the infectious organism is itself rarely found in the wound.
Tetanus occurs worldwide. Occurrence is uncommon and sporatic in industrial countries, and it is more common in agricultural regions and underdeveloped countries.
The infectious agent is the bacillus Clostridium tetani. The reservoir is the intestinal tract of animals and man and soil contaminated with their feces. The incubation period averages about 10 days and ranges from 1 days to several months. Transmission is by introducing tetanus spores into the body through a wound, usually a puncture wound. Tetanus is not communicable directly from man to man.
The specific treatment includes tetanus immune globulin, administered intramuscularly or intravenously, and intensive medical support.
Preventive measures are based on appropriate immunizations. Immunization with a basic series of tetanus toxoid, with a booster at 10-year intervals, is required of everyone. Tetanus prophylaxis for patients with wounds requires careful determination and assessment of whether the wound is clean or contaminated, in addition to the appropriate use of tetanus toxoid and/or tetanus immune globulin, wound cleansing, and surgical debridement. The proper use of antibiotics is also needed. The public should be educated concerning the need for proper wound care and active and/or passive prophylaxis after significant injury to the skin.
International travelers should maintain an up-to-date immunization for tetanus.
Tuberculosis
Although tuberculosis may affect many organs, it is primarily a pulmonary bacterial disease that may result in death and disability. The infection usually causes pulmonary lesions that heal within a few weeks without being noticed. The only evidence of this invasion may be lymph node calcifications in the lungs or chest. In some cases, the initial invasion progresses to pulmonary tuberculosis with symptoms of weight loss, fever, cough, chest pain, and, in advanced stages, hoarseness, and bleeding from the lungs. Less frequently, extrapulmonary tuberculosis occurs when the bacillus is disseminated to other parts of the body through the lymph and blood systems.
Tuberculosis infection is inferred when the tuberculin skin test is equal to or greater than 10 mm of induration. A presumptive diagnosis is made by demonstrating acid-fast bacilli in stained smears of sputum or other body fluids, and is confirmed by isolation of the tubercle bacilli on culture.
Tuberculosis occurs worldwide. The infectious agent in humans is primarily Mycobacterium tuberculosis. The most important reservoir is man and, in some areas, cattle. The incubation period from infection to primary lesion or positive tuberculin skin test reaction is about 2 to 12 weeks. Tuberculosis may be communicable as long as tubercle bacilli are discharged in the sputum. Extrapulmonary tuberculosis is generally not considered communicable. Susceptibility to tuberculosis is general. Children under 3 years old, adolescents, and young adults are at greatest risk. Susceptibility to disease is increased in the undernourished or underweight and in those with chronic conditions such as diabetes and alcoholism.
NAVMEDCOMINST 6224.1 series provides guidelines on the control, screening, follow-up and treatment, and reporting of tuberculosis among Navy and Marine Corps personnel and dependents. Control and screening are primarily with the use of purified protein derivative (PPD) intradermal injections. High risk personnel who require annual screening are all medical/dental personnel or fleet personnel. Individuals whose PPD skin test show them to be positive for a past or present infection are placed on a 1-year program of antituberculosis medication and periodic evaluations.
Active tuberculosis cases are treated with specific drugs under the direction of a medical officer. Respiratory isolation precautions are used for hospitalized patients. Contacts of active cases—whether in a household, office, or ship— are evaluated with situational PPD skin testing for evidence of infection.
Typhoid Fever
Typhoid fever is a serious systemic bacterial disease characterized by symptoms of fever, loss of appetite, malaise, headache, cough, red spots on the trunk, and constipation, or diarrhea.
Typhoid fever occurs worldwide. In the United States and other areas with developed sanitary facilities, most cases are imported from endemic areas.
The infectious agent is Salmonella typhi, the typhoid bacillus. The reservoir is man. The incubation period is from 1 to 3 weeks. Transmission is through food or water contaminated by the feces or urine of a carrier or patient. Shellfish
