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Eggs of both species are disseminated into the environment as long as the worm remains in the intestine order lozol 1,5mg with mastercard, sometimes more than 30 years; eggs may remain viable in the environment for months cheap lozol 2,5mg online. No apparent resistance follows infection; the presence of more than one tapeworm in a person has rarely been reported. Appropriate measures to protect pa- tients from themselves and their contacts are necessary. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Selectively reportable, Class 3 (see Reporting). Where cysticidal treatment is not indicated, symptomatic treatment, such as with anti-epileptic drugs, may bring relief. Identification—An acute disease induced by an exotoxin of the tetanus bacillus, which grows anaerobically at the site of an injury. The disease is characterized by painful muscular contractions, primarily of the masseter and neck muscles, secondarily of trunk muscles. A common first sign suggestive of tetanus in older children and adults is abdominal rigidity, though rigidity is sometimes confined to the region of injury. Generalized spasms occur, frequently induced by sensory stimuli; typical features of the tetanic spasm are the position of opisthotonos and the facial expres- sion known as “risus sardonicus. The case-fatality rate ranges from 10% to over 80%, it is highest in infants and the elderly, and varies inversely with the length of the incubation period and the availability of experienced intensive care unit personnel and resources. The organism is rarely recovered from the site of infection, and usually there is no detectable antibody response. The disease is more common in agricul- tural regions and in areas where contact with animal excreta is more likely and immunization is inadequate. Parenteral use of drugs by addicts, particularly intramuscular or subcutaneous use, can result in individual cases and occasional circumscribed outbreaks. In 2001, an estimated 282 000 people worldwide died of tetanus, most of them in Asia, Africa and South America. In rural and tropical areas people are especially at risk, and tetanus neonatorum is common (see below). There is some inconclu- sive evidence that at high altitude the risk for tetanus could be lower. Reservoir—Intestines of horses and other animals, including hu- mans, in which the organism is a harmless normal inhabitant. Tetanus spores, ubiquitous in the environment, can contaminate wounds of all types. Mode of transmission—Tetanus spores are usually introduced into the body through a puncture wound contaminated with soil, street dust or animal or human feces; through lacerations, burns and trivial or unnoticed wounds; or by injected contaminated drugs (e. Tetanus occasionally follows surgical procedures, which include circumcision and abortions performed under unhygienic conditions. The presence of necrotic tissue and/or foreign bodies favors growth of the anaerobic pathogen. Incubation period—Usually 3–21 days, although it may range from 1 day to several months, depending on the character, extent and location of the wound; average 10 days. In general, shorter incubation periods are associated with more heavily contaminated wounds, more severe disease and a worse prognosis.

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Passive immunity is attained either nat- urally through transplacental transfer from the mother lozol 1,5 mg visa, or artificially by inoculation of specific protective antibodies (from immunized animals cheap 1,5mg lozol visa, or convalescent hyperimmune serum or immune serum globulin [human]); it is of short duration (days to months). Inapparent infection—The presence of infection in a host with- out recognizable clinical signs or symptoms. Inapparent infections are identifiable only through laboratory means such as a blood test or through the development of positive reactivity to specific skin tests. Incidence—The number of instances of illness commencing, or of persons falling ill, during a given period in a specified population. The incidence rate is the ratio of new cases of a specified disease diagnosed or reported during a defined period of time to the number of persons at risk in a stated population in which the cases occurred during the same period of time (if the period is one year, the rate is the annual incidence rate). This rate is expressed, usually as cases per 1000 or 100 000 per annum, for the whole population or specifically for any population characteristic or subdivision such as age or ethnic group. The numerator can be determined through the identification of clinical cases or through seroepidemiology. The secondary attack rate is the ratio of the number of cases among contacts occurring within the accepted incubation period following exposure to a primary case to the total number of exposed contacts; the denominator may be restricted to the numbers of susceptible contacts when this can be determined. The infection rate is a proportion that expresses the incidence of all identified infections, manifest or inapparent (the latter identified by seroepidemiology). Incubation period—The time interval between initial contact with an infectious agent and the first appearance of symptoms associated with the infection. In a vector, it is the time between entrance of an organism into the vector and the time when that vector can transmit the infection (extrinsic incubation period). The period between the time of exposure to an infectious agent and the time when the agent can be detected in blood or stool is called the prepatent period. Infected individual—A person or animal that harbours an infec- tious agent and who has either manifest disease or inapparent infection (see Carrier). An infectious person or animal is one from whom the infectious agent can be naturally acquired. Infection—The entry and development or multiplication of an infectious agent in the body of persons or animals. Infection is not synonymous with infectious disease; the result may be inapparent (see Inapparent infection) or manifest (see Infectious disease). The presence of living infectious agents on exterior surfaces of the body, or on articles of apparel or soiled articles, is not infection, but represents contamination of such surfaces and articles. Infectious agent—An organism (virus, rickettsia, bacteria, fungus, protozoan or helminth) that is capable of producing infection or infectious disease. Infectivity expresses the ability of the infectious agent to enter, survive and multiply in the host. Infectiousness indicates the relative ease with which an infectious agent is transmitted to other hosts. Infectious disease—A clinically manifest disease of humans or animals resulting from an infection. Infestation—For persons or animals, the lodgement, development and reproduction of arthropods on the surface of the body or in the clothing. Infested articles or premises are those that harbour or give shelter to animal forms, especially arthropods and rodents. Insecticide—Any chemical substance used for the destruction of insects; can be applied as powder, liquid, atomized liquid, aerosol or “paint” spray; an insecticide may or may not have residual action.

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