Zoonotic Diseases
(also known as zoonoses)
• Zoonoses are caused by infections that are
shared between animals and people.
• Bacterial, viral, parasitic or fungal infections.
• More than 6 out of every 10 known infectious
diseases in people are spread from animals.
• 3 out of every 4 new or emerging infectious
diseases in people are spread from animals.
Cases of infections reported in the
Czech Republic in 2013-2017
2013 2014 2015 2016 2017
Campylobacteriosis 18 389 20 903 21 102 24 291 24 508
Salmonelosis 10 280 13 633 12 739 11 912 11 779
Lyme disease 4 646 3 743 2 913 4 694 3 939
Hepatitis E 218 299 412 339 344
Tularemia 36 49 59 59 51
Listeriosis 35 37 34 46 30
Leptospirosis 7 37 17 18 21
Taeniasis 30 18 6 5 6
Ehrlichiosis 8 6 2 6 4
Leishmaniasis 2 0 1 3 2
Psittacosis 1 0 0 2 1
Echinococcosis 2 6 3 4 1
Brucellosis 0 0 0 1 1
Q - fever 0 0 1 2 0
Why Are Zoonoses a Public Health
Concern?
• The number and types of zoonotic diseases are
increasing as we can travel in less time than it
takes for disease symptoms to develop after
exposure (incubation period).
• Human manipulation of the environment (e.g.,
climate change) is helping some zoonotic
disease vectors thrive.
• Overuse of antibiotics has made some of these
diseases harder to treat (antibiotic resistance).
• Some organisms that cause zoonoses could be
used for bioterrorism.
• Vaccines are not available to protect humans
against many zoonoses.
• Treatments may not exist or be readily available.
How do germs spread between
animals and people?
Direct contact: with body fluids of an infected
animal - petting or touching animals, and bites or
scratches.
Indirect contact: with areas where animals live or
objects that have been contaminated with germs
- aquarium tank water, pet habitats, chicken
coops, plants, and soil, as well as pet food and
water dishes.
Vector-borne: ticks, mosquitos or fleas.
Foodborne: Eating or drinking something unsafe
(such as unpasteurized milk, undercooked meat or
eggs, or raw that are contaminated with feces from
Who is at a higher risk of serious
illness from zoonotic diseases?
Anyone can become sick from a zoonotic disease,
including healthy people.
Some people are more likely than others to get
really sick, and even die, from infection. These
groups of people include:
– Children younger than 5
– Adults older than 65
– People with weakened immune systems
– Pregnant women
Prevention
Keep hands clean.
Prevent bites from mosquitoes, ticks, and fleas.
Avoid bites and scratches from animals.
Vaccinate yourself.
Enteric Zoonotic Diseases.
Mostly Salmonella and Campylobacter, but
Escherichia coli too.
Leptospirosis
Infectious disease of humans and animals that is
caused by pathogenic spirochetes of the genus
Leptospira.
It is considered the most common zoonosis in the
world.
The most important reservoirs
are rodents, and rats are the
most common source
worldwide.
Leptospirosis
Leptospira species infect a wide range of animals,
including mammals, birds, amphibians, and reptiles.
Humans are considered accidental hosts.
The organism is typically transmitted via exposure of
mucous membranes or abraded skin to the soil or
fresh water contaminated with the urine of an animal
that is a chronic carrier.
 Occupational exposure probably accounts for
30-50% of human cases (farm workers,
veterinarians, plumbers, workers in the fishing
industry and sewer workers).
 Sporting events that involve fresh water or
hiking.
Leptospirosis
The traditional system divided the genus into 2
species: the pathogenic Leptospira interrogans and
the nonpathogenic Leptospira biflexa.
The current classification system is based on DNA
homology and recognizes the heterogeneity of the
classic leptospires, dividing L interrogans and L
biflexa into 20 named species. Within these species,
leptospires are further grouped by serogroups,
and strains on the basis of microscopic agglutination
testing (MAT).
Although certain species (eg, L interrogans) have a
classic association with Weil disease, knowledge of
the species type does not necessarily help predict
Leptospirosis
• In 90% of cases, leptospirosis manifests as an acute
febrile illness with a biphasic course and an
excellent prognosis. Nonspecific signs and symptoms
of leptospirosis (eg, fever, headache, nausea,
vomiting) are often confused with viral illness.
• In 10% of cases, the presentation is more dramatic,
and the infection has an overall case fatality rate of
5%-10%. Known as Weil disease or icteric
leptospirosis, the classic definition of this form of
leptospirosis includes fever, jaundice, renal failure,
and hemorrhage. Other organ systems (ie,
pulmonary system, cardiac system, central nervous
system) are also frequently involved.
Leptospirosis
• The incubation period is usually 5-14 days but
has been described from 72 hours to a month or
more.
• Mediators induced by the leptospire are the
suspected causes of the disease's various
manifestations (endotoxin, hemolysin and lipase
as possible sources of pathogenicity).
• The most consistent pathologic finding in
leptospirosis is vasculitis of capillaries and
resulting loss of red blood cells and fluid through
enlarged junctions and fenestrae, which cause
secondary tissue injury, probably accounts for
many of the clinical findings.
Leptospirosis - laboratory
• Elevated ESR, CRP and WBC (3,000-26,000 x 109/L)
• Significant anemia due to pulmonary and
gastrointestinal hemorrhage can occur
• The platelet count may be diminished and
coagulation times may be prolonged as a component
of disseminated intravascular coagulation (DIC)
• Levels of serum urea and creatinine may be
profoundly elevated in the anuric or oliguric phase
• Serum creatine kinase levels are often elevated in
patients with muscular involvement.
• Serum bilirubin levels (disproportional to
transaminases) elevate as part of the obstructive
disease due to capillaritis in the liver.
Leptospirosis
• Culture times for Leptospira are long and
recovery rates are low.
• The criterion standard for serologic identification
of leptospires, microscopic agglutination
testing (MAT), is available only at reference
laboratories. Paired acute and convalescent
serum specimens can provide delayed
confirmation of the diagnosis.
• Blood and CSF may produce positive PCR or
cultures during the first 7-10 days of symptoms.
Leptospirosis - treatment
• Treatment is begun empirically in patients with a
exposure history and compatible symptoms.
• In uncomplicated infections that do not require
hospitalization, oral doxycycline has been shown to
decrease duration of fever and most symptoms.
• In hospitalized patients (Weil disease), penicillin G /
3.g ceph. are the treatment of choice +
management of renal, hepatic, hematologic, and
central nervous system complications.
• Corticosteroid therapy is controversial. Treatment
with high-dose methylprednisolone (30 mg/kg/d, not
to exceed 1500 mg) has been used successfully to
treat patients with leptospiral renal failure and in the
Tularemia
Disease of animals and humans caused
by the bacterium Francisella tularensis (G-).
Humans can become infected through several routes:
• Skin contact with infected animals (In particular,
rodents, most often rabbits, but many other animals
have also been known to become ill with tularemia.)
• Ingestion of contaminated water
• Tick bites
• Inhalation of contaminated aerosols or agricultural
dusts
Tularemia
Two main serologically identical biovars, differing
primarily in geographic distribution, fermentation
reactions, and virulence.
• F tularensis biovar tularensis
– is found predominantly in North America
– an extremely virulent organism, as few as 10-
50 organisms may result in disease if inhaled
or injected intradermally
• F tularensis biovar holarctica
– is found primarily in Europe and Asia
– less-virulent subspecies
Tularemia
The incubation period for tularemia depends on the
size of the inoculum, but ranges from 1-21 days
(average 2-6 days).
1) acute inflammatory response at entry point,
necrosis
2) phagocytosis, ability to survive in infected cells is
the main virulence factor
3) IC dissemination into lymphatic system
4) A) focal necrosis or granulomas formation
B) "cytokine storm" causing capillary leakage,
tissue injury, and lethal organ failure
Tularemia
The signs and symptoms of tularemia vary
depending on how the bacteria enter the
body.
Illness ranges from mild to life-threatening.
All forms are accompanied by fever.
Main forms of this disease are listed below:
Ulceroglandular
Glandular
Oculoglandular
Oropharyngeal
Pneumonic
Typhoidal
Ulceroglandular form
This is the most common form of
tularemia and usually occurs following a
tick bite or after handling of an infected
animal.
A skin ulcer appears at the site where
the bacteria entered the body. The ulcer
is accompanied by swelling of
regional lymph glands, usually in the
armpit or groin.
Glandular form
Similar to ulceroglandular tularemia
but without an ulcer.
Also generally acquired through the
bite of an infected tick or from
handling sick or dead animals.
Oculoglandular form
This form occurs when the
bacteria enter through the eye.
This can occur when a person
is butchering an infected
animal and touches his or her
eyes.
Symptoms include irritation
and unilateral conjunctivitis
and swelling of lymph
glands in front of the ear.
- corneal ulceration,
photophobia, lacrimation, lid
edema, vision loss (rare).
Oropharyngeal form
This form results from eating or drinking contaminated
food or water.
Patients with orophyangeal tularemia may have sore
throat, mouth ulcers, tonsillitis, and swelling of
lymph glands in the neck.
- Stomatitis and
exudative pharyngitis
or tonsillitis;
abdominal pain,
nausea, and vomiting;
diarrhea;
gastrointestinal
bleeding.
Pneumonic form
This is the most serious form of tularemia.
This form results from breathing dusts or aerosols
containing the organism. It can also occur when
other forms of tularemia (e.g. ulceroglandular) are
left untreated and the bacteria spread through the
bloodstream to the lungs.
- Dry cough, dyspnea, and pleuritic-type chest pain.
Tularemia
Intestinal form
- Abdominal pain, vomiting, and diarrhea
Typhoidal form
This form is characterized by any combination of
the general symptoms (without the localizing
symptoms of other syndromes)
- Fever, chills, myalgias, malaise, and weight
loss.
Tularemia
The diagnosis of tularemia is usually based on serology
results (latex agglutination or ELISA).
… approx. 3 weeks…
An agglutination titer greater than 1:160 is considered
presumptively positive, and treatment may be started
if this result is obtained. A second titer, demonstrating
a 4-fold increase after 2 weeks, confirms the diagnosis.
Indirect fluorescent antibody testing
PCR
Tularemia - treatment
Gentamicin is considered the drug of choice in
systemic forms.
Amikacin, fluoroquinolones and rifampicin were used
successfully, but have limited clinical experience and
in vitro data.
While chloramphenicol and doxycycline are
clinically useful, relapse rates of up to 50% have
been reported in patients treated with these agents
(in US).
F. tularensis is naturally resistant to penicillins and
first-generation cephalosporins.
Ceftriaxone has been examined - although it was
Tularemia
Surgical care is not needed in tularemia
management unless an ulcerative lesion develops a
superinfection and requires debridement or
drainage is required for empyema or a fluctuant
lymph node.
No tularemia vaccine is currently available.
A vaccine based on a live strain of the bacterium
was previously available but is no longer produced
because of concerns about unknown attenuation,
safety, and production.
Listeria (Listeriosis)
Usually caused by eating food contaminated with the
bacterium Listeria monocytogenes (G+), (which is
ubiquitous in the environment).
The infection is most likely to sicken pregnant women
and their newborns, adults aged 65 or older and
immunocompromised.
Listeriosis
People with normal immune systems rarely develop
invasive infection. However, they may experience a
self-limited acute febrile gastroenteritis
following high-dose Listeria exposure.
Incubation period is mostly 1-2 days.
Rarely diagnosed outside of outbreak settings.
Listeriosis - pregnancy
Many pregnant women can carry Listeria
asymptomatically in their GI tract or vagina.
Pregnant women typically experience only fever
and other flu-like symptoms, such as fatigue and
muscle aches.
However, infections during pregnancy can rarely
lead to chorioamnionitis, premature labor,
spontaneous abortion, or life-threatening infection
of the newborn.
Listeriosis – neonatal
infection
Early-onset neonatal listeriosis (day 0-5) is
usually acquired through transplacental
transmission.
- usually associated with sepsis or meningitis
The sources of late-onset listeriosis (day 6-28)
are less clear; they may involve exposure during
delivery or nosocomial exposure.
- may present with purulent meningitis
Some neonates develop granulomatosis
infantiseptica, disseminated rash with small pale
nodules (microabscesses or granulomas) involving
Listeriosis – neonatal
infection
Listeriosis presents in the same manner as other
more common neonatal pathogens, such as group
B streptococci and Escherichia coli:
Respiratory distress - tachypnea, grunting,
apnea
Temperature instability
Poor feeding
Lethargy/irritability
Seizures
Granulomatosis infantisepticum
Listeriosis – children
Beyond the neonatal period, most children with
Listeria infections have an underlying
immunodeficiency.
Meningitis is developed more often.
Listeriosis –
immunocompromised and
aged 65 or older
Self-limited gastrointestinal tract or a more
severe CNS infection, bacteremia, or a localized
infection such as monoarticular septic arthritis.
• Listeria has a predilection for the brain
parenchyma, especially the brain stem, and the
meninges.
• Mental status changes are common.
• Seizures, both focal and generalized, occur in at
least 25% of patients.
• Cranial nerve deficits may be present.
• Strokelike syndromes with hemiplegia may occur.
Listeriosis - diagnosis
Because Listeria cannot be detected by routine
stool culture, febrile gastroenteritis from Listeria
infection is rarely diagnosed outside of outbreak
settings…
• Blood culture
• Microscopy and culture of cerebrospinal
fluid
Laboratory results that show diphtheroids should
prompt heightened awareness for the possibility of
Listeria infection, particularly in
Listeriosis - treatment
Intravenous antibiotics must be started
immediately when the diagnosis is suspected or
confirmed.
Ampicillin is generally considered the preferred
agent, but other agents may be acceptable (ie co-
trimoxazole).
Gentamicin is added frequently for synergy with
ampicillin.
Bacteremia should be treated for 2 weeks.
Longer courses may be required in the
immunocompromised. (endocarditis, for 4-6 weeks;
Listeriosis prevention
Listeriosis may be part of a larger
epidemic.
Year Location Source
2014 United States
Prepackaged caramel
apples
2011 United States Cantaloupe
2007 Massachusetts Milk
2003 United Kingdom Sandwiches
2002 United States
Delicatessen turkey
breast
Aug 1998 to Jan 1999 United States Hot dogs, deli meats
1997 Italy Corn
1997 Sweden Rainbow trout
1995 Switzerland Soft cheese
1994 Illinois Chocolate milk
Listeriosis prevention
• Avoid eating soft cheese (brie, blueveined,
…) unless it is labeled as made
with pasteurized milk.
• Do not eat raw or lightly cooked sprouts
of any kind.
• Eat cut melon right away or refrigerate
it.
• Avoid eating hot dogs, lunch meats,
refrigerated pâté or meat spreads,
fermented or dry sausages unless they
are heated to an internal temperature of
74°C just before serving.
• Do not eat refrigerated smoked seafood
unless it is canned or shelf-stable or it is
Rabies
Viral disease of mammals most often transmitted
through the bite of a rabid animal.
There are 10 viruses in the rabies serogroup, most
of which only rarely cause human disease.
The genus Lyssavirus, includes the classic rabies
virus, Mokola virus, Duvenhage virus, Obodhiang
virus, Kotonkan virus, Rochambeau virus, European
bat Lyssavirus types 1 and 2, and Australian bat
Lyssavirus.
Rabies
Unvaccinated dogs are the major
reservoir for rabies worldwide.
In Europe mostly foxes, bats and
wolves in Eastern Europe.
www.who-rabies-bulletin.or
Occurrence of wildlife mediated
rabies
www.who-rabies-bulletin.org
Reported number of human rabies
deaths, 2014
http://apps.who.int/neglected_diseases/ntddata/rabies/rabies.html
Rabies
Rabies is a highly neurotropic virus that evades
immune surveillance by its sequestration in the
nervous system.
Upon inoculation, it enters the peripheral nerves.
A prolonged incubation follows, the length of which
depends on the size of the inoculum and its proximity
to the CNS.
The virus travels along axons to enter the spinal
ganglion and then spreads into the CNS.
Thereafter, the virus spreads to the periphery and
salivary glands.
Rabies
Rabies does not cause cytotoxicity.
Death occurs from global neurologic and organ
dysfunction.
 The virion bind neurotransmitter receptors in
the synaptic space. Thus, its action is
neurotoxic, rather than direct damage.
Rabies – incubation period
The average duration of incubation is 20-90 days,
depends on the distance between entry point and
CNS.
In more than 90% of cases, incubation is less than 1
year.
In most cases, there are no symptoms until the virus
reaches CNS.
Rabies - prodromal period
The virus enters the CNS. The duration of this
period is 2-10 days.
Paresthesia, pain, or intense itching at the
inoculation site is pathognomonic for rabies and
occurs in 50% of cases.
• Malaise
• Headaches
• Fever or chills
• Pharyngitis
• Anorexia , nausea, emesis or diarrhea
• Anxiety, agitation or depression
• Insomnia
may be present.
Rabies - acute neurologic period
The duration is 2-7 days and ends up with a coma
and death.
Symptoms include muscle fasciculations and
focal or generalized convulsions.
Patients may die immediately because of
cardiorespiratory arrest or may progress to
paralysis.
Rabies - acute neurologic period
Furious episodes lasting less than 5 minutes may
develop
- agitation, restlessness, biting, confusion or
hallucinations
- episodes may be triggered by visual, auditory, or
tactile stimuli or may be spontaneous.
20 % of patients do not develop the furious form
(paralytic rabies)
- fever and headache are prominent.
Rabies - diagnosis
History of suspected virus exposure:
• The nature of the interaction with the animal
(humans may not understand what is provocative
to a wild animal)
• Strange animal behavior (eg, nocturnal animal
out during the daytime)
• Vaccination status of the animal for rabies
• Availability of the animal for testing
Rabies - diagnosis
Intra-vitam diagnosis in suspect human patients is
based on detecting virus or viral RNA in saliva, in
innervated skin biopsy samples or hair follicles.
Serological assays are not suitable for diagnosis.
Brain tissue is the preferred specimen for postmortem
diagnosis in both humans and animals.
Rabies - prevention
Pre-exposure prophylaxis - recommended to
anyone at increased risk for exposure to the rabies
virus
Post-exposure treatment
1) Any bite wound or scratches should immediately
be flushed with rinsing water as first-aid
procedure! Thorough washing for a minimum of
15 minutes with soap and water, detergent,
povidone iodine will drastically reduce infectivity
of the virus.
2) Administration of a rabies vaccine / and the
rabies immunoglobulin in cases of transdermal
bites or scratches, bleeding or contamination of
Taenia Infection (tapewoms)
• Of the 32 recognized species of Taenia,
only Taenia solium and Taenia saginata are
medically important.
• Approximately 50 million people worldwide
are infected and approx. 50 000 people die
annually of cysticercosis.
• T saginata is common in cattle-breeding
regions. Areas with the highest prevalence
are central Asia, the Near East, and central
and eastern Africa.
• T solium is endemic in Central and South
America, Southeast Asia, India, the
Philippines, Africa, Eastern Europe, and
Taenia Infection - taeniasis
• Adult tapeworms live in the human small
intestine.
• Humans pass mature eggs in feces; these eggs
contaminate pastures and barnyards, where
cattle and pigs ingest them.
• Upon reaching the alimentary canal of infected
animals, the larvae are released, penetrate the
gut wall, enter the circulation and encyst in
muscular tissue (cysticerci).
• Humans develop a taeniasis by eating raw or
undercooked beef or pork.
Taenia Infection -
cysticercosis
Humans can also act as an intermediate host for T
solium.
Cysticercosis results from human ingestion of T
solium eggs through fecal contamination (or
autoinfection). The cysticerci may develop in any
organ, and their effects depend entirely on the
location of the cysticerci.
Cysticercosis caused by T saginata is rare.
Taeniasis symptoms
Most individuals are asymptomatic or have
mild complaints.
The most common complaint is passage of
proglottids, which is associated with slight
discomfort.
Other symptoms include the following:
– Colicky abdominal pain (more common in
children)
– Nausea
– Loss of appetite or increased appetite
– Constipation or diarrhea
– Weakness, headache, dizziness, fever
Cysticercosis and
neurocysticercosis
The cysticerci are most often located in
subcutaneous and intermuscular tissues, followed
by the eye and then the brain. Most patients have
more than one cyst.
1. Neurocysticercosis: 3 possible syndromes
– Convulsions and/or seizures
– Intracranial hypertension: symptoms include headache,
nausea, vomiting, vertigo, and papilledema.
– Psychiatric disturbances: behavioral changes and
learning disabilities.
2. Muscular and dermatologic cysticercosis:
most patients are asymptomatic, subcutaneous
nodules may be evident.
Taenia Infection - diagnosis
Intestinal taeniasis
• CBC count detects eosinophilia in no more than
45% of patients.
• Examine 3 consecutive stool samples (direct and
concentrated stool preparations) from patients
and contacts.
Taenia Infection - diagnosis
Neurocysticercosis
• Examine stool samples as described above.
• CSF findings are abnormal in 50-90%
– Protein levels are usually , glucose levels are usually
mildly , predominantly mononuclear pleocytosis is
common (<300/μL).L).
• ELISA or immunoblot on both CSF and serum
• Imaging Studies
– Plain X-ray of the chest, neck, arms, and thighs can
depict calcified cysticerci (takes >3 years to occur).
– CT or MRI of the brain.
• Funduscopic examination
• Biopsy of subcutaneous nodules
Taenia Infection - treatment
If adult tapeworms are detected in the stools,
anthelmintic therapy usually suffices.
Asymptomatic cysticercosis requires no treatment.
Treatment for symptomatic neurocysticercosis is
challenging
- albendazole , praziquantel or both + high-dose
glucocorticosteroids + anticonvulsants.
Ocular, ventricular, and spinal lesions may require
surgical treatment because treatment with
anthelmintic drugs can provoke irreversible drug-
Taenia Infection
Following treatment, patients should carefully
examine stools for proglottid elimination during the
next 5 weeks for T solium infection and for 3 months
for T saginata infection.
Individuals should avoid eating inadequately cooked
beef or pork in endemic regions.
Toxocariasis
An infection caused by the
ingestion of larvae of the
dog roundworm Toxocara canis
or
the cat roundworm Toxocara
cati.
The soil of parks and playgrounds is commonly
contaminated with the eggs of T canis, and
infection may cause human disease.
In humans, toxocariasis is considered an aberrant
infection because humans are incidental hosts,
as the parasites cannot successfully reach full
Toxocariasis
Adult worms live in the small intestine of dogs.
Almost all puppies are infected at, or soon after,
birth.
The soil is commonly contaminated with the eggs
and humans typically ingest the eggs via oral
contact with contaminated hands.
Once introduced into the human intestine, the eggs
decorticate, releasing the larvae (0.5 mm x 0.02
mm).
The larvae penetrate the bowel wall and migrate
through vessels to the muscles, liver, and lung and
sometimes to the eye and brain.
Toxocariasis
Toxocariasis
Disease severity depends not only on the number of
larvae ingested but also on the degree of the
allergic reaction.
The most common characteristic is chronic
eosinophilia, without any symptoms.
Other typical findings follow according to the
involved organs.
The two main clinical presentations of
toxocariasis are visceral larva migrans (VLM) and
ocular larva migrans (OLM).
Visceral larva migrans
VLM is caused by the migration of larvae through
the internal organs of humans and the resulting
inflammatory reaction.
Syndrome is characterized by bouts of fever,
coughing, wheezing, lymphadenitis and
hepatomegaly.
Fatigue, anorexia, weight loss, pneumonia, fever,
cough, bronchospasm, abdominal pain,
headaches, rashes, and, occasionally, seizures
may develop.
Severe cases can rarely lead to myocarditis or
respiratory failure.
Ocular larva migrans
OLM is caused by migration of larva into the
posterior segment of the eye.
Patients may present with decreased vision, red
eye, or leukokoria (white appearance of the
pupil).
Granulomas and chorioretinitis can be observed in
the retina, especially at the macula. Unilateral
visual loss, retinal fibrosis, retinoblastoma, and
retinal detachment occur.
Tends to occur in older children and young adults
Toxocariasis - diagnosis
Diagnosis is based on clinical and serologic
findings.
Laboratory: leukocytosis, anemia, eosinophilia,
hypergammaglobulinemia IgM, and positive
Toxocara titers.
Imaging studies in toxocariasis (VLM and OLM)
depend on the body location of the disease.
Stool examination for Toxocara larvae is not a
helpful diagnostic test for toxocariasis.
Toxocariasis - treatment
Most patients recover without therapy.
Treatment with anthelmintic agents is indicated
for severe complications, such as for patients with
cerebral, cardiac, ocular and/or pulmonary
involvement.
Anthelmintic treatment can induce an increased
systemic inflammatory reaction, as such
corticosteroids are sometimes used in conjunction
with or without anthelminthic therapy.
Toxocariasis - treatment
Drug Dose and duration
Albendazole
(Zentel)
400 mg by mouth twice a day for five days
(both adult and pediatric dosage)
Mebendazole
(Vermox)
100-200 mg by mouth twice a day for five days
(both adult and pediatric dosage)
Quiz
• http://www.prognosisapp.com/cases/play/M140_en/Muddy
• http://www.prognosisapp.com/cases/play/M54_en/Skin-Deep
• http://www.prognosisapp.com/cases/play/M250_en/Invaded
• http://www.prognosisapp.com/cases/play/M133_en/Feathers
• http://www.prognosisapp.com/cases/play/M147_en/Zoonotic
• http://www.prognosisapp.com/cases/play/M143_en/Infested