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By: M. Jack, M.A., Ph.D.
Medical Instructor, Louisiana State University School of Medicine in New Orleans
Those in command of the vessel are ultimately responsible for ensuring that effective preventive measures are in place anxiety genetic buy venlor 75mg. The infectious agent or its toxic product may be transmitted directly from an infected person anxiety 24 weeks pregnant cheap venlor 75mg amex, animal anxiety breathing gif cheap venlor 75mg free shipping, or the environment to a susceptible host patient anxiety 6 things you can touch with your hands cheap venlor 75mg fast delivery, or it may be transmitted indirectly through an intermediate plant or animal host or a vector (often an insect). These elements include: crowding (easier to pass a cold to other crew in the bunkroom); physical stress (irregular sleep patterns, changes in diet, weather extremes, noise); self-contained food and water systems (susceptible to lapses in proper maintenance and cross-contamination with infectious agents); 2-1 exposure to cargos (animals and animal products such as hides and wool); travel to other countries (exposure to diseases such as malaria, typhoid fever and cholera through contaminated food or water). Disease transmission requires an agent that is capable of causing a disease, a host that is susceptible to the agent, and an environment that permits the agent and host to come together. For an infectious disease to circulate within a population there must be a chain of transmission from one infected host to another and a suitable route of spread. Why is it essential to understand the principles of preventing and controlling communicable diseases If most of the crew are ill (an outbreak), fewer will be able to operate the ship safely; medical supplies may run low and care may become inadequate. Thus, it is important to know how various diseases are spread, what can be done to prevent their spread, and what can be done to control them once they appear. Infectious Agents An infectious agent or its toxic product causes communicable disease in a susceptible host. Organisms that can produce disease in humans range in size from submicroscopic viruses to the fish tapeworm, a parasite that can attain a length of more than 30 feet. For example, infection with many different respiratory viruses can result in a common cold, and infectious diarrhea can be caused by many bacteria and viruses. Other diseases, such as tuberculosis or polio, occur only after infection with the specific infectious agent. Other organisms, such as those found normally on human skin, have low pathogenicity because they rarely cause disease. Thus, an individual infected with an organism may or may not "get sick" or have symptoms. Chain of Transmission the concept of the chain of transmission is basic to understanding the prevention and control of disease. When the chain of transmission is understood, ways to break the chain can be identified. If the chain is broken, then the disease will be controlled and future cases prevented. A chain of transmission or infection contains the following links: Reservoir: or source of the agent; Portal of exit: or mode of escape of the agent from the reservoir or source; Mode of transmission: of the agent from the source to the new host; Portal of entry: into the new host; Susceptible new host: (who may become the source for additional transmission). Reservoirs or Sources of Infection the reservoir of infection is where the organism is normally found. The source of infection is the location from which the organism is transmitted to the host (either directly or indirectly through a vehicle such as air or water). For example, the reservoir of the organism causing botulism, Clostridium botulinum, is the soil. The source of the toxin produced by this agent is often improperly processed food contaminated by soil. Eliminating the source of the organism may not prevent further spread of infection if the reservoir remains intact. Most of the infectious diseases harmful to man have a human source or reservoir, which means that the infection is transmitted directly or indirectly from a person with the disease. An infection with an organism may lead to consequences ranging from no symptoms and signs, to mild or moderate illness, to serious disease or death. A carrier is a person who harbors an infectious agent but may show no signs of illness. The period of carriage of an organism may occur during the incubation period (the time between infection with the agent and when the patient actually shows symptoms of illness), during an infection (whether apparent or inapparent), or following recovery from illness. Carriage of an infectious agent may be transient, lasting from the onset of infection through a portion of convalescence. Asymptomatic carriers serve as reservoirs of infection and play an important role in the spread of some diseases. However, for other zoonotic diseases, both man and another animal or animals are essential to the normal life cycle of the infecting agent.
Horseflies and Deerflies the family Tabanidae consists of species including horseflies anxiety xyrem buy 75mg venlor otc, deerflies anxiety symptoms early pregnancy generic venlor 75 mg overnight delivery, gadflies anxiety symptoms face numbness 75mg venlor with mastercard, and mangoflies that attack mainly animals anxiety natural remedies buy venlor 75 mg low cost. In the act of biting, the female fly leaves a deep wound, causing blood to flow, which the fly laps up. Muscoid Flies Physiology and Structure the muscoid flies include three medically important insects: the housefly, Musca domestica; the stablefly, Stomoxys calcitrans; and the tsetse flies of the genus Glossina. The stablefly, often mistaken for the housefly, is a true bloodsucker capable of serving as a short-term mechanical vector of a number of bacterial, viral, and protozoal infections. The tsetse fly (Figure 78-9) is also a biting fly and serves as the biological vector and intermediate host for the agents of African trypanosomiasis, Trypanosoma brucei rhodesiense and T. The common housefly represents a host of genera that are nonpiercing or contaminating flies. Because of their living and feeding habits, they mechanically transmit diverse agents to humans. The housefly and stablefly are cosmopolitan in distribution and serve as indicators of poor sanitation. Stableflies commonly lay eggs in moist, decaying vegetable matter such as grass clippings or compost heaps found in suburban communities. Prevention and Control Control of tsetse fly populations has been problematic because of their widespread distribution in primarily rural and undeveloped areas. Myiasis-Causing Flies Myiasis is the term applied to the disease produced by maggots that live parasitically in human tissues. The number of myiasis-producing flies and the diversity in lifestyle requirements are enormous. Only the host relations and sites of predilection of some of the more important species are covered in this section. Specific myiasis refers to myiasis caused by flies that require a host for larval development. One important example is the human botfly, Dermatobia hominis, which is found in the humid regions of Mexico and Central and South America. The adult botfly attaches her eggs to the abdomen of bloodsucking flies or mosquitoes, which in turn distribute the eggs while obtaining a blood meal from an animal or human. The larvae develop over 40 to 50 days, during which time a painful lesion known as a warble appears (Clinical Case 78-3). The resulting lesion may take weeks to months to heal and may become secondarily infected. Semispecific myiasis is caused by flies that normally lay their eggs on decaying animal or plant matter; it develops in a host if entry is facilitated by the presence of wounds or sores. Representatives of this group include the greenbottle fly, Phaenicia; bluebottle flies, Cochliomyia; and blackbottle flies, Phormia. These flies are worldwide in distribution, and their presence is encouraged by poor sanitation. They occasionally lay their eggs on the open sores or wounds of animals and humans. These flies have a worldwide distribution and normally breed in decomposing matter. They may deposit their larvae on foods that if ingested may serve as a source of infection. Flies that produce accidental myiasis have no requirement for development in a host. Accidental infection may occur when eggs are deposited on oral or genitourinary openings and the resulting larvae gain entry into the intestinal or genitourinary tract. Sucking Lice Physiology and Structure Although several species of lice (Anoplura) infest humans as blood-feeding parasites, only the body louse is important in medicine as the vector of the rickettsia of typhus and trench fevers and the vector of the spirochetes of relapsing fever (see Table 78-2). The pubic or crab louse, Phthirus pubis, has a short crablike abdomen with clawed second and third legs (Figure 78-11). Dermoscopy revealed a central opening surrounded by dilated blood vessels from which a yellowish structure with black barblike spines on the extremity extruded intermittently. This corresponded to the posterior extremity of Dermatobia hominis (human botfly) larva. The lesion was occluded with a double layer of plaster for 24 hours, and the immobile dead larva was removed with forceps and gentle squeezing.
Active Tetanus protection should be maintained by a Tetanus (Td) booster every 10 years anxiety 8 year old cheap venlor 75 mg otc. Wound management prophylaxis can be accomplished by the following recommendations: Clean and uncomplicated wounds - Booster immediately anxiety 8 year old trusted venlor 75 mg, if Td immunization was greater than 10 years ago anxiety getting worse buy generic venlor 75 mg online. Special Diets Seriously ill and recovering patients may not be able to tolerate a regular diet anxiety out of nowhere buy discount venlor 75mg on line. Clear Liquid: Clear fluids and foods that are liquid at body temperature, such as broth, gelatin, popsicles and juices. Full Liquid: Foods that are liquid or liquefy at body temperature such as strained meat and vegetable cream soups, ice cream, custards, and hot cereals. Soft Diet: Foods that are mildly flavored, non-gas forming and easily chewed, such as tender meat, cooked carrots, canned fruit, pudding and cake. When there is injury in the mouth or oral cavity area, or when the patient is nauseous and vomiting, give a clear liquid diet. Flow 1-40 sheets are useful to log information such as vital signs, medications, changes in condition, treatments, fluids, intake and output. Flow sheets can show information in chart or graphic form, and can be reviewed quickly. Each and every patient visit should be clearly documented in a medical record format. Complete and accurate written records are an essential component of quality medical care, and are the responsibility of every health care provider. Aboard ship, maintenance of the health of passengers, crew, and staff is essential for a successful journey. Specific measures can be taken to prevent, control, or remove threats to the health of those aboard ship. Such measures may be aimed at preventing injury, chemical or other toxic exposure, or infectious diseases. Measures that prevent infectious disease include avoiding risky behaviors; proper sanitation and food hygiene; control of animals and insects that carry disease; and, when indicated, chemoprophylaxis (use of medication or other chemicals to prevent disease), immunization, and quarantine. Presenting educational talks and distributing pamphlets on how to minimize disease risk are also helpful. Thus an infectious agent may require two or more hosts for its development during different stages in its life cycle. The agent that causes malaria (a parasite that must live in two different hosts-mosquitoes and man-at different periods of its life cycle) is an example of such an organism. For some infectious agents, either man or another animal can serve as reservoirs of infection. Fungi (such as those causing coccidioidomycosis, histoplasmosis, and blastomycosis) and molds are found in soil and dust or on vegetation grown in endemic areas (places where the diseases are common). Certain species of bacteria that form spores also are found in the soil, but only if the soil has been 2-4 contaminated previously with the spores. Tetanus (lockjaw) and anthrax are examples of diseases that may be acquired through exposure to the environment. Portals of Entry and Exit Portals of entry and exit are the routes through which the infectious agent enters and exits the body of the host. Portals of entry and exit in the human body include the respiratory, digestive, and urinary systems, as well as the skin (including mucous surfaces such as the eye), wounds, and blood. Often the causative organism enters and exits the body through the part of the body primarily involved in the disease process. This is true, for example, for illnesses such as the common cold as well as other respiratory and digestive system diseases. Conversely, the portal of entry may have no relation to the organ system involved in the disease. For example, the infectious agents for malaria and yellow fever, transmitted by mosquitoes, enter and leave the host through the skin, but involve other areas of the body (such as the liver and brain) in the disease process. Modes Of Transmission the main modes of transmission of communicable diseases are person-to-person, common vehicle, airborne, vector-borne, sexual contact, and blood-borne spread. The chain of transmission of an illness can be broken by interrupting the route of transmission.
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