AIR AND

DROPLET BORNE
DISEASES
Learning outcomes
At the end of this lecture, students will be
able to:
define air and droplet borne diseases.
list etiology of air and droplet borne diseases.
explain pathophysiology of air and droplet borne
diseases.
state clinical manifestations of air and droplet
borne diseases.
Learning outcomes
state common diagnostic investigations for air
and droplet borne diseases.
discuss medical management for air and droplet
borne diseases.
explain nursing management for air and droplet
borne diseases.
explain the preventive measures taken by
government to control the spread of air and
droplet borne diseases.


Chicken pox(cacar air)
Definition

Known as virus varicella zostur
causes infection but not dangerous.


Etiology
Caused by varicella-zoster virus (VZV) from
the patient whom is infected with the virus.

This can sperad by discaj from respiratory.

Pathophysiology
Mode of transmission
- Airborne ,droplet

Incubation period
- 14 -16 days

Clinical manifestations
Phase 1
Fever (38.8c slowly temperature reduce after
2weeks)
-malasie,anorexia
Phase ll
Rash (small red pimples or blisters)
- Appears over the next 2-4 days
- Starts on the trunk and then spreads to the
head, face, arms, and legs
- Also in the mouth or the genital areas
- The pimples will progress to blisters

Clinical manifestations
The blisters mature, break open, form a sore,
and then crust over
Most of the blisters will heal within 10-14 days
Infected period 6/7 after sore occur.

Phase lll
Usually no scarring unless the blisters
become infected.patient will start to heal and
the crust pile off,will take 7-14 days.

Complications

Pneumonia
Encephalitis
Arthritis
Inflammation of the testes (orchitis)
Ulcerative gastritis

Diagnostic investigations

Assessment
History find out patient is expose to
infected people.

Physical
Fever,rash(macule,papule,vesikel ,pustule)
Pruritis

Psychological
Patient will feel irritability ,kids will cry
frequent.

Laboratory
For complication cases blood work will be
done.
Medical management
Anti viral agent
- Acyclovir (Zovirax)
For fever
- Acetaminophen, ibuprofen
To relieve itch
- Calamine lotion
- Diphenhydramine (Benadryl)

Nursing management
Encourage plenty of fluids
Continue intake as tolerated
Activity: Continue activity as tolerated
Isolation until all lesions have crusted at
least 5 days after the rash appear
Rash tends to be extremely itchy
- Cool compresses
- Cool water baths to calm itching
- Keep short fingernails to prevent scratching
the blisters
Preventive measure
Varivax vaccination

Pulmonary
Tuberculosis
Definition

An infectious disease caused by bacillus
Mycobacterium tuberculosis

It is transmitted by airborne

The infection may spread through lymphatic or
blood stream to the lymph nodes or other
sites such as bone marrow, kidneys, and
meninges

Etiology
Human
Cow(infection from cow,s droplet),milk which
is not boiled.
Pathophysiology
If the body defenses are strong the inhaled
droplet nuclei reach the alveoli the
organisms are destroyed the lesions healed

But a few may continue to survive remain
confined and dominant.

If the hosts defenses becomes low, the bacilli
start multiply and he will develop active
disease
Clinical manifestations

Fatigue
Weight loss
Fever
Loss of appetite
Productive cough (sputum containing
mucus, pus or blood)
Pneumonia , Pleural effusion

If there is no induration, the result should be recorded as "0 mm(5 mm, 10 mm, or 15 mm) of
induration the result is considered positive, A positive result indicates TB exposure, False
positives can also occur when the injected area is touched, causing swelling and itching.

Tuberculin skin test (PPD)
(Purified Protein Derivative) OR
Tuberculin Sensitivity Test,
Diagnostic investigations
Tuberculin skin test (PPD)
Sputum smear and culture ,sputum
blood,AFB (x3)-IF POSITIVE confirm
TB.urine for AFB.
Chest x-ray. Classified (TB) ,infliltrated into
the lung cavity causes fibrosis,lung
infection
Other baseline invertigation
buse,SGOT,URIC ACID,(to see anyother
complication)
ACID FASTBACILLI COLLECTION
Saliva is not acceptable as a specimen for the recovery of
mycobacteria and is usually rejected as a contaminated
specimen.
A series of early morning sputum specimens are
recommended over a three-day period. The ideal amount
of sputum specimen for processing and recovery of
mycobacteria is 5-10 mL of sputum approximately .
Upon rising in the morning, the patient is instructed to
cough deeply to produce sputum (expectorated sputum).
A patient who is unable to bring up any sputum is given an
aerosol treatment (aerosol-induced sputum) by a
respiratory therapist in order to recover a sufficient amount
of sputum for culture.

Type of TB(nice to know)
TB MENINGITIS
BILIRARY TB
TB NODUS LYMPATIC
TB KIDNEY,INTESTINAL ,LARING,SKIN
PERITONUEM ,MATA.


Medical management
Five drugs are most commonly used today:
Isoniazid (INH, Laniazid, Nydrazid)
Rifampin (Rifadin, Rimactane)
Pyrazinamide (Tebrazid)
Streptomycin
Ethambutol (Myambutol)
Follow-up involves monitoring of side effects and
monthly sputum tests.

Nursing management
Administer anti tuberculosis drugs
Monitor side effect of the drugs
Nutritional diet
Good ventilation
Isolation air borne precaution

Preventive measures
Avoidance of overcrowded and unsanitary
conditions
Vaccination
- BCG (Bacillus Calmette-Gurin)
- made from a weakened mycobacterium
Prophylactic use of Isoniazid
- Given daily over a period of 6 to 12 months
to people in high-risk categories
Measles
Definition
Also known as rubeola is a viral infection of your
respiratory system

Measles and German measles (known as
rubella) are different diseases caused by
different viruses

Etiology
Caused by paramyxovirus of the
genus Morbillivirus


Pathophysiology
Through respiration (contact with fluids from an
infected person's nose and mouth, either
directly or through aerosol transmission)

Incubation period (4 - 12 days) asymptomatic

Remain contagious (from appearance of 1
st

symptoms till 3 - 5 days after rash appears)


Pathophysiology
Virus infects epithelial cells of its new host

Can replicate in urinary tract, lymphatic system,
conjunctivae, blood vessels and CNS
Clinical manifestations
Fever at least 3 days (may reach 40
0
C)
3Cs - Cough, Coryza (runny nose) and
Conjunctivitis
Kopliks spots (tiny red spots with bluish-white
centers inside mouth on inner lining of cheek)


Clinical manifestations
Measles rash
- Generalized, maculopapular, erythematous and
itchy rash begins several days after fever starts
- Starts on head then cover most of body
- Changing color from red to dark brown before
disappearing
Complications
Diarrhea
Bronchopneumonia
Subacute sclerosing panencephalitis (SSPE)
Otitis media that develop into mastoiditis, brain
abscess or meningitis
Diagnostic investigations
Physical findings and positive contact with
others known to have measles
Serology test
- Positive measles IgM antibodies
Enzyme immunoassay @ Complement
fixation (for infection following secondary
vaccine failure)
- Increase IgG antibodies


Diagnostic investigations
Warthin-Finkeldey cell (multinucleated giant
cell with eosinophilic cytoplasmic and nuclear
inclusions)
Found in paracortical region of hyperplastic
lymph nodes
For client with pneumonia complication

Medical management
Antipruritic medication for
itchiness
Cool mist vaporizer to relieve
cough
Nursing management
Maintain bed rest and provide quiet activities
Keep room darkly lit (for light sensitive client)
Remove eye secretions with warm saline or
water
Encourage not to rub the eyes
Tepid sponge baths as ordered (to prevent
itchiness)
Isolate the child until 5
th
day of rash


Preventive measures
MMR vaccine (measles, mumps ans rubella)
Age of 18 months then age 4-5 years old (booster
dose)
Re-vaccination:
- Persons vaccinated with live measles vaccine
before their 1
st
birthday (considered
unvaccinated and should receive at least 1 dose)
2
nd
dose (for young adults in settings where
individuals congregate)
Rubella(campak)
Definition
Commonly known as German
measles
Contagious viral infection with mild
symptoms associated with rash that
primarily affects the skin and lymph
nodes
Etiology
Rubella virus - RNA Toga virus
Pathophysiology
Mode of transmission

Droplet transmission
- Enters body through nose or throat
- Transmitted by tiny droplets in the breathed air

Transplacental transmission
- from mother to her fetus through bloodstream
via placenta


Pathophysiology
Incubation period: 14 to 21 days after
exposure
Communicability periods: virus can be passed
from 7 days before to 5 days after rash appears
Infected but asymptomatic person can still spread
the virus
Clinical manifestations
Low grade fever (38
0
C or lower)
Headache
Malaise
Runny nose
Bloodshot eyes
Rash with skin redness or inflammation
Muscle or joint pain

Clinical manifestations
Enlarged lymph nodes in post auricular,
auricular suboccipital, and cervical areas 24 hrs
before rash develops.
Discrete rose spots on soft palate
Complications

Transient arthritis
Thrombocytopenia
Congenital rubella syndrome (deafness, mental
retardation, congenital heart defects)
Otitis media
Encephalitis

Diagnostic investigations
Tissue culture of throat
Blood or urine test
Passive immunity birth to 6 months of age
from maternal antibodies.

Medical management
Acetaminophen or ibuprofen (for fever)
Avoid Aspirin (can cause Reye syndrome that
lead to liver failure and death)
Nursing management
Monitor childs temperature - inform doctor if
fever rises too high
Preventive measures
Screening by rubella serology (to detect
immunity status)

Preventive measures
Immunization
- If conception can be prevented for 28 days
after vaccination
- NOT for pregnant mother
- NOT for immunosuppressive client
- Give at least a month after delivery (for
exposed pregnant mother)


Preventive measures
Rubella virus vaccination

MMR immunization
- For children 12 15 months old (1
st
dose)
- Between age 4 6 year old (Booster)
Pertussis
Definition
Highly contagious upper respiratory tract
bacterial infection that causes uncontrolled,
violent coughing

Also known as whooping cough
Etiology
Bordetella pertussis or B. parapertussis
bacteria
Pathophysiology
Mode of transmission:
Direct contact
Respiratory droplet
It mostly affects - infants, young children

Pathophysiology
Incubation period:
3 to 14 days

Communicability period:
7 days after exposure to 3 week after onset of
paroxysms or until cough has ceased
Clinical manifestations
1. Catarrhal stage (after 2 days incubation
period)
Rhinorrhea
Conjunctival injection
Lacrimation
Cough
Low grade fever

Clinical manifestations
2. Paroxysmal stage (after 1 2 weeks)
Frequent severe violent coughing with
inspiratory whooping sound
Vomiting
Cyanosis

3. Convalescent stage (1 2 months)
Coughing attacks decreases but may return
with each respiratory infection

Complications
Pneumonia
Encephalitis
Pulmonary hypertension
Secondary bacterial superinfection
Diagnostic investigations
Culture of nasopharyngeal mucus
Complete Blood Count (high lymphocyte count)
Polymerase chain reaction (PCR)
Serology test

Medical management
Antibiotics:
Erythromycin
Azithromycin
Trimethoprim-sulfamethoxazole
Chemoprophylaxis
(During 7 - 21days incubation period)




Nursing management
Bed rest
Quiet environment to reduce coughing
Gentle suctioning
Increased fluid intake
Administer oxygen
Provide antipyretics

Preventive measures
Immunization:
DTP (Diptheria, Tetanus, Pertussis)
combination vaccine
2, 4 and 6 months old, 15-18 months old, 4-6
years and 11 years old


Preventive measures

Isolation:
Unimmunized children under age 7
Until 14 days after the last reported case
Mumps
Definition
Also known as epidermic parotitis

An infection of parotid glands caused by the
paramyxovirus

Mode of transmission: Droplet

The incubation period is 16-18 days.


Risk factors
Contact with infectious person

Lack of immunization against mumps

Immune deficiency

Malnutrition


Pathophysiology
Mumps virus entry into the oropharynx, viral
replication occurs, causing subsequent viremia
and inflammation of parotid glands tissue.

Affected glands show edema and lymphocyte
infiltration.

Clinical manifestations
Fever (usually lasting for 3-4 days)
Swelling of the parotid glands
Swelling may last from 7-10 days.
Eating or drinking acidic or citric foods
causes much discomfort.
Stiff neck
Difficulty swallowing
Anorexia
Headache
Abdominal pain
Orchitis: enlarged and painful scrotum

Diagnostic investigations
Physical examination:
- parotid swelling on one or both sides
- tenderness in these glands

Nursing management
Altered comfort r/t parotid swelling
Hyperthermia r/t infection process
Altered nutrition: less than body requirements r/t
jaw pain
Activity intolerance related to fatigue
Fear/Anxiety r/t fear of unknown
Social isolation

Medical and nursing management
Droplets isolation precaution
Supportive measures include:
Analgesics for pain
Ice packs applied to scrotal area for swelling
Soft diet/ nutritional fluid is recommended
Avoiding acid-containing foods/ liquids
(tomato, vinegar-containing food and orange
juice) to reduce pain.

Preventive measures
Active immunization
MMR Vaccine

Poliomyelitis
Definition
Acute viral infection that affects nerves and
can produce permanent muscle weakness
and paralysis.

Also known as Infantile paralysis

The incubation period is 5-35 days.

Etiology
Causative agent - RNA enterovirus

POLIO VIRUS
Risk factors
Affects children under five years of age.
Travel to an area that has experienced a polio
outbreak
Lack of immunization against polio
Immune deficiency
Malnutrition

Pathophysiology
Mode of transmission:
Spread from person-to-person primarily via the
fecal-oral route

E.g. poor hand washing allows the virus to
remain on the hands after eating or using the
bathroom.
Pathophysiology
The virus enters the body through the mouth
and multiplies in the intestine
Virus enters CNS via the blood stream
Virus invasion causes inflammation
and destroy of the nerve cells motor neurons
Muscle weakness, atrophy and finally completely paralyzed
Clinical manifestations
Fever
Headache
Sore throat
General malaise
Stiffness in the back and neck
Muscle weakness - asymmetrical
(depend on where the spinal cord is affected)
Clinical manifestations
Muscle pain
Difficulty swallowing
Irritability
Constipation
Difficulty urinating
Diagnostic investigations

Stool culture to identify polio virus

Detecting high levels of antibodies to the virus
in the blood

Lumber puncture - increased number of white
blood cell and a mildly elevated protein level
Medical management
No cure for polio
Supportive measures include:
antibiotic for secondary infection
analgesics for pain
physiotherapy
nutritious diet (high fiber)
A ventilator support may be needed if the
muscle used in breathing are weakened
Nursing management
Observe for respiratory distress
Encourage child to move
use of moist hot packs to relieve muscle pain
administer analgesics to maximum comfort
before physical activity
Maintain body alignment - use footboard
to prevent contractures
Physiotherapy - ROM, isometric exercise

Nursing management
Ineffective breathing pattern r/t diminished chest
wall expansion associated with muscle
weakness
Hyperthermia r/t infection process
Altered comfort r/t muscle pain
Altered nutrition: less than body requirements r/t
difficulty in swallowing
Activity intolerance related to fatigue
Nursing management
Fear/Anxiety r/t fear of unknown
Social isolation
Risk for impaired tissue integrity
Risk for trauma
Preventive measures
Active immunization
inactivated poliovirus vaccine given by
injection more costly

live poliovirus vaccine taken by mouth

Preventive measures
Passive immunization
injection of blood gamma globulin containing
antibodies to poliovirus to reduce the severity
of disease in patient who had contracted
polio.