New York State Department of Health
Amebiasis
Last Reviewed: November 2006
What is amebiasis?
Amebiasis is an intestinal illness caused by a microscopic parasite called Entamoeba histolytica. Approximately
1,000 cases are reported each year in New York State.
Who gets amebiasis?
Anyone can get amebiasis, but it is recognized more often in people arriving from tropical or subtropical areas,
individuals living in institutions, and men who have sex with men.
How is amebiasis spread?
Amebiasis is contracted by consuming contaminated food or water containing the cyst stage of the parasite. It
can also be spread by person-to-person contact.
What are the symptoms of amebiasis?
People exposed to this parasite may experience mild or severe symptoms or no symptoms at all. Fortunately,
most exposed people do not become seriously ill. The mild form of amebiasis includes nausea, loose stools,
weight loss, abdominal tenderness and occasional fever. Rarely, the parasite will invade the body beyond the
intestines and cause a more serious infection, such as a liver abscess.
How soon after exposure do symptoms appear?
The symptoms may appear from a few days to a few months after exposure but usually within two to four
weeks.
For how long can an infected person carry this parasite?
Some people with amebiasis may carry the parasite for weeks to years, often without symptoms.
Where are the parasites that cause amebiasis found?
The parasite lives only in humans. Fecal material from infected people may contaminate water or food, which
may spread the parasites to anyone who consumes them.
How is it diagnosed?
Examination of stools under a microscope is the most common way for a doctor to diagnose amebiasis.
Sometimes, several stool samples must be obtained because the number of amoeba being passed in the stool,
which varies from day to day, may be too low to detect from any single sample
What is the treatment for amebiasis?
Specific antibiotics such as metronidazole can be prescribed by a doctor to treat amebiasis.
Should an infected person be excluded from work or school?
Although people with diarrhea due to amebiasis should not attend school or go to work, it is not necessary to
exclude infected persons when they feel better and stools are normal. Casual contact at work or school is
unlikely to transmit the disease. Special precautions may be needed by foodhandlers or children enrolled in
daycare settings. Consult your local health department for advice in such instances.
What precautions should the infected person follow?
The most important precautions are careful handwashing after each toilet visit and proper disposal of sewage.
Homosexual males should refrain from intimate contact until effectively treated.
Revised: June 2004
http://www.nursingnotesforall.blogspot.com
New York State Department of Health
Tuberculosis (TB)
Last Reviewed: June 2007
What is tuberculosis?
Tuberculosis is a bacterial disease usually affecting the lungs (pulmonary TB). Other parts of the body can also
be affected, for example lymph nodes, kidneys, bones, joints, etc. (extrapulmonary TB). Approximately 1,300
cases are reported each year in New York State.
Who gets tuberculosis?
Tuberculosis can affect anyone of any age. People with weakened immune systems are at increased risk.
How is tuberculosis spread?
Tuberculosis is spread through the air when a person with untreated pulmonary TB coughs or sneezes.
Prolonged exposure to a person with untreated TB usually is necessary for infection to occur.
What is the difference between latent tuberculosis infection and tuberculosis
disease?
Latent tuberculosis infection (LTBI) means the person has the TB germ in their body (usually lungs), but has
yet to develop obvious symptoms. In latent TB, the person has a significant reaction to the Mantoux skin test
with no symptoms of tuberculosis, and no TB organisms found in the sputum. Tuberculosis disease indicates
the person has symptoms, a significant reaction to a Mantoux skin test and organisms found in the sputum. In
order to spread the TB germs, a person must have TB disease. Having latent TB infection is not enough to
spread the germ. Tuberculosis may last for a lifetime as an infection, never developing into disease.
What are the symptoms of tuberculosis?
The symptoms of TB include a low-grade fever, night sweats, fatigue, weight loss and a persistent cough.
Some people may not have obvious symptoms.
How soon do symptoms appear?
Most people infected with the germ that causes TB never develop active TB. If active TB does develop, it can
occur two to three months after infection or years later. The risk of active disease lessens as time passes.
When and for how long is a person able to spread tuberculosis?
A person with TB disease may remain contagious until he/she has been on appropriate treatment for several
weeks. However, a person with latent TB infection, but not disease, cannot spread the infection to others,
since there are no TB germs in the sputum.
What is the treatment for tuberculosis?
People with latent TB infection should be evaluated for a course of preventive therapy, which usually includes
taking antituberculosis medication for several months. People with active TB disease must complete a course
of treatment for six months or more. Initial treatment includes at least four anti-TB drugs, and medications
may be altered based on laboratory test results. The exact medication plan must be determined by a
physician. Directly observed therapy (DOT) programs are recommended for all TB patients to help them
complete their therapy.
What can be the effect of not being treated for tuberculosis?
In addition to spreading the disease to others, an untreated person may become severely ill or die.
What can be done to prevent the spread of tuberculosis?
The most important way to stop the spread of tuberculosis is for TB patients to cover the mouth and nose
when coughing, and to take all the TB medicine exactly as prescribed by the physician.
What is multidrug-resistant tuberculosis (MDR-TB)?
This refers to the ability of some strains of TB to grow and multiply even in the presence of certain drugs
which would normally kill them.
What is extensively drug-resistant tuberculosis (XDR-TB)?
Extensively drug-resistant TB (XDR-TB) is a subset of MDR-TB in which the strains of TB bacteria are resistant
to several of the best second-line drugs for TB. These strains are very difficult to treat. XDR-TB cases make up
approximately 10 percent of MDR-TB cases.
Who gets MDR-TB?
TB patients with drug sensitive disease may develop drug resistant tuberculosis if they fail to take
antituberculosis medications as prescribed, as well as TB patients who have been prescribed an ineffective
treatment plan. TB cases diseased with MDR-TB can transmit the drug resistant infection to other individuals.
What is the treatment for multidrug-resistant tuberculosis?
For patients with disease due to drug resistant organisms, expert consultation from a specialist in treating
drug resistant TB should be obtained. Patients with drug resistant disease should be treated with drugs to
which their organisms are susceptible. The effectiveness of treatment for latent infection with MDR-TB is
uncertain.
What can be done to prevent the spread of MDR-TB?
Ensuring people with MDR-TB take all their medication and teaching patients to cover their mouth and nose
when coughing and sneezing can reduce the risk of spread of MDR-TB. In addition, directly observed therapy
should be used to ensure patients complete the recommended course of therapy.
Revised: June 2007
http://www.nursingnotesforall.blogspot.com
New York State Department of Health
Anthrax (malignant edema, woolsorters' disease)
Last Reviewed: November 2006
What is anthrax?
Anthrax is a rare infectious disease caused by the bacterium Bacillus anthracis. Anthrax occurs naturally
around the world in wild and domestic hoofed animals, especially cattle, sheep, goats, camels and antelopes.
It can also occur in humans when they are exposed to the bacterium, usually through handling animals or
animal hides. There are three forms of anthrax infection: cutaneous (skin), inhalation (lungs) and
gastrointestinal (stomach and intestine). If people have been intentionally exposed, as in a bioterrorist
release, contact with skin would be the most likely route of exposure. Breathing in the spores that have been
spread through the air could cause inhalation anthrax.
How common is anthrax and who can get it?
Anthrax can be found around the world. It is most common in agricultural regions where it occurs in animals.
It is more common in developing countries or countries without veterinary public health programs. Anthrax is
reported more often in some regions of the world (South and Central America, Southern and Eastern Europe,
Asia, Africa, the Caribbean and the Middle East) than in others. It has been extremely rare in the United
States in recent decades, and until cases in Florida and New York City in 2001, has been limited to the
cutaneous (skin) form. When anthrax affects humans, it is usually due to an occupational exposure to infected
animals or their products. However, anthrax is considered to be one of a number of potential agents for use in
biological terrorism.
How is anthrax spread?
Anthrax is usually spread in the form of a spore. (A spore is a dormant form that certain bacteria take when
they have no food supply. Spores can grow and cause disease when better conditions are present, as in the
human body.) Anthrax is generally spread in one of three ways. Most persons who are exposed to anthrax
become ill within one week:
�� Skin (cutaneous) - Most anthrax infections occur when people touch contaminated animal products like
wool, bone, hair and hide. The infection occurs when the bacteria enters a cut or scratch in the skin.
�� Inhalation (lung) - Some anthrax infections occur when people breathe in the spores of the bacteria.
However, the infectious dose for inhalational anthrax is quite high, and requires exposure to a large
number of spores (8,000-10,000).
�� Gastrointestinal - Some people may get anthrax by eating infected meat that has not been properly
cooked.
What are the symptoms of anthrax?
�� Skin (cutaneous) - This is the most common form of anthrax. Infection requires a break in the skin. The
first symptoms include itching where the skin has been exposed. Then, a large boil or sore appears. The
sore becomes covered by a black scab. If not treated, the infection can spread to the lymph nodes and
bloodstream.
�� Inhalation - Inhalation anthrax has been very rare in the U.S. First symptoms include fever, fatigue,
malaise and a cough or chest pain. High fever, rapid pulse and severe difficulty breathing follow in two
to five days. Inhalation anthrax is often fatal.
�� Gastrointestinal - This form occurs only after eating infected, undercooked meat. First symptoms
include fever; abdominal pain; loose, watery bowel movements; and vomiting with blood.
How soon after exposure do symptoms develop?
Symptoms usually develop between one and seven days after exposure but prolonged periods up to 12 days
for cutaneous (skin) anthrax and 60 days for inhalation anthrax are possible, though rare.
Can anthrax be spread person to person?
Inhalation (lung) anthrax is not spread from person to person. Even if you develop symptoms of inhalation
anthrax, you are not contagious to other persons. If you develop cutaneous (skin) anthrax, the drainage from
an open sore presents a low risk of infection to others. The only way cutaneous (skin) anthrax can be
transmitted is by direct contact with the drainage from an open sore. Anthrax is not spread from person to
person by casual contact, sharing office space or by coughing and sneezing.
How is it diagnosed?
Anthrax is diagnosed when the Bacillus anthracis bacterium is found in the blood, skin lesions or respiratory
secretions by a laboratory culture. It can also be diagnosed by measuring specific antibodies in the blood of
infected persons. Nasal swabs are not a good way to diagnose anthrax because a swab cannot definitively
determine if someone has not been exposed to anthrax.
What is the treatment for illness caused by anthrax?
There are several antibiotics that are used successfully to treat anthrax. Treatment is highly effective in cases
of cutaneous (skin) anthrax and is effective in inhalation and gastrointestinal anthrax if begun early in the
course of infection. The United States has a large supply of these antibiotics and can quickly manufacture
more if needed.
Is there a way to prevent infection?
Persons known to be exposed to confirmed anthrax spores will be given antibiotics, usually ciprofloxacin
(cipro) or doxycycline, to prevent infection.
Do I need to disinfect myself or my belongings if I believe I was exposed to
anthrax?
Most threats regarding anthrax have proven to be hoaxes. However, in the event of a possible exposure to a
powder or other unknown substance with a threat that may indicate anthrax, call 911 and leave the material
alone. To prevent infection if you have a skin exposure to the powder or other substance, wash your hands
vigorously with soap and water, and shower with soap and water if necessary. Similarly, washing possibly
contaminated clothes in the regular laundry will safely remove any possible anthrax. To be inhaled, anthrax
spores must first be aerosolized (dispersed in the air) which does not usually occur. In the unlikely event that
you do inhale spores, medical evaluation and treatment is needed, usually after spores are identified.
Revised: November 2006
http://www.nursingnotesforall.blogspot.com
New York State Department of Health
Tetanus (lockjaw)
Updated: September 2008
What is tetanus?
Tetanus, commonly called lockjaw, is a serious bacterial disease that affects muscles and nerves. It is characterized by muscle stiffness that usually involves the jaw and neck that then progresses to involve other parts of the body. Death can result from severe breathing difficulties or heart abnormalities.
Who gets tetanus?
As a result of widespread immunization, tetanus is now a rare disease in the United States. Tetanus occurs more often in older people and in agricultural workers for who contact with animal manure is more likely and immunization is inadequate. Neonatal (newborn) tetanus remains a major problem in many developing countries where women are not immunized appropriately against tetanus.
How is tetanus spread?
In unvaccinated individuals, tetanus is contracted through a cut or deep wound which becomes contaminated with the organism. Tetanus has also been associated with clean wounds, surgical procedures, insect bites, dental infections, and intravenous drug use. It is not transmitted from person to person.
Where is the tetanus bacteria found?
The tetanus bacterium is present throughout the environment and is commonly found in soil contaminated with manure, and animal and human feces.
What are the symptoms of tetanus?
A common first sign of tetanus is muscular stiffness in the jaw (lockjaw), followed by stiffness of the neck, difficulty in swallowing, rigidity of abdominal muscles, spasms, sweating, and fever.
How soon after infection do symptoms occur?
The incubation period is usually eight days but may range from three days to three weeks. Shorter incubation periods are associated with more heavily contaminated wounds.
What are the complications associated with tetanus?
Complications include spasm of the vocal cords and/or spasms of the respiratory muscles causing interference with breathing. Other complications include fractures of the spine or long bones from stiff muscles, elevated blood pressure, abnormal heartbeats, coma, generalized infection, clotting in the blood vessels of the lung, and pneumonia. Death occurs in about 11 percent of all cases, especially in persons 60 years of age and older and unvaccinated individuals.
What is the treatment for tetanus?
The use of tetanus toxoid-containing vaccine and tetanus immune globulin (TIG) or antitoxin in the management of wounds depends on the nature of the wound and the history of immunization. Persons with clean , minor wounds may need to catch-up their tetanus toxoid-containing vaccine. For more severe wounds, persons may need TIG in addition to vaccine.
If the disease develops, supportive care and therapy to control severe spasms are indicated.
Does past infection with tetanus make a person immune?
Recovery from tetanus may not result in immunity. Second attacks can occur and immunization is needed after recovery.
Is there a vaccine for tetanus?
An effective vaccine called tetanus toxoid has been available for many years. It is contained in the DTP (diphtheria, tetanus, pertussis), DT (diphtheria, tetanus), DTaP (diphtheria, tetanus, acellular pertussis), Tdap (tetanus, diphtheria and acellular pertussis),and Td (tetanus and diphtheria)vaccines. A tetanus booster shot is recommended every ten years after the completion of a three-dose series.
In New York State, children born after 1/1/2005 are required to have at least three doses of DTaP to attend pre-kindergarten programs and school. Children born on or after 1/1/1994 and enrolling in sixth grade are required to have one dose of Tdap. Although tetanus vaccine is not required for all children, it is highly recommended.
What can be done to prevent the spread of tetanus?
The single most important preventive measure is to maintain a high level of immunization in the community.
Revised: December 2008
http://www.nursingnotesforall.blogspot.com