MMIC PBL2 - Blog 2

Fungal

Fungal Diseases	Treatment	Prevention
Tinea capitis(scalp ringworm)	-Oral antifungal medicines-Oral antifungal pills such as griseofulvin, terbinafine, itraconazole, fluconazole and ketoconazole	-Medicated shampoo maybe used to reduce the risk of spreading the scalp ringworm to someone else:such as selenium sulfide shampoo and ketoconazole shampoo -Keep skin dry and cool
Tinea cruris(jock itch)	-Antifungal creams or ills	-Keep skin dry and cool
Tinea pedis(athelete’s foot)	Antifungal ointment, lotion, powder or spray such as terbinafine (Lamisil AT), clotrimazole (Lotrimin AF) and miconazole (Micatin)- Oral medications such as itraconazole (Sporanox), fluconazole (Diflucan) and terbinafine (Lamisil)	-Keep skin dry and cool
Sporotrichosis	-Oral potassium iodide such as itraconazole (Sporanox)	nil
Histoplasmosis	-Antifungal medications such as amphotericin B (Fungizone IV) and itraconazole (Sporanox)	-No vaccine is available. -Itraconazole is used for chronic suppression,AIDS patients.
Disseminated candidiasis	- Antifungal medications such as Amphotericin B and Fluconazole.	-Predisposing factors shold be reduced or eliminated. -Oral thrush can be prevented by using Clotrimazole troches/nystatin "swish & swallow". -No vaccine is available..
Chronic mucocutaneous candidiasis	-Antifungal agents, immunologic therapies, and combination therapy -Such as ketoconazole	-Predisposing factors shold be reduced or eliminated. -Oral thrush can be prevented by using Clotrimazole troches/nystatin "swish & swallow". -No vaccine is available.
Cryptococcal meningitis	-Antifungal medications such as amphotericin B	-Fluconazole (Diflucan) is used to prevent the cryptococcal infection from coming back (maintenance treatment). -No vaccine is available.
Aspergillosis	-Oral corticosteroids-Antifungal medications such as amphotericin B and oriconazole	-No vaccine is available.

Virus

Dieases/virus	Treatment	Prevention
Hep A	There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.	Hepatitis A immunisation is given in a series of injections. The first single injection in the arm gives protection for a year. The second booster injection at 6 to 12 months extends protection for up to 10 years.
HEPATITIS B	In the majority of patients with active HBV, symptoms will not be severe and treatment will not be required Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and Baraclude	Three immunisation injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check that they have worked. Immunity should last for at least 5 years.
NAIROVIRUS	The antiviral drug ribavirin has been used in treatment of established CCHF infection with apparent benefit. Both oral and intravenous formulations seem to be effective.	Avoidance of areas where tick vectors are abundant and when they are active (Spring to Fall); Regular examination of clothing and skin for ticks, and their removalUse of repellents.
WEST NILE FEVER	There is no specific treatment for West Nile virus infection. Intensive supportive therapy is directed toward the complications of brain infections. Anti-inflammatory medications, intravenous fluids, and intensive medical monitoring may be required in severe cases	When you are outdoors, use insect repellent containing an EPA-registered active ingredient.
RABIES	If rabies vaccine treatment is called for, it should be started as soon as possible after exposure. Counting the first day of vaccine treatment as day 0, injections are administered on days 0, 3, 7, 14, and 28.	The rabies vaccine is administered after exposure to the virus. No matter where the wound, authorities emphasize that the first and most valuable preventive measure is thorough cleaning of the site with soap and water, and immediate medical attention.
JAPANESE ENCEPHALITIS	nil	In general, vaccine should be offered to persons spending a month or longer in endemic areas during the trans-mission season, especially if travel will include rural areas. Use of insect repellants
YELLOW FEVER	Serious cases of yellow fever always need hospital treatment. As there are no products that combat the virus itself, the doctor can only treat the symptoms. If there is a lack of fluid in the body, leading to disturbances in the electrolyte balance, this can be remedied by administration of fluids by intravenous drip. In mild cases, the pain may be relieved with simple painkillers. High temperatures can be treated by cooling the patient and giving them appropriate medicines to lower the temperature, such as aspirin (eg Disprin) or ibuprofen (eg Nurofen).	Vaccination available: This vaccine contains a live, weakened form of the yellow fever virus. It provokes the body's immune response without causing the disease.
Leishmania virus	itraconazole/ Fluconazole/ Paromomycin/ miltefosine (impavido)	· Stay in well-screened or air-conditioned areas as much as possible. Avoid outdoor activities, especially from dusk to dawn, when sand flies are the most active.· When outside, wear long-sleeved shirts, long pants, and socks. Tuck your shirt into your pants. · Apply insect repellent on uncovered skin and under the ends of sleeves and pant legs. Follow the instructions on the label of the repellent. The most effective repellents are those that contain the chemical DEET (N,N-diethylmetatoluamide). The concentration of DEET varies among repellents. Repellents with DEET concentrations of 30%-35% are quite effective, and the effect should last about 4 hours. Lower concentrations should be used for children (no more than 10% DEET). Repellents with DEET should be used sparingly on children from 2 to 6 years old and not at all on children less than 2 years old.· Spray clothing with permethrin-containing insecticides. The insecticide should be reapplied after every five washings. · Spray living and sleeping areas with an insecticide to kill insects.· If you are not sleeping in an area that is well screened or air-conditioned, use a bed net and tuck it under your mattress. If possible, use a bed net that has been soaked in or sprayed with permethrin. The permethrin will be effective for several months if the bed net is not washed. Keep in mind that sand flies are much smaller than mosquitoes and therefore can get through smaller holes. Fine-mesh netting (at least 18 holes to the inch; some sources say even finer) is needed for an effective barrier against sand flies. This is particularly important if the bed net has not been treated with permethrin. However, it may be uncomfortable to sleep under such a closely woven bed net when it is hot.NOTE: Bed nets, repellents containing DEET, and permethrin should be purchased before traveling and can be found in hardware, camping, and military surplus stores
RIFT VALLEY FEVER	Ribavirin	. Hepatotoxic medication as well as aspirin and NSAIDs should be avoided during the acute disease. Contact with sick or dead animals must be avoided.Smithburn vaccine (single dose, life-long protection), or vaccination with the formol-inactivated vaccine (boosters needed). For personal protection covering clothing (long sleeves, long trousers), insect repellents (best with DEET) and impregnated mosquito nets are adequate in normal situations. Barrier-nursing is indicated in the care of patients. There is still no commercial vaccine available for humans. It is true that experimental cell-culture vaccines for medical use do exist, but they are not easy to obtain.

General precautions to be taken when at camp
Preferably apply insect repellent whenever the individual is in the jungle and also apply before sleeping. This is to lower the risk of getting beaten by insects (sandflies, mosquitoes, etc.). Before consuming food, ensure to wash hands with clean water or boiled river/ stream water to reduce chances of consuming vectors of viruses. Ensure consumption of fluids from clean bottled water or boiled water from water bodies. Observe good personal hygiene to reduce chances of being infected by viruses and to reduce chances of transmitting viruses to other platoon members. Quarantine sick individuals to reduce chances of spreading the viruses contracted. Clean wounds or cuts properly to reduce chances of infection.

Protozoa

Dieases	Treatment	Prevention
Schistosomiasis	Praziquantel/ Oxamniquine/ Mirazid	· Swimming in the ocean and in chlorinated swimming pools is generally thought to be safe · Drink safe water(don’t drink water coming directly from canals, lakes, rivers, streams or springs is safe, you should either boil water for 1 minute or filter water before drinking it. Boiling water for at least 1 minute will kill any harmful parasites, bacteria, or viruses present. Iodine treatment alone WILL NOT GUARANTEE that water is safe and free of all parasites. · Bath water should be heated for 5 minutes at 150o F. Water held in a storage tank for at least 48 hours should be safe for showering · Vigorous towel drying after an accidental, very brief water exposure may help to prevent the Schistosoma parasite from penetrating the skin. You should NOT rely on vigorous towel drying to prevent schistosomiasis Castor oil as an oral- penetration
Balantidiasis	Tetracycline/ metronidazoleiodoquinol / paromomycin.	· Purification of drinking water. Water can be purified by filtering, boiling, or treatment with iodine. · Proper food handling. Measures include protecting food from contamination by flies, cooking food properly, washing one's hands after using the bathroom and before cooking or eating, and avoiding foods that cannot be cooked or peeled when traveling in countries with high rates of balantidiasis. · Careful disposal of human feces. Monitoring the contacts of balantidiasis patients. The stools of family members and sexual partners of infected persons should be tested for the presence of cysts or trophozoites.
Cholera	Tetracycline/ azithromycin/ oral rehydration solution/ mixture or salts, sugar and water drunk in large amount	· Wash your hands. Frequent hand washing is the best way to control cholera infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food, after using the toilet, and when you return from public places. Carry an alcohol-based hand sanitizer for times when water isn't available. · Avoid untreated water. Contaminated drinking water is the most common source of cholera infection. For that reason, drink only bottled water or water you've boiled or disinfected yourself. Hot beverages such as coffee and tea as well as bottled or canned soft drinks, and wine and beer are generally safe. Carefully wipe the outside of all bottles and cans before you open them and ask for drinks without ice. Use bottled water to brush your teeth. · Eat food that's completely cooked and hot. Choose food that's been thoroughly cooked and is served hot. Cholera bacteria can survive on room temperature food for up to five days and aren't destroyed by freezing. It's best to avoid street vendor food, but if you do buy it, make sure your meal is cooked in your presence and served hot. · Avoid sushi. Don't eat raw or improperly cooked fish and seafood of any kind. · Be careful with fruits and vegetables. When you're traveling, make sure that all fruits and vegetables that you eat are cooked or have thick skins that you peel yourself. Avoid lettuce in particular because it may have been rinsed in contaminated water. · Be wary of dairy foods. Avoid ice cream, which is often contaminated, and unpasteurized milk. Cholera vaccine. Because travelers have a low risk of contracting cholera and because the traditional injected vaccine offers minimal protection, no cholera vaccine is currently available in the United States. A few countries offer two oral vaccines that may provide longer and better immunity than the older versions did. If you'd like more information about these vaccines, contact your doctor or local office of public health. Keep in mind that no country requires immunization against cholera as a condition for entry.
Amebiasis	metronidazole, paromomycin, iodoquinol, or diloxanide furoate	· Drinking only water that has been bottled in sanitary conditions or boiled (water-purifying tablets are ineffective against amebic cysts) · Eating only cooked or peeled vegetables or fruits · Protecting food from fly contamination Washing hands after defecation and before preparing or eating food
Cryptosporidiosis	Nitazoxanide	Stools of patients with cryptosporidiosis are highly infectious · Frequent washing of the hands, including under the fingernails · Not eating unwashed fruits unless peeled · Boiling water if there is any doubt about its source · Boiling stream or river water for three minutes · Using filter paper with pore size of 1 micro<>
Cyclosporiasis	trimethoprium- sulfamethoxazole/ bactrim / septra/ cotrim	· Drinking only water that has been bottled in sanitary conditions or boiled (water-purifying tablets are ineffective against amebic cysts) · Eating only cooked or peeled vegetables or fruits · Protecting food from cyclosporasis contamination Washing hands after defecation and before preparing or eating food
Toxoplasmosis	pyrimethamine / trisulfapyrimidines / sulfadiazine./ folinic acid/ spiramycin	· Make sure your physician checks your blood for toxoplasma antibodies . Use work gloves and wash your hands afterwards. · Control flies and cockroaches as much as possible. They can spread contaminated soil or cat feces onto food. · Avoid eating raw or undercooked meat (or poultry) and unwashed fruits and vegetables. · Wash your hands thoroughly before you eat and after handling raw meat, soil, sand or cats. · Avoid rubbing your eyes or face when preparing food, and wipe the counter clean afterwards. Avoid eating raw eggs and drinking unpasteurized milk.
Giardiasis	metronidazole (Flagyl)/ furazolidone (Furoxone)/ paromycin (Humatim), / quinacrine (Atrabine)	· Frequent washing of the hands, including under the fingernails · Not eating unwashed fruits unless peeled · Boiling water if there is any doubt about its source · Boiling stream or river water for three minutes · Using filter paper with pore size of 1 micro <>
Malaria	Metronidazole/ Nitazoxanide/ Furazolidone/ Tinidazole/ aminoglycoside paromomycin/ chloroquine/ mefloquine(lariam)/ primaquine, quinine/ pyrimethamine-sulfadoxine (Fansidar)/ doxycycline/ artemisin- derivatives/ atovaquone-proguanil (malarone)	· evaluating the risk of exposure to infection · preventing mosquito bites by using DEET mosquito repellant, bed nets, and clothing that covers most of the body chemoprophylaxis (preventive medications)
Leishmaniasis	Na stibogluconate (Na antimony gluconate) / meglumine antimonite/ liposomal amphotericin/ pentamidine/ itraconazole/ Fluconazole/ Paromomycin/ miltefosine (impavido)	insect repellents containing DEET provide protection. Insect screens, bed nets,and clothing are more effective if treated with permethrin or pyrethrum, because the tiny flies can penetrate mechanical barriers. Vaccines are not currently available. Wear long selves shirt and long pants and sock.(tuck in shirt into the pants)

References

http://www.itg.be/itg/DistanceLearning/LectureNotesVandenEndenE/13_Arbovirusesp5.htm#T10
http://www.medicinenet.com/leishmaniasis/page4.htm

MMIC PBL 2

Virus

Microbe	Transmission	Signs and symptoms	Disease	Geographical distribution
Hepatitis A virus	Fecal-oral route	Diarrhea and nausea with possible acute infection	Hepatitis A	Worldwide, but most common where sanitary conditions are poor and the safety of drinking water is not well controlled
Hepatitis B virus	Parenteral route	Similar to HAV with higher possibilities of leading to chronic infections and liver cancer	Hepatitis B	Worldwide, but with differing levels of endemicity. In north America, Australia ,northern and western Europe and New Zealand, prevalence of chronic HBV infection is relatively low (less than 2% of the general population)
Nairovirus	Bite from Hyalomma tick, animal reservoirs	Fever, shaking chills, severe headache, rash and possible hepatomegaly	Crimean- Congo Hemorrhagic Fever	Nil
Viruses belonging to the Flaviviridae family	Bite from Mosquitoes ( eg. Culex tritaeniorhynchus) or Ticks, Birds serve as the reservoir	Fever, drowsiness, facial flushing, lymph node Largement, conjunctival infection	West Nile Fever	Nil
Flavi- viruses	Bites from mosquitoes, most commonly Aedes aegypti, a day biting mosquito	Dengue hemorrhagic fever, rash, headache, respiratory manifestations that mimic a cold	Dengue	Dengue fever is widespread in tropical and subtropical regions of central and south America and south and south-east Asia and also occurs in Africa; in these regions , dengue is limited to altitudes below 600 metres (2,000 feet)
Alphavirus	Bite from Culex mosquito , Birds serve as the reservoir	Fever, rash and polyarthritis	Sindbis	Nil
Phlebovirus	Bite from mosquitoes, exposure to infected animals and possible aerosol	Nonspecific febrile reaction with fever, nausea and possible visual loss	Rift Valley Fever	Nil
Viruses from Rhabdoviridae family	Open cuts or wound in skin or mucous membranes via bites or infected animal saliva	Fever, severe headache, malaise ,possible neurologic Manifestations	Rabies	Rabies is present in animals in many countries worldwide. Most cases of human infection occur in developing countries
Phlebo- viruses	Bites from sandfly (Phleobotomus papatasi)	Fever, severe frontal headache, nausea, vomiting, possible aseptic Meningitis	Sandfly fever	Nil
Leishmania- viruses	Leishmania species	Infection with Leishmania	Leishmania- virus	Nil
Japanese encephalitis (JE)virus, which is a flavivirus	The Japanese encephalitis virus is transmitted by various mosquitoes of the genus Culex	asymptomatic (e.g. cause no symptoms). In symptomatic cases, severity varies ;mild infections are characterized by febrile headache or aseptic meningitis	Japanese encephalitis	Nil
an arbovirus of the Flavivirus genus	Bites from mosquitoes (Aedes aegypti)	asymptomatic, most lead to an acute illness characterized by two phases. Initially, there is fever, muscular pain, headache, chills, anorexia, nausea and/ or vomiting, often with bradycardia	yellow fever	The yellow fever virus is endemic in some tropical areas of Africa and central and south America. The number of epidemics has increased since the early 1980s. Other countries are considered to be at risk of introduction of yellow fever due to the presence of t he vector and suitable primate hosts (including Asia, where yellow fever has never been reported)

Fungal

Causes of FUNGUS DISEASES
Fungal infection outbreak could happen in a clinical setting where climate are often hot and high humidity such as tropical areas like Indonesia. These diseases are caused by poor personal health practices (harsh living conditions of NS soldier). The jungle environment promotes fungus and bacterial diseases of the skin and warm water immersion skin diseases. Bacteria and fungi are tiny plants which multiply fast under the hot, moist conditions of the jungle. Sweat-soaked skin invites fungus attack. The following are common skin diseases that are caused by long periods of wetness of the skin:

Warm Water Immersion Foot. This disease occurs usually where there are many creeks, streams, and canals to cross, with dry ground in between. The bottoms of the feet become white, wrinkled, and tender. Walking becomes painful.
Chafing. This disease occurs when soldiers must often wade through water up to their waists, and the trousers stay wet for hours. The crotch area becomes red and painful to even the lightest touch.
Most skin diseases are treated by letting the skin dry.

Microbe	Transmission	Signs and symptoms	Disease	Geographical distribution
Dermatophytes, e.g: Microsporum, Trichophyton, epidermophyton sp	Direct contact with skin, usually on warm, sweaty and humid part of the body, hair and nails,feet.	typical ringworm lesion, itching, scaling, inflammation, and blisters	tinea capitis(scalp ringworm), tinea cruris(jock itch) and tinea pedis(athelete’s foot)	contact with infected lesions, soiled or contaminated articles such as shoes and towels, almost anywhere in the world
Sporothrix schenckii	mold spores enter skin in puncture wounds by thorns in jungle	small bumps on skin but painless, local abscess and ulcerative nodules	sporotrichosis	soil, wood, sphagnum moss, and decaying vegetation throughout the world
Histoplasma Capsulatom	Inhalation of airborne asexual pores causing acute respiratory diseases	Often no symptoms but fever, cough, malaise, respiratory symptoms can occur.	Histoplasmosis	grows preferentially in soil enriched with bird droppings
Candida Albicans	Part of the normal flora of skin, mucous membrane and GI tract, can invade tissue if the infected person is injured or wounded	: itchy skin rash, skin inflammation, skin lesions on moisture-damaged skins, rash in e penis area	disseminated candidiasis and chronic mucocutaneous candidiasis	Human body
Aspergillus fumigatos	Inhalation of airborne spores and their invasion through a wound or other tissue injury	Fever, cough, pneumonia, endocarditis, eosinophilia	Aspergillosis	live in soil, commonly in decaying vegetation, such as fermenting compost piles and damp hay.
Cryptococcus neoformans	Inhalation of airborne yeast cells, affects the central nervous system and the lungs in people with weakened immune systems.	early lung infection often has no symptoms, meningitis, encephalitis and headache.	Cryptococcosis, especially Cryptococcal meningitis	live in soil, especially when enriched with pigeon droppings

Prevention of FUNGUS DISEASES in soldiers
To prevent these diseases, soldiers should:

• Bathe often, and air- or sun-dry the body as often as possible.
• Wear clean, dry, loose-fitting clothing whenever possible.
• Not sleep in wet, dirty clothing. Soldiers should carry one dry set of clothes
• just for sleeping. Dirty clothing, even if wet, is put on again in the morning.
• This practice not only fights fungus, bacterial, and warm water immersion
• diseases but also prevents chills and allows soldiers to rest better.
• Not wear underwear during wet weather. Underwear dries slower than jungle fatigues, and causes severe chafing
• Take off boots and message feet as often as possible.
• Dust feet, socks, and boots with foot powder at every chance.
• Always carry several pairs of socks and change them frequently.
• Keep hair cut short.

Protozoa

Microbe	Transmission	Signs and symptoms	Disease	Geographical distribution
Leishmaniasis species	sand fly	fever, damage to the spleen and liver, and anaemia, Visceral/ Cutaneous/ Diffuse cutaneous /Mucocutaneous leishmaniasis	Leishmaniasis	Jungle setting: large number of mosquitoes and sand fly
Plasmodium falciparum and malariae	bites from Female anopheline mosquito	Moderate to severe shaking chills High fever, Profuse sweating as body temperature falls, General feeling of unease and discomfort, (malaise), Headache ,Nausea, Vomiting, Diarrhea	Malaria	Occur in many tropical and sub-tropical countries- P. falciparum and P. malariae is most common in Asia
Giardia	Contaminated food and water Raw food like fruits and vegetables	Abdominal pain, Watery diarrhea Foul smelling gas and burping, Mild fever, sometimes with chills, Malabsorption, where nutrients are not absorbed, frequently with weight loss	Giardiasis	Found in surface waters all over the Earth and spread in the feces of both humans and animals
Toxoplasma gondii	Contaminated food and water Raw food like fruits and vegetables	headache, chronic malanise, fever lymphadenopathy	Toxoplasmosis	almost everywhere from surface of water to contaminated veggies and fruits to soil and infects warm blooded vertebrates
Cryptosporidium	Contaminated food and water Raw food like fruits and vegetables /faecal-oral route or swimming	Dehydration, Malnutrition, Weight loss, Stomach cramps or pain, Fever, Nausea , Malaise , Vomiting	Cryptospori- diosis	Found in surface waters all over the Earth and spread in the feces of both humans and animals
Cyclospora cayetanensis	Contaminated food and water Raw food like fruits and vegetables	Headache, Nausea, Vomiting, sever Diarrhea, bloating, muscle aching, fatigue and asymptomatic	Cyclosporiasis	mainly in America and Canada
Entamoeba histolytica	Contaminated food and water Raw food like fruits and vegetables	sever diarrhea, abscesses in the intestine, liver, and other organs	Amebiasis	Entamoeba histolytica is endemic in tropical countries ,usually found in water, decaying organic matter, soil, and sewage, is of particular interest to contact lens wearers
Naegleria fowleri	nasal passage via swimming and diving	disease primary amebic meningoen- cephalitis (PAM), a brain inflammation	Naegleria infection	found in environment water and soil worldwide, commonly in Warm bodies of freshwater, such as lakes, rivers, Geothermal water such as hot springs, Warm water discharge from industrial plants, Poorly maintained and minimally chlorinated swimming pools
Balantidium coli	Contact with pig feces or soil contaminated with pig feces	severe diarrhea and intestinal abscesses	Balantidiasis	common in tropical regions and many developing countries in the tropical region lack proper water structures for much of the poor, rural population such as Bolivia, the Philippines, and Papua New Guinea
Vibrio cholerae	Faceal-oral route or contaminated food and drink sand more prevalent in warmer cilmate	sever diarrhoea, dehydration, shock , muscle cramps , nausea and vomitting	Cholera	Cholera is most common in Africa, southern and Southeast Asia, and the Middle East, although outbreaks have occurred in Japan , Australia, and Europe
S.japonicum, S.mekongi, S.mansoni, S.intercalatum and S.haematobium	faecal oral route	Katayama fever, abdominal pain, hematuria, weakness, headaches , joint and muscle pain, diarrhea, nausea, producing seizures or transverse myelitis as a result of mass lesions of the brain or spinal cord and cough	Schistoso- miasis	This infection occurs widely throughout the tropics and subtropics

References

http://www.microbiologybytes.com/iandi/6b.html

http://www.mayaparadise.com/diseasee.htm

http://www.nuim.ie/staff/dpringle/courses/mg/chapter02.pdf

http://human-infections.suite101.com/article.cfm/protozoan_parasites_in_dirt\

http://www.who.int/water_sanitation_health/dwq/admicrob5.pdf