COMMUNICABLE DISEASES

DISEASES ACQUIRED MAINLY THROUGH THE RESPIRATORY TRACT CHICKEN POX

OTHER NAMES: VARICELLA,SHINGLES

AGENT: HERPES VIRUS VARICELLA note: same virus that causes herpes zoster SOURCE : respiratory secretions of infected persons

MODE OF TRANSMISSION: DIRECT CONTACT, RESPIRATORY,RARELY THRU SKIN LESIONS Airborne Contact with contaminated linen and fomites Severe small pox skin lesions Period of communicability

1 day before the appearance of lesions and 6 days after the last scab formation

Most contagious in the early satges of eruption of skin lesions Incubation period 2-3 weeks or 13 to 17 days NOTE: Neonatal infection is rare An attack confers long immunity VACCINES

Varicella zoster Immune Globulin (VZIG) - effective in modifying or preventing disease if given within 96 hours after exposure.

Live attenuated varicella virus vaccine-shown to protect children with leukemia exposed to siblings exposed with Congenital varicella results to: Hypoplastic deformities and scarring of limb Retarded growth

CNS and ophthalmic manifestations DIAGNOSTIC EVALUATION Isolation of the virus from the vesicular fluid Giemsa stain

Serum antibodies is present in 7 days after onset Nursing considerations Strict isolation until all vesicles and most scabs disappear (usually 1 week after appearance of rash ) Exclude children from school for at least 5 days after eruption first appears or until vesicles becomes dry DIPTHERIA Toxin mediated disease with formation of pseudomembranes on faucial areas and tonsils Toxin affects heart, kidneys,and peripheral nervous system KLEBS-LOEFFLER BACILLUS Immunity of the baby disappears at 6 mos with mothers who have vaccinations High prevalence is during cooler month of December and February Does not confer immunity Prolonged active immunity can be induced by vaccination Source of infection Discharges and secretions mucus membrane of nose, pharynx and other lesions of infected persons Reservoir of infection is MAN Incubation period : 2-5 days LARYNGOTRACHEAL INVOLVEMENT: Hoarseness and barking cough Noisy breathing Inspiratory stridor Progressive suffocation Death NASAL INVOLVEMENT Persistent serous nasal discharge Bloody and foul Nasal obstruction Excoriation of external nares MEDS : ERYTHROMYCIN PENICILLIN Administration of diptheria AT DIAGNOSTIC EVALUATION: Schick test for immunity to diphtheria

LEPROSY

OTHER NAMES: Lepra, Leontiasis,Hansenosis,Hansens disease ETIOLOGIC AGENT: Mycobacyerium leprae or Hansen's bacillus an acid fast bacilli MODE OF TRANSMISSION: Prolonged skin contact, droplet infection

Children below 12 years old are more susceptible CARDINAL SIGNS 1. peripheral nerve enlargement 2. loss of sensation 3. positive smear test

EARLY MANIFESTATIONS Color changes in the skin which does not disappear even with treatment Skin ulcers which does not heal with treatment Pain and redness of the eyes Nasal obstruction and nose bleeding Muscle weakness and paralysis Loss of sensation on the affected area Loss of hair growth Anhydrosis- loss of sweating LATE MANIFESTATIONS: Lagopthalmos- inability to close the eyelids Madarosis- loss or absence of eyebrows Sinking of bridge of the nose Leonine face Natural amputation-toes,fingers,ear,nose Contractures clawing of fingers and toes Chronic skin ulcers Gynecomastia DIAGNOSTIC EXAMINATIONS Skin smear test Skin lesion biopsy Lepromine test MANAGEMENT Ambulatory, multi drug therapy Domicilary treatment as embodied in R.A. 4073 which advocated home treatment The MULTI DRUG THERAPY RECOMMENDED BY WHO Rifampicin Dapsone-photosensistivity Ofloxacin Minocycline Clofazimine (lamprene)- discoloration of skin which is reversible, discolors body fluids from pink to brownish black

NOTE: once the treatment has been complied with, the patient is considered cured and no longer infective even if he displays the sequela of the disease. MEASLES URT symptoms KOPLIKS spot Not associated with congenital abnormalities but can cause abortion, induced labor ,stillbirth AGENT: PARAMYXOVIRIDAE SOURCE OF INFECTION: MAN MODE OF TRANSMISSION: 1.Droplet infection 2. Direct contact with infected persons 3. Indirectly freshly contaminated articles 4. In some instances,airborne

INCUBATION PERIOD: 10 days, varying from 7-18 days from exposure to onset of fever. Usually 14 days after rash appears

MANIFESTATIONS PRODROMAL PHASE: Lasting 4-5 days Catarrhal appears Respiratory symptoms usually appears At the end of the prodrome: Koplik spots appear About 5 days after the appearance of the Koplik spots: Temperature rises sharply Spots slough off Rash appears behind the ears, neck and cheeks Macules becomes papular and erythematous spreading on the entire face ,neck, arms,chest,back , abdomen and thighs About 2-3 days later when the rashes reaches the feet, it begins to fade in the same sequence it appeared , leaving brownish discoloration that disappears in 7-10 days. The climax of measles occurs 2-3 days after the rash appears and is marked by : a. temperature of 39.4-40.6 degree C b. severe cough c. Puffy red eye d. rhinorrhea At about 5 days after the rash appears , other symptoms disappear and communicability ends

SOME REMINDERS ON MEASLES VACCINE Defer vaccination of persons who are having fever ,severe acute illness Do not give to people allergic to eggs Vaccine should be given 14 days before or 3 months after IG and blood transfusions Isolation of patients from diagnosis until 5-7 days onset of rash MUMPS

OTHER NAMES: Epidemmic parotitis, Infectious Parotitis ETIOLOGIC AGENT: Paramyxoviruses SOURCE OF INFECTION: mouth and nose, saliva

Mode of transmission: Direct contact, contact with freshly contaminated secretions from the respiratory tract of the patient (Fomites) Occurrence of immunity Basically a childhood disease Prevalent in children older than age 5 but younger age 9 One attack if unilateral always confers lifelong immunity INCUBATION PERIOD:12 to 26 days usually 18 days

CLINICAL MANIFESTATIONS: myalgia anorexia malaise headache low grade fever earache parotid gland swelling Inform patient that common complication of mumps is orchitis, rarely sterility

RUBELLA OTHER NAMES: German Measles Mild febrile Self-limiting ETIOLOGIC AGENT: Rubella Virus (TOGAVIRIDAE) RESERVOIR: MAN FORSCHEIMERS SPOTS-Small red petechial macules on soft palate CONGENITAL RUBELLA SYNDROME Acquired the disease during 1st trimester of pregnancy Fetuses infected early are at risk of: a. Intrauterine death b. spontaneous abortion c. Congenital malformations

DEFECTS MAY INCLUDE: Deafness Cataracts Micropthalmia Congenital glaucoma Microcephaly Meningoencephalitis Mental retardation PDA Atrial Ventricular septal defects Purpura Hepatosplenomegaly Jaundice Radiolucent bone disease ROSEOLA INFANTUM Other names: Roseola subitum,The sixth disease, exanthem subitum,exanthem criticum,rose rash of infants Common among 4 years old and below Benign self limiting Etiologic agent: Human Herpes virus Mode of Transmission: Unknown Incubation period: 10-15 days
AVIAN INFLUENZA Bird Flu

CA: Type A Influenza virus H5N1 MOT: fecal-oral

s/sx: typical influenza like; eye infection pneumonia FMD/ Foot and Mouth Disease CA: Coxsackie virus MOT: direct contact with nose/throat discharges, blisters and feces Droplet IP: 2-5 days PC: 1st sx to disappearance of blisters s/sx: Blisterlike rashes, fever Tx: symptomatic, fever control, oral hygiene

TUBERCULOSIS

Phthisis/Consumption/Kochs

CA; Mycobacterium tuberculosis hominis bovine avis MOT: droplet Tubercle lesions hardening calcification - necrosis

PRIMARY COMPLEX: non-contagious because children swallow phlegm S/sx: afternoon fever, night sweats, fatiguability, back pain, chest pain MILLIARY TB: very ill, e.g. Pots disease Tuberculin Tests: Vollmerpatch Von Parquet Mantoux test NI: Diet, Drugs, Rest Anti-TB drugs R Rifampicin (Rifadine/Rimactane) 600mg once a day I Isoniazid (Laniazid) 300 mg once a day P Pyrazinamide (Zinamide) 500 mg/tablet E Ethambutol (Myambutol) 1.5mg/kg once a day S Streptomycin 1 g/day RIFAMPICIN Empty stomach Body fluid discoloration Hepatotoxic (metabolism) Nephrotoxic (elimination) Permanent discoloration of contact lenses ISONIAZID Empty stomach Peripheral neuropathy Avoid alcohol Hepatotoxic Nephrotoxic PYRAZINAMIDE

Before meals Monitor s/sx of liver impairment anorexia fatigue dark urine photosensitivity Liver function studies ETHAMBUTOL Not affected by food Report visual disturbances Hepatotoxic Not recommended for children

STREPTOMYCIN After meals Report Oliguria nephrotoxic Ototoxic Neurotoxic MALARIA CA: Plasmodium STAGES: cold - chilling; 10-15min -hot water bath on soles 0 Hot - 41 C fever; TSB, antipyretics Diaphoretic stage - increase fluids; rest Dx: Malarial smear (peak of fever) Tx: CHLOROQUINE; QUININE DENGUE FEVER Grade I: (+) tourniquet test Fever Abdominal sign Hermans sign Grade II: Grade 1 + bleeding Petechiae Epistaxis Melena Gingival bleeding Coffee ground vomitus

Grade III: Grade II + circulatory collapse hypotension Cold clammy skin Weak thready pulse Grade IV: Grade III + shock

Grade I: Dengue fever Grade II to IV: Dengue Hemorrhagic Fever Diagnostic Tourniquet test/ Rumpel Lead Test BP cuff: S + D 2 Hematocrit decreased Clotting & Bleeding time (3 series in 8 hours) Platelet count : decreased Dengue Blot test Nursing Mgt Monitor bleeding cold compress epistaxis: lean forward gingival bleeding: ice chips hematemesis: NPO FILARIASIS Helminthic infestation CA: Wuchereria bancrofti; Brugia Malayi Vector: Aedes albopictus; Culex fatigans, Anopheles s/sx: Acute: fever, malaise, chills Chronic: lymphadenitis, swelling of scrotum; elephantiasis Lymphatic channel affected

Dx: Blood smear Bentonite flocculation test Tx: Diethylcarbamazepine citrate

KAWASAKI UNKNOWN cause Associated with autoimmune response r/t viral infections Lesions and desquamation: palms, soles of the feet Strawberry tongue DOC : ASPIRIN HELMINTHS Ascaris lumbricoides roundworm Trichinella spiralis trichinosis Trichuris trichuria - whipworm Enterobius vermicularis pinworm Strongyloides stercoralis (Cochin-china diarrhea)


SARS

Ancylostoma duodenale and Necator Americanus (hookworms)

Atypical pneumonia CA: Corona Virus MOT: close contact/ droplet IP: 2-7 days s/sx: high fever >380C, dry cough dyspnea, malaise, myalgia, Thrombocytopenia, respiratory distress DX: Chest X-ray NDx: Impaired Gas Exchange Mgt: Strict respiratory and mucosal barrier isolation Tx/NI: symptomatic; no meds Case: 1ST: Hanoi, Guandong, China Ans. SURVEILLANCE & CASE FINDING

DISEASES MAINLY ACQUIRED THROUGH THE DIGESTIVE SYSTEM TYPHOID FEVER

OTHER NAMES: Enteric Fever, Typhus Abdominalis ETIOLOGIC AGENT: Salmonella Typhi,Typhoid bacillus, Salmonella typhosa SOURCE: Man,family contacts become carriers Characterized by ladder like fever Involves ulceration of the Peyers Patches

MODE OF TRANSMISSION: 5 Fs fingers food feces fomites flies Fecal-Oral contamination

Oral-anal

INCUBATION PERIOD: 2 weeks Susceptibility is general but more prevalent for those with Achlorhydria

DIAGNOSIS

ISOLATION OF THE ORGANISM a. Blood Culture- positive for the organism after a week b. Urine Culture- positive during the first 2 weeks c. Stool Culture- positive for the organism after the first week or throughout the course of treatment

WIDAL TEST or Blood serum agglutination test -Usually becomes positive by the end of the 2nd week -Time recommended on 8th or 10th and repeat by 4th week MEDS

CHLORAMPHENICOL TMP SMZ

PARAGOMNIASIS Lung dwelling trematode, from eating fresh or half cooked crabs

Closely resembles signs and symptoms of PTB ETIOLOGIC AGENT: paragonimus westermani-ASIA paragonimus siamenses paragonimus heterotrema

RESERVOIR: man , dog, cat and pig Incubation period is 6 weeks Eggs may be discharged by infected persons up to 20 years Not directly transmitted from person to person PATHOLOGY AND MANIFESTATIONS Flukes and eggs elicit inflammatory response Formation of fibrous capsule Cyst ruptures into the bronchioles and lung parenchyma Blood,eggs and inflammatory exudates are extruded result Pleural-based lesions causes eosinophilic empyemas Long standing lesions shows fibrosis and decreased inflammatory response Flukes can reach distant locations ( brain,abdominal wall, viscera) Signs and symptoms Pleuritic pain Cough

Rusty blood tinged sputum Hemoptysis Dyspnea Chest pain fever Praziquantrel

MEDS

DISEASES MAINLY ACQUIRED THROUGH THE GENITO URINARY TRACT CHLAMYDIA TRACHOMATIS Uretheritis Mucopurolent cervicitis Man is the reservoir Relapses are possible Incubation : 1-2 weeks MANIFESTATIONS MALE Uretheritis Urethral itching Dysuria Some case are asymptomatic Scrotal swelling Infertility Proctitis-from anorectal intercourse( diarrhea, tsenesmus,bloody discharge) females Breakthrough bleeding Bleeding after intercourse Vaginal discharge Dysuria dyspareunia GONORRHEA GC,DRIP,CLAP,DOSE,GLEET,STRAIN,GONOCOCCAL CERVICITIS,G.BARTHOLINITIS,G.VULVOVAGINITIS Urethra,cervix ,rectum,pharynx Opthalmia neonatorum ETIOLOGIC AGENT Nisseria gonorrhea RESERVOIR: MAN MOT: contact exudates from mucus membranes,sexual activity Communicability end within hours if with effective treatment males Purulent discharge after 2-7 days of exposure Rectal infection- tsenesmus , pruritus and discharge females Initially uretheritis and cervicitis

Endometritis Salphyngitis Pelvic peritonitis infertility diagnosis Gram staining Oxidase reaction meds Non complicated Ceftriaxone Cefixime Ciprofloxacin ofloxacin Concurrent with chlamydia Doxycycline Azithromycin PO SD Pregnant and allergic to penicillin Ceftriaxone erythromycin SYPHILIS SY,LUES,THE POX,BAD BLOOD,LUES VENEREA,MORBUS GALLICUS SPIROCHETE-TREPONEMA PALLIDUM SALIVA , SEMEN, blood, VAGINAL discharges Contaminated articles are theoretically possible source Primary CHANCRE -painless at 2-6 week on penis, anal canal,rectum,mouth secondary alopecia areata- patchy alopecia,affects eyebrows and beard(due to follicular syphilides) involving hair follicles Condylomata lata- highly infectious lesions at perianal, vulva,scrotum,inner thighs,axilla,undersides of breasts latent GUMMA-diffuse solitary lesions,skin ,skeletal, URT,liver,stomach Meningeal syphilis-brain and spinal cord Most common is stroke syndrome in young adult

P- personality changes A-affect disturbance R-reflexes hyperactive E-eye disturbance S-sensorium disturbsnces I-intellect disturbance S-speech disturbance congenital

Rhinitis desquamation

PARALYTIC SHELLFISH POISONING OTHER NAME: RED TIDE ETIOLOGIC AGENT Pyrodinium Bahamense- a plankton SOURCES: bivavalve mollusks sea fishes crustaceans DESCRIPTION A syndrome occurring due to the effect of saxitoxin a toxin released by dinoflagellate (algae ) ingested by seashells and other aquatic animals during filter feeding. SAXITOXIN Is a derivative of tetrahydropurine which is one of the most lethal poison known ( 0.1mg is lethal to man) It is water soluble , acid base stable and heat stable exotoxin Toxicity is dose related Clinical Manifestations Symptoms occurs within 15 min up to 12 hours after eating contaminated sea products. Circumoral tingling, numbness, on the face neck to upper and lower extremities, generalized body weakness and respiratory paralysis Treatment Lavage with activated charcoal Sodium Bicarbonate Diuretics Rabies: P.R.O. Pinoy Responsible Owner of Dog DOH primer

350-400 Filipinos die of rabies every year. WHAT TO DO IF BITTEN BY A DOG Wash wound immediately with soap & water. Consult a health worker at the nearest health center. Observe the dog for 14 days for any change in behavior. If the dog cannot be observed (stray) or if suspected to be rabid, consult your physician immediately for immunization. If dog shows s/sx of rabies, it usually dies within 3-7 days.

Pinoy Responsible Pet Owner P.R.O. Have your pet immunized against rabies at 3 months old & every year thereafter Current WHO Guide for Rabies Pre & Post Exposure Tx General considerations in Post-exposure Tx: WHO advocates the use of modern vaccines for PET Abandon the production of BRAIN-TISSUE VACCINES Immediate washing/flushing & disinfection of the wound Disinfecting with ETHANOL (700ml) or Iodine tincture Rapid administration of purified Ig TREATMENT MODALITIES Administration of RIG Infiltrate into the depth of the wound & around the wound Any remaining amount, administer IM to distal part (e.g. anterior thigh) Quantities/vol. Of RIG 20 IU/kg for Human RIG 40 IU/kg for Equine RIG If the calculated dose is insufficient to infiltrate all wounds, sterile saline may be used to dilute it 2 to 3 fold to permit thorough infiltration. Post exposure Tx IM TWO IM schedule for modern vaccine Vaccine shouldnt be injected into the gluteal region CLASSICAL 5 DOSE IM (Essen regimen) 1 dose: days 0, 3, 7, 14 & 28 Deltoid antero-lateral thigh: children Post exposure Tx IM ALTERNATIVE: the 2-1-1 regimen 2 doses: day 0 deltoid, R & L 1 dose : deltoid on day 7 1 dose : on day 21 Post exposure Tx Intradermal Economical: use 1 ml syringe & short hypodermic needles 3 vaccines: HDCV (Human Diploid Cell Vaccine) RABIVAC PVRV (Purified Verocell Vaccine) VERORAB, IMOVAX, Rabies vero PCECV (Purified Chick Embryo Cell Vaccine) RABIPUR

8 SITE ID METHOD: 8-0-4-0-1-1 for use with HDC (Rabivac); PCECV (Rabipur) When no RIG is available in emergency

For use: Rabivac & Rabipur 0.1ml per ID site 2 SITE ID: 2-2-2-0-1-1 for use with: PVRV (Verorab, Imovax, Rabies Vero, TRC verorab) 0.1ml PCECV (Rabipur) 0.2ml

ID minimum value of 2.5IU/ampule CHOLERA OTHER NAMES: El Tor, Asiatic cholera, Epidemic cholera ETIOLOGIC AGENT: Vibrio Cholerae-a motile aerobic microbe Vibrio El Tor- includes Ogawa and Inaba stereotypes, has the ability to hemolyze human, sheep red blood cells SOURCE OF INFECTION: Humans are the only HOST and VICTIMS Fecal oral route or ingestion of contaminated food or water INCUBATION PERIOD: few hours to 5 days PERIOD OF COMMUNICABILITY: 7-14 days

STOOL CHARACTERISTICS watery and without fecal material contains white flecks of mucus ( rice water stools ) Fishy odor MEDS Tetracyclines