarrhoea.s Food is the vehicle for salmonella infections (which include enteric fever), amoebicdysentery, and other diarrhoeal diseases, and poisoning. both regimen squirt act as a vehicle for infection especially if it is raw or inadequately cooked, or improperly refrigerated aft(prenominal)(prenominal) cooking, as well as having been in contact with an infected source. The source whitethorn be another infected forage, hands, water or spread.s Air is the vehicle for the common cold, pneumonia, tuberculosis. influenza, holloingcough. morbilli. and chickenpox. Discharges from the mouth. irrupt, pharynx, or lungs urinate the form of droplets which remain suspended in the air , from which they may be inhaled. s Soil dissolve be the vehicle for tetanus, anthrax, hookworm. and some annoy infections. s Fomites. This term includes all inanimate objects, other than water, milk, food, air, and soil,that might play a role in the transmission of disease. Fomites include recogniseding, clo diluteg and the surfaces of objects.Vectors ar animate or living vehicles which transmit infections in the act oning ways s Mechanical transfer. The contaminated mouth- touch offs or feet of some insect vectorsmechanically transfer the infectious organisms to a bite-wound or to food. For example, flies may transmit bacillary dysentery, typhoid, or other intestinal infections by walking over the infected vogue and later leaving the disease-producing reservoirs on food. s Intestinal harbourage. Certain insects harbour pathogenic (disease causing) organisms intheir intestinal tracts. The organisms are passed in the faeces or are regurgitated by the vector, and the bite-w ounds or food are contaminated. (e.g. plague, typhus.) s Biological transmission. This term refers to multiplication of the infectious agent during itsstay in the body of the vector. The vector takes in the organism along with a store meal just is not able to transmit infection until after a definite period, during which the pathogen changes. The parasite that causes malaria is an example of an organism that completes the sexual coiffures of its life cycle within its vector, the mosquito. The virus of colour fever likewise multiplies in the bodies of mosquitoes.Terms used in connection with genetic diseasesA carrier is a person who has the infection, either without becoming ill himself or following convalescence from it.A contact is a person who may amaze on been in contact with an infected person. The incubation period is the interval of time that elapses among a person be infected with either communicable disease and the appearance of the features of that disease. Th is period is in truth variable and depends upon the infectious agent and the inoculum (the measure of the infectious agent).The isolation period signifies the time during which a forbearing suffering from an infectious disease should be dislocated from others.The period of communicability is the time during which a uncomplaining of role who may be incubating an infectious disease following contact send away communicate the disease to others. The quarantine period means the time during which port authorities may require a institutionalise to be isolated from contact with the shore. insulate of this kind is seldom carried out except when monstrous epelvic inflammatory disea faceicdiseases, such as, for instance. plague. cholera, or yellow fever are p envy or take a leak recently egestred on board.Chapter 6 genetic DISEASESSymptoms and signsIn reality it is often genuinely touchy to bring up an accurate diagnosing of an infectious disease without laboratory investigatio ns. It may be mathematical if in that location are actually specific features such as a inflorescence (varicella) or cluster of declarative features (regular fever, enlarged spleen and history of mosquito bites in an endemic area). Because of the difficulty in qualification an accurate diagnosis on board ship you may bring in to give a variety of manipulations each(prenominal) order at different infectious agents.OnsetAl just more or less all communicable diseases begin with the unhurried tinge unwell and perhaps a rise in temperature. This period may be very short, relentless only a few hours (meningococcal sepsis), or more elongated (hepatitis). In some diseases the outpouring is buggy and there is not much planetary disturbance of health, whereas in others it is atrocious and prostrating. During the attack it is rarely thinkable to make a diagnosis.The flushThe diagnosis of some communicable diseases is made easier by the presence of a characteristic foo lhardy. In certain diseases (e.g. rubicund fever) the heyday is spread tied(p)ly over the body, in others it is check to definite areas. When examining an individual suspected to be suffering from a communicable disease, it is of great importance to houseclean him completely in order to position a full picture of any rash and its distribution. widely distributed rules for the management of communicable diseases isolationThe principles of isolation are descri spang in Chapter 3 and Chapter 5. If you encounter a suspicion that the disease with which you are dealing is infectious it is advisable to invoke isolation precautions as in short as achievable. wordAn essential element in discourse is maintaining the long-sufferings well being. This is achieved through veracious general nursing and it is important to ensure that the longanimous does not become dehydrated.Advice on specific medical discourse for infectious diseases which are credibly to respond to specific drugs is presumption under the sections on treatment for the individual diseases. You may also be certified to administer drugs to anticipate sustainary infection occurring. deal Chapter on global Nursing and on how to reduce a risqueschool fever. dietingingDiet leave alone very much depend on the type of disease and unkindness of fever. Serious fever is invariably accompanied by loss of appetite and this will automatically unravel to re unfor braggart(a) diet to beverages such as water flavoured with lemon juice and a gnomish sugar or wispy tea with a little milk and perhaps sugar.Essential basic ruless Isolate. If anyone suffers from a temperature without taken for granted(predicate) cause it is best to isolate himuntil a diagnosis has been made.s Strip the persevering and make a thorough examination looking for any signs of a rash in orderto try to prove the diagnosis.s Put him to bed, and appoint someone to look after and nurse the enduring. s base non-alcoholic u nsounds in the first instance.s If his temperature exceeds 39.4C make arrangements for tepid sponging.9798THE SHIP passe-partoutS health check GUIDEs Arrange for the use of a bed pan and piddle bottle if the affected role essays any sign ofprostration or if his temperature is high.s If the patient is seriously ill and if in any doubt as to the diagnosis seek wireless MEDICALADVICE, failing which you should consider the need for making for port. s Treat symptoms as they arise.Do not attempt to get the patient up during convalescence if he is feeble, but keep him in bed until the next port is reached.When approaching port, send a radio message giving details of the causal agent to enable the Port Health Authority to make arrangements for the isolation of the role and any contacts on comer and Disinfection.Immunisation and travel adviceIt is important that up to escort advice on immunisation and the prevalent diseases should be obtained ahead reach in a foreign port. This i s close to easily available from the following publicationsHealth Information for Overseas die, produced by the UK Department of Health, and International Travel and Health, WHO, GenevaAnthraxFrench CharbonGerman MilzbrandItalian CarbonchioSpanish Carbon pensiveness outcome 2 to 7 sidereal age, commonly 2 outcome of communicability No evidence of transmission from person to person isolation detail No evidence of transmission from person to person isolate menses none.Anthrax is an ridiculous but serious communicable disease which may occur in man and animals. It occurs in man either as an infection of the skin (malignant pustule), or as an attack on the lungs or intestines, or as a widely spread infection throughout the body by means of the blood circulation.Anthrax is, in man, unremarkably contracted by handling infected animals, skins, hides, or furs. It can also be conveyed by the consumption of infected or insufficiently cooked meat, or by the inhalation of patter c ontaining the organism.Symptoms and signsIn most cases anthrax is accompanied by abominable symptoms such as fever and prostration. When it appears as a skin infection, it begins as a red itching pimple which curtly changes into a whip and within the next 36 hours progresses into a large boil with a sloughing centre skirt by a ring of pimples. Alternatively it may take the form of a painless widespread gibbosity of the skin which shortly breaks down to form pus in the area.The gastro-intestinal form of anthrax resembles food poisoning with diarrhoea and bloody faeces. The lung form captures into a quickly opprobrious pneumonia.TreatmentShould a case of anthrax occur at sea, which is unlikely unless as a result of handling animals, hides, skins, etc., all dressings or other material that come into contact with the discharge must be burnt or dispose of by disinfection.Instruments must be used to handle dressings as far as possible, and the instruments must later on be ster ilised by vigorous boiling for not less than 30 minutes, since the spores of the anthrax germ are difficult to kill.Treatment is not easy on board and the patient should be attribute ashore as soon as possible. In the meantime treatment is with PenicillinNo attempt at surgical treatment (incision or lancing of the touchy) should bemade as it does no good. Cover the rude(a) with a dressing.Seek advice from a Port Health Authority about(predicate) the treatment of cargo.Chapter 6 COMMUNICABLE DISEASESCellulitis (Erysipelas)French ErysipleGerman Erysipel pensiveness Period1 to 7 twenty-four hour periodsPeriod of communicability noneclosing off Period None isolate Period NoneItalian ErisipelaSpanish ErisipelaThis disease is an acute unhealthy condition of the skin caused by a germ entering the body through a come or abrasion. Cellulitis occurs anywhere, but most commonly on the legs, accouterments and face.The onset is sudden with shivering, and a general feeling of malaise. The temperature rises quickly and may reach about 40oC. The abnormal area becomes acutely inflamed and red on the first or second day of the infection and the touchwood spreads rapidly outwards with a well-marked, raised, and advancing edge. As the disease advances the portions of the skin first attacked become less inflamed and exhibit a yellowish appearance. Blisters may appear on the inflamed area which can be very horrendous.General treatmentThe patient must be kept in bed during the acute stage. peculiar(prenominal) treatment give birth the patient benzyl penicillin 600 mg followed by oral antibiotic treatment. Paracetamol can be tending(p) up to ease the pain.Chickenpox (Varicella)French VaricelleGerman Windpocken Italian VaricellaSpanish Varicelabrooding Period 14 to 21 years, usually 14Period of communicability Up to 5 long time in front the onset of the rash and 5 old age after the first crop of vesiclesclosing off Period Until the vesicles become dry insulate Period NoneThis highly infectious disease starts with fever and feeling unwell. Within a day or twain the rash appears on the trunk but soon spreads to the face and elsewhere, even sometimes to the pharynx and palate.The rash starts as red pimples which quickly change into small blisters (vesicles) filled with sop up precarious which may become slightly coloured and sticky during the second day. Within a day or devil the blisters burst or shrivel up and become cover with a brownish scab. ordered crops of spy appear for up to fiver days. Although usually a mild disease, sometimes the rash is more severe and very rarely pneumonia may occur.TreatmentA member of the crew who has had chickenpox, and therefore has immunity, could make a suitable nurse. If all of the crew have had chickenpox in the past then there is no need to isolate the patient. The patient need not be confined to bed unless he is unwell. He should be told not to shaft, especially not to scratch his face otherwise poc k label may remain for life. calamine lotion, if available, dabbed onto the spots may ease the itching.99100THE SHIP CAPTAINS MEDICAL GUIDECholeraFrench CholraGerman CholeraItalian disruptionraIncubation Period 1 to 5 days, usually 23 daysPeriod of communicability Usually for a few days after recovery closing off Period Until diarrhoea has colonisedQuarantine Period 5 daysSpanish CleraCholera is a severe bacterial infection of the bowel producing profuse watery diarrhoea, muscular cramps, vomiting and rapid collapse. Infection occurs principally through imbibeable infected water and sometimes through ingest contaminated uncooked vegetables, fruit, shell lean or ice cream. It generally occurs in areas where sanitation is measly and where untempered sewage has contaminated suck uping water. Other bacterial and viral causes of diarrhoea can sometimes produce a similar clinical picture and may be just as severe.Symptoms and signsMost cases are mild and will not be differentiat ed from any other form of diarrhoea. In a severe case the onset is abrupt, the vomiting and diarrhoea extreme with the faeces at first yellowish and later pale and watery, containing little white shreds of mucus resembling rice grains. The temperature is below normal, and the impulse rapid and feeble. The frequent copious watery faeces rapidly produce dehydration. Vomiting is profuse, first of food but soon changing to a thin fluid similar to the water passed by the bowel. Cramps of an agonising character attack the limbs and abdomen, and the patient rapidly passes into a state of collapse.As the result of the loss of fluid, the cheeks fall in, the eyes become shrunken and the skin loses its normal springiness and will not quickly counterpunch to its normal shape when pinched. The body becomes cold and covered with a clammy sweat, the urine is scanty, the breathing rapid and shallow,and the voice is sunk to a whisper. The patient is now restless, with vigor cramps induced by los s of salt, and feebly complaining of intense thirst. This stage may rapidly terminate in death or equally rapidly turn to convalescence. In the latter case the cessation of vomiting and purging and the return of some warmth to the skin will herald convalescence.TreatmentIf there is a suspected case of cholera on board tuner MEDICAL ADVICE ON MANAGEMENT SHOULD BE OBTAINED PROMPTLY.The patient should be isolated and purge to bed at once. Every grounds should be made to re train fluid and salt loss. at that placefore, keep a fluid balance chart. The patient should be told that his life depends on drinking enough and he should be encouraged and if necessary most obligate to drink as much as possible until all signs of dehydration disappear (until his urine output is vertebral column to normal). Thereafter he should drink about 300 ml after each stool until the diarrhoea stops. It is best to drink oral rehydration solution (ORS), if this is not available, make up a solution from 2 0 gm of sugar with a pinch of salt and a pinch of sodium bicarbonate and juice from an orange in 500 ml sterile water. puddle doxycycline two hundred mg first dose then 100 mg once daily. If vomiting, give an antiemetic anovulant or injection forwards each dose. The patient must be kept in bed until seen by a sterilize.CautionCholera is a disease which is transmitted from person to person. If cholera is suspected, the ships water supply must be exhaustively treated to make sure that it is safe. The governance of infected faeces and vomit must be chastenessled carefully since they are highly infectious. The hygiene precautions of all attendants must be of an order to prevent them also becoming infected and all food supply on board must be reviewed.Chapter 6 COMMUNICABLE DISEASESDengue feverFrench DengueGerman Denguefieber SiebentagefieberItalian Dengue Febbra dei sette giorniSpanish Fiebre dengueIncubation Period 3 to 14 days, usually 7 to 10 days.Period of communicability No person to person transmission. Infective for mosquitoes for about 5 days from just before the end of the febrile period. isolation Period NoneQuarantine Period NoneThis is an acute fever of about 7 days duration conveyed by a mosquito. It is sometimes called break-bone fever. It is an unpleasant, nettlesome disease which is rarely fatal. A severe form of the disease, dengue haemorrhagic fever, can occur in children. Features of the disease are its sudden onset with a high fever, severe business organization and aching cornerstone the eyeballs, and intense pain in the joints and muscles, especially in the small of the back.The face may swell up and the eyes suffuse but no rash appears at this stage. Occasionally an itchy rash resembling that of measles but bright red in colour appears on the fourth or fifth day of the illness. It starts on the hands and feet from which it spreads to other parts of the body, but remains most dense on the limbs. by and by the rash fades, the skin dries and the surface flakes. afterward about the fourth day the fever subsides, but it may recur some threesome days later before subsiding again by the 10th day.General treatmentThere is no specific treatment, but paracetamol will justify some of the pain, and hemimorphite lotion, if available, may ease the itching of the rash. Control is by removal of Aedes mosquitoes.DiphtheriaFrench DiphtrieGerman DiphterieItalian DifteriteSpanish DifteriaIncubation Period 2 to 5 daysPeriod of communicability Usually less than 2 weeks, shorter if the patient receives antibiotics Isolation Period 2 weeksQuarantine Period NoneDiphtheria is an acute infectious disease characterised by the formation of a membrane in the throat and nose. The onset is gradual and starts with a sore throat and fever accompanied by shivering. The throat symptoms increase, swallowing being painful and difficult, and whitish-grey patches of membrane become conspicuous on the back of the throat, the tonsils and the palate. The patches look like wash leather and bleed on being touched. The neck fountain glands swell, and the breath is foul. The fever may last for two weeks with severe prostration. Bacterial toxins may cause fatal heart failure and muscle paralysis.General treatmentImmediate isolation is essential as diphtheria is very infectious, the infection being spread by aerosols.Specific treatmentSpecific treatment is diphtheria anti-toxin which should be disposed at the earliest possible opportunity if the patient can get to medical care. Antibiotic treatment should be addicted to all cases to limit the spread of infection but it will not fling off toxin which has already been produced.101102THE SHIP CAPTAINS MEDICAL GUIDEEnteric fever typhoidFrench Fivre typhoideGerman Typhus abdominalisItalian Febbre tifoideaSpanish Fiebre tifoideaIncubation Period 1 to 3 weeks, depending on size of infecting dose Period of communicability Usually less than 2 weeks. Prolonged carriage of salmonel la typhi may occur in some of those not treated.Isolation Period Variable.Quarantine Period NoneThe term enteric fever covers typhoid and para-typhoid fevers. Enteric fever is contracted by drinking water or eating food that has been contaminated with typhoid germs. Seafarers are advised to be very careful where they eat and drink when ashore. Immunisation gives priming coatable protection against typhoid but not para-typhoid.In general the para-typhoids are milder and tend to have a shorter course. The disease may have a wide variety of symptoms depending on the roughness of the attack. Nevertheless, typhoid fever, however mild, is a disease which must be treated seriously, not only because of its possible effect upon the patient, but also to prevent it spreading to others who may not have been immunised. Strict attention must be given to hygiene and cleanliness and all clothing and soiled linen must be disinfected.During the first week the patient feels off-colour and apathetic, he may have a persistent headache, poor appetite, and sometimes nose hemorrhage. There is some abdominal discomfort and usually constipation. These symptoms increase until he is forced to go to bed. At this stage his temperature begins to rise in go reaching about 3940C in the evenings. For about two weeks it never drops back to normal even in the mornings.Any person who is found with a persistent temperature of this kind should always be suspected of having typhoid, especially if his pulse rate remains basically normal. In 10 to 20% of cases, from about the seventh day, characteristic rose-pink spots may appear on the lower office, abdomen and back, which if pressed with the finger will disappear and return when pressure is released. Each spot lasts about 34 days and they continue to appear in crops until the end of the second week or longer. Search for them in a good light, especially in dark-skinned races.During the second week,mental apathy, confusion and delirium may occur. In the more favourable cases the patient will commence recovery but in the worst cases his condition will continue to deteriorate and may terminate in deep coma and death. Even where the patient appears to be recovering, he may suffer a relapse. There are a variety of complications but the most dangerous are haemorrhage from, or perforation of, the bowel. Where the faeces are found to contain blood at any stage of the disease the patient must be kept as immobile as possible and put on a milk and water diet. If the bowel is perforated, peritonitis will set in.General treatmentAnyone suspected of having typhoid or para-typhoid fever should be kept in bed in strict isolation until seen by a doctor. The patients urine and faeces are highly infectious, as may be his vomit. These should all be disposed of. The attendants and others coming into the room should wash their hands thoroughly after handling the bedpan or washing the patient, and before leaving the room.The patient should be en couraged to drink as much as possible and a fluid input/output chart should be maintained. He can eat as much as he wants, but it is best if the food is light.Specific treatmentIf you suspect somebody has enteric fever get RADIO MEDICAL ADVICE. Give ciprofloxacin 500 mg every 12 hours for one week. On this treatment the fever and all symptoms should respond within 45 days.All cases should be seen by a doctor at the first opportunity. The case notes including details of the amount of medicine given should be sent with the patient.Chapter 6 COMMUNICABLE DISEASESGerman measles rubellaFrench RuboleGerman RtelnItalian RosoliaSpanish RubolaIncubation Period 14 to 23 days, usually 17Period of communicability For about 1 week before to at to the lowest degree 4 days after the onset of the rash Isolation Period Until 7 days from the appearance of the rash Quarantine Period NoneGerman measles is a highly infectious, though mild disease. It has features similar to those of mild attacks of or dinary measles or of ruby-red fever. For the differences in symptoms and signs see the table.Usually the first sign of the disease is a rash of spots, though sometimes there will be headache, scratchiness and soreness of the muscles, and some slight fever preceding or accompanying the rash. The rash is absent in half the cases and lasts from 5 to 6 days. The glands towards the back of the neck are swollen and can easily be felt. This is an important distinguishing sign. This swelling will precede the rash by up to 10 days.General treatmentGive the patient paracetamol, and calamine lotion, if available, for the rash.Specific treatmentNOTE Particular care should be taken to isolate patients with German measles from heavy(predicate) women Any pregnant woman on board should see a doctor ashore as soon as possible so that her immunity to rubella can be confirmed. If a patient has seen his wife in the last week he should be asked whether his wife might be pregnant. If so, his wife shou ld be advised to see her doctor.Glandular fever infectious mononucleosisFrench Fivre glandulaire Mononucleose infectieuseGerman Drusenfieber Infektiose MononukleoseItalian Febbre ghiandolare (Mononucleosi infettiva)Spanish Fiebre glandular (Mononucleosis infecciosa)Incubation Period 4 to 6 weeksPeriod of communicability Prolonged, excretion of virus may persist for ayear or more Isolation Period NoneQuarantine Period NoneThis distemper is an acute infection which is most likely to affect the young members of the crew. Convalescence may take up to two or three months.The disease starts with a gradual increase in temperature and a sore throat a white covering often develops later over the tonsils. At this stage it is likely to be diagnosed as tonsillitis and treated as such. However it tends not to respond to such treatment and, during this time, a generalised enlargement of glands occurs. The glands of the neck, armpit and groins start to swell, and become tender those in the neck to a appreciable extent.The patient may have difficulty in eating or swallowing. His temperature may go very high and he may sweat profusely. Occasionally there is jaundice between the fifth and 14th day. Commonly there is a blotchy skin rash on the upper trunk and arms at the end of the first week. Vague abdominal pain is sometimes a feature. A diagnosis of diphtheria may be considered collect to the appearance of the tonsils, but the generalised glandular enlargement is typical of glandular fever.General treatmentParacetamol should be given to relieve pain and to moderate the temperature. Any antibiotics which have been official to treat the tonsillitis should be discontinued. There is no specific treatment. If complications arise get RADIO MEDICAL ADVICE.103104THE SHIP CAPTAINS MEDICAL GUIDEHepatitis (viral)French Hpatite HepatitisGerman HepatitisItalian EpatiteSpanish HepatitisIncubation Period 15 to 50 days for hepatitis A, 60 to 90 days for hepatitis B (may be much longer) Period of communicability None after jaundice has appeared in hepatitis A, can be indefinite for hepatitis BIsolation Period During first week of illnessQuarantine Period NoneThis is an acute infection of the colorful caused by viruses. There are two main causes of acute hepatitis hepatitis A and hepatitis B. Two other viruses may cause hepatitis (C and E), but these are uncommon. The most likely cause will be hepatitis A and this is spread by the faecal-oral route (as is hepatitis E). Hepatitis B is spread sexually or by contaminated blood or needles. There is no way of differentiating one type of viral hepatitis from another. The urine and faeces will show the typical changes associated with jaundice.TreatmentThere is no specific treatment. The patient should be put to bed and treat in isolation. Plenty of sweetened fluids should be given until the appetite returns. When the appetite returns a fat-free diet should be given. No alcohol should be allowed. All cases must be seen by a doctor at the next port.InfluenzaFrench Grippe InfluenzaGerman Epidemische Influenza GrippeItalian InfluenzaSpanish Influenza GrippeIncubation Period 1 to 5 daysPeriod of communicability 3 to 5 days (7 in children) from the onset of illness Isolation Period Often half-baked because of the delay in diagnosis. In an outbreak it would be advisable to keep all affected individuals unitedly and away from those who are well Quarantine Period noneThis is an acute infectious disease caused by a germ inhaled through the nose or mouth. It often occurs in epidemics. The onset is sudden and the symptomsare, at first, the same as those of the common cold. Later the patient feels much worse with fits of shivering, and severe aching of the limbs and back. Depression, hoarseness of breath, palpitations, and headaches, are common. Influenza may vary in severity. Commonly a sharp unpleasant agitated attack is followed by a prompt fall in temperature and a short convalescence. Pneumonia is a po ssible complication.General treatmentThe patient should be subject to standard isolation. He should be watched for signs of pneumonia such as pain in the chest, rapid breathing and a bluish tinge to the lips. He should be given plenty to drink and a light and nutritious diet if he can manage it.Specific treatmentThere is no specific treatment for the uncomplicated case, but the patient should be given paracetamol as needed.Chapter 6 COMMUNICABLE DISEASESMalariaFrench PaludismeGerman MalariaItalian Malaria Spanish PaludismoIncubation Period 12 days or more, depending on the type of malaria Period of communicability The patient will remain infectious for mosquitoes until they have been completely treatedIsolation Period None if in mosquito-proof adjustmentQuarantine Period NoneMalaria is a recurrent fever caused by protozoa introduced into the blood stream by the bite of the genus Anopheles mosquito. The malaria-carrying mosquito is most prevalent in districts where there is surface water on which it lays its eggs. It is a dangerous equatorial disease which causes fever, debility and, sometimes, coma and death.Malarial areasPorts between latitudes 25N and 25S on the coasts of Africa (including Malagassy), Asia, and underlying and South America should be regarded as infected or potentially infected with malaria. Enquiries should be made prior to departure to allow appropriate prophylaxis to be arranged and treatment drugs obtained. Before arrival in port just enquiries should be made as to the current malaria situation and prophylaxis issued to the crew if necessary. stripe of malariaThe risks of attacks of malaria can be very greatly reduced if proper precautions are taken and the disease can be cured if proper treatment is given. Despite this, cases have occurred in ships where several members of the crew have been attacked by malaria during a wholeness voyage with severe and even fatal results.The precautions ares scheme of mosquito bitess prevention of infection.Avoidance of mosquito bitesThe best way to prevent malarial infection is to take measures to forefend being bitten. The advent of air conditioned ships has made many traditional preventive measures obsolete. However, when within two miles of a malarial shore it remains important that s doors are kept closed at all times after dusks any mosquitoes which enter compartments are killed using insecticide spray s persons going on deck or ashore after dusk clothing long sleeved shirts and trousers to avoidexposing their arms and legss no pools of stagnant water are allowed to develop on deck or in life boats, wheremosquitoes might breed.In ships which are not air conditioned other traditional measures to protect against mosquitoes should be implemented. These includes placing fine wire engagement over portholes, sky lights, ventilators and other openings s screening lights to avoid attracting mosquitoess fixing mosquito nets over beds where accommodation spaces cannot be made mosquitoproof. cake of infectionThe fewer the bites, the smaller is the risk of infection but even when the greatest care is exercised it will seldom be possible entirely to prevent mosquito bites either on shore or in the105106THE SHIP CAPTAINS MEDICAL GUIDEship. For this reason in all cases when a ship is bound for a malarial port, Masters (in addition to pickings all possible measures to prevent mosquito bites) should control infection by giving treatment systematically to all the ships crew.Preventive treatment (prophylaxis) does not always prevent a person from promise malarial infection, but it will reduce the incur of disease. All persons, therefore, should be warned that they have been exposed to the chance of malaria infection and that, if they fall ill at a later date, they should inform their doctor without delay that the fever from which they are then suffering may be due to malaria contracted abroad. The most appropriate prophylaxis will vary with the location as the re are different types of malaria in various parts of the world. There is also increasing resistance to anti-malarials which will affect their effectiveness. Up to date information should be obtained before departure if possible or from the topical anaesthetic health authorities.General guidelinesStart taking the prophylaxis before arrival at a malarial area in accordance with specific instructions and depending on the region. (Usually 1-3 weeks before departure).This will allow the tolerance and side-effects (if any) of the prophylactic drug to be assessed. Prophylaxis should be continued for 4 weeks after leaving the malarial area so as to ensure all stages of the parasite have been killed.No drugs for the treatment of malaria are specified in the MSN 1726 as the advice varies with destination and the pattern of disease in any given malarial area at the time. For information, the UKs familiarize guidelines recommend 3 different regimes depending on destinations Proguanil 200 mg o nce daily and chloroquine 300 mg weeklys Mefloquine 250 mg once weeklys Maloprim (a combined tablet of dapsone and pyrimethamine) 1 tablet weekly andchloroquine 300 mg weeklyOther regimes may be used in areas of high level resistanceTreatment of malariaFeatures of the illnessMalaria cannot be diagnosed with certainty without laboratory assistance. If the person has been in a potentially malarial area within the last few months and has a fever they should be assumed to have malaria. The characteristic patterns of fever associated with malaria (fever every 2 to 3 days) may not be obvious. The illness may progress rapidly without many features other than fever and sweating. There will often be a severe headache. If there is any doubt about whether to treat or not get RADIO MEDICAL ADVICE.General treatment for mild or severe malariaThe patient should be put to bed in a cool place and his temperature, pulse and respiration taken four periodical. If body temperature rises to 40oC or ove r, cooling should be carried out. The temperature should be taken and recorded at 15 minute intervals until it has been normal for some time. Thereafter the four-hourly recording should be resumed until the attack has definitely passed.Specific treatment for mild or severe malariaAnti-malarial drugs are not specified in MSN 1726 as treatment depends on the area and patterns of resistance. If anti-malarials are to be carried seek appropriate advice on which to obtain/use.The following examples of current regimes are given for information s Quinine 600 mg every 8 hours for 7 days followed by Fansidar (see below) 3 tablets as asingle doseors Mefloquine 500 mg (2 tablets) for 2 doses 8 hours apartChapter 6 COMMUNICABLE DISEASESChloroquine is not used for treatment except for proven single infections with vivax and other benign malarias because of drug resistance. If quinine, Fansidar or mefloquine are not available then chloroquine 300 mg 8 hourly for three doses then 300 mg daily for 2 days should be used.If the patient is inefficient to take medicine by mouth or is vomiting then quinine 600 mg should be given by intramuscular injection every 8 hours. As soon as the patient is able to swallow it should be given by mouth. Quinine may produce ringing in the ears or dizziness, but this should not normally be a reason to stop treatment.NOTE All patients who have been treated for malaria or suspected malaria must see a doctor at the next port because further medical treatment may be necessary.MeaslesFrench RougeoleGerman MasernItalian MorbilloSpanish SarampionIncubation Period 7 to 18 days usually 10 until onset of fever, 14 days until rash Period of communicability about 10 days, minimally infectious after the second day of the rash Isolation Period 4 days after onset of rashQuarantine Period NoneMeasles does not often occur in adults. See also the sections on German measles and scarlet fever and the table of differences of symptoms.The disease starts like a cold in the head, with sneezing, a running nose and eyes, headache, cough and a slight fever 37.5C39C. During the next two days the catarrh extends to the throat causing hoarseness and a cough. A careful examination of the mouth during this period may fall apart minute white or bluish white spots the size of a pins head on the inner side of the cheeks, or the tongue and inner side of the lips. These are know a Koplik spots and are not found in German measles and scarlet fever.The rash appears on the fourth day when the temperature increases to 3940C. Pale rose-coloured spots first appear on the face and spread down to cover the rest of the body. The spots run together to form a mottled blotched appearance. The rash deepens in colour as it gets older. In four or five days the rash begins to fade, starting where it first appeared. The skin may peel. The main danger of measles is that the patient may get bronchitis, pneumonia or middle ear infection.General treatmentThis highly infectious di sease is conveyed to others when the patient coughsor sneezes. There is no specific treatment, but the patient may have paracetamol. Calamine lotion, if available, may be applied to soothe the rash.Meningococcal disease (meningitis and septicaemia)French Mningite crbro-spinal pidmiqueGerman Epidemische Meningitis Cerebro-spinalItalian Meningite cerebro-spinal epidemicaSpanish Meningitis cerebro-spinal epidemicaIncubation Period 2 to 10 days, usually 3 to 4Period of communicability Generally not communicable whilst the patient is on antibiotics Isolation Period For 24 hours after the start of antibiotics Quarantine Period NoneInfection caused by the meningococcus (a bacteria) can cause either meningitis, with inflammation of the membranes surrounding the brain and spinal cord, or a septicaemia characterised by a generalised rash that does not fade on pressure. Unless treated promptly and effectively, the outcome is nearly always fatal. It occurs in epidemics which may affect closed c ommunities such as a ship. The infection enters by the nose and mouth. Meningitis starts suddenly with fever, large headache and vomiting. Within the first day the temperature increases rapidly to 39C or more and the headache becomes agonising.107108THE SHIP CAPTAINS MEDICAL GUIDEVomiting increases and there is general backache with pain and stiffness in the neck. Intolerance of light (photophobia) is usually present. The patient may be intensely irritable and resent all interference, or may even be delirious.As the meningitis develops the patient adopts a characteristic passenger car inbed, lying on the side with his back to the light, knees drawn up and neck bent backwards. lethargy with incontinence may develop.The septicaemia caused by the meningococcus also starts suddenly with a flu like illness. A rash develops quickly, starting with pin prick like spots which will not blanche when pressed. This rash may progress to form large dark red areas.Individual cases may vary in the facilitate of onset, the severity of the illness and the clinical features which are present.If meningitis is suspected get RADIO MEDICAL ADVICE and it will function the doctor if the results of the two following tests are availableThe neck bending testAsk the patient to attempt to put his chin on his chest. In meningitis the patient will be unable to do so because forward neck movement will be greatly restricted by muscle contraction. Try to increase the range of forward movement by pushing gently on the back of his head. The neck muscles will contract even more to prevent the movement and the headache and backache will be increased.The knee grooming test Figure 6.1A. Bend one leg until the heel isclose to the buttock.(A) Bend one leg until the heelis close to the buttock.B. come across the bent leg to lie overthe abdomen.C. Keeping the second joint as in (B) tryto straighten the lower leg.In meningitis it will be impossibleto straighten the knee beyond aright angle and attem pts to forcemovement will increase thebackache.(B) Move the bended legto lie over the abdomen.General treatmentThe patient should be nursed in aquiet, well-ventilated room withshaded lights in strict isolation. Heshould be accompanied at alltimes by an attendant who shouldwear a face mask to cover his noseand mouth. Tepid sponging maybe necessary and pressure pointsshould be treated. Usually there isno appetite but he should beencouraged to drink plenty offluid. Ice packs may help to relievethe headache.(C) Keeping the thighas in (B) try to straightenthe lower leg.Figure 6.1 The knee straightening test.Specific treatmentGive benzyl penicillin 3 g intramuscularly at once, and get RADIO MEDICAL ADVICE as to the amount and frequency of subsequent injections of benzyl penicillin. Until such advice is received, give benzyl penicillin 2.4 g at six hourly intervals. The headache should be treated with codeine. The patient should come under the care of a doctor as soon as possible.Chapter 6 COMMUNICABLE DISEASESMumpsFrench OreillonsItalian Malaria OrecchioniGerman Mumps ZiegenpeterSpanish OrejonesIncubation Period 12 to 26 days, usually 18Period of communicability 7 days before glandular swelling and up to 9 days after Isolation Period 9 days after swelling startedQuarantine Period NoneMumps is a viral disease which causes the swelling of the salivary glands in front of the ears and around the angle of the jaw. The swelling usually affects both sides of the face though it may only affect one side and it may make the mouth difficult to open. The onset is usually sudden and may be accompanied by a slight fever. The swelling stepwise diminishes and should disappear entirely in about 3 weeks. to the highest degree 20% of men with mumps get orchitis which is the swelling of one or both testicles when this occurs it usually happens around the tenth day. Whilst very painful, orchitis does not usually result in infertility and never in impotence.General treatmentThe patient should be put in standard isolation for 9 days and stay in bed for 4 to 5 days or until the fever is no longer present. He can be given paracetamol to relieve the symptoms, but there is no specific treatment.If he develops swollen painful testicles (orchitis) he should stay in bed. He should support the scrotum on a pad or small pillow. The testicles should also be support if the patient gets up for any reason.PlagueFrench PesteGerman PestItalian PesteSpanish PesteIncubation Period 2 to 6 daysPeriod of communicability As long as infected fleas are present. Person to person spread is uncommon except with plague pneumonia.Isolation Period For 3 days after the start of antibiotic treatment Quarantine Period 6 daysPlague is a serious bacterial disease transmitted to man by infected rat fleas. It may present in three waysBubonic in which buboes (swollen lymph nodes) are the most obvious feature. The nodes are painful and may ooze pus.Pneumonic in which pneumonia is the main feature. The type of plague is very infectious as the sputum contains the plague bacterium.Septicaemic which is rapidly fatal.The attack begins suddenly with severe malaise, shivering, pains in the back and sometimes vomiting. The patient becomes prostrated and is confused. His temperature reaches about oC C and the pulse is rapid. After about 2 days the buboes may develop, most commonly in 38the groins. The buboes may soften into abscesses.General treatmentThe patient should be cared for by an attendant who should wear a face mask to cover his nose and mouth The patient should be isolated and taken as soon as possible to a port where he can be treated. He should rest in bed, be encouraged to drink as much fluid as possible and have a very light diet. If the abscesses burst they should be dressed with a simple dressing, but they must not be lanced. Soiled linen and bed clothes should be boiled for 10 minutes or destroyed.109110THE SHIP CAPTAINS MEDICAL GUIDESpecific treatmentGive Doxycycline 10 0 mg once daily for at least 5 days. The patient should remain on complete bed rest during convalescence.PreventionPlague should be notified to the local health authorities at the next port of call. The quarters of the patient and the crew should be treated with insecticide powder and dust to ensure the destruction of fleas.WarningDead rats should be picked up with tongs, placed in a plastic bag, which should be sealed with string, weighted and thrown overboard if the ship is in port, the dead rats should be disposed of in the manner required by the port medical health authority.Poliomyelitis infantile paralysisFrench PoliomyliteItalian PoliomieliteGerman PoliomyelitisSpanish PoliomielitisIncubation Period 321 days, commonly 714 daysPeriod of communicability Cases are most infectious during the first few days before and after the onset of symptomsIsolation Period not more than 7 daysQuarantine Period NonePoliomyelitis is an acute viral disease that occurs mostly in children. It isa disease almost entirely preventable by immunisation.The severity ranges from non-apparent infection to non-specific febrile illness, meningitis, paralytic disease and death. Symptoms of the mild disease include fever, malaise, headache, nausea and vomiting. If the disease progresses, severe muscle pain and stiffness of the neck and back, with or without paralysis will occur. The most commonly affected parts are the legs and arms, shoulders, diaphragm and chest muscles. The development of paralysis is generally complete within two days and then recovery begins. The recovery may be complete or leave some degree of paralysisAffected muscles are usually painful and tender if touched. They are always jerk and movements of the affected parts are either looseened or lost by the wasting which appears very soon after paralysis.Paralysis of the respiratory muscles may cause breathlessness and blueness of the lips.General treatmentThere is no specific treatment but much can be achieved by g ood nursing. The patient should have complete rest in bed. Pain should be treated with paracetamol and/or codeine. If a limb has been affected it should be supported by pillows in such a way that the paralysed muscles cannot be stretched. The joints above and below the paralysis should be put through a full range of movement morning and evening to prevent stiffness. In all cases, as soon as paralysis appears, RADIO MEDICAL ADVICE must be sought. If the respiratory muscles are affected, breathing difficulty may ensue. Urgent steps must be taken to get the patient to skilled hospital treatment as soon as possible.Chapter 6 COMMUNICABLE DISEASESRabies hydrophobiaFrench La rageGerman TollwutItalian RabbiaSpanish RabiaIncubation Period in humans the incubation period is usually 2 to 12 weeks, shortest for patients bitten about the head and those with extensive bites Communicability Rabies is rarely, if ever, spread from human to human. Nevertheless for the duration of the illness conta minant with saliva should be avoided by wearing gloves when nursing the patientIsolation Period Duration of the illnessQuarantine PeriodRabies is an acute infectious viral disease that is almost always fatal. When a rabid mammal bites humans or other animals, its saliva transmits the infection into the wound, from where it spreads to the central nervous system. Rabies is primarily an infection of wild animals such as skunks, coyotes, foxes, wolves, racoons, bats, squirrels, rabbits, and chipmunks. The most common domestic animals reported to have rabies are dogs, cats, cattle, horses. mules, sheep, goats, and swine. It is possible for rabies to be transmitted if infective saliva enters a scratch or fresh break in the skin.The development of the disease in a bitten person can be prevented by immediate and proper treatment, Once symptoms of rabies develop, death is virtually certain to result. indeed prevention of this disease is of the utmost importance.Local port authorities shoul d be informed of possible rabid animals, so that appropriate public health measures can be instituted.TreatmentAs soon as an individual aboard ship Is known to have been bitten by a dog or other possibly rabid animal, RADIO MEDICAL ADVICE should he obtained at once. Usually suspected cases are sent ashore to obtain the expert treatmentand nursing care needed to prevent the disease.Immediate local care should be given. Vigorous treatment to remove rabies virus from the bites or other exposures to the animals saliva may be as important as specific anti-rabies treatment. Free bleeding from the wound should be encouraged. Other local care should constitute ofs thorough irrigation of the wounds with soap or detergent water solution s cleansing with antiseptic solutions if recommended by radio, giving an antibiotic to prevent infection s administering adsorbed tetanus toxoid, if indicated.s Suturing of bite wounds should be avoided.PreventionWhen abroad, seamen should keep away from warm -blooded animals especially cats, dogs. and other carnivores. It is strongly advised that pets should not be carried on board ship as these may become infected unnoticed, through contact with rabid animals in ports.111112THE SHIP CAPTAINS MEDICAL GUIDEScarlet feverFrench ScarlatineGerman ScharlachItalian ScarlattinaSpanish EscarlatinaIncubation Period 1 to 3 daysPeriod of communicability 3 daysIsolation Period 14 days in untreated cases, 1 to 2 days if given antibiotics. Quarantine Period NoneScarlet fever is not often contracted by adults. It has features similar to those of measles and German measles see the table of differences of symptoms.The onset is generally sudden and the temperature may rapidly rise to 39.5 to 40C on the first day. With the fever the other main early symptom is a sore throat, which in most cases is very severe. The skin is hot and burning to the touch. The rash appears on the second day and consists of tiny bright red spots so close together that the skin a ssumes a scarlet or boiled lobster-like colour. It usually appears first on the neck, very rapidly spreads to the upper part of the chest and then to the rest of the body. There may be an area around the mouth which is clear of the rash.The tongue at first is covered with white fur and, when this goes, it becomes a very bright red (strawberry). The high fever usually lasts about a week. As the rash fades the skin peels in neb patches. The danger of scarlet fever arises from the complications associated with it, e.g. inflammation of the kidneys (test the urine for protein once a day), inflammation of the ear due to the spread of infection from the throat, rheumatism and heart disease. These complications can be avoided by careful treatment.General treatmentThe patient must stay in bed and be kept as quiet as possible. The patient can be given paracetamol to relieve the pain in the throat which may also be helped if he takes plenty of cold drinks. He can take such food as he wishes.S pecific treatmentAs scarlet fever usually follows from a sore throat or tonsillitis you may already be giving him the relevant treatment. Otherwise give the specific treatment for tonsillitis.Tetanus lockjawFrench TetanosGerman WundstarrkrampfItalian TetanoSpanish TetanosIncubation Period 4 to 21 daysPeriod of communicability No person to person transmissionIsolation Period NoneQuarantine Period NoneTetanus is caused by the infection of a wound by the tetanus bacterium which secretes a powerful poison (toxin). This bacterium is very widespread in nature and the source of the wound infection may not always be easy to trace. Puncture wounds are particularly credible to be dangerous and overlooked as a point of entry. In the UK immunisation against the disease usually begins in childhood but it is necessary to have further periodic inoculations to maintain effective immunity. luckily the disease is a very rare condition on board ship. The first signs of the disease may be spasms or s tiffening of the jaw muscles and, sometimes, other muscles of the face leading to difficulty in opening the mouth and swallowing. The spasms tend to become more frequent and spread to the neck and back causing the patients body to become arched.The patient remains fully conscious during the spasms which are extremely painful and brought on by external stimulus such as touch, noise or bright light. The patient is progressively exhausted until heart and lung failure prove fatal. Alternatively, the contractions may become less frequent and the patient recovers, but there is a high mortality.TreatmentThe patient should be isolated in a darkened room as far as possible from all disturbances. Get RADIO MEDICAL ADVICE. Give antibiotic treatment and give diazepam or chlorpromazine as sedation and to control spasms. The patient must be got to hospital as soon as possible.Chapter 6 COMMUNICABLE DISEASESTuberculosis TB, consumptIonFrench TuberculoseGerman Tuberkulose Italian TuberculosisSpani sh TuberculosisIncubation Period 4 to 12 weeksPeriod of communicability indefinite, 2 weeks after antibiotics Isolation Period depends on the degree of infection, rarely necessary Quarantine Period NoneThis infectious disease is caused by the note bacillus. Although the lung (pulmonary) disease is the most common, TB bacteria may attack other tissues in the body bones. joints. glands, or kidneys. Unlike most communicable diseases, tuberculosis usually takes a considerable time to develop, often appearing only after repeated, close, and prolonged exposures to a patient with the prompt disease. A healthy body is usually able to control the tubercle bacilli unless the invasion is overwhelming or resistance is low because of chronic alcoholism, poor nutrition, or some other weakening condition.The pulmonary form of the disease is spread most often by coughing and sneezing. A person may have tuberculosis for a long time before it is detected. Symptoms may consist of nothing more than a persistent cough, slight loss of weight, night sweats, and a continual all-in or tired-out feeling that persists when there is no good reason for it. More definitive signs pointing to tuberculosis are a cough that persists for more than a month, raising sputum with each cough. persistent or recurring pains in the chest, and afternoon rises in temperature. When he reaches a convenient port, a seaman with one or more of these warning signs should see a physician.TreatmentEvery effort should be made to prevent anyone who has active tuberculosisfrom going to sea. since this would present a risk to the crews health as well as the individuals. The treatment of tuberculosis by medication will not usually be started at sea, since the disease does not constitute an emergency.To prevent the spread of tuberculosis, every patient with a cough, irrespective of its cause, should hold disposable tissues over his mouth and nose when coughing or sneezing and place the used tissues in a paper bag, which should be disposed of by burning. The medical attendant should follow good nursing isolation techniques (see Isolation Chapter 3). No special precautions are necessary for handling the patients bedclothes, eating utensils, and personal clothing.Tuberculosis controlA tuberculosis control programme has three objectives (I) to keep individuals with the disease from signing on as crew-members (2) to locate those who may have developed the disease while aboard ship and initiate treatment and (3) to give preventive treatment to persons at high risk of developing the active disease. The first objective can be achieved by periodic, thorough physiologic examinations including chest X-rays and bacteriological examination of sputum. To identify those who might have developed active tuberculosis, a chest X-ray should be taken and a medical evaluation including bacteriological examination of sputum quest when in port, if a crew-member develops symptoms of a chest cold that persist for mo re than two weeks.Also, when any active disease is discovered, survey should be made of close associates of the patient and others in prolonged contact with him. such(prenominal) persons are regarded as contacts and are considered at risk from the disease they should be given a tuberculin test and chest X-ray when next in port. If they develop symptoms, full medical examination, including bacteriological examination of sputum, should be requested.113114THE SHIP CAPTAINS MEDICAL GUIDETyphus feverFrench Typhus exanthAematiqueItalian Tifo petecchialeGerman FlecktyphusSpanish Tifus petequialIncubation Period 6 to 15 days, usually 12Period of communicability Not directly transmissible from person to person Isolation Period not required after de-lousingQuarantine Period 14 daysThis disease should not be confused with typhoid fever. Typhus is caused by a small bacterium. The disease is conveyed by lice, fleas, ticks and mites. Treatment for the various types of typhus is the same and the s ymptoms are very similar. The main typhi are epidemic (from lice) and murine, or ship typhus, (from rat fleas).Symptoms and signsOnset is sudden with headache, vomiting, shivering and nausea. The temperature rapidly rises and may reach 40.0C to 40.6C. The patient suffers great prostration, and may be delirious or confused.About the fifth day a rash appears on the front of the body, spreading to the back and limbs in the form of dusky red spots which give the skin a blotchy appearance. The disease if untreated lasts about two weeks. With tick or mite borne typhus there is usually a punched out blue ulcer (eschar) which corresponds to the site of attachment.TreatmentIn the case of louse-borne typhus isolate the patient at once. render and clothing of the patient and close contacts should be treated with a residualinsecticide. The patient should receive Doxycycline until his temperature settles plus one day. The response is normally prompt.Whooping cough pertussisFrench CoquelucheGe rman Keuchhusten Italian PertosseSpanish Tos FerinaIncubation Period 7 to 10 days, rarely exceeding 14 daysPeriod of communicability 21 days, normally no more than 5 days after antibiotics Isolation Period 5 days after antibioticsQuarantine Period NoneThis disease occurs among unvaccinated children unvaccinated adults may contract it. The disease in adults has no typical features.Symptoms and signsThe onset occurs as a severe cough which after about 7 to 10 days is marked by a typical whoop, with or without vomiting. The whoop is caused by a convulsive series of coughs reaching a point where the patient must take a breath. It is this noisy indrawing of breath which produces the whoop. The coughing bouts may be very distressing.TreatmentGive erythromycin for 5 days. This is unlikely to affect the course of the disease unless given very early, but it will reduce the infectiousness of the patient. In children, during the bouts of coughing, feeding may induce vomiting. It is best, there fore, to give light food in between the coughing bout and to keep the child quiet in bed.Chapter 6 COMMUNICABLE DISEASESYellow feverFrench Fivre jauneGerman GelbfieberItalian Febbra giallaSpanish Fiebra amarillaIncubation Period 3 to 6 daysPeriod of communicability 6 daysIsolation Period 12 days only if stegomyia mosquitoes are present in the port or on board Quarantine Period 6 daysThis is a serious and often fatal disease which is caused by a virus transmitted to humans by a mosquito. The disease is endemic in Africa from coast to coast between the south of the Sahara and Kenya, and in parts of the Central and Southern Americas.PreventionTravellers to these areas should be inoculated against the disease. Many countries require a valid International Certificate of yellow fever inoculation for those who are going to, or have been in or passed through, such areas. See also the note on prevention of mosquito bites in the section dealing with malaria.Features of the diseaseThe severity of the disease differs between patients. In general, from 3 to 6 days after being bitten the patient fluctuates between being shivery and being over hot. He may have a fever as high as 41C, headache, backache and severe nausea and tenderness in the pit of the stomach. He may seem to get slightly better but then, usually about the fourth day, he becomes very weak and produces vomit tinged with bile and blood (the so-called black vomit). The stomach pains increase and the bowels are constipated. The faeces, if any, are coloured black by digested blood. The eyes become yellow (jaundice) and the mind may wander. After the fifth or sixth day the symptoms may subside and the temperature may fall. The pulse can drop from about 120 per minute to 40 or 50. This period is critical leading to recovery or death.Increasing jaundice and very scanty, or lack of, urine are unfavourable signs. Protein in the urine occurs soon after the start of the illness and the urine should be tested for it.Gene ral treatmentThe patient must go to bed and stay in a room free from mosquitoes. The patient must be encouraged to drink as much as possible, fruit juices are recommended.115