Communicable Diseases Reviewer

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COMMUNICABLE DISEASE



Disease caused by an infectious agent that are transmitted directly or indirectly to a well person through an agency, vector or inanimate object

CONTAGIOUS DISEASE



Disease that is easily transmitted from one person to another INFECTIOUS DISEASE



Disease transmitted by direct inoculation through a break in the skin

INFECTION

-Entry and multiplication of an infectious agent into the tissue of the host

INFESTATION

- Lodgement and development of arthropods on the surface of the body

ASEPSIS

- Absence of disease – producing microorganisms SEPSIS

- The presence of infection MEDICAL ASEPSIS

-

Practices designed to reduce the number and transfer of pathogens

-

Clean technique

SURGICAL ASEPSIS

-

Practices that render and keep objects and areas free from microorganisms

-

Sterile technique



CARRIER – an individual who harbors the organism and is capable of transmitting it without showing manifestations of the disease



CASE – a person who is infected and manifesting the signs and symptoms of the disease



SUSPECT – a person whose medical history and signs and symptoms suggest that such person is suffering from that particular disease



CONTACT – any person who had been in close association with an infected person

HOST

- A person, animal or plant which harbors and provides nourishment for a parasite

RESERVOIR

- Natural habitat for the growth, multiplication and reproduction of microorganism

ISOLATION

- The separation of persons with communicable diseases from other persons

QUARANTINE

- The limitation of the freedom of movement of persons exposed to communicable diseases



STERILIZATION – the process by which all microorganisms including their spores are destroyed



DISINFECTION – the process by which pathogens but not their spores are destroyed from inanimate objects



CLEANING – the physical removal of visible dirt and debris by washing contaminated surfaces

CONCURRENT

- Done immediately after the discharge of infectious materials / secretions

TERMINAL

- Applied when the patient is no longer the source of infection BACTERICIDAL

- A chemical that kills microorganisms BACTERIOSTATIC

- An agent that prevents bacterial multiplication but does not kill microorganisms

CHAIN OF INFECTION

INFECTIOUS AGENT



Any microorganism capable of producing a disease RESERVOIR



Environment or object on which an organism can survive and multiply

PORTAL OF EXIT



The venue or way in which the organism leaves the reservoir MODE OF TRANSMISSION



The means by which the infectious agent passes from the portal of exit from the reservoir to the susceptible host

PORTAL OF ENTRY



Permits the organism to gain entrance into the host SUSCEPTIBLE HOST



A person at risk for infection, whose defense mechanisms are unable to withstand invasion of pathogens

STAGES OF THE INFECTIOUS PROCESS



Incubation Period – acquisition of pathogen to the onset of signs and symptoms



Prodromal Period – patient feels “bad” but not yet experiencing actual symptoms of the disease



Period of Illness – onset of typical or specific signs and symptoms of a disease



Convalescent Period – signs and symptoms start to abate and client returns to normal health

MODE OF TRANSMISSION CONTACT TRANSMISSION



Direct contact – involves immediate and direct transfer from person-to-person (body surface-to-body surface)



Indirect contact – occurs when a susceptible host is exposed to a contaminated object

DROPLET TRANSMISSION



Occurs when the mucous membrane of the nose, mouth or conjunctiva are exposed to secretions of an infected person within a distance of three feet

VEHICLE TRANSMISSION



Transfer of microorganisms by way of vehicles or contaminated items that transmit pathogens

AIRBORNE TRANSMISSION



Occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens

VECTOR-BORNE TRANSMISSION



Transmitted by biologic vectors like rats, snails and mosquitoes TYPES OF IMMUNIZATION



ACTIVE – antibodies produced by the body

NATURAL – antibodies are formed in the presence of active infection in the body; lifelong

ARTIFICIAL – antigens are administered to stimulate antibody production



PASSIVE – antibodies are produced by another source

NATURAL – transferred from mother to newborn through placenta or colostrum

ARTIFICIAL – immune serum (antibody) from an animal or human is injected to a person

SEVEN CATEGORIES OF ISOLATION



STRICT- prevent highly contagious or virulent infections



Example: chickenpox, herpes zoster



CONTACT – spread primarily by close or direct contact



Example: scabies, herpes simplex



RESPIRATORY – prevent transmission of infectious distances over short distances through the air

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

Example: measles, mumps, meningitis

TUBERCULOSIS – indicated for patients with positive smear or chest x-ray which strongly suggests tuberculosis

ENTERIC – prevent transmission through direct contact with feces Example: poliomyelitis, typhoid fever

DRAINAGE – prevent transmission by direct or indirect contact with purulent materials or discharge

Ex. Burns

UNIVERSAL – prevent transmission of blood and body-fluid borne pathogens

Example: AIDS, Hepatitis B

CENTRAL NERVOUS SYSTEM

MENINGO-COCCEMIA

MENINGITIS

ENCEPHALITIS

MAIN PROBLEM ETIOLOGIC AGENT INCUBATION PERIOD MODE OF TRANSMISSION - Inflammation of the brain - Inflammation of the meninges - Acute infection of the bloodstream and developing vasculitis - Arboviruses - Streptococcus - Staphylococcus - Pneumococcus - Tubercle bacillus - Neisseria meningitides

5-15 days 1-10 days 3-4 days

Bite of infected

mosquito Respiratory droplets

SIGNS AND SYMPTOMS OF ENCEPHALITIS

Virus enters neural cells

Perivascular

congestion

Disruption in

cellular

functioning

Inflammatory

reaction

Lethargy

Convulsions

Seizures

Headache

Photophobia

Vomiting

Stiff neck

Fever

Sore throat

SIGNS AND SYMPTOMS OF MENINGITIS

THREE SIGNS OF MENINGEAL IRRITATION OPISTHOTONUS

State of severe hyperextension and spasticity in which an individual’s head, neck and spinal column enter into a complete arching position BRUDZINSKI’S SIGN

Place the patient in a dorsal recumbent position and then put hands behind the patient’s neck and bend it forward.

If the patient flexes the hips and knees in response to the manipulation, positive for meningitis

KERNIG’S SIGN

Place the patient in a supine position, flex his leg at the hip and knee then straighten the knee; pain and resistance indicates meningitis

SIGNS AND SYMPTOMS OF MENINGOCOCCEMIA

URTI:

cough, sore

throat,

fever,

headache,

nausea and

vomiting

Vasculitis:

petechial

rash in the

trunk and

extremities

DIC

Micro-thrombosis

Purpura

Hypotension

Shock

Death

MENINGO-COCCEMIA

MENINGITIS

ENCEPHALITIS

SIGNS AND SYMPTOMS

INCIDENCE

5-10 years old

< 5 years old

6 months–5

years old

Stiff neck

Photophobia

Lethargy

Convulsions

Nuchal rigidity

Opisthotonus

Brudzinski’s

Kernig’s sign

Vasculitis

Waterhouse-Friderichsen

syndrome

Petechiae with

the development

of hemorrhage

DIAGNOSTIC EXAM  Informed consent  Empty bowel and bladder  Fetal, shrimp or “C” position

 Spinal canal, subarachnoid space between L3-L4 or L4- L5  After: bedrest

 Flat on bed to prevent spinal headache

MENINGO-COCCEMIA

MENINGITIS

ENCEPHALITIS

TREATMENT MODALITIES PREVENTION

1. Japanese

encephalitis

VAX

1. HiB vaccine

Dexamethasone

Mannitol

Anticonvulsants

Antipyretics

Ceftriaxone

Penicillin

Chloramphenicol

Rifampicin

Ciprofloxacin

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MENINGO-COCCEMIA

MENINGITIS

ENCEPHALITIS

NURSING MANAGEMENT 1. Comfort: quiet, well-ventilated room 2. Skin care: cleansing bath, change in position 3. Eliminate mosquito breeding sites: CULEX mosquito 1. Respiratory isolation 24-72 hours after onset of antibiotic therapy 2. Room protected against bright lights 3. Safety: side-lying position and raised side rails

1. Side boards 2. Close contacts H – ouse I – nfected person kissing S – ame daycare center S – hare mouth instruments 3. Antibiotics as prophylaxis

TETANUS

RABIES

POLIOMYELITIS MAIN PROBLEM ETIOLOGIC AGENT Acute infection of the CNS – muscle spasm, paresis and paralysis

Acute viral disease of the CNS – by saliva of infected animals

Acute infectious disease with systemic neuromuscular effects Legio debilitans Rhabdovirus Bullet-shaped Affinity to CNS Killed by sunlight, UV light, formalin Resistant to antibiotics Clostridium tetani Anaerobic Gram positive Drumstick appearance

TETANUS

RABIES

POLIOMYELITIS INCUBATION PERIOD MODE OF TRANSMISSION 7-21 days 2-8 weeks Adult: 3 days-3 weeks Distance of bite to brain

- Direct contact with infected feces Bite of an infected animal Direct inoculation through a broken skin Extensiveness of the bite Resistance of the host Neonate: 3-30 days

- Direct contact with respiratory secretions - Indirect with soiled

linens and articles

TETANUS

RABIES

POLIOMYELITIS

1. Abortive type

1. Prodromal /

invasion

phase

R – isus sardonicus

3. Paralytic type

2. Pre-paralytic

or meningetic

type

3. Terminal /

paralytic type

2. Excitement /

neurological

phase

O – pistothonus

T – rismus

C – onvulsions

H – eadache

I – rritability

L – aryngeal

spasm

POLIO ABORTIVE TYPE

 Does not invade the CNS  Headache

 Sore throat



Recovery within 72 hours and the disease passes by unnoticed PRE-PARALYTIC OR MENINGETIC TYPE

 Slight involvement of the CNS  Pain and spasm of muscles  Transient paresis

 (+) Pandy’s test (increased protein in the CSF) PARALYTIC TYPE

 CNS involvement



Flaccid paralysis  Asymmetric

 Affects lower extremities  Urine retention and constipation

 (+) HOYNE’S SIGN (when in supine position, head will fall back when shoulders are elevated)

RABIES

PRODROMAL/INVASION PHASE  Fever

 Anorexia  Sore throat

 Pain and tingling at the site of bite  Difficulty swallowing

EXCITEMENT OR NEUROLOGICAL PHASE  Hydrophobia (laryngospasm)

 Aerophobia (bronchospasm)  Delirium

 Maniacal behavior  Drooling

TERMINAL OR PARALYTIC PHASE  Patient becomes unconscious  Loss of urine and bowel control  Progressive paralysis  Death

TETANUS

RABIES

POLIOMYELITIS COMPLICATION ISOLATION PRECAUTION DIAGNOSTIC PROCEDURES Paralysis of respiratory muscles RESPIRATORY FAILURE DEATH

1. Stool culture 1. Throat washings 1. Blood exam

Enteric isolation Respiratory isolation 2. CSF culture 2. Flourescent rabies antibody (FRA) 3. Negri bodies

TETANUS

RABIES

POLIOMYELITIS TREATMENT MODALITIES

1. Analgesics

1. Local

treatment of

wound

1. Tetanus immune globulin (TIG)

2. Morphine

3. Moist heat

application

4. Bed rest

5. Rehabilitation

2. Active

immunization

Lyssavac

Imovax

Antirabies vax

2. Passive

immunization

2. Tetanus antitoxin (TAT) 3. Penicillin G 4. Tetracycline 5. Diazepam 6. Phenobarbital 7. Tracheostomy 8. NGT feeding

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TETANUS

RABIES

POLIOMYELITIS

NURSING MANAGEMENT

1. Enteric isolation _{1. Isolation} 1. Adequate airway 2. Proper disposal

of secretions 3. Moist hot packs 4. Firm / nonsagging bed 5. Suitable body alignment 6. Comfort and safety 2. Optimum comfort 3. Restful environment 4. Emotional support 5. Concurrent and terminal disinfection 2. Quiet, semi-dark environment 3. Avoid sudden

stimuli and light

TETANUS

RABIES

POLIOMYELITIS PREVENTION

Salk vaccine

- Inactivated

polio vaccine

- Intramuscular

1. If the dog is healthy

1. Aseptic

handling of

umbilical cord

Sabin vaccine

- Oral polio

vaccine

- Per orem

2. If the dog dies or shows signs suggestive of rabies 3. If dog is not available for observation 4. Have domestic dog 3 months to 1 year old immunized

2. Tetanus toxoid

immunization

3. Antibiotic

prophylaxis

- Penicillin

- Erythromycin

- Tetracycline

RESPIRATORY SYSTEM

SARS

BIRD FLU

MAIN PROBLEM ETIOLOGIC AGENT INCUBATION PERIOD MODE OF TRANSMISSION

Flu infection in birds that affects humans

A new type of atypical pneumonia that infects the lungs

Avian influenza virus, H5N1 Corona virus

3-5 days 2-8 days

Inhalation of feces and discharge of an infected bird

Respiratory droplets

SARS

BIRD FLU

Body weakness or muscle

pain

High fever >38’Celsius

Chills

Cough

Difficulty breathing

Episodes of sore throat

Fever

SARS

BIRD FLU

COMPLICATIONS

Severe viral pneumonia

Acute respiratory distress

syndrome

Hypoxemia

Fluid accumulation in

alveolar sacs

Severe breathing difficulties

Multiple organ failure

DEATH

Severe viral

pneumonia

Respiratory failure

SARS

BIRD FLU

TREATMENT MODALITIES

- Generic flu drugs

1. No definitive treatment

for SARS

1. Amantadine/Rimantadine

- H5N1 developed resistance

2. Oseltamivir (TAMIFLU)

Zanamavir (RELENZA)

- Primary treatment

- Within 2 days at onset of

symptoms

- 150 mg BID x 2 days

2. Antiviral drugs

(normally used to treat

AIDS)

- RIBAVIRIN

3. Corticosteroids

SARS

BIRD FLU

PREVENTION

1.Culling – killing of

sick or exposed

birds

1.Quarantine

2. Banning of

importation of

birds (Executive

order # 280)

3. Cook chicken

thoroughly

2. Isolation

3. WHO alert

on SARS

(March 12,

2003)

NURSING MANAGEMENT

BIRD FLU

WHAT TO DO WITH A PERSON SUSPECTED TO HAVE BIRD FLU

• Isolation

•

Face mask on the patient

•

Caregiver: use a face mask and eye goggles/glasses

•

Distance of 1 meter from the patient

•

Transport the patient to a DOH referral hospital REFERRAL HOSPITALS

•

National Referral Center – Research Institute for Tropical Medicine (RITM) (Alabang, Muntinlupa)

•

Luzon – San Lazaro Hospital (Quiricada St., Sta. Cruz, Manila)

•

Visayas – Vicente Sotto Memorial Medical Hospital (Cebu City)

•

Mindanao – Davao Medical Center (Bajada, Davao City) S A R S

SUSPECT CASE

1. A person presenting after 1 November 2002 with a history of:



High fever >38 0C AND

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

One or more of the following exposures during the 10 days prior to the onset of symptoms:



Close contact , with a person who is a suspect or probable case of SARS



History of travel , to an area with recent local transmission of SARS



Residing in an area with recent local transmission of SARS

2. A person with an unexplained acute respiratory illness resulting in death after 1 November 2002, but on whom no autopsy has been performed :

AND

 One or more of the following exposures during the 10 days prior to the onset of symptoms:



Close contact , with a person who is a suspect or probable case of SARS



History of travel , to an area with recent local transmission of SARS



Residing in an area with recent local transmission of SARS

PROBABLE CASE

1. A suspect case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome on Chest x-ray. 2. A suspect case of SARS that is positive for SARS coronavirus by one or more assays.

3. A suspect case with autopsy findings consistent with the pathology of SARS without an identifiable cause.

PERTUSSIS

DIPHTHERIA

Acute bacterial disease characterized by the elaboration of an exotoxin

Repeated attacks of spasmodic coughing

Corynebacterium diphtheriae or

Klebs-Loeffler bacillus Bordetella pertussis

2-5 days 7-14 days

1. Respiratory droplets

2. Direct contact with respiratory secretions 3. Indirect contact with articles

PERTUSSIS

DIPHTHERIA

Types:

1.Nasal

2.Tonsilopharyngeal

3.Laryngeal

4.Wound or

cutaneous

Stages:

1. Catarrhal

2. Paroxysmal

3. Convalescent

NASAL DIPHTHERIA

• Bloody discharge from the nose • Excoriated nares and upper lip TONSILOPHARYNGEAL DIPHTHERIA

• Low grade fever • Sore throat

• Bull-neck appearance

•

Pseudomembrane- Group of pale yellow membrane over tonsils and at the back of the throat as an inflammatory response to a powerful necrotizing toxins

LARYNGEAL DIPHTHERIA • Hoarseness • Croupy cough • Aphonia

•

Membrane lining thickens à airway obstruction • Suffocation, cyanosis or death

WOUND OR CUTANEOUS DIPHTHERIA • Yellow spots or sores in the skin PERTUSSIS

CATARRHAL STAGE

•

Lasts for 1 to 2 weeks

•

Most communicable stage

•

Begins with respiratory infection, sneezing, cough and fever

•

Cough becomes more frequent at night PAROXYSMAL STAGE

• Lasts for 4 to 6 weeks

•

Aura: sneezing, tickling, itching of throat

•

Cough, explosive outburst ending in “whoop”

•

Mucus is thick, ends in vomiting

•

Becomes cyanotic

•

With profuse sweating, involuntary urination and exhaustion CONVALESCENT STAGE • End of 4th-6th week • Decrease in paroxysms

PERTUSSIS

DIPHTHERIA

DIAGNOSTIC PROCEDURES

SCHICK’S TESTS 

CBC – increase in

lymphocytes

- Susceptibility and immunity to

diphtheria

-ID of dilute diphtheria toxin (0.1 cc)

(+) local circumscribed area of redness, 1-3 cm

MALONEY’S TEST -Determines hypersensitivity to diphtheria anti-toxin

-ID of 0.1 cc fluid toxoid -(+) area of erythema in 24 hours

PERTUSSIS

DIPHTHERIA

COMPLICATIONS

Toxins in the bloodstream

Myocarditis (epigastric or chest pain) Peripheral paralysis (tingling, numbness, paresis) Broncho-pneumonia (fever, cough) Heart failure Decreased _in respiratory rate Respirat ory arrest DEATH

C

onvulsions (brain

damage from

asphyxia)

O

titis media

(invading

organisms)

B

ronchopneumonia

(most dangerous

complication)

PERTUSSIS

DIPHTHERIA

1. Diphtheria anti-toxin 1. Erythromycin – drug of choice

- Requires skin testing - Early administration

aimed at neutralizing the toxin present in the circulation before it is absorbed by the tissues

2. Antibiotic therapy - Penicillin G - Erythromycin 2. Ampicillin – if resistant to erythromycin 3. Betamethasone (corticosteroid) – decrease severity and length of paroxysms 4. Albuterol

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PERTUSSIS

DIPHTHERIA

NURSING MANAGEMENT 1. Isolation: 14 days (until

2-3 cultures, 24 hours apart)

1. Isolation: 4-6 weeks from onset of illness

2. Bedrest for 2 weeks 3. Care for nose and

throat (gentle swabbing) 4. Ice collar (decrease pain

of sore throat) 5. Diet (soft food, small

frequent feedings)

2. Supportive measures (bedrest, avoid

excitement, dust, smoke and warm baths) 3. Safety (during

paroxysms, patient should not be left alone) 4. Suctioning (kept at

bedside for emergency use)

MUMPS

MAIN PROBLEM

An acute contagious disease, with swelling of one or both of the parotid glands

ETIOLOGIC AGENT

Filterable virus of paramyxovirus group INCUBATION PERIOD

12-26 days

MODE OF TRANSMISSION Respiratory droplets

PERIOD OF COMMUNICABILITY

6 days before and 9 days after onset of parotid swelling SIGNS AND SYMPTOMS

PRODROMAL PHASE F-ever (low grade) H-eadache M-alaise PAROTITIS F-ace pain E-arache

S-welling of the parotid glands COMPLICATIONS

•

Orchitis – the most notorious complication of mumps

•

Oophoritis – manifested by pain and tenderness of the abdomen

•

CNS involvement – manifested by headache, stiff neck, delirium, double vision

•

Deafness as a result of mumps NURSING MANAGEMENT

1. Prevent complications

− Scrotum supported by suspensory − Use of sedatives to relieve pain

− Treatment: oral dose of 300-400 mg cortisone followed by 100 mg every 6 hours

− Nick in the membrane 2. Diet

- Soft or liquid diet

- Sour foods or fruit juices are disliked 3. Respiratory isolation

4. Comfort: ice collar or cold applications over the parotid glands may relieve pain

5. Fever: aspirin, tepid sponge bath

6. Concurrent disinfection: all materials contaminated by these secretions should be cleansed by boiling

7. Terminal disinfection: room should be aired for six to eight hours

GASTROINTESTINAL TRACT

SHIGELLOSIS

AMOEBIASIS

MAIN PROBLEM

ETIOLOGIC AGENT Protozoal infection of the large intestine

Acute infection of the lining of the small intestine

Entamoeba histolytica

Shigella group - Prevalent in areas with ill

sanitation

-Acquired by swallowing - Trophozoites: vegetative form

- Cyst

: infective stage

1. Shigella flesneri – most common in the Philippines 2. Shigella connei

3. Shigella boydii

4. Shigella dysenterae – most infectious type

SHIGELLOSIS

AMOEBIASIS

1. Acute amoebic dysentery

_Fever

- Diarrhea alternated with

constipation

- Tenesmus

2. Chronic amoebic dysentery

- Bloody mucoid stools

- Enlarged liver

- Large sloughs of intestinal

tissues accompanied by hemorrhage

Abdominal pain

Diarrhea and

tenesmus

Bloody mucoid

stool

SHIGELLOSIS

AMOEBIASIS

DIAGNOSTIC TESTS 1. Stool exam TREATMENT MODALITIES

1. Metronidazole – drug

of choice

1. Cotrimoxazole – drug

of choice

2. Blood exam 3. Sigmoidoscopy

2. Tetracycline

3. Chloramphenicol

SHIGELLOSIS

AMOEBIASIS

1.Enteric isolation

2. Boil water for

drinking

3. Handwashing

4. Sexual activity

5. Avoid eating

uncooked leafy

vegetables

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TYPHOID FEVER

CHOLERA

Acute bacterial disease of the GIT characterized by profuse secretory diarrhea

An infection affecting the Peyer’s patches of the small intestines

Vibrio cholerae Salmonella typhi

1 to 3 days 1 to 3 weeks

1. Fecal-oral transmission 2. 5 F’s

TYPHOID FEVER

CHOLERA

Rice-water stool

Fever (ladder-like)

Abdominal cramps

Vomiting

Intravascular

Dehydration

Shock

Rose spots

Diarrhea

TYPHOID STATE

Sordes

Subsultus Tendinum

Coma vigil

Carphologia

TYPHOID FEVER

CHOLERA

1.Lactated Ringer’s

solution

1.Chloramphenicol –

drug of choice

2. Oral rehydration

therapy

3. Antibiotic therapy

- Tetracycline – drug

of choice

- Cotrimoxazole

- Chloramphenicol

2. Ampicillin/

Amoxicillin – for

typhoid carriers

3. Cotrimoxazole – for

severe cases with

relapses

TYPHOID FEVER

CHOLERA

1. Maintain and restore the fluid

and electrolyte balance

2. Enteric isolation

3. Sanitary disposal of excreta

4. Adequate provision of safe

drinking water

5. Good personal hygiene

INTEGUMENTARY SYSTEM

HERPES ZOSTER

CHICKENPOX

A highly contagious disease characterized by vesicular eruptions on the skin and mucous membranes

An acute viral infection of

the sensory nerve

Varicella zoster virus

10-21 days 13-17 days 1. Droplet method 2. Direct contact 3. Indirect contact

HERPES ZOSTER

CHICKENPOX

SIGNS AND SYMPTOMS PERIOD OF COMMUNICABILITY

One day before eruption

of 1

st

_{lesion and five days}

after appearance of last

crop

One day before eruption

of 1

st

_{rash and five to six}

days after the last crust

PRODROMAL

PERIOD

- Fever (low-grade)

- Headache

- Malaise

HERPES ZOSTER

CHICKENPOX

•

Rashes : Centrifugal

distribution

•

Rashes

-Unilateral, band-like

distribution

•Rash stages: macule

papule vesicle

pustule crust

• Pruritus

-Dermatomal

- Erythematous base

- Vesicular, pustular or

crusting

•Regional

lymphadenopathy

•Pruritus

•Pain – stabbing or

burning

HERPES ZOSTER

CHICKENPOX

COMPLICATIONS

SCARRING – most common complication; associated with staphylococcal or streptococcal infections from scratching NECROTIZING FASCIITIS – most severe complication REYE SYNDROME – abnormal accumulation of fat in the liver plus increase of pressure in the brain resulting to coma, therefore leading to DEATH

RAMSAY-HUNT

SYNDROME -Involvement of Involvement of the facial nerve in herpes zoster the facial nerve in herpes zoster with facial paralysis, hearing with facial paralysis, hearing loss, loss of taste in half of the loss, loss of taste in half of the tongue

tongue GASSERIAN GANGLIONITIS –

Involvement of the optic nerve resulting to corneal anesthesia ENCEPHALITIS – acute inflammatory condition of the brain

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HERPES ZOSTER

CHICKENPOX

1. Antihistamines –

symptomatic relief of itching Ex. Diphenhydramine (Benadryl)

2. Analgesics and antipyretics Ex. Acetaminophen

3. Antiviral agents – for patient to experience less pain and faster resolution of lesions when used within 48 hours of rash onset

Ex. Acyclovir (Zovirax)

4. Corticosteroids – anti-inflammatory and decreased pain Ex. Prednisone

HERPES ZOSTER

CHICKENPOX

S

trict isolation

P

revent secondary infection (cut fingernails short, wear mittens)

E

liminate itching: calamine lotions, warm baths, baking soda paste

E

ncourage not going to school: usually 7 days

D

isinfection of clothes and linen with nasopharyngeal discharges by sunlight or boiling

GERMAN MEASLES

MEASLES

MAIN PROBLEM ETIOLOGIC AGENT INCUBATION PERIOD MODE OF TRANSMISSION A contagious exanthematous disease with chief symptoms to the upper respiratory tract

A benign communicable exanthematous disease caused by rubella virus 1. Droplet method Rubella virus 10-12 days 14-21 days Filterable virus of paramyxoviridae

2. Direct contact with respiratory discharges 3. Indirect with soiled linens and articles

GERMAN MEASLES

MEASLES

PERIOD OF COMMUNICABILITY

4 days before and 5 days after the appearance of rashes

One week before and four days after the appearance of rashes

PRE-ERUPTIVE STAGE PRE-ERUPTIVE STAGE

C

ough

C

oryza

C

onjunctivitis

F

ever (high-grade)

P

hotophobia

F

ever

H

eadache

M

alaise

C

oryza

C

onjunctivitis

KOPLIK’S SPOT (Rubeola)

- Bluish white spots surrounded by a red halo

- Appear on the buccal mucosa opposite the premolar teeth FORCHEIMER’S SPOTS (Rubella)

- small, red lesions

- Soft palate to mucus membrane

GERMAN MEASLES

MEASLES

SIGNS AND SYMPTOMS 2. ERUPTIVE STAGE

ERUPTIVE STAGE Rashes

- Elevated papules

- Begin on the face and behind the ears

- Spread to trunk and extremities

Color: Dark red – purplish hue – yellow brown

3. Stage of Convalescence - Desquamation

- Rashes fade from the face downwards

1. Rash

- pinkish, maculopapular - Begins on the face - Spread to trunk or limbs - No pigmentation or

desquamation 2. Posterior auricular and

suboccipital lymphadenopathy

GERMAN MEASLES

MEASLES

COMPLICATIONS

P

neumonia

1. Encephalitis

O

titis media

S

evere diarrhea (leading

to dehydration)

E

ncephalitis

2. Congenital rubella syndrome - Spontaneous abortion - Intrauterine growth retardation

(IUGR)

- Thrombocytopenia purpura “blueberry muffin skin” - Cleft lip, cleft palate, club foot - Heart defects (PDA, VSD) - Eye defects (Cataract,

glaucoma)

- Ear defects (Deafness) - Neurologic (microcephaly,

mental retardation, behavioral disturbances

GERMAN MEASLES

MEASLES

1.Vitamin A – helps

prevent eye damage

and blindness

1.Aspirin – help reduce

inflammation and

fever

2. Antipyretics – for

fever

3. Penicillin – given

only when secondary

infection sets in

GERMAN MEASLES

MEASLES

1. Darkened room to relieve photophobia 2. Diet: should be liquid but nourishing 3. Warm saline solution for eyes to relieve

eye irritation

4. For fever: tepid sponge bath and anti-pyretics

5. Skin care: during eruptive stage, soap is omitted; bicarbonate of soda in water or lotion to relieve itchiness

6. Prevent spread of infection: respiratory isolation

SCABIES

MAIN PROBLEM

Infestation of the skin produced by the burrowing action of a parasite mite resulting in skin irritation and formation of vesicles and pustules ETIOLOGIC AGENT

(9)

INCUBATION PERIOD Within 24 hours MODE OF TRANSMISSION Direct contact Indirect contact Sarcoptes scabiei

1. Yellowish white in color 2. Barely seen by the unaided eye

3. Female parasite burrows beneath the epidermis to lay eggs 4. Males are smaller and reside on the surface of the skin SIGNS AND SYMPTOMS

•

T hin, pencil-mark lines on the skin

•

Itching, especially at night

•

Rashes and abrasions on the skin PRIMARY LESIONS

NODULAR LESIONS SECONDARY LESIONS TREATMENT MODALITIES

• SCABICIDE : Eurax ointment (Crotamiton) • PEDICULICIDE : Kwell lotion (Gamma Benzene

Hexachloride) – contraindicated in young children and pregnant women

• Topical steroids

• Hydrogen peroxide : cleanliness of wound • Lindane Lotion

• Apply cream at bedtime, from neck to toes • Instruct patient to avoid bathing for 8 to 12 hours • Dry-clean or boil bedclothes

• Report any skin irritation

• Family members and close contact treatment • Good handwashing

• Terminal disinfection

SEXUALLY TRANSMITTED DISEASES

SYPHILIS

AIDS

MAIN PROBLEM

ETIOLOGIC AGENT

INCUBATION PERIOD Final and most serious stage of HIV disease, which causes severe damage to the immune system

Infectious disease caused

by a spirochete

Retrovirus – Human T-cell lymphotropic virus III (HTLV-3)

Treponema pallidum

3 to 6 months to 8 to 10 years 10-90 days

SYPHILIS

AIDS

MODE OF TRANSMISSION

•

Sexual contact – oral, anal or

vaginal sex

•Blood transfusion

•Mother-to-child

•Indirect contact through soiled

articles

SYPHILIS

AIDS

SIGNS AND SYMPTOMS OPPORTUNISTIC INFECTIONS 1. Pneumocystis carinni pneumonia 2. Oral candidiasis 3. Toxoplasmosis 4. Acute/chronic diarrhea 5. Pulmonary tuberculosis MALIGNANCIES 1. Kaposi’s sarcoma 2. Non-Hodgkin’s lymphoma

SYPHILIS

AIDS

SIGNS AND SYMPTOMS 1. PRIMARY SYPHILIS - CHANCRE: small, painless,

pimple-like ulceration on the penis, labia majora, minora and lips

- May erupt in the genitalia, anus, nipple, tonsils or eyelids - Lymphadenopathy

SYPHILIS

AIDS

SIGNS AND SYMPTOMS 2. SECONDARY SYPHILIS - Skin rash

- Mucous patches - Hair loss

- CONDYLOMATA LATA: coalescing papules which form a gray-white plaque frequently in skin folds

SYPHILIS

AIDS

SIGNS AND SYMPTOMS _{3. TERTIARY SYPHILIS} - 1 to 10 years after infection - Appear on the skin, bones,

mucus membrane, URT, liver and stomach

- GUMMA: chronic, superficial nodule or deep

granulomatous lesion that is solitary, painless, indurated

(10)

SYPHILIS

AIDS

DIAGNOSTIC PROCEDURES

1.ELISA

1.Dark Field

Illumination test

2. Western blot

3. RIPA

4. PCR

2. Flourescent

Treponemal

Antibody

Absorption Test

3. VDRL

SYPHILIS

AIDS

1. Antivirals

- Shorten the clinical

course, prevent

complications, prevent

development of

latency, decrease

transmission

- Example: Zidovudine

(Retrovir)

1. Penicillin G Benzathine - Disease < 1 year: 2.4 M units

once in two injection sites - Disease > 1 year: 2.4 M units

in 2 injection sites x 3 doses 2. Doxycycline – if allergic to penicillin 3. Tetracycline - if allergic to penicillin - Contraindicated for pregnant women

GONORRHEA

CHLAMYDIA

Purulent inflammation of mucous membrane surfaces

Sexually transmitted disease caused by a bacteria

Chlamydia trachomatis Neisseria gonorrhea

2-3 weeks (males) _{2-10 days}

Sexual contact: Oral, vaginal or anal sex Asymptomatic (females)

GONORRHEA

CHLAMYDIA

Women

Abdominal or pelvic pain Bleeding after intercourse and in-between menses

Unusual vaginal discharge

Women

Bleeding after intercourse Burning sensation during urination

Yellow or bloody vaginal discharge

Men

Burning with urination Swollen, painful testicles Discharge from the penis

White, yellow or green pus from the penis

GONORRHEA

CHLAMYDIA

COMPLICATIONS Women Pelvic inflammatory disease Ectopic pregnancy Sterility Men Epididymitis Sterility Newborn Conjunctivitis Otitis media Pneumonia Newborn Gonococcal ophthalmia

GONORRHEA

CHLAMYDIA

1. Azithromycin

(Zithromax)

1. Cefixime

- Drug of choice because

of single-dose treatment

effectiveness and lower

cost

2. Doxycycline

- Secondary drug of

choice

- Drug of choice

because of oral

efficacy, single dose

2. Ciprofloxacin

3. Ceftriaxone

4. Erythromycin

HERPES SIMPLEX

CANDIDIASIS

MAIN PROBLEM ETIOLOGIC AGENT INCUBATION PERIOD

Mild superficial fungal

infection

A viral disease

characterized by the

appearance of sores and

blisters on the skin

Candida albicans

Herpes simplex virus

_{types 1 and 2}

2-3 weeks

2-12 days

HERPES SIMPLEX

CANDIDIASIS

1. Rise in glucose as in

diabetes mellitus

2. Lowered body

resistance as in cancer

3. Increase in estrogen

level in pregnant women

4. Broad-spectrum

antibiotics are used

TYPE 1

- Respiratory droplets

- Direct exposure to

infected saliva

- Kissing and sharing

utensils

TYPE 2

- Sexual or genital

contact

SIGNS AND SYMPTOMS (Candidiasis) ONYCHOMYCOSIS

• Red, swollen darkened nailbeds • Purulent discharge

• Separation of pruritic nails from nailbeds DIAPER RASH

• Scaly, erythematous, papular rash • Covered with exudates

(11)

• Appears below the breasts, between fingers, axilla, groin and umbilicus

THRUSH

• Cream-colored or bluish-white patches on the tongue, mouth or pharynx

• Bloody engorgement when scraped MONILIASIS

• White or yellow discharge • Pruritus

• Local excoriation

• White or gray raised patches on vaginal walls with local inflammation

HERPES SIMPLEX

CANDIDIASIS

1. Antifungals

- Fluconazole (Diflucan)

- Ketoconazole (Nizoral)

- Imidazole (Nystatin)

- Used for oral thrush

- 48 hours until

symptoms disappear

- Cotrimoxazole

1. Antivirals

(12)

VECTOR-BORNE DISEASES

MALARIA

DENGUE

MAIN PROBLEM

ETIOLOGIC AGENT

An acute febrile disease An acute and chronic parasitic disease

The most common arboviral

illness transmitted globally The most deadly vector-borne disease in the world

Dengue virus types 1, 2, 3 and 4 Chikungunya virus

O’nyong’nyong virus West Nile virus

Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae

MALARIA

DENGUE

INCUBATION PERIOD MODE OF TRANSMISSION P. Falciparum – 12 days P. Vivax – 14 days P. Ovale – 14 days P. Malariae – 30 days 3-14 days

Bite of an infected mosquito

Blood transfusion, contaminated syringe or needle Trans-placentally

MALARIA

DENGUE

VECTOR Aedes aegypti (Aedes albopictus) White stripes on the back and legs (Tiger mosquito)

Day biting (2 hours after sunrise and 2 hours before sunset) Breeds on clear stagnant water Urban-based

Anopheles flavirostris

Brown in color

Night biting (9 PM-3 AM) Breeds on clear, flowing and shaded streams

Rural-based

MALARIA

DENGUE

FEVER

CHILLS

PROFUSE SWEATING

FEVER

HEADACHE

MALAISE

RASH

EPISODES OF

BLEEDING

MALARIA

DENGUE

DIAGNOSTIC PROCEDURES 1. TORNIQUET TEST

- Screening test for dengue - A test for the tendency for blood

capillaries to break down or produce petechial hemorrhage

- Performed by examining the skin of the forearms after the arm veins have been occluded for 5 minutes - To detect unusual capillary fragility

1. CLINICAL DIAGNOSIS

- Based on triad symptoms, 50% accuracy

2. PLATELET COUNT

- Confirmatory test for dengue - Decreased count is confirmatory

2. BLOOD SMEAR

- Definitive diagnosis of infection is based on demonstration of malaria

parasites in blood film 3. RAPID DIAGNOSTIC TEST

- Uses immunochromatographic methods to detect Plasmodium-specific antigens

- Takes about 7 to 15 minutes - Sensitivity and specificity > 90%

MALARIA

DENGUE

TREATMENT MODALITIES 1. Analgesics and antipyretics - acetaminophen

2. Volume expanders

- Used in the treatment of

intravascular volume deficits

- Example: Lactated Ringers

3. Blood transfusion – for severe bleeding 4. Oxygen therapy 5. Sedatives 1. Chloroquine 2. Primaquine 3. Pyrimethamine 4. Sulfadoxine 5. Quinine 6. Quinidine

LEPTOSPIROSIS

SCHISTOSOMIASIS

MAIN PROBLEM ETIOLOGIC AGENT A slowly progressive disease

caused by a blood fluke A zoonotic infectious disease

1. SCHISTOSOMA JAPONICUM

- Intestinal tract, endemic in the Philippines

2. SCHISTOSOMA MANSONI

- Africa

3. SCHISTOSOMA HAEMATOBIUM

- Middle East countries like Iran and Iraq

Leptospira interrogans

LEPTOSPIROSIS

SCHISTOSOMIASIS

INCUBATION PERIOD

At least 2 months 7 to 19 days

Ingestion Skin penetration Contact with the skin

(13)

LEPTOSPIROSIS

SCHISTOSOMIASIS

VECTOR

Oncomelania quadrasi 1. Thrives in fresh water stream

2. Clings to grasses and leaves 3. Greenish brown in color 4. Size is as big as the smallest grain of palay

LEPTOSPIROSIS

SCHISTOSOMIASIS

SIGNS AND SYMPTOMS ACUTE STAGE 1. Cercarial dermatitis (swimmer’s itch) 2. Katayama syndrome C - ough

H – eadache and fever A – norexia and lethargy R – ash

M - yalgia

Septic or Leptospiremic Stage F – ever (remittent H – eadache M – yalgia N – ausea V – omiting C – ough C – hest pain

LEPTOSPIROSIS

SCHISTOSOMIASIS

SIGNS AND SYMPTOMS CHRONIC STAGE 1. Hepatic: pain, abdominal distension, hematemesis, melena 2. Intestinal: fatigue, abdominal pain, dysentery

3. Urinary: dysuria, urinary frequency, hematuria

4. Cardiopulmonary: palpitations, dyspnea on exertion

5. CNS: seizures, headache, back pain and paresthesia

Immune or Toxic Stage - Lasts for 4 to 30 days - Iritis, headache, meningeal manifestations

- Oliguria, anuria with renal failure

- Shock, coma and congestive heart failure

LEPTOSPIROSIS

SCHISTOSOMIASIS

DIAGNOSTIC PROCEDURES 1. Fecalysis 2. Kato-Katz Technique

3. Cercum ova precipitin test (COPT)

- Confirmatory test for schistosomiasis

LEPTOSPIROSIS

SCHISTOSOMIASIS

TREATMENT MODALITIES 1. Praziquantel (Biltricide) - Taken for 6 months - 1 tablet BID for 3 months - 1 tablet OD for 3 months

1st_{line drugs}

1. Penicillin G – drug of choice 2. Doxycycline 2nd_{line drugs} 3. Ampicillin 4. Amoxicillin

FILARIASIS

MAIN PROBLEM

A parasitic disease caused by an African eye worm ETIOLOGIC AGENT Wuchereria bancrofti Brugia malayi Brugia timori INCUBATION PERIOD 8 to 16 months MODE OF TRANSMISSION Person-to-person by mosquito bites ACUTE STAGE

•

Lymphadenitis (inflammation of lymph nodes)

•

Lymphangitis (inflammation of lymph vessels)

• Male genitalia affected leading to funiculitis, epididymitis and orchitis (redness, painful and tender scrotum) CHRONIC STAGE

• Develop 10-15 years from onset of first attack

•

Hydrocele (swelling of the scrotum)

•

Lymphedema (temporary swelling of the upper and lower extremities)

•

Elephantiasis (enlargement and thickening of the skin of the upper and lower extremities, scrotum and breast LABORATORY EXAMINATIONS

•

Nocturnal blood examination (NBE) – taken at patient’s residence/hospital after 8PM

•

Immunochromatographic test (ICT) – rapid assessment method; an antigen test done at daytime

TREATMENT

•

Diethylcarbamazine Citrate (DEC) or HETRAZAN – an individual treatment kills almost all microfilaria and a good proportion of adult worms.

PREVENTION AND CONTROL

• Measures aimed to control vectors

•

Environmental sanitation such as proper drainage and cleanliness of surroundings

•

Spraying with insecticides PREVENTION AND CONTROL

•

Measures aimed to protect individuals and families:

•

Use of mosquito nets

•

Use of long sleeves, long pants and socks

•

Application of insect repellants