Health Handout South Sudan-All text and photos on the Alliance for the Lost Boys web site is copyright protected and cannot be used without written permission.

DONATE NOW!

Health Handout

 

The following information was adapted from a health handout distributed and compiled by Joan Hecht for the health seminar that she organized and helped to teach at the The Lost Boys and Girls of Sudan: The National Network’s 2009 Conference and Reunion
in San Diego, California, May 2009.

 

***The contents of this handout are for educational purposes only and are not intended for diagnosis or treatment. If you or someone you know is experiencing any of the symptoms listed in this handout, you should consult with your local physician or health care provider.
This handout is copyright protected and no photographs or text may be copied or reproduced without written permission from the authors/photographers.

 

 **If this information is helpful to you, please consider making a tax-free donation so that we can help others.  

Index

1. Schistosomiasis  

2. Strongyloidiasis

3. Malaria

4. River Blindness (Onchocerciasis)

5. Trachoma

6. Guinea Worm Disease (Dracunculiasis)

7. Hepatitis B

8. Helicobacter pylori (H. pylori)             

 

 

1. Schistosomiasis
(Also known as bilharzia, bilharziosis or snail fever)

 

Definition:

 “Schistosomiasis is a parasitic disease caused by several species of flukes (worms) from the Schistosoma genus. It is the second most socioeconomically devastating parasitic disease following malaria. Areas most commonly found include Asia, Africa and South America in bodies of water that contain freshwater snails that harbor the parasite. An estimated 200 million people in 74 countries are infected with the disease — 100 million in Africa alone.

Although the number of deaths associated with Schistosomiasis is low, it can become a chronic illness, causing internal damage to organs and impairing the growth and cognitive development of children and weakening the bodies’ resistance to other infections. Urinary infestation has been associated with an increased risk of bladder cancer in adults.

Method of Transmission:

“The parasite Schistosoma is transmitted through freshwater sources, such as ponds, dams, and rivers. During its larval stage, the parasite emerges from infected snails and swims in water until it can penetrate the skin of people in contact with the water. Once in the body, the larvae develop into adult male and female parasites, which pair and live together in human blood vessels for years. The female parasites release thousands of spiny eggs, some of which are passed out in the urine (in the case of urinary schistosomiasis) or feces (in the case of intestinal schistosomiasis), but some eggs remain trapped in body tissues.

When infected people urinate or defecate in a community water source, the eggs are immediately released. The eggs hatch and infect freshwater snails, which then become the intermediate hosts. Inside the snails, the parasites develop and multiply; they are now able to re-enter the skin, infecting new victims and continuing the cycle.”

Symptoms:

 “Within days after becoming infected, you may develop a rash or itchy skin. Fever, chills, cough, and muscle aches can begin within 1-2 months of infection. Most people have no symptoms at this early phase of infection.

Eggs travel to the liver or pass into the intestine or bladder, causing inflammation or scarring. Children who are repeatedly infected can develop anemia, malnutrition, and learning difficulties. After years of infection, the parasite can also damage the liver, intestines, lungs, and bladder. Rarely, eggs are found in the brain or spinal cord and can cause seizures, paralysis, or spinal cord inflammation. Worms have also been found in the lungs.

Symptoms of schistosomiasis are caused by the body’s reaction to the eggs produced by worms, not by the worms themselves. Symptoms associated with urinary and intestinal schistosomiasis are caused by the eggs that remain trapped in body tissues. In the case of urinary schistosomiasis, the trapped eggs tear and scar the tissues of the bladder, ureters, and kidneys. Bladder cancer is common in advanced cases of the disease. In intestinal schistosomiasis, the disease develops more slowly. Symptoms include progressive enlargement of the liver, lungs, and spleen; intestinal damage due to fibrotic lesions around lodged eggs; and hypertension of the abdominal blood vessels. Bleeding from these vessels leads to blood in stools. The disease seriously weakens its victims and, in some cases, impairs the function of organs such as the spleen and kidneys. Death resulting from the disease is mostly due to bladder cancer associated with urinary schistosomiasis and to bleeding from varicose veins in the esophagus associated with intestinal schistosomiasis.” *Patients sometimes exhibit no symptoms at all.”

Symptoms for Schistosomiasis include:

Skin rash                      Fever                          Itchy skin
Chills                            Cough                        Muscle aches
Hives                            *No symptoms

Liver symptoms:

Enlarged liver               Liver tenderness

Symptoms of eggs in spinal cord:

Seizures                        Paralysis                      Spinal cord inflammation

Gastrointestinal symptoms:

Diarrhea               Blood in stool                        Anemia
Dysentery            Hepatosplenomegaly –  (Enlargement of the liver and spleen).

Bladder infection symptoms:

Cystitis- (inflammation of the bladder or urethra)    Bladder stones”

Suggested Treatment:

CDC recommendations for the treatment of schistosomiasis is a dose of 20 mg/kg, of the drug praziquantel (Biltricide ®) given in two oral doses 6-8 hours apart.

[1] Carter Center Foundation web site-http://www.cartercenter.org accesssed 5/29/09.

 [1] CDC website-http://www.cdc.gov accessed 5/29/09

 [1][1] http://www.wrongdiagnosis.com  accessed 5/29/09

 

Schistosome dermatitis, or “swimmers itch” occurs when skin is penetrated by a free-swimming, fork-tailed infective cercaria. US Federal Government public domain image archive. Source: CDC. 

shisto arm photo.

Adults of Schistosoma mansoni.  Unlike the flukes, adult schistosomes have the sexes separate, with the female residing in a gynecophoral canal within the male.  Male worms are robust, tuberculate and measure 6-12 mm in length. Females are longer (7-17 mm in length) and slender.  Adult S. mansoni reside in the venous plexuses of the colon and lower ileum and in the portal system of the liver of their host. The thin female resides in the gynecophoral canal of the thicker male.  Note the tuberculate exterior of the male in Figure B. (source CDC website)

shisto worm.

 

Schistosomiasis Lifecycle: (Source CDC)

shisto life cycle

 

 

2. Strongyloidiasis 

(Strongyloides)

Definition:

Strongyloidiasis is an infection caused by the parasite Strongyloides stercoralis. Although found in the southern United States, Strongyloides is mainly found in the tropics. It is common in Africa, including Sudan, Kenya, and Ethiopia.

Method of Transmission:

Infection occurs when your skin comes in contact with soil that contains Strongyloides. The parasite penetrates the skin and migrates to the lungs; then it travels up to the mouth and is swallowed into the intestinal tract. Once there, it matures and lays eggs. The resulting worms and eggs are then passed in the stool and can infect other persons via soil, or can re-infect the same person. This re-infection of the original host can cause infections that last for many years.

Symptoms:

Many infected persons have no symptoms. Among persons who do have symptoms, the most common are abdominal pain, diarrhea, and rash. Less commonly, nausea, vomiting, weight loss, cough, or breathing problems can result. Because the infection can persist, a person can have symptoms on and off for many years.

Treatment:

Several drugs can be used to treat Strongyloides. A drug called albendazole, taken twice a day for three days, is the treatment we recommend for the Lost Boys and Girls. Albendazole is safe, but may cause some side effects, including abdominal pain, nausea, vomiting, and hair loss. Rarely, it can cause abnormal blood tests involving the liver and blood cells. Lastly, someone infected with both Strongyloides and another parasite called cysticercosis may have a seizure if they take albendazole; infection with both of these parasites in someone from Sudan is unusual. All of these side effects would be rare with only three days of treatments. This treatment cures most persons infected with this disease. Pregnant women should not take albendazole.

It is difficult to tell if a person has been cured after taking albendazole. If a person’s immune system became weakened later in life (for example, through an organ transplant, chemotherapy, or taking other drugs that weaken the immune system), ensuring the disease had been cured would be important. Cure could be confirmed by a repeat blood test, done at least six months after the treatment. Alternatively, a person can be treated with a different drug called ivermectin, which cures some persons not cured by albendazole.

Why treatment is important if you have strongyloidiasis?

If at any time an infected person’s immune system becomes weak (for example, through an organ transplant, chemotherapy, or other drugs that weaken the immune system), the infection can become fatal. Thus, it is important to treat this infection any time a person is diagnosed with it, even if they have no symptoms. “

Source: CDC website http://www.cdc.gov accessed 6/9/09

stronyloids worm.

 

Strongyloids Life Cycle: (Source CDC)

The Strongyloides life cycle is more complex than that of most nematodes with its alternation between free-living and parasitic cycles, and its potential for autoinfection and multiplication within the host.  Two types of cycles exist:
Free-living cycle: The rhabditiform larvae passed in the stool (see “Parasitic cycle” below) can either molt twice and become infective filariform larvae (direct development) or molt four times and become free living adult males and females that mate and produce eggs from which rhabditiform larvae hatch .  The latter in turn can either develop into a new generation of free-living adults (as represented in ), or into infective filariform larvae .  The filariform larvae penetrate the human host skin to initiate the parasitic cycle (see below) .
Parasitic cycle: Filariform larvae in contaminated soil penetrate the human skin , and are transported to the lungs where they penetrate the alveolar spaces; they are carried through the bronchial tree to the pharynx, are swallowed and then reach the small intestine .  In the small intestine they molt twice and become adult female worms .  The females live threaded in the epithelium of the small intestine and by parthenogenesis produce eggs , which yield rhabditiform larvae.  The rhabditiform larvae can either be passed in the stool (see “Free-living cycle” above), or can cause autoinfection .  In autoinfection, the rhabditiform larvae become infective filariform larvae, which can penetrate either the intestinal mucosa (internal autoinfection) or the skin of the perianal area (external autoinfection); in either case, the filariform larvae may follow the previously described route, being carried successively to the lungs, the bronchial tree, the pharynx, and the small intestine where they mature into adults; or they may disseminate widely in the body.  To date, occurrence of autoinfection in humans with helminthic infections is recognized only in Strongyloides stercoralis and Capillaria philippinensis infections.  In the case of Strongyloides, autoinfection may explain the possibility of persistent infections for many years in persons who have not been in an endemic area and of hyperinfections in immunodepressed individuals.

strongyloid chart

Geographic Distribution:

Tropical and subtropical areas, but cases also occur in temperate areas (including the South of the United States).  More frequently found in rural areas, institutional settings, and lower socioeconomic groups.  

 

 

3. Malaria

Definition:

1 “Malaria is a mosquito-borne disease caused by a parasite.” It is the leading cause of morbidity and mortality in Sudan.” 2“Each year, malaria kills more than 1 million people, mostly children, with 350-500 million cases reported worldwide. Approximately 90 percent of all cases of malaria—a preventable disease—are in Africa, where one child in 10 dies before the age of five.  Malaria most affects people who live, work, and sleep in unscreened houses where mosquitoes can easily enter through open eaves and windows…  Anemia and learning impairments are also associated with the disease.  Pregnant women, their unborn children, and infants are particularly vulnerable to malaria, which is a major cause of maternal mortality and low birth weight.” 

Prevention:

 1 “Anyone who goes to a malaria-risk country should take precautions against contracting malaria. During the last several years that you have spent in the United States, you have lost any malaria immunity that you might have had while living in your native country. Without frequent exposure to malaria parasites, your immune system has lost its ability to fight malaria. You are now as much at risk as someone who was born in the United States (a “non-immune” person). Please consult with your health-care provider or a travel clinic about precautions to take against malaria (preventive drugs and protection against mosquito bites) and against other diseases. To allow enough time for the drugs to become effective and for a pharmacy to prepare any special doses of medicine (especially doses for children and infants), visit your health care provider 4-6 weeks before travel. There is currently no malaria vaccine approved for human use.

Ways to avoid infection include:

  • Keeping mosquitoes from biting you, especially at night
  • Taking antimalarial drugs to kill the parasites
  • Spraying insecticides on your home’s walls to kill adult mosquitoes that come inside
  • Sleeping under bed nets – especially effective if they have been treated with insecticide, and
  • Using insect repellent and wearing long-sleeved clothing if out of doors at night

Symptoms:

Fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. Any traveler who becomes ill with a fever or flu-like illness while traveling, and up to 1 year after returning home should immediately seek professional medical care.

Method of Transmission:

Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

Malaria is not spread from person to person like a cold or the flu, and it cannot be sexually transmitted. You cannot get malaria from casual contact with malaria-infected people, such as sitting next to someone who has malaria.

Treatment:

The surest way for you and your health-care provider to know whether you have malaria is to have a diagnostic test where a drop of your blood is examined under the microscope for the presence of malaria parasites. If you are sick and there is any suspicion of malaria (for example, if you have recently traveled in a malaria-risk area) the test should be performed without delay.

Determination of the infecting Plasmodium species for treatment purposes is important for three main reasons: P. falciparum infections can cause rapidly progressive severe illness or death while the non-falciparum ( P. vivax, P. ovale, or P. malariae) species rarely cause severe manifestations; P. vivax and P. ovale infections require treatment for the hypnozoite forms that remain dormant in the liver and can cause a relapsing infection; and P. falciparum and P. vivax species have different drug resistance patterns in differing geographic regions. For P. falciparum infections, the urgent initiation of appropriate therapy is especially critical.

The second factor affecting treatment is the clinical status of the patient. Patients diagnosed with malaria are generally categorized as having either uncomplicated or severe malaria. Patients diagnosed with uncomplicated malaria can be effectively treated with oral antimalarials. However, patients who have one or more of the following clinical criteria (impaired consciousness/coma, severe normocytic anemia, renal failure, pulmonary edema, acute respiratory distress syndrome, circulatory shock, disseminated intravascular coagulation, spontaneous bleeding, acidosis, hemoglobinuria, jaundice, repeated generalized convulsions, and/or parasitemia of > 5%) are considered to have manifestations of more severe disease and should be treated aggressively with parenteral antimalarial therapy.

Finally, knowledge of the geographic area where the infection was acquired provides information on the likelihood of drug resistance of the infecting parasite and enables the treating clinician to choose an appropriate drug or drug combination and treatment course. If the diagnosis of malaria is suspected and cannot be confirmed, or if the diagnosis of malaria is confirmed but species determination is not possible, antimalarial treatment effective against P. falciparum must be initiated immediately.”

(Image provided by CDC)

1 CDC web site-www.cdc.gov accessed 5/29/09

2 Carter Center Website -www.cartercenter.org accessed 5/27/09

Life Cycle: (Source CDC)

The malaria parasite life cycle involves two hosts.  During a blood meal, a malaria-infected female Anopheles mosquito inoculates sporozoites into the human host. Sporozoites infect liver cells and mature into schizonts , which rupture and release merozoites .  (Of note, in P. vivax and P. ovale a dormant stage [hypnozoites] can persist in the liver and cause relapses by invading the bloodstream weeks, or even years later.)  After this initial replication in the liver (exo-erythrocytic schizogony ), the parasites undergo asexual multiplication in the erythrocytes (erythrocytic schizogony ). Merozoites infect red blood cells .  The ring stage trophozoites mature into schizonts, which rupture releasing merozoites .  Some parasites differentiate into sexual erythrocytic stages (gametocytes) .  Blood stage parasites are responsible for the clinical manifestations of the disease. 

The gametocytes, male (microgametocytes) and female (macrogametocytes), are ingested by an Anopheles mosquito during a blood meal .  The parasites’ multiplication in the mosquito is known as the sporogonic cycle .  While in the mosquito’s mid-gut, the microgametes penetrate the macrogametes generating zygotes .  The zygotes in turn become motile and elongated (ookinetes) which invade the midgut wall of the mosquito where they develop into oocysts .  The oocysts grow, rupture, and release sporozoites , which make their way to the mosquito’s salivary glands.  Inoculation of the sporozoites into a new human host perpetuates the malaria life cycle.

Malaria Life Cycle:(Source CDC)

MALARIA LIFE CYCLE. JPG

 4. River Blindness

(Onchocerciasis)

 

Definition:

Onchocerciasis is a parasitic disease that is transmitted by the bites of small black flies, which breed in rapidly flowing streams and rivers.

Method of Transmission:

[1] “To contract river blindness, a person typically must be bitten hundreds of times by infected black flies, since only a small percentage of the flies carry the infection. Therefore, the disease is not common among travelers or visitors to endemic countries. It is in fact the poorest of the poor who cannot protect themselves or escape from the black flies who are at greatest risk. It is estimated that in some river blindness areas of the world such as Ethiopia, men, women, and children are bitten by these flies as many as 20,000 times each year. Larvae enter the body through the fly bites and eventually mature into adult worms.

The offspring of the worms, called microfilariae, swarm under the skin where they can infect black flies when they bite. The microfilariae irritate the skin and cause intense itching, skin discoloration, and rashes. If the microfilariae enter the eyes, they cause inflammation and irritation, which can cause diminished vision and potential blindness. The disruption of family life and education resulting from the disease directly impacts local economies and long-term development.” 

RIVER BLINDNESS FLY.

www.cals.ncsu.edu

Prevention:

 Black flies bite during the day. The best prevention is to avoid infective bites of the black fly by:

  • Using insecticides such as DEET, and
  • Wearing long sleeve shirts and pants.

Symptoms:

[1]“Infected persons may be without symptoms. Those with symptoms will usually have one or more of the three manifestations: skin rash, eye lesions, and/or subcutaneous bumps under the skin. The most serious manifestation consists of lesions in the eye that can progress to blindness.

The normal incubation period of onchocerciasis ranges from nine to 24 months after the bite of an infected black fly. Each female worm can reproduce millions of microfilariae during her lifetime. Worms can live for 10-15 years.”

RIVER BLINDNESSimage008

www.cartercenter.org

Recommended Treatment:

1”Studies in the 1980s showed that the drug Mectizan®, made by Merck & Co. Inc., could effectively and safely treat and prevent river blindness by killing the microfilariae in the human body.

 With the use of Mectizan and health education, experts have concluded that it is possible to completely eliminate river blindness from the Western Hemisphere where it occurs. In Africa, the strategy is to control river blindness with one treatment per year. However, in 2006, areas in Sudan and Uganda began a twice-per-year treatment elimination strategy modeled after the successful Onchocerciasis Elimination Program of the Americas approach.

Health education and the distribution of Mectizan have not only prevented millions from contracting river blindness but also have saved multitudes of communities from near extinction. People who once abandoned fertile land near rivers to avoid being bitten have returned to their land and revived their local economy.”

”The CDC recommends Ivermectin administered as an oral dose of 150 micrograms per kilogram (maximum 12 mg) every 6-12 months. The drug should probably not be given to pregnant women or children under 5 years. Ivermectin does not kill the adult parasites, but reduce the numbers of microfilariae in skin so the disease does not progress.

*There is neither a vaccine nor recommended drug available to prevent onchocerciasis.”

1.Carter Center website –www.cartercenter.org

2. CDC web site –http://www.cdc.gov -accessed 5/29/09

RIVER BLINDNESS PHOTO NODULES

www.icp.ucl.ac.be/~opperd/parasites/onch1.html

A patient infected suffering from river blindness. This elderly man
shows nodules, skin changes and blindness, all manifestations of the
disease.

River Blindness Life Cycle: (Source Carter Center)

river_blindness cycle

 

5. Trachoma

 

Definition:

Trachoma is the leading cause of preventable blindness worldwide. It is caused by infection with Chlamydia trachomatis bacteria, making it both treatable and preventable. Trachoma affects the poorest of the poor – people marginalized and neglected in developing countries who are already struggling to survive.

Method of Transmission:

Young children bear the heaviest burden of trachoma infections and are the main source of infection for other people. Transmission takes place when the bacteria move from the eyes of young children to the eyes of an uninfected person through several different ways: flies, touching eyes, mothers’ shawls, bed sheets, pillows, and towels.

Transmitting trachoma through flies, faces, and feces:

The fly that transmits trachoma, Musca sorbens, breeds in feces, especially in human feces lying in the shade on the soil surface. Where Musca sorbens is present in trachoma-endemic areas, steps to minimize fly-eye contact and reduce breeding opportunities by disposing of feces properly are taken.

Transmitting trachoma through touching eyes:

Children touch their faces and rub their eyes much more frequently than adults do. Children usually touch their faces when they are irritated by dirt, dust, and flies. All of the Carter Center’s trachoma control programs promote good hygiene practices including hand and face washing.

Transmitting trachoma through shawls, bed sheets, pillows, towels
and washcloths:

Mothers like to keep their children’s faces clean by wiping them. In most countries, the mother uses her own clothes to do this. The bacteria that cause trachoma are often present in the discharge from the eyes and nose and can be spread to another child like this. Additionally, because children in a household often share the same bed, bed sheets and pillows may become infectious agents if a child with active trachoma uses them. Sharing face-washing cloths or towels can also lead to transmission of trachoma. This may contribute to high levels of infection in a family or even within a school or other group of people who share washing facilities.

Treatment: The SAFE Strategy

 To combat trachoma, the World Health

Organization has endorsed an integrated strategy

known as SAFE:

Surgery for people at immediate risk of blindness

Antibiotic therapy (Zithromax) to treat individual active cases

and reduce the community reservoir of infection

Facial cleanliness and improved hygiene to

reduce transmission

Environmental improvements to make living

conditions better so that the environment

no longer facilitates the maintenance and

transmission of trachoma.

S – Surgery

Surgery reverses the in-turned eyelashes of people with severe trachoma. Lid surgery is a fairly simple procedure that can be offered in the community or at health centers. Offering community-based surgery is the best way to encourage people suffering with trichiasis to seek help. Lid surgery takes away the pain of lashes scraping against the eyes and prevents further damage, but does not restore sight that was already lost.

A – Antibiotics

Antibiotics are used to treat active trachoma and reduce infection in a community. Antibiotics may be given on a case-by-case basis or in mass drug administration to the community. The World Health Organization currently recommends mass drug administration if the prevalence of active trachoma among children aged 1 to 9 years exceeds 10 percent. Pfizer Inc. generously donates millions of doses of the antibiotic Zithromax ® for trachoma control.

F – Facial cleanliness

Dirty faces are associated with active trachoma. Children with dirty faces are more likely to transmit trachoma if they have an active infection or to get trachoma if they are not infected. Discharge from the eyes and nose attracts flies that can bring the infection or carry it to other people. Wiping or rubbing dirty eyes with cloths, bed sheets, or a mother’s shawl can contribute to the transmission of trachoma. With support from the Carter Center Trachoma Control Program, communities are educated on the importance of clean faces.

E – Environmental improvement

Trachoma persists where people live in poverty with crowded living conditions and without water, sanitation, and proper waste disposal. Transmission of trachoma occurs where these conditions exist and should be expected to return after antibiotic treatment if the conditions are not changed. Improvements like construction of household pit latrines and hand-dug wells will bring about sustainable elimination of trachoma.

These four components form the foundation of the effort to eliminate blinding trachoma. All four components must be present for a trachoma control program to be successful. That is, equal attention must be given to providing surgery, antibiotics, hygiene promotion, and environmental improvements.

Source: The Carter Center web site- http://www.cartercenter.org

TRACHOMA EYE PHOTO.

Photo Credit: Carter Center/L. Gubb

“Fly-eye contact is an opportunity for trachoma transmission. Construction of pit latrines reduces breeding opportunities for the fly population.”

 

TRACHOMA LATRINE 1.       

Carter Center Photo: Jim Zingeser                    Photo credit: Carter Center/ L. Gubb

“The latrines are comprised of simple pits 2 to 4 meters deep, with a cement slab laid over it, and a traditionally built superstructure. The Carter Center-assisted Trachoma Control Program has built more than 720,000 latrines in six countries to help prevent the spread of blinding trachoma.”

Trachoma Life Cycle: (Source Carter Center)

TRACHOMA LIFE CYCLE

 

6. Guinea Worm Disease

(Dracunculiasis)

 

Guinea worm disease, often known as the “fiery serpent,” has existed since ancient times and is more than 3,000 years old. It has even been found in calcified Egyptian mummies. Many believe the symbol of medicine, often interpreted as a snake wrapped around a stick, may be a Guinea worm.

The presence of Guinea worm disease is an indicator of extreme poverty, including the absence of safe drinking water, in a community. Entire communities suffer, not just the individuals afflicted with Guinea worm disease. Victims are totally incapacitated as a worm emerges from their body. Children cannot attend school. Farmers cannot farm. Communities suffer food shortages when their residents are unable to work. In southeastern Nigeria, rice farmers in a single county lost $20 million in just one year due to outbreaks of Guinea worm disease.

Method of Transmission:

Guinea worm disease is contracted when a person drinks stagnant water that is contaminated with microscopic water fleas carrying infective larvae. Inside a person’s body, the larvae grow for a year, becoming thin thread-like worms, up to 3-feet-long. These worms create agonizingly painful blisters in the skin, through which they slowly exit the body. People with emerging worms must not bathe or step in sources of drinking water, because a worm will release hundreds of thousands of eggs, or larvae, into the water. Water fleas then eat the larvae, and people who drink unfiltered water from the pond become infected — continuing the life cycle of the parasite.

Symptoms:

 One year after the larvae are ingested, a worm up to 1 meter long emerges through a blister in the victim’s skin, causing fever, nausea, and other symptoms.

Treatment:

There is no vaccine or medicine to treat or prevent Guinea worm disease. Infected people won’t even realize they have it until a year after drinking contaminated water, when they will develop blisters as the worm begins to emerge. Once that happens, a local health worker or the patient will wrap the live worm around a piece of gauze, extracting it from the body little by little. The long, painful process often takes up to one month. 

Humans are a Guinea worm’s only host, so spread of the disease can be controlled by identifying all cases and modifying human behavior to prevent it from recurring.  Once all human cases are eliminated, the disease will be eradicated. Today, cases of Guinea worm disease are down more than 99% since 1986, making it poised to be the next disease after smallpox to be eradicated.

It will be the first parasitic disease to be eradicated and the first disease to be eradicated without vaccines or medicines. The only other “active” eradication campaign is against polio.

Source- The Carter Center Foundation- http://www.cartercenter.org – accessed June 9 2009

“A and B: The female guinea worm induces a painful blister (A); after rupture of the blister, the worm emerges as a whitish filament (B) in the center of a painful ulcer which is often secondarily infected.” (Image Source: CarterCenter Foundation)

                                                                                            

A  

B

Photo  http://ib.berkeley.edu/courses/ib116/guinea-worm.jpg

C  Guinea worm is typically removed by rolling it on a stick or other object            

 

Guinea Worm Life Cycle: (Source Carter Center)

 

 

7. Hepatitis B

Definition:

“Hepatitis means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver.

Hepatitis B is a serious contagious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. Approximately 2,000–4,000 people die every year from hepatitis B-related liver disease. It ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It results from infection with the hepatitis B virus. Hepatitis B can be either “acute” or “chronic.”

Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. Acute infection can — but does not always — lead to chronic infection.

Chronic hepatitis B virus infection is a long-term illness that occurs when the hepatitis B virus remains in a person’s body.

The most common types of hepatitis in the United States are hepatitis A, hepatitis B, and hepatitis C. Hepatitis A, B and C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently.

  • Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with hepatitis A usually improve without treatment.
  • Hepatitis B and C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent hepatitis A and B; however, there is not one for hepatitis C. Even if a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

Method of Transmission:

Hepatitis B is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus during activities such as:

  • Birth (spread from an infected mother to her baby during birth)
  • Sex with an infected partner
  • Sharing needles, syringes, or other drug-injection equipment
  • Sharing items such as razors or toothbrushes with an infected person
  • Direct contact with the blood or open sores of an infected person
  • Exposure to blood from needlesticks or other sharp instruments

Hepatitis B virus can survive outside the body at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected. 

Prevention:

The best way to prevent hepatitis B is by getting vaccinated. The hepatitis B vaccine is safe and effective and is usually given as 3-4 shots over a 6-month period.

Symptoms:

Although a majority of adults develop symptoms from acute hepatitis B virus infection, many young children do not. Adults and children over the age of 5 years are more likely to have symptoms. Seventy percent of adults will develop symptoms from the infection.

On average, symptoms appear 90 days (or 3 months) after exposure, but they can appear any time between 6 weeks and 6 months after exposure.

Symptoms of acute hepatitis B, if they appear, can include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint pain
  • Jaundice (yellow color in the skin or the eyes)

Symptoms of Chronic Hepatitis B:

Some people have ongoing symptoms similar to acute hepatitis B, but most individuals with chronic hepatitis B remain symptom free for as long as 20 or 30 years. About 15%–25% of people with chronic hepatitis B develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities.

Treatment:

There is no medication available to treat acute hepatitis B. During this short-term infection, doctors usually recommend rest, adequate nutrition, and fluids, although some people may need to be hospitalized.

People with chronic hepatitis B virus infection should seek the care or consultation of a doctor with experience treating hepatitis B. This can include some internists or family medicine practitioners, as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists (liver specialists). People with chronic hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment. Several medications have been approved for hepatitis B treatment, and new drugs are in development. However, not every person with chronic hepatitis B needs to be on medication, and the drugs may cause side effects in some patients.

*People with hepatitis B should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver.

If you are concerned that you might have been exposed to the hepatitis B virus, call your health professional or your health department. If a person who has been exposed to hepatitis B virus gets the hepatitis B vaccine and/or a shot called “HBIG” (hepatitis B immune globulin) within 24 hours, hepatitis B infection may be prevented.”

Source: CDC website -http://www.cdc.gov- accessed 6/15/09

 

8. Helicobacter pylori

 (H. pylori)

 

Definition:

[1]Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that is found in the gastric mucous layer or adherent to the epithelial lining of the stomach. H. pylori causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. Before 1982, when this bacterium was discovered, spicy food, acid, stress, and lifestyle were considered the major causes of ulcers. The majority of patients were given long-term medications, such as H2 blockers, and more recently, proton pump inhibitors, without a chance for permanent cure. These medications relieve ulcer-related symptoms, heal gastric mucosal inflammation, and may heal the ulcer, but they do NOT treat the infection. When acid suppression is removed, the majority of ulcers, particularly those caused by H. pylori, recur. Since we now know that most ulcers are caused by H. pylori, appropriate antibiotic regimens can successfully eradicate the infection in most patients, with complete resolution of mucosal inflammation and a minimal chance for recurrence of ulcers.

Method of Transmission:

It is not known how H. pylori is transmitted or why some patients become symptomatic while others do not. The bacteria are most likely spread from person to person through fecal-oral or oral-oral routes. Possible environmental reservoirs include contaminated water sources.” Contamination via contaminated endoscopes has been documented but can be prevented by proper cleaning of equipment.

Prevention:

“Since the source of H. pylori is not yet known, recommendations for avoiding infection have not been made. In general, it is always wise for persons to eat food that has been properly prepared, to wash hands thoroughly, and to drink water from a source that is known to be clean and safe. 

Symptoms:

Most persons who are infected with H. pylori never suffer any symptoms related to the infection; however, H. pylori cause chronic active, chronic persistent and atrophic gastritis in adults and children. Infection with H. pylori also causes duodenal and gastric ulcers. Infected persons have a 2- to 6-fold increased risk of developing gastric cancer and mucosal associated- lymphoid-type (MALT) lymphoma compared with their uninfected counterparts. The role of H. pylori in non-ulcer dyspepsia remains unclear.

The most common ulcer symptom is:

  • Gnawing or burning pain between the breastbone and the navel. This pain occurs when the stomach is empty, between meals and in the early morning hours, but it can also occur at other times. It may last from minutes to hours and may be relieved by eating or by taking antacids.

Less common ulcer symptoms include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Bleeding ulcers can also occur; prolonged bleeding may cause anemia leading to weakness and fatigue. If bleeding is heavy, stools may be bloody, dark red or tarry in appearance.

Treatment:

[1]‘Antibiotic medications are used to treat H. pylori infection. Doctors typically prescribe a combination of medications, with the hope that this strategy will help keep H. pylori from developing a resistance to one particular medication. You’ll likely take two antibiotic medications for 14 days. Medications that reduce acid in your stomach may help enhance the effectiveness of antibiotics. Acid-reducing medications may also help alleviate symptoms and promote healing.

Your doctor may recommend that you undergo testing for H. pylori several weeks after your treatment. A follow-up breath or stool test may confirm that the H. pylori bacterium is no longer present in your body and treatment was successful. Or follow-up testing may show that treatment was unsuccessful. In that case, you may undergo treatment again, receiving a different combination of antibiotic medications.”

1. CDC web site: http://www.cdc.gov/dhdsp/cdcynergy_training/content/activeinformation/resources/Fact_Sheet.pdf accessed 6/15/09

2. Mayoclinic.com- http://www.mayoclinic.com/health/h-pylori/DS00958/DSECTION=treatments-and-drugs accessed 6/12/09

 

Alliance for the Lost Boys of Sudan is a registered 501 C-3 Foundation EIN #59-3808251