Communicable

Disease Nursing
Communicable Diseases
Communicable Diseases are Primary Cause
of Mortality Gap between Rich and Poor
Countries
Non-communicable diseases account for
59% of all deaths worldwide estimated to
rise from 28m in 1990 to 50m in 2020
Communicable Diseases
About 60% of deaths caused by communicable
diseases can be attributed to:
HIV/AIDS
Malaria
Tuberculosis
Measles
Diarrheal disease
Acute respiratory infection
 Communicable Disease
is an illness due to an infectious agent or its toxic
products which is easily transmitted or communicated
directly or indirectly from one person or animal to
another
** Both infectious and contagious diseases are
communicable**
**All contagious diseases are communicable
but not all communicable diseases are
contagious**
Philippines top 10 leading causes of morbidity
& mortality in the year 2007:
Diarrhea
Bronchitis
Pneumonia
Influenza
Hypertension
Tuberculosis
Malaria
Heart diseases
Cancer
Accidents
Chronic obstructive pulmonary disease and other respiratory
diseases
Diabetes and Kidney diseases.
Host and Microbial Interaction
INTRODUCTION

Although most microorganisms

live in harmony with the human
body, somecalled
pathogenscan infect the
body and cause disease.
Infectious diseases range from
mild illnesses, such as a cold, to
fatal illnesses, such as AIDS.
We occasionally come into
contact with people or animals
that are infected and thus
expose ourselves to the
pathogens of their diseases. In
fact, our environment is such
that everyday we live with
some risk of exposure to
diseases.
Communicable Disease
= any disease that spreads from one host to
another, either directly or indirectly
Contagious Disease
= disease that easily spreads directly from one
person to another
Infectious Disease
= disease not transmitted by ordinary contact
but require a direct inoculation through a break in a
previously intact mucous membrane. On the other
hand, all contagious diseases are infectious.
 Examples of communicable diseases include
herpes, malaria, mumps, HIV/AIDS, influenza,
chicken pox, ringworm, and whooping cough.
Cancer, on the other hand, is not a
communicable disease.
 Carrier is an individual who harbors the
organism and is capable of transmitting it to a
susceptible host without showing manifestations
of the disease.
Contact - is any person or animal who is in
close association with an infected person,
animal, or freshly soiled material
Classification of Infectious Diseases:
Based on Occurrence of Disease:
1. Sporadic Disease
= disease that occurs only occasionally &
irregularly with no specific pattern
i.e. botulism, tetanus
2. Endemic Disease
= constantly present in a population,
country or community
i.e. Pulmonary Tuberculosis; malaria
3. Epidemic Disease
= patient acquire the disease in a relatively
short period of time ; greater than normal
number of cases in an area within a short
period of time
i.e, cholera; typhoid
4. Pandemic Disease
= epidemic disease that occurs worldwide
i.e. HIV infection; SARS
 Based on Severity or Duration of Disease
1. Acute Disease
= develops rapidly (rapid onset) but
lasts only a short time
i.e. measles, mumps, influenza
 2. Chronic Disease
= develops more slowly (insidious onset)
disease likely to be continual or recurrent for
long periods
i.e. TB, Leprosy
3. Subacute Disease
= intermediate between acute and chronic
i.e. bacterial endocarditis
4. Latent Disease
= causative agent remains inactive for a time but
then becomes active to produce symptoms of
the disease
i.e. chickenpox shingles (zoster); amoebiasis
 Based on State of Host Resistance:

1. Primary Infection
= acute infection that causes the initial
illness
2. Secondary Infection
= one caused by an opportunistic pathogen
after primary infection has weakened the bodys
defenses
3. Subclinical (Inapparent Infection)
= does not cause any noticeable illness
 Period of Decline
s/sx subside
pathogen replication is brought under control
vulnerable to secondary infection
Period of Convalescence
Replication of pathogenic organisms is stopped
regains strength and the body returns to its
pre diseased state
= recovery has occurred
Nurse Alert!!!!

Note that in the case of acquired immunity

against a pathogen the progress of disease may end
during the prodromal period as a consequence of
the rapid immune system response to the infection.
For example, acquired immunity might be as a
consequence of vaccination or previous natural
exposure to the pathogen.
MICROBES against HUMAN
Definitions:
Symptoms
subjective evidence of disease that is experienced
or perceived
subjective changes in body function noted by
patient but not apparent to an observer
Signs
objective evidence of a disease the physician can
observe and measure
Syndrome
a specific group of signs and symptoms that
accompany a particular disease
 Incidence
the number of people in a population who
develop a disease during a particular time
period
Prevalence
= the number of people in a population
who develop a disease, regardless of when it
appeared
= refers to both old and new cases
Stages of Diseases
 Stages of Disease
Incubation Period
- time interval between the initial infection and the 1st
appearance of any s/sx
- patient is not yet aware of the disease
Prodromal Period
- early, mild appearance of symptoms of the disease
Period of Illness
Time of greatest symptomatic experience ( pt. is sick)
- overt s/sx of disease
WBC may increase or decrease
can result to death if immune response or medical
intervention fails
 INFECTION
- condition caused by the entry and
multiplication of pathogenic microorganisms
within the host body
 CONDITIONS THAT AFFECT INFECTION
DEVELOPMENT
Pathogenicity ability to cause disease
Infective dose (sufficient number of
microorganisms needed to initiate infection)
Virulence ( disease severity) and Invasiveness of
microorganisms ( ability to enter and move through
tissue)
Organisms specificity ( host preference)
Resistance of the host
Immunity of the host
**Cycle of infection must be completed**
Chain of Infection
 Chain of Infection

The chain begins with the

existence of a specific
pathogenic microorganism

The second link is

the reservoir, an
environment where
the pathogen can
survive.
 Chain of Infection

The third link is the

means of escape from
the reservoir. ( Mode of Exit )

The fourth link is the

mode of transmission
from the reservoir to
the host.
 Chain of Infection

The fifth link is

the means of
entry into the
host ( Mode of
entry)

And the last link is the

host's susceptibility
to the pathogenic
microorganism
 Infection control: 1st line of
defense
Hand hygiene, first line of defense and the
most important practice in preventing infection.
Handwashing single most important
way of preventing transfer of
microorganisms
 IMMUNITY
- is the condition of being secure against any
particular disease, particularly the power which a
living organism possesses to resist and overcome
infection
- is the resistance that an individual has against
disease
 IMMUNE SYSTEM

PROTECTION AGAINST INFECTIVE OR

ALLERGIC DISEASES BY A SYSTEM OF
ANTIBODIES, IMMUNOGLOBULINS AND
RELATED RESISTANCE FACTORS.

ANTIBODY

- a specific immune substance produced by

the lymphocytes of the blood of tissue
juices of man or animal in response to the
introduction into the body of an antigen
 ANTIGEN
TRIGGERING AGENT OF THE IMMUNE
SYSTEM; FOREIGN SUBSTANCE
INTRODUCED INTO THE BODY causing the
body to produce antibodies
TYPES OF ANTIGENS:
1. INACTIVATED ( KILLED ORGANISM)
1. Not long lasting
2. Multiple doses needed
3. Booster dose needed
2. ATTENUATED ( LIVE WEAKENED
ORGANISM)
1. single dose needed
2. long lasting immunity
** all vaccines lose their potency after a certain time.
 TYPES OF IMMUNITY
NATURAL =innate; within the HOST;
Immune System

ACQUIRED = outside the HOST

Natural = active or passive
Artificial = active or passive
Types of Immunity

A. NATURAL :
1. Natural active through exposure or
diseases; had the disease & recovered
2. Natural Passive maternal antibodies;
acquired through placental transfer
B. ARTIFICIAL ( Laboratory )
1. Artificial active introduction of antigen
Ex. Vaccines ; toxoids
( No exposure yet; preventive measure)
= gives long immunity months to years
2. Artificial passive- introduction of
antibodies Ex. Antitoxins;
immunoglobulin ( gammaglobulin),
antiserum, convalescent serum
Ex. TAT ( tetanus antitoxin)
( w/ exposure to the causative agent)
= gives short immunity 3-4 weeks
 Immunity

NATURAL ACQUIRED
- INHERENT BODY TISSUES Outside the host

1. NATURAL 2. ARTIFICIAL
( HUMAN) ( LABORATORY)

A. ACTIVE B. PASSIVE A. ACTIVE B. PASSIVE

-HAD THE DISEASE & - MATERNAL - VACCINES - ANTITOXINS
-RECOVERED ANTIBODIES - TOXOIDS - IGS
 Infection control and prevention

Immunization
Active
Passive
 IMMUNIZATION
- is the induction or introduction of
specific protective antibodies in a
susceptible person or animal, or the
production of cellular immunity in
such a person or animal.

- A PROCESS BY WHICH RESISTANCE TO

AN INFECTIOUS DISEASE IS INDUCED
OR AUGMENTED.
 Active Immunization
1. BCG
2. DPT
3. OPV/IPV
4. Measles
5. MMR
6. TB
7. Hepatitis B
8. Varicella
9. Hemophilus influenzae B (Hib)
 Active immunization not routinely
given
1. Cholera vaccine
2. Rabies
3. Typhoid
4. Influenza A & B
5. Meningococcal
6. Pneumococcal vaccine
7. HPV vaccine
 Passive immunization
1. Diphtheria antitoxin
2. Hepatitis B immunoglobulin (HBIG)
3. Measles immunoglobulin
4. Varicella immunoglobulin (VZIG)
5. Rabies Human immunoglobulin (RIG)
6. Tetanus human immunoglobulin (TIG)
7. Tetanus Toxin ( ATS)
 NURSE ALERT !!!

ALL VACCINE LOSE THEIR POTENCY

AFTER A CERTAIN TIME.
EXPIRY DATE SHOULD BE NOTED ON THE LABEL
 What
damages
vaccine ??
Heat and sunlight damages vaccine
Esp. LIVE VACCINE

Freezing damages the KILLED vaccine

And TOXOID
Use water only in cleaning the refrigerator
Or freezer.
( antiseptics, disinfectants and detergents
Or alcohol lessen potency of vaccine )

Cold Chain System

KEEP VACCINES IN CORRECT COLD TEMPERATURE
(0-8 c)
 Immunization
EPI : PPD 996
GOAL : universal child immunization
( Proc. No. 6)
Common Goal to Prevent childhood diseases covered
by the EPI ( expanded program immunization)
1. Tb
2. Measles
3. Diphtheria, Pertusiss
4. Polio ,
5. Tetanus
6. Hepatitis
 IMMUNOGLOBULINS
( IGS)
IgG
MOST PREVALENT ANTIBODY 80%, PRODUCED LATER IN THE
IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS PLACENTA
IgA
FOUND IN COLOSTRUM, TEARS, SALIVA, SWEAT
IgM
PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN
RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL
IMMUNIZATION
IgE
RESPONDS TO ALLERGIC REACTION
IgD
UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B
CELLS
 Expanded Program of
Immunization

BCG At birth ID Once None, mild fever, local rxn

DPT 6 weeks IM 3 x (4weeks int) Local rxn, acute

encephalopathy
MMR 15 wks

OPV 6 weeks oral 3 x (4wks int) None

Measles 9 mos SQ Once Fever

Hep B At birth IM 3 x ( 2,4,6 ) Mild local rxn

 Special-use Vaccine
Meningoccocal Epidemic areas SQ None

Rabies Exposures ID/IM Local rxn

Typhoid travellers IM Local rxn

Japanese encep travellers SC Anaphylactic

Pneumococcal immunocompro IM/SQ Local rxn

 Contraindications when giving
immunizations:

Severe febrile illness

Live virus vaccine are generally not administered
with altered immune system
Allergic reaction
 Permanent C.I.
Allergy
Encephalopathy without known cause
Convulsion within 7 days after
Pertussis vaccine
 Temporary C.I
Pregnancy
Immunocompromised
Very severe disease
Previously received blood
product/transfusion
 EPIDEMIOLOGY AND DISEASE
TRANSMISSION
Reservoirs of Infection:
= any site where the pathogen can multiply or
merely survive until it is transferred to the host
Human Reservoir
= principal living reservoir of human disease
1. Direct Transmission
= usually associated with signs and symptoms
2. Carriers
= harbor the pathogen without associated signs
and symptoms
 Recognition of
Susceptible Host
 Susceptible Host

Recognition of high risk patients

Immunocompromised
DM
Surgery
Burns
Elderly
 Nosocomial Versus
Community Acquired
Infection
Preventing the Spread of Communicable Disease
Community vs. Nosocomial
Community Acquired Infection
- infection present or incubating at the time of
consultation

Nosocomial Infection or hospital

acquired
- infection that develop during the course of hospital stay
& was not evident at time of admission
Percentage of Nosocomial Infections
17% Surgical
34% UTI
13% LRI
14% Bacteremia
22% Other (incldng
skin Infxn)
 Factors for Nosocomial Infection

Microorganism/Hospital Environment
Most common cause
Staph aureus, Staph Enterococci
E. coli, Pseudomonas, Enterobacter, Klebsiella
Clostridium Difficile
Fungi ( C. Albicans)
Other ( Gram (-) bacteria)
70% are drug resistant bacteria
Compromised Host
One whose resistance to infection is impaired by
broken skin, mucous membranes and a suppressed
immune system
INFECTION
CONTROL
MEASURES
 General Control Measures

Prevention of Airborne Contamination

Cover mouth and nose ( coughing or

sneezing)
Limit number of persons in a room
Removal of dirt and dust
Open room to fresh air and sunlight
Roll linens together
Remove bacteria from the air (air filters)
Handling of Food and Eating
Utensils
 Use high quality foods
Proper refrigeration and storage of food
Proper washing, preparing, and cooking of food
Proper disposal of uneaten food
Proper hand washing
Proper disposal of oral and nasal secretion
Cover hair and wear clean clothes and apron
Provide periodic health exam for kitchen workers
Keep cutting boards clean
Prohibit anyone with respiratory or GIT disease
from handling food
Rinse and wash utensils with a temperature above
80C
 Handling of Fomites

Use disposable equipments

Sterilize or disinfect equipment
Use individual equipment for each patient
Use single use thermometers
Empty bedpans and urinals properly and wash
with hot water, store in dry ,clean area or
storage
Place used linens and personal care
equipments, and soiled laundry in a bag
Medical Asepsis
CLEAN TECHNIQUE: Involves procedures and
practices that reduce the number and transfer of
pathogens
Will exclude pathogens ONLY
Attained by:
Frequent and thorough hand washing
Personal grooming
Proper cleaning of supplies and equipment
Disinfection
Proper disposal of needles, contaminated materials
and infectious waste
Sterilization
Surgical Asepsis
STERILE TECHNIQUE : Practices used to
render and keep objects and areas sterile
Exclude ALL microorganism
Attained by:
Use strict aseptic precautions for invasive
procedures
Scrub hands and fingernails before entering O.R.
Use sterile gloves, masks, gowns and shoe covers
Use sterile solutions and dressings
Use sterile drapes and create an sterile field
Heat sterilized surgical instruments
1. Universal Precaution ( Standard Precaution )
Defined by center for disease control (CDC) 1996
Primary strategy for reducing the risk of & controlling
Nosocomial infections
Used for care of all hospitalized patients, regardless of
diagnosis and are presumed infectious
Protect healthcare workers from contamination and infection
( i.e. HIV, HBV)
Hand Washing
Routine: Plain (non microbial) soap

Outbreak Control: Antimicrobial/Antiseptic Agent

Wash After: 1.touching blood and other body fluids

2. touch contaminated items

3. removal of gloves
4. between patient contact, task, procedure
Infection Control Signage
Universal Precaution Materials
Patient Care Equipment
Prevent contaminating yourself or transfer
microbes to others
Properly clean, disinfect or sterilize
Dispose single use items
Linens
Handled, transported and processed to prevent
contamination and transfer of microorganisms
Occupational Health and Blood borne Pathogens
Never recap used needles
Puncture resistant containers
Revised C.D.C. Isolation Precaution
( centers for disease control)

2. Transmission-Based Precautions
The second tier of precaution
Precaution are instituted for patients who are known
to be or suspected of being infected with highly
transmissible infection.

THREE TYPES OF TRANSMISSION-

BASED PRECAUTIONS:
1. Airborne precautions
2.Droplet precautions
3.Contact precautions
Infection Control Signage
Infection Control Signage
Infection Control Signage
Personal Protective Equipment
( PPE)
( Barrier Technique)
mask

gloves

gown

shoe cover

goggles
Transmission based precautions for
Hospitalized patient :
Category Single Masks Gowns Gloves
Precaution Room

Airborne Yes, with (-) Yes No No

air pressure
ventilation

Droplet Yes Yes, mask for No No

persons close
to patient

Contact Yes yes yes yes

 Isolation
- is a protective procedure that limits
the spread of infectious diseases
among hospitalized clients, hospital
personnel, and visitors. It is the
separation from other persons of an
individual suffering from a
communicable disease.
- other terms are: protective aseptic
technique or barrier technique.
Quarantine - is the limitation of
freedom of movement of persons or
animals which have been exposed to
communicable disease / s for a period
of time equivalent to the longest
incubation period of that disease.
Surveillance -
 Seven categories recommended
in isolation
1. Strict isolation
Use mask , gown and gloves (MUST)
Private room
For highly contagious or virulent infections
2. Contact isolation
3. Respiratory isolation
4. TB isolation
5. Enteric isolation
6. Drainage/secretion precaution
7. Universal precaution when handling blood and body
fluids
Type : STRICT
Purpose: Prevent Transmission of highly contagious or
virulent infections spread by air and contact

Specification: Private Room necessary

Hand Washing X
Gown X
Masks X
Gloves X
Articles Discard or bag and label and send
for decontamination and reprocessing.
Diseases requiring Isolation Diphtheria (pharyngeal) , Lassa
fever, Smallpox , Varicella.
Type : Contact
Purpose: Prevent Transmission of highly transmissible
infections that do not require strict isolation.

Specification: Private Room necessary

Hand Washing X
Gown wear if soiling is likely
Masks wear in close contact with client
Gloves wear if touching infective material.
Articles Discard or bag and label and send
for decontamination and reprocessing.

Diseases requiring Isolation Acute Resp. infection in

infant and young children, Herpes simplex, Impetigo,
multiple resistant bacterial infection.
Type : Respiratory

Purpose: Prevent Transmission of infectious diseases

primarily over short distances by air droplets.
Specification: Private Room necessary
Hand Washing X
Gown not necessarily
Masks wear in close contact with client
Gloves not necessarily
Articles Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation Measles, Meningitis, Pneumonia,

Hemophilus Influenza in children , Mumps.
Type : Tuberculosis

Purpose: For client with PTB who

has positive
sputum or chest x-ray that indicates active
disease

Specification: Private Room necessary

Hand Washing X
Gown Wear if soiling is likely
Masks wear if client is coughing and does
not consistently cover mouth
Gloves not necessarily
Articles Rarely involved in transmission of
TB. Should still be thoroughly
cleansed and disinfected.

Disease requiring Isolation Tuberculosis

Type : Enteric Precautions

Purpose:To prevent infections that are transmitted by

direct or indirect contact with feces.

Specification: Private Room Indicated if clients hygiene is poor and

there is risk of contamination with infective
materials.
Hand Washing X
Gown wear if soiling is likely
Masks not necessary
Gloves wear if touching infective material
Articles Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation Hepatitis, viral (type A),

Gastroenteritis caused by highly
infectious organism cholera, Diarrhea,
acute with infectious etiology.
Type : Drainage- secretion precautions
Purpose: To prevent infections that are transmitted by direct or
indirect contact with purulent material or
drainage from infected site.

Specification: Private Room not necessary

Hand Washing X
Gown wear if soiling is likely
Masks not necessary
Gloves wear if touching infective material
Articles Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation Abscess, Burn infection,

conjunctivitis, decubitus- ulcer skin or wound
infection.
Type : Blood- body fluid precaution
Purpose: To prevent infections that are transmitted by
direct or indirect contact with blood or body fluid.

Specification: Private Room Only if clients hygiene is poor

Hand Washing X
Gown Wear if soiling with blood or body fluid
is likely
Masks not necessary
Gloves wear if touching blood or body fluid.
Articles Discard or bag and label and send
for decontamination and reprocessing.

Disease requiring Isolation AIDS, Hepatitis, viral (Type B)

Malaria, Syphilis, primary and
secondary.
Reverse Isolation
Protective or neutropenic isolation
Used for patients with severe burns, leukemia,
transplant, immuno deficient persons,
receiving radiation treatment, leukopenic
patients
Those that enter the room must wear masks
and sterile gowns to prevent from introducing
microorganisms to the room
Additional Pointers
Regarding Disposal Precaution

Secretion: Patient should be instructed to expectorate

into tissue held close to mouth. Suction catheters and
gloves should be disposed of in impervious, sealed
bags.

Excretion: Strict attention should be paid to careful

hand washing; disease can be spread by oral- fecal
route.

Blood: needles and syringes should be disposable.

Used needles should not be recapped. They should
be placed in a puncture-resistant container that is
prominently labeled Isolation Specimens should be
labeled Blood Precaution.
Environmental Control

Routine care, cleaning and disinfection of

environmental surfaces

PRECAUTIONS FOR INVASIVE

PROCEDURES:

wear gloves during all invasive procedure +

goggles + mask
 Work Practice Precaution
Prevent injuries caused by needles, scalpels and
other sharps instrument or devices when cleaning
used instrument, when disposing of used needles
Do not recap used needles, bend , break nor remove
them from disposable syringes or manipulate them.
Place sharps in puncture resistant containers
If gloves tears or a needle-stick or other injury occurs,
REMOVE the gloves, wash hands, and wash sites of the
needle stick thoroughly then put new gloves
Report injuries and mucous membrane exposure to appropriate
infection control officer.
 Waste management
is the collection, transport, processing,
recycling or disposal of waste materials.
Involves:
1. sharps
2.Solid infectious cotton swab, dressing
3. Anatomic Infectious placenta / organ
4.Solid non-infectious used IV / bottle IV
5.General waste scrap paper / food material
 Philippines set-up
black plastic bags are for non-biodegradable and
noninfectious
wastes such as cans, bottles, tetrabrick
containers, styropor, straw, plastic, boxes,
wrappers, newspapers.

Green plastic bags are biodegradable wastes

such as fruits and vegetables' peelings, leftover
food flowers, leaves, and twigs.
 Philippines set-up

Yellow plastic bags are for infectious waste

such as disposable materials used for collection
of blood and body fluids like diapers, sanitary
pads, incontinent
pads; materials (like tissue paper) with blood
secretions and other exudates; dressings,
bandages, used cotton balls, gauze; IV tubings,
used syringes; Foleys catheter/ tubings; gloves
and drains.
 Means of controlling the spread
of CD
1. Elimination of the source of infection
2. Interruption of transmission
3. Protection of susceptible host.
INFECTIOUS
DISEASE
 INFECTIOUS DISEASES
CLASSIFIED AS:
Blood/ vector borne
Enteric diseases
Eruptive fever
Respiratory diseases
CNS infection
Diarrheal Diseases
EMERGING DISEASES
 INFECTIOUS DISEASES
CLASSIFIED AS :
1. Blood/ vector borne
a. DHF
b. Malaria
c. Leptospirosis
d. Filiariasis
2. Enteric diseases
a. Typhoid fever
b. Viral Hepatitis
c. Schistosomiasis
3. Eruptive fever
a. Measles (Rubeola)
b. Varicella
c. German Measles ( Rubella)
d. Small pox

4. Respiratory diseases
a. Pneumonia
b. Diphtheria
c. PTB
d. Mumps
5. CNS Infections 7. Emerging Diseases:
a. Encephalitis SARS
b. Meningitis Birds FLU
c.Meningococcemia
d. Rabies
e. Tetanus
f. Snake bite
6.Diarrheal diseases
a. E.coli
b. Staphyloccus aureus
c. Cholera
d. Rotavirus
e. Salmonella
f. Parasitism
VECTOR BORNE DISEASES
 Dengue Fever, H-Fever, Dandy
Fever, Breakbone Fever, Phil
Hemorrhagic fever

Acute Febrile Disease

Flavivirus, dengue virus 1,2,3,4

Incidence: Rainy season, urban areas

IP: 3 to 10 days ( average 4-6 days
** Life span of the mosquito is 4 months
 Dengue Fever, H-Fever, Dandy Fever,
Breakbone Fever, Phil Hemorrhagic
fever
THE DISEASE PRESENTS WITH FEVER AND
HEMORRHAGIC MANIFESTATIONS AND
LABORATORY FINDINGS OF
THROMBOCYTOPENIA AND
HEMOCONCENTRATION
Pathogenesis
1. increased capillary fragility d/t immune complex
reactions
2. thrombocytopenia d/t faulty maturation of
megakaryocytes
3. decreased blood clotting factors
 Vector- Aedes aegypti

- Daybiting mosquito ( they appear 2 hours after

sunrise and 2 hours before sunset. Low flying ( Tiger
mosquito white stripes, gray wings )
- Breeds on clear stagnant water
 CRITERIA FOR DIAGNOSIS:
Fever ,acute, high continous, lasting for 2-
7 days
Positive torniquet test
Spontaneous bleeding
(petechiae,purpura,ecchymoses,pistaxis,
gum bleeding, hematemesis, melena)
Laboratory: thrombocytopenia </=
100,000mm3, hemoconcentration- an increase
of at least 20% in the hematocrit or its steady
rise
 Assessment:
Tourniquet test (Rumpel Leedes test) -
screening test, done by occluding the arm veins
for about 5 minutes to detect capillary fragility.
Keep cuff inflated for 6 10 minutes ( child); 10-
15 minutes ( adults)
Count the petechiae formation 1 square inch ( 20
petechiae/sq.in)(+)TT
Platelet count ( decreased) confirmatory
test
 Classification of Dengue Fever
according to severity

Grade I Dengue fever, saddleback fever plus

constitutional signs and symptoms plus positive
torniquet test
Grade II Stage I plus spontaneous bleeding,
epistaxis, GI, cutaneous bleeding
Grade III Dengue Shock Syndrome, all of the
following signs and symptoms plus evidence of
circulatory failure
Grade IV Grade III plus profound shock and
massive bleeding, undetectable BP and pulse
Laboratory criteria DHF:
Platelet count Thrombocytopenia <100,000

Hct increased by 20 % or more

1st 2 clinical criteria plus 2 laboratory criteria or

rising Hct DHF( dengue hemorrhagic fever)
Shock w/ high hematocrit and marked
thrombocytopenia DSS ( dengue shock
syndrome)
Other :
PT (Prothrombin Time)
APTT (Activated Partial Thromboplastin Time)
Bleeding time
Coagulation time
Period of communicability pts. are usually
infective to mosquito from a day before the
febrile period to the end of it
The mosquito becomes infective from day 8 to
12 after the blood meal & remains infective all
throughout life
pathophysiology
Dengue Fever
DHF
Vector caries virus (AEDES aegypti)
Febrile phase
2-7 days
Bite host ( IP 3-10d)

First 2 days s/sx : Fever , headache, myalgia ,anorexia

Vascular injury Vomiting, sorethroat, rashes
Plasma leakage
IMPROVE
(+) petechiae , (+) TT
3rd day WBC, PLT Ct , Hct >20% (+) Pleural effussion

Circulatory failure
Dengue progress -hypotension death
-narrow pulse pressure
,20mm Hg (shock)
S/sx:
Mild dengue abrupt onset of fever, headache,
muscle and joint pains, anorexia, abdominal
pain. Petecchiae, Hermans rash (5th-7th day;
purplish macules w/ blanched areas on
extremities)
Severe dengue DHF/DSS
*TRIAD: fever, rashes and muscle pain
Bleeding leading to hypovolemic shock
 Medical MX
There is no effective antiviral therapy for dengue
fever. Treatment is entirely SYMPTOMATIC
Paracetamol for headache ( never give ASPIRIN)
IVF for hydration & replacement of plasma
BT for severe bleeding
O2 therapy is indicated to all patients in shock
Sedatives for anxiety & apprehension
No IM injections
Nasal packing with epinephrine
Gastric lavage
Giving cytoprotectors
 Nursing Mx

Symptomatic tx
Mosquito free environment to avoid further
transmission of infection
Keep patient at rest during bleeding episodes
VS must be promptly monitored
For nose bleeding, maintain pts position in
elevated trunk, apply ice bag to bridge of nose
Observe for signs of shock
Restore blood volume ( supine with legs elevated)
 Dengue hemorrhagic Fever
PREVENTION : DOH 1995 Program

C- hemically treated Mosquito Net

L arvae eating fish Gold fish
E nvironmental Sanitation 4 0 clock habit
A antimosquito soap lanzones peeling
N atural mosquito repellant Neem tree , eucalyptus
, oregano
 PREVENTION
Cover water drums and water pails at all times to
prevent mosquitoes from breeding.
Replace water in flower vases once a week.
Clean all water containers once a week. Scrub the
sides well to remove eggs of mosquitoes sticking
to the sides.
Clean gutters of leaves and debris so that rain
water will not collect as breeding places of
mosquitoes.
Old tires used as roof support should be punctured
or cut to avoid accumulation of water.
Collect and dispose all unusable tin cans, jars,
bottles and other items that can collect and hold
water
 Prevention & Control
The 4-S Against DENGUE
1. Search and destroy breeding places
of dengue causing mosquitoes such as
old tires, coconut husks, roof
gutters, discarded bottles,
flower vases & other containers
that can hold clean stagnant water
2. Self protection measures such as wearing
of long sleeve shirts and long pants and using
mosquito repellants are a must during daytime.

3. Seek early consultation when early signs such

as fever and rashes set in

4. Say NO to indiscriminate fogging except for

dengue outbreak
Malaria
 MALARIA (Ague)
King of Tropical Disease
Acute and chronic parasitic diseases
Causative agent : Protozoa of genus Plasmodia
4 species of Protozoa:
1. Plasmodium falciparum ( malignant tertian)
Most fatal ; common in the Philippines
2. Plasmodium vivax ( Benign tertian)
Non-life threatening except for the very
young & old ; manifest chills q48H on
the 3rd day onward if untreated
 MALARIA (Ague)
King of Tropical Disease
3. Plasmodium malariae (Quartan)
Less frequently seen ; non life
threatening , fever & chills usually
occur q72H usually on the 4th day
after the onset
4. Plasmodium ovale
rare
Vector Female Anopheles
mosquito
Vector: (night biting)
Female anopheles mosquito

or minimus flavirustris
= infectious but not contagious
= thrives in clear, free flowing shaded streams
usually in the mountains
= bigger in size than the ordinary mosquito
= brown in color, usually does not bite a person in
motion
= assumes a 36 degree position when it alights on
walls, trees, curtains and the like
Incubation Period:
1. 12 days for P. falcifarum

2. 14 days for P. vivax and Ovale

3. 30 days for P. malariae

Period of Communicability:
Untreated or insufficiently treated patient may
be the source of mosquito infection for more
than three years in P. malariae; one to two years
in P. vivax; and not more than one year on P.
falcifarum
 Pathogenesis
Anopheles mosquito >> gets parasites in the
blood of infected person >>parasites multiply in
mosquito >>parasites invade the salivary gland
of mosquito >> mosquito bites the individual &
thus, injects the parasites >> parasites invade
RBC where they grow & undergo asexual
propagation >> RBC ruptures or bursts
releasing tiny organisms ( MEROZOITES) >>
merozoites invade new batch Of RBC to start
another schizonic cycle
 Pathology
the most characteristic pathology of
malaria is destruction of red blood cells,
hypertrophy of the spleen and liver and
pigmentation of organs.
The pigmentation is due to the
phagocytocis of malarial pigments
released into the blood stream upon
rupture of red cells
Plasmodium Life Cycle
 Malaria
Transmission : sporozoites, injected travel
by anopheles mosquito to human liver

mature to be released into invade RBC as they

a blood stream as merozoites undergo sexual reproduction to

PATHOPHYSIOLOGY : produce zygotes

RBC decreases deformability and oxygen transport,

increase adhesion and fragility leading to anemia
 Clinical Manifestation
uncomplicated
fever, chills, sweating every 24 36 hrs
Complicated
sporulation or segmentation and rupture of
erythrocytes occurs in the brain and
visceral organs.
Cerebral malaria
changes of sensorium, severe headache
and vomiting
seizures
 MALARIA (Ague)
Clinical manifestations :
1. Cold stage
Chilling sensation of the body ( 10-15 mins)
Chattering of lips, shakes
Keep the patient warm
Hot water bath
Expose to heat
Warm drinks
Last about 10-15min
2. . Hot stage (3-4Hrs)
Recurring high grade fever , headache , abdominal pain
and vomiting
TSB , cold compress
Light clothing,
 MALARIA (Ague)
Clinical manifestation :
I. Cold stage ( 10-15mins)
II. Hot stage (3-4Hrs)

III. Wet stage

Profuse sweating

Keep patient comfortable

Keep them warm and dry

Increase fluid intake

Diagnostics:
1. Malarial smear - Peripheral blood extraction (extract
blood at the height of fever or 2 hrs before chilling (
AGUE)
2. Rapid diagnostic test ( RDT) blood test for malaria
conducted outside the lab & in the field- result is
within 10-15 mins. This is done to detect malarial
parasite antigen in the blood.
Medical Mgmt:
A. IVFs
B. Anti- Malarial Drugs
Chloroquine ( less toxic);
Premaquine
For chloroquine resistant plasmodium quinine
Prophylaxis chloroquine or mefloquine,
pyrimethamine/sulfadoxine (fansidar)
C. Erythrocyte exchange transfusion for rapid
production of high levels of parasites in the blood.
 Nursing Considerations
If entering an endemic area, travellers are advised
to take chloroquine from 1-2 weeks at weekly
interval. Protection is good for 1 year
Patient must be closely monitored
Soaking of mosquito nets in an insecticide solution
Bio pond for fish
On stream clearing cut vegetation overhanging
stream banks to expose the breeding stream to
sunlight
Vectors peak biting is at night (9pm-3am)
 Planting of neem tree ( repellant effect)
Zooprophylaxis ( deviate mosquito bite from man
to animals
Wear long sleeves/ pants/Socks
Apply insect repellant on skin
Screening of houses
Notes:
Malaria stricken mother can still breastfeed
Chloroquine ca be given to a pregnant woman
If there is drug resistance, give quinine SO4
BT in anemia
Dialysis in renal failure
Decreased fluids in cerebral edema
No meds to destroy sporozoites
 Category of provinces
Category A no significant improvement in malaria
for the past 10 years. >1000
- Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao,
kalinga
Category B - <1000/year

- Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan,

zambales, bataan, laguna
Category C significant reduction

-pampanga, la union, batangas, cavite, albay

 Filariasis, Elephantiasis
Lymphatic Filariasis
Extremely debilitating and stigmatizing disease
caused by PARASITIC worm
Affect men, women and children
Causes extensive disability, gross disfigurement.
CAUSATIVE AGENT: Wuchereria
bancrofti ( african eye worm)
Only live in lymphatic system
MOT : person to person by mosquito
bite
FILARIASIS
 FILARIASIS
Parasitic disease caused by an african eye
worm ( microscopic thread like worm)
Wuchereria bancrofti & Brugia malayi
Wuchereria :Camarines norte/sur , albay ,
sorsogon , quezon , masbate , mindoro , romblon ,
marinduque , bohol , samar , leyte , palawan , sulu
, tawi-tawi and basilan.
Malayi : Palawan , eastern samar , agusan ,sulu

Vector: Culex, Mansonia, Anopheles, Aedes

 Filariasis ( elephantiasis )

Mosquito bites
Aedes poiculus , culex
faligans and Person infected bitten by mosquito
anopheles flavirostris Transmitted to another person

Bites a person with lymphatic filariasis Larvae migrate to LN, reach

& infect the mosquito Sexual maturity & cycle is
completed

Microscopic worms pass from mosquito

Through the human skin, travel to LN , grow as adult
Note: a person needs
Many mosquito bite
Adult worm lives for 7 yrs in lymph vessels Over several months- years to get
Mate release into blood stream- microfilaria Filariasis
 Organs affected : kidney & lymph system
Fluid collects and causes swelling in the arms, breast,
legs and for men genitalia
Swelling decrease function of lymph system

Susceptible to bacterial infection

Skin harden and thicken ELEPHANTIASIS
Conjuctival filariasis worm migrate eye cause
blindness if untreated known as Onchoceriasis.
Assessment : s/sx
Chills, headache and fever between 3 months and 1 year
after the insect bite
Swelling redness and pain in arms ,legs or scrotum

Areas of abscesses may appear as result of drying worm

or secondary bacterial infection
Lymphadenitis. Oophoritis, orchitis

Diagnostics :Nocturnal Blood smear

Demonstration of microfiliaria in fresh
blood obtained between 10:00 to 2:00 am
Patient s history must be taken and
pattern of inflammation and signs of
lymphatic obstruction must be Blood
observed.
/vector-borne
 Treatment :
Drugs Ivermectin , albendazole and
DIETHYLCARBAMAZINE (DEC)- 6mg/KBW
in divided doses for 12 consecutive days
Eliminate the larvae

Impairing the adult worms ability to

reproduce
Kill the adult worm

Surgery excision of subcutaneous nodule

Elephantiasis of the legs elevate and provide

elastic bandages
 Management Guidelines

Supportive Therapy
Paracetamol
Antihistamine for allergic reaction due to DEC
Vitamin B complex
Elevation of infected limb, elastic stocking

PREVENTIVE MEASURE
Health teachings
Environmental Sanitation
Mgmt: Environmental sanitation
Personal Hygiene
Provide mosquito nets

Long sleeves, long pants & socks

Mosquito repellant

Take yearly dose of medicine that kills worms

circulating in the blood
Screening of houses
Leptospirosis (Weils disease)
Weils disease, Mud fever, Trench fever, Flood
fever, Spirochetal jaundice, Japanese 7 Days fever,
Leptospiral jaundice, Hemorrhagic jaundice,
Swine Herds disease, Canicola fever
a zoonotic systemic infection caused by Leptospires,
that penetrate intact and abraded skin through exposure
to water, wet soil contaminated with urine of infected
animals.
Species:
L. Manilae, L. Canicula, L. Pyrogens
Incubation Period: 6-15 days
 Spirochete, Leptospira
interrogans, gram (-)
Weils syndrome
severe form
MOT:
Contact of skin or open wound from soil water
contaminated with urine or feces of infected rats
(main host)
INGESTION OF CONTAMINATED
FOOD/H2O
S/SX:
Anicteric Type (without jaundice)
manifested by fever, conjunctival infection

signs of meningeal irritation

Icteric Type (Weil Syndrome)

Hepatic and renal manifestation

Jaundice, hepatomegally

Oliguria, anuria which progress to renal failure

Shock, coma, CHF

Convalescent Period
 Diagnosis

Clinical history and manifestation

Culture
Blood: during the 1st week
CSF: from the 5th to the 12th day
Urine: after the 1st week until convalescent period
LAAT (Leptospira Agglutination Test)
other laboratory
BUN,CREA, liver enzymes
 Treatment

Specific
Penicillin 50000 units/kg/day
Tetracycline 20-40mg/kg/day

Non-specific
Supportive and symptomatic
Administration of fluids & electrolytes
Peritoneal dialysis for renal failure
 LEPTOSPIROSIS

JAUNDICE IS A BAD PROGNOSTIC SIGN

CASE FATALITY RATE : 40%

Blood /vector-borne
 Prevention Control & Nursing
Considerations:
Avoidance of exposure to urine & tissues from infected
animals ( flood)
Rodent Control
Hygienic control in slaughterhouses, farmyard buildings &
bathing pools
Use of protective clothing & boots
Primarily a disease of domesticated & wild animals
transmitted via direct or indirect contact. It enters the skin,
mucus membrane, conjunctiva, inhalation
Disease is usually short lived & mild but severe infection
can damage kidneys & liver
HEPATO-ENTERIC
DISEASES
GIT
 Typhoid Fever
Salmonella typhosa, gram (-)
Carried only by humans
Bacterial infection transmitted by contaminated
water, milk, shellfish ( oyster ) & other foods
Infection of the GIT affecting the lymphoid tissue (
payers patches) of the small intestine
Most severe form of salmonellosis caused by
salmonella typhi
MOT: oral fecal route
5 Fs : Fingers, Fomites, Flies, Feces, Food & Fluids
 Pathophysiology
Oral ingestion

Bloodstream

Reticuloendothelial system (lymph node, spleen, liver)

Bloodstream

Gallbladder

Peyers patches of SI necrosis and ulceration

 Typhoid Fever
Ulceration of the Peyer's Patches
 Typhoid Fever
Clinical Manifestations:
Incubation Period: 1-2 weeks
1. Prodromal 1st week: Step ladder fever 40-41
deg, headache, abdominal pain, GI manifestations
3 cardinal signs of pyrexial stage:
1.ROSE SPOTS ( irregular rashes found on the
chest, abdomen, back
2. Remittent fever ( ladder like)
3. Spleenomegaly
Typhoid Fever
Rose Spots
 2. Fastidial = 2nd week ( Typhoid)
a. High fever, typhoid psychosis w/
hallucination, confusion, delirium
Drug of choice: Antibiotics
1. Chloramphenicol
2. Ampicillin

3. Cotrimoxazole

b. Severe abdominal pain

c Sordes typhoid state
1st week step ladder fever (BLOOD)
2nd week rose spot and fastidial
typhoid psychosis (URINE & STOOL)

3rd week (complications) intestinal bleeding,

perforation, peritonitis, encephalitis,
4th week (lysis) decreasing S/SX
5th week (convalescence)
Dx: Blood culture (typhi dot) 1st week
Stool and urine culture 2nd week
Widal test
Mgmt: Chloramphenicol, Amoxicillin,
Sulfonamides, Ciprofloxacin, Ceftriaxone
** Observe standard precaution until 3 negative
stool culture**
Nursing Interventions
Environmental
Sanitation
Food handlers
sanitation permit
Supportive therapy

Assessment of
complications
(occuring on the 2nd to
3rd week of infection )
- typhoid psychosis,
typhoid meningitis
- typhoid ileitis
 Schistosomias/Snail
Fever/Bilharziasis/Katayama
Causative agent : Oriental Blood Fluke
Schistosoma japonicum (affects intestinal tract)
S. hematobium ( affects urinary tract)
S. mansoni ( affects intestinal tract)
IP: 2 months
Source: feces of infected persons
Dogs, pigs, cows, carabaos, monkeys, wild rats
serve as HOSTS
Pathogenesis- Snail fever Ulceration in the mucosa
Eggs able to escape in the lumen
Larvae ( cercaria) Of intestine, excreted in the feces

Penetrate skin Some eggs carried by portal

Circulation, filtered in the
Work their way to Liver , formed granulomas
Liver venous portal circulation
Granulomas are resolved
In portal vessel , & replaced by fibrous tissues
they mature in 1-3 months Scar formation occur
Diseases progresses
Mature worms live in copula in the portal vessels
Liver enlarges due
Migrate to some part of the body
To increasing fibrosis

Female cercaria lays egg in the blood vessels Blood flow interrupted
Large intestine or bladder Result to portal hypertension
 Schistosomias/Snail
Fever/Bilharziasis/Katayama
Causative agent : Oriental Blood Fluke
Schistosoma japonicum (affects intestinal tract)
S. hematobium ( affects urinary tract)
S. mansoni ( affects intestinal tract)
IP: 2 months

Cycle: Egg - larvae (miracidium) - intermediary host

(oncomelania quadrasi/tiny amphibious snail) cercaria (
infective stage)
 Egg - larvae
(miracidium

intermediary host
(oncomelania
quadrasi/tiny
amphibious snail)
 Schistosomias/Snail Fever
MOT: penetration of cercaria
to the skin >parasites live in
the blood vessels of
intestines>cercaria migrates
to the liver for maturation>
gets out of the liver & goes
against blood flow>
obstruction of hepatic portal
vessels> inc pressure>portal
hpn>leads to esophageal &
gastric varices, ascites &
hepatomegaly
 Assessment :
Swimmers itch or cercarial dermattitis
itching within 24hrs after penetration of the
skin by cercaria last 2-3 days
Migratory phase : sensitized individual
develop systemic reaction of FEVER,
CHILLS , SWEATING , DIARRHEA ,
COUGH and EOSINOPHILIA
Acute Phase : (+) fever , generalized
lympagenopathy, hepatomegaly and
splenomegaly ( KATAYAMA FEVER) 2-3
weeks after initial infection and last for 1-2
months
 Diagnostics:
Fecalysisor direct stool exam
Kato katz technique

Liver and rectal biopsy

ELISA ( enzyme link Immunosorbent Assay)

COPT ( circum-oval precipitin test)

confirmatory diagnostic test

Prevention : proper disposal of feces ; snail

control
 Treatment: Praziquantel for 6 mos
PO
Fuadin
 Prevention & Nursing
Considerations:
Wear knee rubber boots
Avoid washing clothes or bathing in streams
Use potable water supply
Proper & sanitary disposal of human feces
Snail control may be undertaken by chemicals (
Niclosemide)- Molluscides
Annual stool exam in endemic places
Educate people about transmission
Proper maintenance of Latrine
Viral hepatitis
 VIRAL HEPATITIS
A diffuse inflammation of the cells of the liver
that produces liver enlargement and jaundice
Hepatitis A (HAV) fecal-oral route
Hepatitis B ( HBV) contact with body
fluids
Hepatitis C (HCV) percutaneous exposure
to blood ( non A non B)
Hepatitis D (HDV)- contact with body fluids

Hepatitis E (HEV) water , fecal-oral route

 VIRAL HEPATITIS
HAV HBV HCV HDV HEV

IP 15-50d 45-180d 14-182d 14-70d 15-64d

MOT Fecal oral Parenteral Blood Same w/ B Fecal oral

Percutaneous transfusion
placental
commun Till 1 wk During IP As carrier- Throughout Unknown
icability after onset Entire clinical indefinite clinical
of course 1 wk before disease
jaundice Years if carrier clinical
onset
 Virus infect liver-interlobular infiltration

Necrosis and hyperplasia of kuffer cells

Failure of the bile to reach intestine in normal

amount

Obstructed jaundice
s/sx: dark urine, pale feces, itchness

Liver cell damage

Necrosis and autolytic type destroy
parenchyma
 VIRAL HEPATITIS
Assessment : s/sx
Prodromal / Preicteric
S symptoms of URTI

W weight loss

A anorexia , chills , fever

R right upper quadrant pain

M malaise

Icteric

J jaundice

A acholic tool

B bile colored urine ( tea colored)

 Laboratory :
Liver function test
SGPT/SGOT

Specific : the presence of IgM antibody

Hepatitis A IgM HAV

Hepatitis B HbsAg acute or chronic infected

Anti-HBs resolved or immunity

HbeAg infected risk of transmitting
Anti-HBe lower risk of transmitting
Anti-HBc acute resolved or chronic
HBV infection
IgM anti-HBc acute with recent
HBV infection window phase
Enteric fever
 VIRAL HEPATITIS
Analysis
Knowledge deficit related to unfamiliarity with the disease
course and treatment
Activity intolerance related to decreased metabolism of
nutrient / increased basal metabolic rate caused by viral
infection
High risk for Diversional activity deficit secondary to
isolation / lack of energy
High risk for altered body nutrition : less than body
requirement secondary to anorexia
 VIRAL HEPATITIS
Treatment
No specific treatment
Bed rest essential

Diet : high carbohydrate , low fat , low protein

Vitamin supplement ( B complex)

 VIRAL HEPATITIS
Nursing Mgt
Isolation of patient ( enteric isolation)
Standard precaution

Patient should be encouraged to rest during acute or

symptomatic phase
Improved nutritional status

Utilize appropriate measures to minimize spread of the

disease
 VIRAL HEPATITIS
Nursing Mgt
Observe patient for Melena and check stool for the presence of
blood
Provide optimum i and oral care
Increase in ability to carry out activities
Encourage the patient to limit activity when fatigued
Assist the client in planning period of rest and activity
Encourage gradual resumption of activities and mild exercise during recovery
PREVENTION AND CONTROL
Handwashing every after use of toilet

Travelers should avoid water and ice if unsure of their purity

Educate on the mode of transmission of the disease.

ERUPTIVE FEVER
 MEASLES
Extremely contagious
Breastfed babies of mothers have 3 months
immunity for measles
The most common complication is otitis media
The most serious complications are pneumonia
and encephalitis
 Measles, Rubeola, Morbili, 7 Day
Fever, Hard Red Measles,
RNA, Paramyxoviridae
Measles virus is rapidly inactivated by heat, UV
light, & extreme degrees of acidity & alkalinity
Active immunity (MMR and Measles vaccine)

Passive immunity (Measles immune globulin)

Lifetime Immunity

IP: 8-12 days

MOT: Direct ( droplets, airborne); Indirect ( fomites)
*Contagious 1-2 days before rash and 4 days after the
appearance of rash
 Sources of Infection:
Patients blood
Secretions from the eyes, nose & throat

Diagnostics:
Nose & throat swab

Urinalysis

Blood exams ( CBC, leukopenia, leukocytosis)

Rashes: maculopapaular,
cephalocaudal (hairline
and behind the ears to
trunk and limbs),
confluent, desquamation,
pruritus)
 Clinical manifestations:
1. Pre-eruptive stage:
(2-4 days) - malaise, cough, conjunctivitis, , fever,
kopliks spots ( PATHOGNOMONIC SIGN)
(1-2 mm blue white spots on red background along
2nd molars), stimsons ( puffiness of eyelid)
photophobia
2. Eruptive stage:
Rash is usually seen late on the 4th day
Maculo-papular rash
3. Stage of convalescence:
Rashes fade away, desquamation begins,fever
subsides
Cx: pneumonia, meningitis,
 MEASLES

Fever persist means (+) complication

Bronchopneumonia- most common

Otitis media, reactivation of previous TB

Bronchitis, laryngitis, exacerbation

malnutrition
Encephalitis
 MEASLES
Diagnostic procedure
Physical examination
Nose and throat swab

Urinalysis

CBC ( leukopenia & leukocytosis)

Complement fixation or hemogglutinin test

Eruptive fever
 MANAGEMENT
1. Supportive
2. Hydration
3. Proper nutrition
4. Vitamin A
5. Antibiotics if w/
secondary bacterial
infection
6. Vaccine- measles
vaccine @ 9 mos and
MMR @ 15 mos
7. Anti viral drugs (
Isoprenosine)

Observe respiratory Isolation

 Nursing Care
Isolation of the patient if necessary
TSB for fever
Skin care is of utmost importance. The pt. should
have a daily cleansing bed bath.
Oral & nasal hygiene is a very important aspect of
nursing care of patients with measles
Restrict to quiet environment
Dim light if photophobia is present; care of the
eyes is necessary
Administer antipyretic
Use cool mist vaporizer for cough
 German Measles, Rubella, Rotheln
Disease, 3 Day Measles
= contagious viral disease characterized by fever,
URTI, arthralgia, DIFFUSED fine red
maculopapular rash)
CA - RNA, rubella virus ( Togaviridae)
Immunity: Active natural ( permanent or lifetime)
Active immunity - rubella vaccine and MMR
Passive immunity - gammaglobulin
Period of communicability contagious 7 days
before & 7 days after appearance of rash &
probably during the catarrhal stage
German Measles, Rubella, Rotheln Disease, 3
Day Measles

IP: 14-21 days

MOT: Direct contact: droplets spread through the
nasopharynx
Indirect contact: transplacental

** Highly
communicable infant may shed virus for
months after birth**
Rashes:
Maculopapular,
Diffuse/not
confluent, No
desquamation,
spreads from the
face downwards
Clinical Manifestations:
> FORSCHEIMERS SPOTS (petecchial lesion
on buccal cavity or soft palate)
> oval, rose red papule about the size of pin head
> cervical lymphadenopathy,
> low grade fever
Dx: clinical
CX: rare; pneumonia, meningoencephalitis
CX to pregnant women:
1st tri-congenital anomalies ( microcephaly, heart
defects, cataracts, deafness
2nd tri-abortion or bleeding
3rd tri-pre mature delivery
Nursing Considerations:
MMR immunization
Use of immunoglobulins ( IGs)- ppost exposure
prophylaxis 72 hrs after exxposure
Prevention of congenital measles
Avoid exposure
 Roseola Infantum,
Exanthem Subitum, Sixth disease
Human herpes virus 6
3mos-4 yo, peak 6-24 mos

MOT: probably respiratory secretions

S/sx: Spiking fever w/c subsides 2-3 days, Face and trunk
rashes appear after fever subsides, Mild pharyngitis and
lymph node enlargement
Mgmt: symptomatic
 Most highly contagious childhood disease
Affects adults more severely than children
Virus may become dormant
 Chicken Pox, Varicella
Acute & highly contagious disease of viral etiology
Childhood disease & adolescents (adults more
severe) Not common in infancy
Locally called Bulutong
Human beings are the only source of infection
CA = Varicella Zoster virus, Herpes virus
IP 10-21 days
MOT: droplet spread
> nose & throat secretions
> Vesicles ( contagious in early stage of
eruption
> Airborne
 Prodromal period: headache , vomiting, fever
Papulovesicular rashes appear on trunk
spreading to face and extremties (
centrifugal)

Macules papules vesicles with clear fluid

inside crusting and scar formation

The disease is communicable until the last

crust disappear ( D1 before D6 after
appearance of rashes)
Period of Communicability 5 days before rashes & 5 days
after rashes crusting - dry
Rashes:
Maculopapulovesicular
(covered areas),
Centrifugal rash
distribution, starts
on face and trunk and
spreads to entire body

Leaves a pitted scar

(pockmark)
CX = secondary bacterial infection, furunculosis,
pneumonia, meningoencephalitis ( rare)

Dormant: remain at the dorsal root ganglion and

may recur as shingles (VZV)
Curative & Nursing Considerations:
If it feels itchy, give oral antihistamine or local
antihistamine
Avoid rupture of lesions
Cut nails short
Pay attention to nasopharyngeal secretions/
discharges
Disinfection of linen ( sunlight or boiling)
Prophylactic antibiotics
Tepid water and wet compresses for pruritus
Soothing Baths, cool baths
Treatment:
a. oral acyclovir
b. Tepid water and wet compresses for pruritus
c. Potassium Permanganate (ABO)
a. Astringent effect
b. Bactericidal effect
c. Oxidizing effect (deodorize the rash)
 Exclusion from school for 1 week after eruption
appears
An attack gives lifetime immunity. Second attack
is rare
Immunoglobulins can be given ( 12 mos)
Drug of choice: Acyclovir ( Zovirax ) topical
cream applied to crusts
 Preventive measures
Active immunization with LIVE
ATTENUATED VARICELLA VACCINE
Start at 1 yr old ( 1 dose )
booster 4-12y

If >13 yrs = 2 doses

Given SC

Avoid exposure as much as possible to infected

person
 Small Pox, Variola
DNA, Pox virus
Last case 1977
spreads from man-to-
man only
Active: Vaccinia pox virus

IP: 1-3 weeks

S/sx:
Rashes:
Maculopapulovesiculopustular
 Centripetal rash distribution
contagious until all crusts disappeared
 SMALL POX
Complications:
Scarring
Pneumonia

Blepharitis

Corneal ulceration

Mortality rate : 30%

Diagnostic : clinical evaluation
Treatment : analgesic ( pain) antibiotic for
secondary infection
 SMALL POX
Nursing mgt
Strict respiratory and contact isolation
Supportive

Adequate hydration

Mandatory reporting

PREVENTION
Pre-exposure vaccination
Strict isolation of identified cases
Respiratory Diseases
 Meningococcemia

CA : Neisseria meningitides ( bacteria) gram (-

)diplococci
May also be caused by H. Influenzae and S.
Pneumoniae
MOT: Droplets (urti) to blood stream to CNS

IP: 1-2 days ( even faster)

High risk: immunocompromised
S/sx:
1. Meningococcemia usually starts as
nasopharyngitis, followed by sudden onset of
spiking fever, chills, arthralgia. Bacteria is carried by
circulation & when it reaches the meninges of the
brain, BLEEDING occurs into the medulla which
extends to the cortex & petechial, purpuric or
ecchymotic hemorrhage is scattered in the entire
body surface appear.
2. Fulminant Meningococcemia (Waterhouse
Friedrichsen) septic shock; hypotension,
tachycardia, enlarging petecchial rash, adrenal
insufficiency
 Clinical Manifestation
sudden onset of high grade fever, rash and rapid
deterioration of clinical condition within 24 hours
 Meningococcal Septicemia
Waterhouse-friedrichsen Syndrome
 Treatment:
antimicrobial
Benzyl Penicillin 250-400000 u/kg/day ( drug of choice)
Chloramphenicol 100mg/kg/day

Symptomatic and supportive

fever
seizures
hydration
respiratory function
Chemoprophylaxis
Rifampicin 300-600mg q 12hrs x 4 doses
Ofloxacin 400mg single dose
Ceftriaxone 125-250mg IM single dose ( Ciprobay)
Nursing Intervention
1. To prevent the occurrence of further complications
-maintain strict surgical aseptic technique when doing
dressings or lumbar puncture in order to prevent the
spread of microorganism
-administer O2 inhalation to prevent respiratory
distress and to maintain a clear open airway
-TSB for fever to prevent convulsions
-observe signs and symptoms of increase intracranial
pressure
-change positions at least every 2 hours to prevent
pressure sore
-protect the eyes from bright lights and noise
 2. Maintain normal amount of fluid and
electrolyte balance
3. Prevent spread of the disease, prophylaxis for
close contacts ( Rifampicin )
4. Ensure the patients full comfort, prevent
stress provoking factors that may retard
convalescence and to prevent from injury
5. Prevent the spread of infection,
microorganisms and contamination some
precautions should be carried out
 6. Maintain personal hygiene and cleanliness and
avoid microorganisms to harbor in the patients
body
7. Maintain proper elimination of waste product
of metabolism
8. Nutritional intake
 Diphtheria
CA: Corynebacterium diphtheriae, gram (+)
( Klebs Loefflers Bacillus)
IP: 2-5 days
Period of Communicability: 2-4 wks if untreated, 1-2 days
if treated
Active (DPT) and
Passive Immunization
(Diphtheria antitoxin)
Source: Discharges of the nose, pharynx, eyes, or lesion
of other parts of the body infected
More severe in unimmunized and partially immunized

MOT: Direct/indirect contact = Airborne/droplet, fomites

Toxin producing organism = EXOTOXIN
1. Nasal invades nose by extension from pharynx
2. Tonsillar low fatality rate
3. NasoPharygeal- more severe type
- sore throat causing dysphagia
- Pseudomembrane in uvula, tonsils, soft
palate gray exudate
- Bullneck inflammation of cervical LN; neck
tissues are edematous
- increasing hoarseness until aphonia
- wheezing on expiration
- dyspnea
 4. Cutaneous diphtheria affect mucous
membrane & any break on the skin
S/sx: sore throat, fever,
Bull-neck appearance(
CHARACTERISTIC
SIGN)
,Pseudomembrane-(
PATHOGNOMONIC
SIGN) gray exudate, foul
breath, massive swelling
of tonsils and uvula,
thick speech, cervical
lymphadenopathy,
swelling of
submandibular and
anterior neck),
obstruction of
respiratory tract
Dx: 1.Schick test -
susceptibility to
diphtheria toxin
2. Moloney - sensitivity
to diphtheria toxoid
3. Throat swab (K
tellurite and Loefflers
coagulated blood serum
 Treatment
Neutralize the toxins antidiptheria serum
Kill the microorganism penicillin,
erythromycin, rifampicin, clindamycin
Considered cured after 3 negative throat cultures
Prevent respiratory obstruction tracheostomy,
intubation
CBR up to 2 weeks to prevent myocarditis
Strict isolation
 Nursing intervention
Strict isolation of the hospitalized child
Administer anti-toxin
Supportive
Maintenance of adequate nutrition
Encouraged drinks rich in vitamin C
Maintenance of adequate fluid and electrolytes
Bed rest for at least 2 weeks
Avoid exertion
Ice collar must be applied to the neck
Nose and throat must be taken care of
Administer antibiotics as prescribed
Penicillin effective for respiratory diphtheria
Pre exposure prophylaxis for Diphtheria,
Pertussis, Tetanus
DPT- 0.5 ml IM
1 - 1 months old
2 - after 4 weeks
3 - after 4 weeks
1st booster 18 mos
2nd booster 4-6 yo
subsequent booster every 10 yrs thereafter
Household contacts
(+) primary immunization and (-) culture - booster dose
(+) culture and (-) immunization treated as a case of
Diptheria
 Complications
Myocarditis most common ( caused by
diphtheria toxin on the heart muscles)
Polyneuritis paralysis of the soft palate,
paralysis of the ciliary muscle of the eye,
pharyns, larynx, or extremities
Airway obstruction can lead to death through
asphyxiation
 Pertussis/ Whooping Cough
Bordetella pertussis, B. parapertussis, B.
bronchiseptica, gram (-)
Pertussis toxin, tracheal cytotoxin,

Bordet Gengou Bacillus

Common in Infants and young children & fatal
to toddlers
IP: 5-21 days
MOT: airborne/droplet; direct contact ( nose &
throat secretions); indirect contact ( articles)
S/sx:
1. Catarrhal stage (1-2 wks; highly contagious) sneezing, runny nose,tearing
lacrimation, mild cough, low grade fever
2. Paroxysmal stage (2-4 wks) - Clusters of cough that ends with a whoop,
vomiting, exhaustion
3. Convalescent stage (2-3 wks) less frequent cough

Dx: WHO - >21 days cough + close contact w/ pertussis px + (+) culture OR
rise in Ab to FHA or pertussis toxin
* throat culture w/ Bordet gengou agar
Cx: bronchopneumonia, pneumonia
Management:
liquefy thick secretions with Ferrous
iodide
CBR
Warm fresh air is better than cold air
w/c induces vomiting ( NO AIRCON)
Hydration and nutrition
Vit C to inc body resistance
Oxygen ( 1-2L/min)- to lessen the
occurrence of paroxysm
Erythromycin or Ampicillin
Isolation = 4 wks after coughing begins
& continued for 7 days after the onset
of antiobiotic therapy
Pre exposure prophylaxis for Diphtheria,
Pertussis, Tetanus
DPT- 0.5 ml IM
1 - 1 months old
2 - after 4 weeks
3 - after 4 weeks
1st booster 18 mos
2nd booster 4-6 yo
subsequent booster every 10 yrs thereafter
Household contacts
(+) primary immunization and (-) culture - booster dose
(+) culture and (-) immunization treated as a case of
Diphtheria
 Pulmonary Tuberculosis( Kochs
Disease/Pthisis/Consumption disease)
CA: Mycobacterium tuberculosis ( bacteria), acid
fast bacilli
The organism multiplies slowly & is characterized as
acid fast aerobic organism which can be killed by
heat, sunshine, drying & ultraviolet light.
Sputum of persons with TB is the most common
source of the organism spread through droplet (
airborne)
Potts disease thoracolumbar
Milliary TB kidney, liver, lungs
- Is a chronic, or subacute or acute respiratory
disease commonly affecting the lungs
characterized by formation of tubercles in the
tissues which tend to undergo caseation, necrosis
and calcification.
IP: 2 10 weeks
Mode of Transmission:
Direct: droplet ( sneezing, coughing)

Indirect: continuous exposure to infected persons

within the family
Source of Infection:sputum, blood from
hemoptysis, nasal discharges and saliva
 Classification :
Minimal slight lesion
Moderately advanced one or both lung may be
involved
Far advanced- more extensive
 Clinical classification:
1. inactive TB
Symptoms absent
Sputum negative

CXR no evidence of cavity

2. Active
Tuberculin test positive
CXR progressive

(+) of symptoms

Sputum (+)

3. Activity not determined

 Clinical manifestation:
Afternoon rise of temperature for 1 mo. or more
Night sweating

Body malaise, weight loss

Cough, dry to productive

Dyspnea, horseness of voice

Hemoptysis pathognomonic

Occasional chest pain

(+) sputum for AFB

PD 996 Compulsory Immunization below 8 years
( 0 -7 yrs)
Proclamation # 6 WHO Universal Child
Immunization
Etiologic Factors that contribute heavily to the
high Incidence & high mortality rate of TB:
Poverty / Overcrowded homes

Protein undernutrition

Deficiencies in Vit A,D,C

Children below 5 years old prone to infection

due to inadequate levels of immunity
 Pathophysiology
Inhalation

Local infiltration of neutrophils and macrophage

Multiply and survive in macrophage

Destroy bacteria

present it to T helper cells in LN

Sensitized T cells searches bacteria and release lymphokines

Attract macrophages w/c attack bacteria caseous necrosis

bacteria dormant
Heal w/ fibrosis, calcification
and granuloma; Primary TB
If reactivated, Secondary TB
 DX
1. Case Finding:
A. Sputum Microscopy ( cheapest & confirmatory )
Results take about 3 weeks to confirm
Sputum sample shld be taken 1st thing in the
morning upon arising
3 specimens:
1st on the spot = HC
2nd- upon arising = Home
3rd on the spot = HC
 2. Sputum Culture & Sensitivity
3. Chest X-ray cavitary lesion
4. Tuberculin Test
1. PPD Purified Protein Derivative
2. Mantoux Test- (more reliable) = ID injection of
tuberculin extract into the inner aspect of forearm to
detect infection/exposure to CA.
Localized reaction- detected in 48 to 72 hours
(+) induration of 10 mm or above
Tuberculin test. Erythema and induration at site of intradermal
injection of 5 tuberculin units in a child with primary tuberculosis.
This is an unusually severe reaction. Mantoux method.
 Classification of PTB
0 = No exposure; No infection
1 = (+) exposure but not infected = INH for 1
mo especially below 5yo
2 = (+) with infection but w/o disease
(+) skin test; No S/S; CXR(-) -INH 1 yr
( -) sputum exam
3 = infected & w/ the disease = anti TB drug Tx
 CATEGORIES OF TB
category I (new PTB) - (+) sputum(+) chest xray

category II (PTB relapse not less than 6 mos)

category III (active PTB case) - (-) sputum chest x-

ray, regression of infiltrates
Category 1V partially treated; poor compliance to
DOTS
Category V PTB suspect ( (+) skin test; (+) family
member with PTB
Management:
short course 6-9 months

long course 9-12 months

DOTS- directly observe treatment short course

* 2 wks after medications non communicable

3 successive (-) sputum - non communicable
rifampicin or INH- prophylactic
 TREATMENT:

CATEGORY 1 - NEW PTB, (+) SPUTUM

GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS

CATEGORY 2 - PREVIOUSLY TREATED WITH RELAPSES

GIVE RIPES 1ST 2 MONTHS, REPS 1 MONTH,
MAINTENANCE RIE 5 MONTHS

CATEGORY 3 - NEW PTB (-) SPUTUM FOR 3X

GIVE RIP 2 MONTHS, MAINTENACE RI 2 MONTHS

* IF RESISTANT TO DRUGS GIVE ADDITIONAL MONTH/S AS

PRESCRIBED
 Primary Anti TB Drugs
1. Rifampicin =
SE = orange colored urine, GI upset,
Jaundice, Renal failure, thrombocytopenia
 Primary Anti TB Drugs
2. Isoniazid (INH) = ( Bacteriostatic) inhibits
( Bactericidal ) kills
Used prophylactically to patients (+) of PPD
SE = Rashes (give anti-histamine); Peripheral
neuritis ( Give Vit B6- Pyridoxine)50 mg;
Jaundice; Psychosis
3. Pyrazinamide ( PZA)
SE = Hyperuricemia ( inc uric acid)

Mx: Inc fluid intake

4. Ethambutol = 15-20mg/day
SE = Optic neuritis ( dec visual acuity)

Give Vit. B6(Pyrdoxine)

5. Streptomycin
SE = Ototoxicity, 8th cranial nerve damage
( Tinnitus, dizziness, N&V)
MDT side effects
r-orange urine
i-neuritis and hepatitis
p-hyperuricemia
e-impairment of vision
s-8th cranial nerve damage
 PTB- NURSING
MANAGEMENT
1. MAINTAIN REPIRATORY ISOLATION
2. Administer medicine as ordered
3. Always check sputum for blood or purulent expectoration
4. Encourage questions and conversation so that the patient
can air his or her feelings
5. Teach or educate the patient all about PTB
6. Encourage patient to stop smoking
7. Teach how to dispose secretion properly
8. Advised to have plenty of rest and eat balanced diet
9. Be alert of drug reaction
10. Emphasize the importance of follow-up
 PULMONARY TUBERCULOSIS
( Kochs Disease/Phthisis/ consumption
Disease)
PREVENTION:
1. Submit all babies for BCG immunization

2. Avoid overcrowding

3. Improve nutritional and health status

4. Advise persons who have been exposed to infected

persons to receive tuberculin test if necessary CXR
and prophylactic isoniazid.
 Mumps ( Epidemic Parotitis); Infectious
Parotitis
-Acute contagious VIRAL disease. Characteristic
feature is swelling of one or both of the parotid glands
RNA, Mumps virus ; paromyxovirus of the Varicella
family( found in the saliva)
Mumps vaccine - > 1yo
MMR 15 mos
Lifetime Immunity
IP: 14-25 days, usually 18 days
Incidence: 5-15 y/o, cold weather, common in men.
Adults less likely to be attacked ( If so, causes sterility)
MOT: droplet, fomites, saliva
S/sx: Pain at the angle of the jaw (Unilateral or
bilateral) PATHOGNOMONIC SIGN
parotitis, Orchitis - sterility if bilateral,
Period of communicability: 6 days before swelling
; until 9 days after swelling subsides ( 7th 9th
day)
** highest communicability 48 hrs after onset
of swelling
Dx: serologic testing, ELISA
Mgmt: supportive
Supporter for orchitis
Analgesics Antipyretic, cold compress, steroids
 Diet : soft. Dont give sour foods
Promotive:
Proper disposal of nasal & throat secretions

Bed rest

Preventive: MMR vaccine ( 15 mos.)

= LIFETIME IMMUNITY
Diarrheal

Diseases
 Cholera / El Tor
Causative agent: Vibrio coma (inaba, ogawa,
hikojima), vibrio cholerae, vibrio el tor; gram (-)
Curved rod or coma shaped organism; motile

Habitat: small intestine

Can survive longer in refrigerated foods

IP: few hours to 5 days

MOT: oral fecal route ( by contaminated food,
water, shellfish)
S/sx: Severe vomiting, abdominal cramps, massive
diarrhea of watery voluminous whitish grayish
greenish slightly mucoid stools (Rice watery
stool with flecks of mucus & fishy odor), s/sx of
severe dehydration ie Washerwomans hands,
sunken eyeball & fontannel, thirst, poor skin
turgor
Period of communicability: 1st day 10th day ( as
long as CA is seen in feces)
Dx: stool culture (+) vibrio cholerae
Mgmt: IV fluids, Tetracycline, Doxycycline,
Erythromycin, Quinolones, Furazolidone and
Sulfonamides (children)
 Cholera
Sigmoidoscopic view of colonic mucosa
Fatal case of infection
Rice Watery Stool in Cholera
Cholera Cot and Bucket
 Nursing Mx:
Replacement of lost F & E
Administer D5LR ( more in Na) DLR ( more in
K)
Enteric Isolation
All patients should be isolated until rectal swab
shows (-) result
All water & milk should be boiled for 15 minutes
Food must be protected from flies
Prepare food properly
Proper disposal of excreta
Good environmental sanitation
 Bacillary Dysentery
Shigellosis
Shiga bacillus: dysenteriae (fatal), flexneri
(Philippines), boydii, sonnei; gram (-)
Shiga toxin destroys intestinal mucosa
Humans are the only hosts
IP: 1-7 days
MOT : oral fecal route ( contamination
of fingers, toilet seats, glass & table
Ware
 Pathophysiology
Shigella >>> releases toxins>>headache
>>>>vomiting>>.LBM>>>stool ( bloody,
mucoid with pus
S/sx: fever,colicky abdominal pain, diarrhea is
watery to bloody with pus, tenesmus
( pain on defecation)
Dx: stool culture
Mgmt: Oresol, Ampicillin, Trimethoprim-
Sulfamethoxazole, Chloramphenicol,
Tetracycline, Ciprofloxacin
 Nursing Mx:
Replacement of F & E
Good environmental sanitation
Sanitary disposal of human feces
Clean processing, preparation, serving of food
Fly control
 SALMONELLA INFECTION
( Salmonellosis)
Source : contaminated food, drinks ;meat and poultry
product.
MOT : fecal oral-route
Period of communicability : throughout duration of
fecal excretion
IP : 6-72H ( < 24H)
S/SX : abrupt onset nausea, vomiting, abdominal
cramps, chills, LBM with bloody mucoid stool
occassionally
 SALMONELLA INFECTION
( Salmonellosis)
Physical findings: hyperactive peristalsis, abdominal
tenderness and signs of dehydration.
Diagnosis:
Stool culture
Stool examination
Treatment
Non-specific
Correction of fluid and electrolytes
Dietary
Antimicrobial not indicated unless patient is septic
Resistant to antibiotics likes : ampicllin, chloramphenicol and
cotrimoxazole
 Paralytic shellfish Poisoning
Red Tide Poisoning
Pyromidium Bahamense ( Algae), Dinoflagellates
Plankton
Ingestion of Saxitoxin in contaminated bi-valve shellfish
Saxitoxin binds w/ Na channels leading to loss of skeletal
muscle excitability
IP 15 min- 12 hrs
S/sx: Circumoral and extremity numbness, nausea and
vomiting, headache ( bec of the toxins),dizziness, muscle
and respiratory paralysis, rapid pulse, difficulty of speech
( ataxia)
Dx: history
Mgmt: emesis/gastric lavage + activated charcoal,
supportive
 Paralytic shellfish Poisoning
Red Tide Poisoning
Dx: history
Mgmt:
1. Induce vomiting (gastric lavage + activated charcoal)
2. Drink pure coconut milk ( weakens toxins)
3. Give NaHCO3(25 mgs) in glass of water
4. Avoid using vinegar in cooking shellfish affected by red
tide ( 15x increase when mixed with acid)
5. Toxin of red tide is not totally destroyed in cooking
6. Avoid eating tahong , halaan, Kabiya, abaniko during
red tide
7. No specific medicines
 Botulism
Fatal form of food poisoning caused by an
endotoxin
CA = Clostridium Botulinum
MOT = Food borne or contaminated wound
IP = 12-36 hrs after eating improperly canned
foods
 S/SX
1. Severe intoxication
2. Visual difficulty, Dysphagia, dry mouth
3. Descending, symmetrical flaccid paralysis (
weak, soft)
4. Vomiting, constipation, Diarrhea
5. Double vision, difficulty focusing eyes
Dx
Culture of stool & stomach contents

Serum positive of Botulinum toxins

Nursing & Medical Management:

1. IV & IM trivalent Botulinum antitoxin

2. IV fluids & Electrolytes

3. Intensive care to manage respiratory failure

4. No questionable canned food should be

tested
Intestinal

Parasitism
 INTESTINAL PARASITISM
are parasites that populate the gastro-intestinal
tract.
MOT : they are often spread by poor hygiene
related to feces
contact with animals, or poorly cooked food
containing parasites.
 Two main types of intestinal parasites:
A. Helminths
Tapeworms, pinworms, and roundworms are among the
most common helminths
B. Protozoa.
 Cause of intestinal Parasitism
high risk for getting intestinal parasites:
Living in or visiting an area known to have parasites
Poor sanitation (for both food and water)

Poor hygiene

Age -- children are more likely to get infected

Exposure to child and institutional care centers

 INTESTINAL PARASITISM
Some asymptomatic
S/SX:
Diarrhea
Nausea or vomiting
Gas or bloating
Dysentery (loose stools containing blood and mucus)
Rash or itching around the rectum or vulva
Stomach pain or tenderness
Feeling tired
Weight loss
Passing a worm in your stool
Anemia
 Fecal testing (stool exam) can identify both
helminths and protozoa..

The "Scotch tape" test identifies pinworm by

touching tape to the anus. Then the tape is
examine under a microscope for eggs
 Ascariasis (Roundworm)
CA: Ascaris Lumbricoides
IP: weeks to months
MOT: transmitted through contaminated fingers
into the mouth; ingestion of food and drinks
contaminated by embryonated eggs
Affects 4-12 years old

Dx: stool for ova

Mgmt: Mebendazole,/ Albendazole/ Pyrantel

Pamoate
MOT: ingestion of food
contaminated by ascaris eggs
larvae in large intestine
penetrate wall lung
where larvae grow and
coughed up intestine
larvae mature and
passed out in feces
Ascariasis ( roundworm infection)
Nursing Intervention:
Isolation is not needed
Preventive measures in each home and in the
community should be enforced
Wash hands before handling food
Wash all fruits and vegetable thoroughly
Availability of toilet facilities must be ensured
Importance of personal hygiene should be explained
Proper waste disposal.
Ascariasis ( roundworm infection)
Prevention:
Improved sanitation and hygienic practices
Improved nutrition

Deworming may be advised

 Complications
Migration of the worm to different parts of the
body Ex. Ears, mouth,nose
Loefflers Pneumonia
 Tapeworm (Flatworms)
CA: Taenia Saginata (cattle), Taenia Solium
(pigs)
MOT: fecal oral route
(ingestion of uncooked, infected meat )
IP: 2-3 mos - years
Dx: Stool Exam
Mgmt: Praziquantel, Niclosamide
ISOLATION OF HOSPITALIZED
PATIENTS. STANDARS PRECAUTIONS
RECOMMENDED
 Pinworm
Enterobius Vermicularis
MOT: fecal oral route
S/sx: Itchiness at the anal area d/t eggs of the
agent
Dx: tape test at night time
(agents release their eggs during night time)
Mgmt: Pyrantel Pamoate, Mebendazole
Enterobius vermicularis (PIN
WORM)
The pinworm lives in
the lower part of the
small intestine and
the upper part of the
colon
Human the only
natural host
IP : 1-2 months or
longer
MOT : indirectly by
Isolation is not needed contaminated fomites
-shared toys, toilet
seat and bath
 Nursing Intervention
Promote hygiene
Environmental Sanitation
Proper waste and sewage disposal
Antihelmintic medications repeated after 2
weeks (entire family)
 Hookworm (Roundworm)
CA: Necator Americanus, Ancylostoma
Duodenale
IP - few weeks to months to years

S/sx: Ground itch or dew itch at site of entry

of filariform larvae involving the feet/legs,
abdl cramps, diarrhea, abdl distention,
anemia, perforation to peritonitis to
septicemia
** Isolation is not necessary **
Dx: microscopic exam (stool exam)
Mgmt: Pyrantel Pamoate and
Mebendazole
dont give drug without (+) stool
exam
members of the family must be
examined and treated also
Nsg. Intervention:
1. Proper disposal of excreta

2. Avoid walking or playing

barefooted
3. Periodic deworming of school age
group
Amoebiasis ( Amoebic Dysentery)
Protozoal infection of human beings initially
involving the colon, but may spread to soft tissues,
most commonly to the liver or lungs.
CA: Entamoeba Hystolitica, protozoa
Prevalent in unsanitary areas
Common in warm climate
Acquired by swallowing
Cyst survives a few days after outside of the body
Cyst passes to the large intestine & hatch into
TROPHOZOITES. It passes into the mesenteric veins, to
the portal vein, to the liver thereby forming AMOEBIC
LIVER ABSCESS.
 Entomoeba histolytica has two developmental stages:

1. Trophozoites/vegetative form
Trophozoites are facultative parasites that may invade
the tissues or may be found in the parasites tissues
and liquid colonic contents.
2. Cyst
a. Cyst is passed out with formed or semi-formed
stools and are resistant to environmental conditions.
 b. This is considered as the infective stage in the life cycle
of E. histolytica

Pathology
When the cyst is swallowed, it passes through the stomach
unharmed and shows no activity while in an acidic
environment. When it reaches the alkaline medium of the
intestine, the metacyst begins to move within the cyst
wall, which rapidly weakens and tears. The quadrinucleate
amoeba emerges and divides into amebulas that are swept
down into the cecum. This is the first opportunity of the
organism to colonize, and its success depends on one or
more metacystic trophozoites making contact with the
mucosa.
Mature cyst in the large intestines leaves the host
in great numbers (the host remains
asymptomatic). The cyst can remain viable and
infective in moist and cool environment for at
least 12 days, and in water for 30 days. The cysts
are resistant to levels of chlorine normally used
for water purification. They are rapidly killed by
desiccation, and temperatures below 5 and
above 40 degrees.
MOT: Ingestion of cysts from fecally contaminated
sources (Oral fecal route)
oral and anal sexual practices
Extraintestinal amoebiasis- genitalia, spleen, liver,
anal, lungs and meninges
lifecycle
s/sx: Blood streaked, watery mucoid diarrhea,
abdominal cramps
Dx: microscopic stool exam - trophozoites
Pd of Communicability: the microorganism is
communicable for the entire duration of the illness
Mgmt:
Tetracycline 250 mg every 6 hours
Ampicillin, Quinolones, sulfadiazine
Metronidazole (Flagyl) 800 mg TID x 5 days
Strptomycin SO4, Chloramphenicol
F&E balance
 Nsg. Mx
Observe isolation & enteric precaution
Provide health education & instruct patient to:
Boil water for drinking or use purified water
Avoid washing food from open drum or pail

Cover leftover food

Wash hands after defecation or before eating

Avoid ground vegetables ( lettuce, carrots, etc)

 Prevention:

Health education
Sanitary disposal of feces
Protect, chlorinate & purify drinking water
Observe scrupulous cleanliness in food
preparation & food handling
Detection & tx of carriers
Fly control ( they can serve as vectors)
CNS Infections
 MENINGITIS
( Cerebrospinal fever)
Is the inflammation of the meninges of the brain
and spinal cord as a result of viral or bacterial
infection.
IP : varies from 1-10 days
MOT : respiratory droplet
direct invasion through otitis media
may result after skull fructure
 Caused by bacterial pathogen, N.
menigitidis, H. Influenza, Strep.
Pneumoniae, Mycobacterium
Tuberculosis
 Clinical manifestations

headache
irritability
fever
neck stiffness
pathologic reflexes: kernigs, Babinski,
Brudzinski
 Diagnostics:
Lumbar puncture
Gram staining

Smear and blood culture

Urine culture
Supportive/Symptomatic:

a. Antipyretic
b. treat signs of increased ICP
c. Control of seizures
d. adequate nutrition
Poliomyelitis/Infantile Paralysis/ Heine
Medin Disease
- acute infectious disease characterized by changes in the
CNS which may result in pathologic reflexes, muscle
spasm and paralysis
- it is a disease of the lower neurons, and there is
anterior horn involvement
CA: Filterable Virus ( Legio Debilitans)
3 Strains:
Legio Brumhilde
Legio Lansing
Legio Leon ( rare)
MOT: The virus is transmitted from person to person
by:
1. indirectly through contaminated articles and
flies, contaminated water, food & utensils
2. Intimate contact w/ infected person
3. Direct contact thru nasopharyngeal secretions
Dx: 1.Pandys test culture of CSF (increased CHON)
2. Stool culture throughout the disease

3. Isolation of the virus from throat washings or swab

early in the disease
 IP: 7-21 days
Period of Communicability: first three days after
onset of S/SX until three months of illness
The disease is most contagious during
the first few days of active disease,
and possibly from 3-4 days before that
 Types of Polio:
1. Abortive or inapparent type does not
invade the CNS ( fever, malaise, sore throat,
headache, N&V) pt. usually recovers within 72
hours
2. Non-paralytic all the above signs;
marked w/ meningeal irritation; pain in the
neck, back, arms legs & abdomen; inability to
place the head in between the knees; (+)
pandys test; more severe than abortive type (
3. Paralytic polio s/sx listed above are
present; flaccid asymmetrical ascending
paralysis (Landrys sign),
(+) Hoynes sign (head drop),
Pokers sign (opisthotonus), (+) Kernig and
Brudzinski sign
4. Bulbar ( Brain stem) develops rapidly & is
the more serious type; motor neuron in the
brainstem is attacked & affects the medulla. It
weakens the muscles supplied by the cranial
nerves especially the 9th ( glossopharyngeal)
& 10th ( vagus); facial, pharyngeal & ocular
muscles are paralyzed; respiratory failure &
cardiac irregularities
 Predisposing causes
Age about 60% of patients are under 10 yrs of
age
Sex males are more prone to the disease than
females with a ratio of 3:2
Heredity poliomyelitis is not hereditary
Environment & hygienic condition. The rich are
more often spared than the poor. Excessive
work, strain, marked overexertion are also
factors causing the disease.
 Pathology
The organism enters the body through the
alimentary tract, multiplies in the oropharynx &
lower intestinal tract.
Then the organisms are spread to the regional
lymph nodes & the blood
There seems to be subsequent congestion,
edema & necrosis in the area
 Complications
Respiratory failure
Circulatory collapse
Electrolyte imbalance
Bacterial infection
Urinary problems r/t retention or paralysis of
the urinary bladder
MGMT:
Analgesics for pain. Morphine is contraindicated
because of the danger of additional respiratory
suppression.
CBR

Moist heat application may reduce spasm & pain

Paralytic polio requires rehabilitation using physical

therapy , braces, corrective shoes & in some cases,
orthopedic surgery
Prevention:
Active OPV (Sabin) and IPV (Salk)
 Nursing Management:
Carry out enteric isolation
Observe the patient carefully for paralysis & other
neurologic damage
Perform neurologic assessment 1x a day
Check BP regularly especially in bulbar polio
Maintain good personal hygiene, particularly oral care &
skin care
Provide emotional support both to patient & family
Dispose excreta & vomitus properly
Apply hot packs to affected limb to relieve pain &
muscle shortening
 Tetanus/Lockjaw/Trismus
CA:
Clostridium tetani (gram (+), spore forming,
anaerobic ( survives w/o air) non-motile,
vegetative( ability to grow)
Produces potent exotoxin
Tetanus spores are introduced into the wound
contaminated with soil
IP: 4-21 days
Tetanus neonatorum - umbilical cord
 Pathophysiology
Clostridium tetani in puncture wound

Release of Neurotoxin (Tetanospasmin)

Hemolysin ( tetanolysin

attack PNS and CNS

GABA and Glycine inhibited

Tetanic spasm
 Clinical manifestations

Difficulty of opening the mouth

(trismus or lockjaw)
Risus sardonicus ( sneering grin) ngiting aso
Dysphagia
Generalized muscle rigidity
Opisthotonus ( severe arching of the back)
Localized or generalized muscle spasm
Respiratory paralysis to death
S/Sx:
Neonatal tetanus - Poor sucking, irritability,
excessive crying, grimaces, intense rigidity, and
opisthotonus
Criteria Stage I Stage II Stage III

Incubation Period > 11 days 8-10 days <7days

Trismus mild moderate Severe

Muscle rigidity mild Pronounced Severe, boardlike

Spasm absent Mild, short Frequent,

prolonged

Dyspnea, absent absent Present

cyanosis
Dx: history, leukocytosis, serum antitoxin levels

Mgmt:
Anticonvulsant, muscle relaxants, antibiotics, wound
cleansing and debridement
Active-DPT and tetanus toxoid
Passive-TIG and TAT, placental immunity
 Tetanus
Treatment:
1. Specific :
-within 72 hours after punctured wound
received ATS,TAT or TIG espicially if no
previous immunization
- Pen G to control infection
- muscle relaxant to decrease muscle rigidity.
2. Non-specific
- oxygen inhalation
 Treatment:
anti-toxin
Tetanus Anti-Toxin (TAT)
Adult,children,infant 40,000 IU IM,1/2 IV
Neonatal Tetanus 20000 IU, 1/2IM, IV
TIG
Neonates 1000 IU, IV drip or IM
Adult, infant, children 3000 IU, IV drip or IM
 Pre exposure prophylaxis
DPT- 0.5 ml IM
1 - 1 months old
2 - after 4 weeks
3 - after 4 weeks
1st booster 18 mos
2nd booster 4-6 yo
subsequent booster every 10 yrs thereafter
TT 0.5 ml IM
TT1 6 months within preg
TT2 one month after TT1
TT3 to TT5 every succeeding preg or every year
Antimicrobial Therapy
Penicillin !-3 mil units q 4hours
Pedia 500000 2mil units q 4 hrs
Neonatal 200000 units IVP q 12hrs or
q8hrs
 3 types of patients w/ skin wounds
post exposure prophylaxis

1. (+) immunization as a child w/ boosters but

last shot > 10 yrs give TT + TIG/TAT
2. (-) immunization - TT + TIG/TAT

3. (+) tetanus TIG/TAT + TT + Abx + wound

cleansing + supportive therapy
Control of spasms
diazepam

chlorpromazine
Preventive Measures
Treatment of wounds

Tetanus toxoid (0,1,6,1,1)

 Rabies

CA: GenusLyssavirus, Family

Rhabdoviridae ( RNA virus)

Bite/wound setting
 acute viral encephalomyelitis
incubation period is 4 days up to 19 years
risk of developing rabies, face bite 60%, upper
extremities 15-40%, lower extremities 10%
100% fatal
 Pathophysiology
Bite/wound

Local wound replication

CNS encephalitis

ANS

Salivary glands, adrenal medulla, kidney, lungs, skeletal

muscles, skin, heart
 Rabies Virus
The rabies virus is usually transmitted to humans by a bite from an infected dog, but the bite
of any animal (wild or domestic) is suspect in an area where rabies is present. Symptoms of
the disease appear after an incubation period of ten days to one year and include fever,
breathing difficulties, and muscle spasms in the throat that make drinking painful. Death
almost invariably occurs within three days to three weeks of the onset of symptoms. For this
reason, the emphasis of treatment is on prevention. In the United States, veterinarians
recommend regular vaccination of domestic dogs.
 Clinical Manifestation
pain or numbness at the site of bite
fear of water
fear of air

4 STAGES
1. prodrome - fever, headache, paresthesia,
2. encephalitic excessive motor activity,
hypersensitivity to bright light, loud noise,
hypersalivation, dilated pupils
3. brainstem dysfunction dysphagia,
hydrophobia, apnea
4. death
Dx: history
virus isolation from saliva and CSF
serial serum Ab sample
Staining of brain tissue (dog) - Negri bodies
 Postexposure prophylaxis
Category I Observe the dog for 14 days
Licking of intact skin

Category II 1.Activevaccine
Abrasion, laceration, punctured 2.Observe dog for 14 days
wound on the lower extremities

Category III
Abrasion, laceration on upper 1.Active
extremities, head and neck 2.Passive
Dog is killed, lost, died
 Category of bites
I intact skin (lick or scratch)
II mucosal, non bleeding wounds, abrasions

III bleeding bites and above neck, stray dogs,

laceration, multiple bites
Mgmt:
- wound cleansing
- tetanus prophylaxis
- Observe and quarantine dog for maniacal s/sx
- Active- antirabies vaccine (human diploid cell
vaccine)
- 7-10 days to induce an active immune response,
with immunity x 2 years
- Passive human rabies immunoglobulin
Management
No treatment for clinical rabies

Prophylaxis
Active vaccine (PDEV,PCEC,PVRV)
Intradermal (0,3,7,30,90)
Intramuscular (0,3,7,14,28)
(0,7,21)
 Post exposure prophylaxis
Antirabies vaccine
1 ml IM
day 0, 3, 7, 14, 28

OR
0.1 ml ID
day 0 (8 sites), 7 (4 sites), 28, 91 (1 site)

OR
0.1 ml ID
day 0, 3, 7 (2 sites), 30, 90 (1 site)

Rabies immunoglobulin (HRIG/equine antiserum)

20/40 units/kg IM
single shot
wound 40%, deltoid 60%
Passive Vaccine
a. ERIG wt in kg x .2 = cc to be injected im
(ANST)
b. HRIG wt in Kg x .1333
Pre-exposure Prophylaxis
Intradermal/Intramuscular (0,7,21)
Infection control
Patient is isolated to prevent exposure of
hospital personnel, watchers and visitors
PPE

Preventive Measures
Education

Post-exposure and Pre-exposure Prophylaxis

 SNAKEBITE

Neurotoxic Slow swelling Ptosis, Cobra

then necrosis respiratory
paralysis,
cardiac
problems

Myotoxic None Myalgia on Sea snake

moving
paresis

Vasculotoxic Rapid Bleeding Vipers

swelling abnormalities
 Management

Lie the victim flat

ice compress and constrictive materials are
contraindicated
Transport the patient to the nearest hospital
Antivenim administration in patients with signs of
envenomation
It is never too late to give anti-venim
 Antivenim is given thru intravenous
infusion, which is the safest and most
effective route. 2-5 ampules plus D5W to run
over 1-2 hours every 2 hours
Antimicrobial therapy
sulbactam/Ampicillin or co-amoxiclav
Substitute
Prostigmine IVinfusion, 50-100ug/kg/dose
q 8hrs
Atropine
Skin Transmission Diseases
 Leprosy/Hansens disease
Chronic communicable disease of the skin & the
peripheral nerves
Causative Agent: Mycobacterium Leprae, acid fast bacilli
MOT: may be due to prolonged
skin-skin contact or droplets
IP - years to decades

Active immunization (BCG)

 Types of Leprosy:
1. Lepromatous or Nodular or Gravis ( most
severe) Early s/sx: many lesions or patches
2. Tuberculoid high resistant, less severe
3. Mixed type or Borderline or Dimorphous
4. Indeterminate
TYPES:
PAUCIBACILLARY
1. Early/Indeterminate hypopigmented /
hyperpigmented anesthetic macules/plaques
2. Tuberculoid solitary hypopigmened hypoesthetic
macule, neuritic pain, contractures of hand and foot,
ulcers, eye involvement ie keratitis
MULTIBACILLARY
1. Lepromatous inability to close eyelids unblinking
eyes ( lagophthalmos) multiple lesions, Loss of lateral
portion of eyebrows (madarosis), corugated skin
(leonine facies), septal collapse (saddlenose) clawing of
fingers & toes, loss of digits, enlargement of male
breasts ( gynecomastia)
2. Borderline between lepromatous and tuberculoid
 Mgt:
Domiciliary home treatment ( RA 4073)
Multi Drug Therapy ( MDT) use of 2 or
more drugs for the tx of leprosy. Proven
effective cure for leprosy & renders patients
non-infectious a week after starting treatment.
Paucibacillary- Rifampicin and Dapsone
Multibacillary-Rifam,Dapsone,Clofazimine
Diaminodiphenylsulfone DDS( Dapsone)
Rifampicin
Clofazimine (lamprene)
Treatment is from 9 mos to 18 mos(2 years )

Pediculosis
Blood sucking lice/Pediculus humanus
p. capitis-scalp
p. palpebrarum-eyelids and eyelashes
p. pubis-pubic hair
p. corporis-body

MOT: skin contact, sharing of grooming implements

s/sx: nits in hair/clothing, irritating maculopapular or urticarial rash
Mgmt: disinfect implements, Lindane (Kwell) topical
Permethrin (Nix) topical
CX: impetigo to AGN, RHD
Scabies
Sarcoptes scabiei
Pruritus (excreta of mites)
Mites come-out from burrows to mate
at night

MOT: skin contact

s/sx: itching worse at night and after hot

shower; rash; burrows (dark wavy lines
that end in a bleb w/ female mite) in
between fingers, volar wrists, elbow,
penis; papules and vesicles in navel,
axillae, belt line, buttocks, upper thighs
and scrotum
Dx: biopsies/scrapings of lesions

Mgmt: Permethrin (Nix) cream, crotamiton

cream, Sulfur soap, antihistamines and calamine
for pruritus, wash linens with hot water, single
dose of Ivermectin, treat close contacts
Emerging Diseases
Severe Acute Respiratory Syndrome
(SARS)
is a respiratory disease in humans which is caused
by the SARS Coronavirus .
SARS appears to have started in Guangdong Province,
China in November 2002. Pandemic

MOT : direct Mucous membrane/ droplet /

exposure to fomites.
Virus is stable in urine/feces for 1-2 days ; for patient
with diarrhea up to 4 days.
IP: 2-7 days ( max 10d)
Mortality rate 5% only

Heat at 56 c rapidly kills the virus

 Severe Acute Respiratory Syndrome
(SARS)

Clinical criteria :
1. Asymptomatic or mild respiratory illness , fever >38c (
>100.4 F )
2.One or more clinical finding of respiratory illness
cough / shortness of breath / DOB /hypoxia
Epidemiologic Criteria:
Contact (sexual or casual) with someone with a diagnosis of SARS
within the last 10 days OR
Travel to any of the regions identified by the WHO as areas with
recent local transmission of SARS (affected regions as of 10 May
2003 were parts of China, Hong Kong, Singapore and the province of
Ontario, Canada).
 SARS
Treatment
Antibiotics are ineffective as SARS is a viral disease.
supportive with antipyretics, supplemental oxygen and
ventilatory support as needed.
Preventive measures ( HEALTH TEACHING)
Consult doctor promptly early treatment is the KEY
Build up good body immunity
Maintain good personal hygiene
Wear mask if develop runny nose, cough
Wear protective mask in public areas
Wash hand properly and keep them clean
Droplet & contact PRECAUTION
 BIRDS FLU
is an AVIAN FLU , a type of influenza known
to exist worldwide.
Etiologic agent : avian influenza H5N1 strain
MOT : spread in air and manure.
Transmitted through contaminated feeds, water,
equipment, and clothing
No evidence that virus can survive in well cooked
meat
Spread rapidly among birds not infect human easily
No confirmed human-human transmission
 Bird Flu
Human cases of influenza A (H5N1)
infection have been reported in :
Cambodia

China

Indonesia

Thailand

Vietnam.
 BIRDS FLU
Incubation period : 3-5 days
S/sx :
Symptoms in animal vary - can cause death within few
days
In human same as in human influenza
Fever/ sorethroat/ cough/ severe cases Pneumonia.
The highly pathogenic form spreads more rapidly
through flocks of poultry. This form may cause
disease that affects multiple internal organs and has a
mortality rate that can reach 90-100% often within 48
hours.
 BIRDSFLU
Prevention & treatment
Avian influenza in human can be detected with :
STANDARD INFLUENZA TEST
Antiviral drugs clinically effective in both
preventing and treating the disease.
oseltamavir and zanamavir
Vaccines take at least 4 months to produce and
must be prepared for each sub-type
 Nursing Intervention :
Health Teaching
Wash hands with soap and warm water for at least 20 seconds before and
after handling raw poultry and eggs.

Clean cutting boards and other utensils with soap and hot water to keep raw
poultry from contaminating other foods.

Use a food thermometer to make sure you cook poultry to a temperature of

at least 165 degrees Fahrenheit Consumers may wish to cook poultry to a
higher temperature for personal preference.

Cook eggs until whites and yolks are firm.

 FYI
There are only three known A subtypes of
influenza viruses (H1N1, H1N2, and H3N2)
currently circulating among humans.
Influenza A viruses are constantly changing, and
they might adapt over time to infect and spread
among humans.
END
Thank You!
 Communicable Disease
is an illness due to an infectious agent or its toxic
products which is easily transmitted or communicated
directly or indirectly from one person or animal to
another
** Both infectious and contagious diseases are
communicable**
**All contagious diseases are communicable
but not all communicable diseases are
contagious**
 The Infectious Process
Causative Agent:
Type of bacterium , virus, fungus,
parasite, rickettsia, chlamydia etc.
 Reservoir the environment in which
the agent is found
Human man is the reservoir of diseases
that is more dangerous to humans than to
other species
Animal responsible for infestations with
trophozoites, worms etc
Nonanimal street dust, garden soil, lint
from bleeding
 Mode of escape from reservoir:

Respiratory Tract
Gastrointestinal Tract

Genito-urinary tract

Open lesions

Mechanical escape ( include bite of

insects)
Blood
 Mode of Transmission:

1. by contact transmission:
Direct contact immediate direct transfer of
microorganism from person to person)
Touching, biting, kissing, sexual intercourse

Droplet contact occurs within 3 ft from

source
( from coughing, sneezing or talking to an
infective person)
 2. Indirect transmission
by vehicle route ( through contaminated
items)
Serves as an intermediate means to
transport & introduce an infectious agent
into susceptible host through susceptible
port of entry
Fomites
Inanimate objects ( handkerchief, toys,
soiled clothes, eating utensils ,surgical
instruments, or dressing, IV needle,
water, food, milk, serum, plasma
 By vector route
Is an animal or flying or crawling insect
which serves as an intermediate means of
transporting an infectious agent.
Ex. Mosquitoes, snails , flies, ticks and
others
 3. Airborne Transmission:
Droplet neclei ( residue of evaporated
droplets that remain suspended in air)
Dust particles in the air containing the
infectious agent
Organisms shed into the environment
from skin, hair, wounds or perineal
area
 Mode of Entry of Organisms into
the Human Body:

Respiratory tract
Gastrointestinal tract

Genito-urinary tract

Direct infections of mucous

membranes / skin
 Host Factors :

Age, sex, genetics

Nutritional status, fitness, environmental
factors
General physical, mental & emotional health
Absent or abnormal immunoglobulins
Status of hematopoietic system
Presence of underlying disease ( DM,
lymphoma, leukemia
Pt. treated w/ certain antimicrobials,
corticosteroids, irradiation,
immunosuppresive agents