1. Community Medicine V Dr. Mehrdad Askarian MD, MPH Professor of Community Medicine

2. GI infections & Infestations

3. Salmonella infections Age, sex, job and socioeconomic class –In endemic area; >1y/o children are prone, in which the disease is more sever together with complications, in all areas; >5y/o and old age groups are more prone, 75% of patients<30y/o –Higher in low socioeconomic classes –Laboratory workers, travelers to endemic areas, jobs with contact to animals. –More common in summer

4. Salmonella infections Predisposing factors –Low level of hygiene in community –Achlorhydria –Antibiotic prescription before contact with organism –Hemolytic disorders –Immune condition of patient (more common in AIDS patients(*60)

5. Salmonella infections Primary prevention –Education of hygiene in community –Personal hygiene (handwashing is the most important) –Environmental health –Decrease antibiotic prescription in animals –Quality control of food preparing areas –Proper cleaning of food preparing devices in industry –Healthy water –Proper disposal of sewage –Vaccination

6. Salmonella infections Secondary infection –Proper disinfection of stool and contaminated items (20 PPM of Cl) –Chloramphenicol, ciprofloxacin, amoxicillin, co-trimaxozol

7. Salmonella infections Control –Approach to epidemics Document diagnosis Epidemic confirmation Case finding Treat patients (48 hrs after finishing therapy having 3 negative stool culture. Treat carriers Environmental health (chlorination of water) Health education Healthy water in public areas To control making and distribution of ice To ensure healthy food by close observation To ensure hygienic disposal of sewage, wastes

8. Shigellosis Primary prevention –Provide healthy water (chlorination of water) –Insecticides –Vaccination?? –Disinfection of sewage

9. Shigellosis Secondary prevention –Early treatment causes decrease in bacterial passage

10. Shigellosis Tertiary prevention –No any important complication

11. Shigellosis Control measures –Close observation of food preparing areas –Educate handwashing –Don’t prescribe antibiotic as prophylaxis –Enabling of laboratories –Preparing adequate amount of IV fluids

12. Amebiasis & Giardiasis Prevention and control –Environmental health, healthy water and food –To find healthy carriers and treat them –Health education –Resistant to chlorination of water –Heat (55 degree centigrade) kills them –Filtering of water –Ozone –Proper disposal of sewage –To find cases and treat them –Mass campaign

13. Helminthes Importance –Consumption of patient’s food –Micro bleeding –Organ damage –Hypertrophy or hyperplasia of involved organ

14. Helminthes Transmission roots –Direct (pin worm, H. Nana) –Soil (ascaris, hook worms, trichuris trichura) –Snail (schistosoma) –Arthropod :(dracunculiasis) –Animal food :(taenia saginata)

15. Helminthes Incubation period –2 wks in pin worm, 1 year for dracunculiasis, years for Hydatid cyst.

16. Helminthes Clinic –Differs from asymptomatic to hyper acute, chronic. –Things in common Spontaneous recovery No immunity

17. Helminthes Geographic distribution –Soil composition of area, hygiene status of area –Some of helminthes are special for areas

18. Helminthes Time trend –No time trend Age, sex, job, social status –More in childhood, in low social Predisposing factors –Culture and beliefs –Steroids, poor people Sensitivity and resistance –No resistance against it Secondary attack rate –Not known

19. Helminthes Primary prevention –General hygiene of the population Facilities for proper disposal of sewage Proper handwashing Hygienic food preservation Nail cutting Monitoring of meat

20. Helminthes Secondary prevention –Diagnosis and proper treatment –Mass treatment

21. Helminthes Tertiary prevention –Removal of obstruction

23. Any Comments or Questions?