2. Epidemiology-
The study and analysis of the patterns, causes, and effects
of health and disease conditions in defined populations.
It is the cornerstone of public health, and evidence-based
practice by identifying risk factors for disease and targets
for preventive healthcare.
Epidemiology is the branch of medicine which deals with
the incidence, distribution, and possible control of diseases
3. All over the world most of the parasitic diseases are
epidemic , such as malaria, leishmania.
More than one billion people worldwide are infected by
parasites causing different disease.
Parasitic diseases are closely related to geographic, social
and economic factors. These represent a broad group of
eukaryotic and prokaryotic organisms that may cause
severe diseases in animal and human populations.
Parasites are the causative agents of pathologies such as
Malaria. In 2008, there were 247 million cases of Malaria
and nearly one million deaths from the disease, mostly
among children living in Africa. In Africa, a child dies of
Malaria every 45 seconds; the disease accounts for 20% of
all childhood deaths
4. Leishmaniasis threatens approximately 350 million
men, women and children in 88 countries around the
world. As many as 12million people are believed to be
currently infected by this disease.
Schistosomiasis is a chronic, parasitic disease caused
by blood flukes (trematodeworms) of the genus
Schistosoma. More than 207 million people are
infected with these organisms worldwide, with an
estimated 700 million people at risk in 74 endemic
countries.
5. Lymphatic filariasis affects more than 1.3 million
people in 81 countries. Approximately 65% of those
infected live in Southeast Asia, 30% in Africa and the
remainder in other tropical areas .
There is a another importance of epidemiology is
molecular epidemiology is considered a powerful tool
for understanding the genetic variation and evolution
of pathogens. The use of the technologies based on
molecular biology techniques has allowed the
scientific community to reveal disease determinants
and the genetic structure of parasites
6. In animal kingdom, about 800000 parasites have been
identified and they are categorized into 33 phyla.
Taxonomic classification of human parasites
Ectoparasite (lice, fleas, mites)
Endoparasite (schistosoma, plasmodium)
Protozoan(unicellular organisms)
Healminth (multicellular organisms)
7. Protozoan parasite-
A diverse group of eukaryotes of the kingdom Protista.
Primarily unicellular.
Existing singly or aggregating into colonies.
Usually ciliate or flagellate .
Usually nonphotosynthetic.
Live in water or as parasites.
some major protozoan parasites are-
Plasmodium , Leishmania, Giardia, Entamoeba ,
Trypanosoma.
8. Disease caused by protozoan parasite
Malaria-
caused by Plasmodium parasites
spread to people through the bites of infected female
Anopheles mosquitoes.
Sleeping sickness-
caused by infection with protozoan parasites belonging to
the genus Trypanosoma.
are transmitted to humans by tsetse fly (Glossina genus
9. Kala-Azar
caused by a protozoan parasite Leishmania
transmitted to humans by the bite of infected female
Phlebotomine sandflies.
Amoebiasis-
Also known as amebiasis or entamoebiasis.
Infection caused by any of the amoebas of the Entamoeba
group.
10. Giardiasis-
Caused by the flagellate protozoan Giardia lamblia.
Inhabits the digestive tract of a wide variety of domestic
and wild animal species, as well as humans.
11. Prevalance:-
Parasitic infections, caused by protozoan parasites, are
among the most prevalent infections in humans in
developing countries.
In developed countries, protozoan parasites more
commonly cause gastrointestinal infection as well as
disease through blood .
Intestinal parasites cause a significant morbidity and
mortality in endemic countries.
12. Global Distribution
In case of Malaria:
99 countries are endemic to malaria in the world.
Mainly found in African region followed by South-
East Asia region and Eastern Mediterranean region.
About 3.2 billion people are at risk of malaria.
Between 2000 and 2015, malaria mortality rates fell by
60% globally and by 66% in the African region.
14. In case of Leishmaniasis:
The disease is endemic in about 62 countries in the
tropical, sub-tropical and southern Europe.
More than 90% of leishmaniasis cases occur in India,
Bangaladesh, Nepal, Sudan, Brazil and Ethiopia.
East Africa forms the second largest focus of
Leishmaniasis in the world.
Largely found in underdeveloped communities.
Visceral leishmaniasis(VL) killed 100,000 people out of
a population of 280,000 between 1984 and 1994.
500,000 new cases of VL estimated and more than
50,000 deaths from the disease each.
15.
16. Kala-azar is endemic in 54 districts in India.
o Mainly33 districts of Bihar.
o 4 districts of Jharkhand.
o 11 districts of West Bengal.
o Beside this 6 districts of eastern Uttar Pradesh.
17. Of Sleeping Sickness:
Sleeping sickness or African Trypanosomiasis is
caused by 3 species of Trypanosoma.
T. brucei gambiense - most common in central
and Western Africa where humans are primary
reservoir.
Over 95% human infection are found in Congo,
Angola,Sudan,Central Africa.
T. brucei rhodesiense - most common in Southern
and Eastern Asia, where game animals are thought
to be primary reservoir, Tanzania, Uganda,
Malawai and Zambia.
T brucei brucei- it is not human infective. It
causes African trypanosomiasis.
18. In India, few records of Trypanosome infection has
been found , mostly from Maharasta.
19. Amoebiasis :
Mainly caused by Entamoeba histolytica.
Some species are non- pathogenic.
Amoebiasis is most common in the Indian
subcontinent, parts of Central and South America,
and parts of Africa.
Amoebiasis is a rare occurrence in developed
countries of the world.
Travelers to high risk areas where amoebiasis is
endemic may acquire the infection during their
travel.
20. The endemic areas include the tropical and sub-
tropical countries of South and West Africa, Central
and South America, India and Mexico.
21. In case of Giardiasis:
G. intestinalis is found all over the world.
It is one of the most common intestinal infections in
the United States .
Giardiasis is a enteric disease among international
travelers in the United States, Canada, and Europe.
G. intestinalis has high prevalence rates particularly
among young children in third world countries.
Giardiasis is especially common in areas with poor
sanitary conditions and limited water-treatment
facilities.
23. Intensity of Infection:
Malaria-
In case of malaria parasite, About 3.2 billion
people – half of the world’s population – are at
risk .
Young children, pregnant women and non-
immune travellers from malaria-free areas are
become infected.
6.2 million malaria deaths have been averted
globally since 2001.
In sub-Saharan Africa – 15 countries account for
80% of malaria cases and 78% deaths globally.
24. Since 2000, the decline in malaria incidence in
15 countries (32%) has lagged behind that of
other countries globally (53%).
Children under 5 are particularly susceptible to
infection, illness and death.
More than two thirds (70%) of all malaria
deaths occur in this age group.
Between 2000 and 2015, the under-5 malaria
death rate fell by 65% globally.
An estimated 5.9 million child lives saved
between 2001 and 2015.
25. Leishmaniasis:
The World Health Organization (WHO) reports an
estimated 300,000 new cases of visceral leishmaniasis
(VL) with 20,000 to 30,000 deaths annual.
About 12 million people are currently infected in some
98 countries.
Mostly infect the woman due to greater exposure of
sand flies bites.
The male to female ratio is probably about 2:1.
In Southest Asia, 5-10% of VL patients in the Indian
subcontinent develop post-kala azar dermal
Leishmaniasis.
Over 50% of VL patients in East Africa develop post-
kala azar dermal leishmaniasis.
26. Sleeping sickness:
The disease occurs in some regions of sub-
Saharan Africa with the population about 70
million in 36 countries.
As of 2010 it caused around 9,000 deaths per year,
down from 34,000 in 1990.
An estimated 30,000 people are currently infected
with 7000 new infections in 2012.
More than 80% of these cases are in the
Democratic Republic of the Congo.
Both male and female are greatly affected.
The DRC currently reports more than 1000 new
cases annually and accounts for 85% of the cases
reported in 2014.
27. Amoebiasis:
Approximately 50 million people have invasive disease,
resulting in 100,000 deaths per year, more than 10% of the
population have been reported from various developing
countries.
About 480 million people are infected with E. histolytica
and these result in the death of between 40,000–110,000
people every year.
In countries where Amoebiasis is an important health
problem, the majority, approximately 9007, of individuals
with colonic E. histolytica infections are carriers, while
the remain have invasive intestinal Amoebiasis.
Amoebiasis is in 2nd position which causes the high
mortality throughout the world.
28. About 90% of the people exposed to E. histolytica are
asymptomatic or report very mild symptoms.
Amoebic abscesses are 10 times more common in adult
than in children.
A higher frequency occurs in male than female(3:1).
Giardiasis:
There are 19,000 cases of Giardiasis in the United
States from 2006 to 2008.
In South America, rural areas of India, South-East
Asia, and numerous other areas of world giardiasis
may be much higher due to low income population.
29. Distributions is common in children less than 10 years
old and adults aged of 35 to 44 years.
Giardiasis is a global disease. It infects nearly 2% of
adults and 6% to 8% of children in developed
countries worldwide.
In the United States, Giardia infection is the most
common intestinal parasitic disease affecting humans.
Among the child population studied revealed a gender
distribution of 52.8% male and 47.2% female.
Age distribution was 47.4% between 0-5 years and
52.6% between 6-15 years.
31. Symptoms of malaria-
Clinical symptoms of malaria:
9 to 14 days for Plasmodium (P.) falciparum
12 to 18 days for P. vivax and P. ovale
18 to 40 days for P. malariae
33. The cyclic pattern of malaria symptoms is due to the life cycle of
malaria parasites .
they develop, reproduce, and are released from the red blood cells and
liver cells in the human body .
34. Physical and morphological alteration
caused by malarian parasite-
Plasmodium falciparum leads to structural, biochemical, and
mechanical modifications to the host red blood cells
formation of parasitophorus vacuoles
loss of cell volume, and the appearance of small nanoscale protrusions
or knobs on the membrane surface.
35. considerable amount of hemoglobin (Hb) is digested by parasites
during intraerythrocytic development and converted into insoluble
polymerized forms of heme, known as hemozoin.
loss of RBC deformability cause anaemia .
36. Symptoms of sleeping sickness:-
In the first stage, the trypanosomes multiply in subcutaneous tissues,
blood and lymph. This is known as a hemolymphatic phase, which
entails bouts of fever, headaches, joint pains and itching.
In the second stage, the parasites cross the blood-brain barrier to infect
the central nervous system. This is known as the neurological phase.
37. Clinical symptoms:-
Fever
Personality changes
Disturbance of sleep patterns
Troubles with walking and talking
Aching muscles and joints
Slurred speech
Seizures
Swelling around the eyes and hands
Headaches
Fatigue
Prolonged sleep
Death shortly happens a few months, after the invasions of the central
nervous system.
38. Physical and morphological alternation
The primary clinical signs are an intermittent fever, signs of anemia,
lymphadenopathy and weight loss.
Neurological signs, dependent edema, cardiac lesions, diarrhea,
keratitis, lacrimation, appetite loss and other clinical signs have also
been reported .
Affected animals have enlarged lymph nodes and signs of severe
anemia, and they develop widespread visceral and mucosal
hemorrhages, particularly in the gastrointestinal tract .
In one outbreak, the main hemorrhagic sign was bleeding from the
ears. Weight loss can be severe. This syndrome can be rapidly fatal.
39. Clinical symptoms of kala-
azar:-
Fever
Fatigue
Weakness
Pallor of skin and mucous membranes
Loss of appetite
In case of visceral leishmaniasis hepatosplenomegally occur
Weight loss
40. Physical and morphological alteration:-
parasitic invasion of the blood and reticulo-endothelial system (that is,
the general phagocytic system), such as enlarged lymph nodes, spleen
and liver.
Fatigue and weakness are worsened by anaemia, which is caused by the
persistent inflammatory state, hypersplenism (the peripheral
destruction of erythrocytes inthe enlarged spleen) and sometimes by
bleeding.
Patient with V.L should be assessed for possible cutaneous
Leishmaniasis called post- kala-azar dermal Leishmaniasis .
Splenomegally (with the spleen most often soft and non tender)
typically is more impressive than hepatomegally and the spleen can in
fact be massive
Mucosal involvement generally is manifested first by pesistent unusual
nasal symptom (e.g. epistaxis), with erythema and edema of the nasal
mucosae, and then by progressive ulcerative,nasopharyngeal
destruction.
41. In case of Amoebiasis-
Clinical symptoms of amoebiasis:
Most people with this infection do not have symptoms. If symptoms
occur, they are seen 7 to 28 days after being exposed to the parasite.
Mild symptoms are-
Abdominal cramps
Diarrhea, Passage of 3 to 8 semiformed stools per day, or passage of soft
stools with mucus and occasional blood
Fatigue
Excessive gas
Rectal pain while having a bowel movement (tenesmus)
Unintentional weight loss.
Severe symptoms:-
Abdominal tenderness
Bloody stools, including passage of liquid stools with streaks of blood,
passage of 10 to 20 stools per day
Fever
Vomiting
42. :
Physical and morphological
alteration
The E. histolytica parasite can cause inflammation in the lining of host
gut (intestines). This condition is known as amoebic colitis .
The disease is often mild and can just lead to tummy (abdominal) pain
and diarrhoea.
severe inflammation with ulceration of the intestinal lining can occur
in some people and so-called 'amoebic dysentery' can develop.
symptoms of amoebic dysentery include severe abdominal pain and
diarrhoea which can contain blood and mucus.
43. High temperature (fever) may be another symptom
but this is not common loss of appetite and weight los
Some people with amoebic colitis may just develop
bleeding from their back passage (rectal bleeding)
with no diarrhoea.
few people with amoebic colitis, an 'amoeboma' can
develop.
Anaemia is another complication of amoebic colitis
due to blood loss in the bloody diarrhea.
The most typical presentation of amebic liver abscess
is fever right upper quadrant pain, and tenderness.
44. In case of Giardiasis
Physical and morphological alteration :-
Some people with giardia infection never develop signs or symptoms
but still carry the parasite and can spread it to others through their
stool.
signs and symptoms usually appear one to three weeks after exposure
and may include.
Watery, sometimes foul-smelling diarrhea that may alternate with soft,
greasy stools
Fatigue or malaise
Abdominal cramps and bloating
45. Clinical symptoms:-
Vomiting
Urticaria
Flatulence
Malaise, weaknes
Various neurologic symptoms (e.g.., irritability,
sleep disorder, mental depression, neurasthenia)
Anorexia
Gas or flatulence
Nausea
Weight loss
46. Physical and morphological alternation
less common symptoms include itchy skin, hives, and swelling of the eye and
joints .
Sometimes, the symptoms of giardiasis might seem to resolve, only to come
back again after several days or weeks.
Giardiasis can cause weight loss and failure to absorb fat, lactose, vitamin A
and vitamin B12 .
When the parasite does cause symptoms, the illness usually begins with severe
bouts of watery diarrhea, without blood or mucus .
giardiasis affects the body's ability to absorb fats from the diet .
diarrhea seen in giardiasis contains unabsorbed fats - so it floats and is very
foul-smelling and shiny .
47.
48. for
MALARIA
Treatment and prophylaxis
Quinine, quinidine
Chloroquine, amodiaquine, and relatives
Pyrimethamine and combinations
Proquanil and chlorproguanil
Mefloquine
Halofantrine
Artemisinin and derivatives (qinghaosu)
Antibiotics—tetracycline, clindamycin, rifampicin
“Causal”prophylaxis
Primaquine
Combination chemotherapy, e.g., artemisininplus X
Now essential despite increase in adverse reactions and cost
50. Rational use of vector control methods
An effective vector control method should be able to reduce the
vectorial capacity of mosquitoes. There are five determinants of the
choice of vector control method applied in an area. These are:
Intensity of the disease transmission or the magnitude of the
malaria burden;
Vector behaviour, human behaviour and environment;
Availability of resources;
Feasibility of timely and correct application;
Possibility of sustainability
Malaria Free Zone: In this zone continuous surveillance should
be maintained to keep watch of introduction of malaria in such
zones.
Seasonal Transmission Zone:The most cost effective control
method includes the use of Indoor Residual Spray (IRS). This
includes epidemic prone areas. However, the coverage of IRS
should be about 80% for high impact.
Endemic And Holoendemic Zone: In such areas the most cost
effective method of control is the use of Insecticide Treated Nets
(ITNs). The coverage must be in more than 80% of the community
members for it to have impact.
VECTOR CONTROL
51. General Measures for Prevention and
Control
Controlling mosquito breeding;
Preventing mosquitoes from biting people;
Killing adult mosquitoes before they bite people;
52. for
SLEEPING SICKNESS
A-B-C Method:
Awareness of Risk
Bite Avoidance
Chemoprophylaxis
And also,
avoiding the bushy areas and using the
bed nets at the bed time
53. Drugs Species Phase Dosage Route Common side effects
Pentamidine
isethionate
T. gambiense acute 7-10 doses of 4mg/kg
per day
IM Diarrhea
Dizziness
Headache
Upset stomach
Nausea
Suramin sodium T. gambiense
T. rhodisiense
acute 5mg/kg on the 1st day,
10 on the 3rd and 20 on
the 5th,11th, 23rd and
30th
IV Renal failure
Anaphylactic shocks
Signs of neurotoxicity
Severe cutaneous
reactions
Melasoprol T. gambiense
T. rhodisiense
chronic 3-4 series of 3-4
injections per day
IV Reactive
encephalopathic
syndrome
Elfornithine T. gambiense chronic 400mg/kg per day in 4
daily infusions for 1-2
wks.
IV Diarrhea
Pancytopenia
Convulsion
Hallucination
Nifurtimox T. gambiense
T. cruzi
chronic 400mg/kg per day in 4
daily infusions for 1-2
wks.
Oral Anorexia
Neurological problems
TREATMENT
54. TREATMENT
Good nursing
Diet
Antibiotics
Pentavalent antimony (sodium stibogluconate and
meglumine antimoniate have been used as first-line
chemotherapeutic agents)
Pentamidine
Amphotericin B, which is a macrolide, is another drug of
second choice used in the treatment of leishmaniasis
for
KALA AZAR
57. Location Clinical Class Drug Name Drug Action
Intestinal
Asymptomatic Iodoquinofonnum lumenal amebicide
Mild to moderate
intestinal disease
Metronidazole tissue amebicide
Severe intestinal
disease
Metronidazole plus a lumenal
drug
both
Extraintestinal
Hepatic disease Metronidazole plus a lumenal
drug
both
58. • Individual measures
Diagnosis and treatment of E.
histolytica patients
Safe drinking water (boiling or 0.22 µm
filtration)
Cleaning of uncooked fruits and
vegetables
Prevention of contamination of foods
• Chemotherapeutic Trial
59. Community measures
Public services and utilities
Adequate disposal of human stools
Safe and adequate water supply
Primary health care systems
Health education (washing hands, cleaning and
protecting food, controlling insects)
Specific surveillance programs and Control programs
integrated into ongoing sanitation & diarrhea
control
Health Regulations
Control of food vendors and food handlers
Control of flies and cockroaches
60. for
GIARDIASIS
When signs and symptoms are severe or the infection persists, doctors
usually treat giardiasis with medications such as:
Metronidazole (Flagyl): Metronidazole is the most commonly used
antibiotic for giardia infection. Side
effects may include nausea and a metallic taste in
the mouth. Don't drink alcohol while taking this
medication.
Tinidazole (Tindamax): Tinidazole works as well as metronidazole
and has many of the same side effects, but it can
be given in a single dose.
Nitazoxanide (Alinia): Because it comes in a liquid form,
nitazoxanide may be easier for children to swallow.
Side effects may include nausea,
flatulence, yellow eyes and brightly colored
yellow urine.
61. Children and adults who have giardia infection
without symptoms usually don't need treatment
unless they're likely to spread the parasites. Many
people who do have problems often get better on their
own in a few weeks
There are no consistently recommended medications
for giardiasis in pregnancy because of the potential for
adverse drug effects to the baby. If your symptoms are
mild, your doctor may recommend delaying
treatment until after the first trimester. If treatment is
necessary, discuss the best available treatment option
with your doctor
62. Prevention by maintenance of good hygeine
Wash hands with soap and clean running water for at least 20 seconds; rub hands
together to make a lather and be sure to scrub the backs of your hands, between
fingers and under the nails :
Before and after taking food
Before and after using toilet
After coughing, sneezing or blowing nose
Thoroughly washing your hands after gardening can help prevent exposure to
parasitic diseases .
To reduce the risk of spreading the disease, children with diarrhea should be
removed from child care settings until the diarrhea has stopped.
Protect others by not swimming if you have diarrhea (this is most important for
children in diapers).
If diagnosed with giardiasis, do not swim for at least 1 week after diarrhea stops.
Shower before entering the water.
Wash children thoroughly (especially their bottoms) with soap and water after they
use the bthroom or after their diapers are changed and before they enter the water.
Minimize contact with animal feces in order to prevent spread of infections
