COMMUNICABLE

DISEASES
Prepared by:
John Gil B. Ricafort, RN
Revised C.D.C. Isolation Precaution

3. STANDARD PRECAUTION
Indication:
All patients regardless of diagnosis or
presumed infection
2. AIRBORNE PRECATION
Indications:
Patients known to have or suspected of
having a serious illness transmitted by
airborne droplet nuclei, such as:
- measles
- varicella
- tuberculosis
3. DROPLET PRECAUTION
Indications:
Patients known to have or suspected of
having serious illness transmitted by
large-particle droplet, such as:
Influenza, Menigitis, Pneumonia,
Epiglotitis and sepsis
4. CONTACT PRECAUTION
Indication:
Patients known to have or suspected of
having a serious illness easily
transmitted by direct patient contact or
by contact with items in the patient’s
environment, such as:
Multidrug-resistant bacteria
Enteric Infection
Viral hemorrhagic infection
Chain of Infection
 Causative Agent – any microbe that is capable
of producing disease.
 Reservoir – is the environment or object in or
on which the microbe can survive and, in
some cases, multiply.
 Portal of Exit – is the path by which an
infectious agent leaves its reservoir.
 Mode of Transmission – is the means by
which the infectious agent passes from the
portal of exit in the reservoir to the
susceptible host.
Mode of Transmission:
 Contact

Subdivided into:
a. Direct Contact
b. Indirect Contact
c. Droplet Spread
 Airborne
 Vehicle
 Vector Borne
 Portal of Entry – refers to the path by
which an infectious agent invades a
susceptible host.
 Susceptible Host – person that is likely
to develop the infection.
Anthrax
Also called Malignant Pustule, Malignant Edemia,
Woolsorter Disease, Ragpicker Disease
An acute bacterial disease usually affecting the skin
but which may very rarely involve the oropharynx,
LRT and mediastinum or intestinal tract.
 Causative Agent: Bacillus Anthracis
 Mode of Transmission: Direct contact
Ingestion
Inhalation
 Incubation Period: a few hours to 7 days
Signs and Symptoms

Cutaneous Form – most common

lesion, septicemia
Pulmonary Form – mild to severe
symptoms of URTI, fever, shock
Gastrointestinal Form – violent
gastroenteritis with vomiting
and bloody stools
Methods of Control:

 Immunization
 Health education
 Environmental sanitation
 Good personal hygiene
 Do not sell the hides of animals
exposed to anthrax
Treatment:
High-dose of PENICILLIN
Isolation
Botulism
- a life-threatening paralytic illness that
results from an exotoxin produced by
the gram (+) anaerobic bacillus,
Clostridium Botulinum
- RESPIRATORY FAILURE is the most
common cause of death
Cause:
The most common cause of botulism is
ingestion of contaminated food
especially low acid content:
Home Canned fruits/ vegetables
Sausages
Smoked or preserved fish/ meat
Honey
Corn syrup
Signs and Symptoms
Arises usually 6 hours to 8 days after
ingestion
CARDINAL SIGNS:
Acute symmetrical cranial nerve
impairment (ptosis,
diplopia, dysarthia)
Descending weakness
Dyspnea
Respiratory paralysis
Other signs: (EARLY)
Dry mouth
Sore throat
Weakness
Vomiting and diarrhea
Diagnosis
Identification of the toxins in the serum,
stool, gastric contents or suspected
food – CONFIRMS the DIAGNOSIS
Treatment
Administration of Botulinum Antitoxin
- given IV or IM
- the treatment of choice
ALERT:
Watch for anaphylaxis after
administration. Keep EPINEPHRINE
available at all times
Nursing Special Considerations:
2. Obtain a careful history of the patient’s
food intake for the past several days.
3. Observe carefully for abnormal
neurologic signs.
4. If ingestion has occurred within
several hours, induce VOMITING and
give HIGH ENEMA to purge any
unabsorbed toxins.
 If clinical signs and symptoms appear:
4. Bring the patient to the ICU and monitor
cardiac and respiratory status
5. Administer Botulinum Antitoxin
6. Closely observe and accurately record
neurologic function, including bilateral
motor status.
7. Give IV fluids as needed.
Brucellosis
- also known as Undulant Fever, Malta
Fever, Bang’s Disease
- an acute febrile illness transmitted to
humans from animals
Cause:
Brucella Suis (found in swine)
Brucella Melitensis (found in goats)
Brucella Abortus (found in cattle)
Brucella Canis (found in dog)
Signs and Symptoms

Acute Phase
Fever, chills, profuse sweating,
fatigue, headache, backache, enlarged
lymph nodes, hepatosplenomegaly,
granuloma formation in the SQ
Chronic Phase

Sleep disturbance, sexual impotence,

meningitis, encephalitis, osteomyelitis,
orchitis, endocarditis

Diagnostic Test
Culture testing
Treatment:
Bed rest
Antibiotic therapy
Combination of Doxycycline and
Aminoglycoside for 4 weeks then
Doxycycline and Rifampicin for 4
weeks
Surgery ( Heart complication)
Nursing Special Considerations:
2. During the acute phase, monitor and
record the patient’s temperature every
4 hours.
3. During the chronic phase, watch for
depression and disturbed sleep
patterns.
4. Keep suppurative granulomas and
abscesses dry.
5. Stress the importance of continuing
medication.
Cholera
also called EL TOR
An acute serious illness characterized by sudden
onset of acute and profuse colorless diarrhea,
vomiting, severe dehydration, muscular cramps,
cyanosis and in severe cases collapse.
Etiologic Agent: Vibrio El Tor
Sources of Infection: Vomitus and feces
Mode of Transmission: Food and water contaminated
with vomitus and stools of patients and carriers
Incubation Period: From few hours to 5 days, usually
3days
Period of Communicability: 7-14 days after onset
Treatment
Improve sanitation
Administration of Cholera vaccine
Infusion of Isotonic Saline Solution
Potassium replacement
Doxycycline
Tetracycline
Nursing Special Considerations
2. Wear a gown when handling feces-
contaminated articles or when a
danger of contaminating clothing
exists, wash your hands after leaving
the patient’s room.
3. Monitor output and regulate the IV
infusion accurately.
4. Protect the patient’s family by
administering Tetracycline, as ordered
Methods of Prevention and Control
 Report cases at once to Health
Officer
 Bring patient to hospital for proper
isolation and prompt competent
medical care
 All contacts of the cases should
submit for stool examinations and
be treated accordingly if found or
discovered positive
Encephalitis
- a severe inflammation of the brain
- is usually caused by mosquito-borne
or tick-borne virus, in some rare cases,
transmitted through ingestion of
infected goat’s milk and accidental
injection or inhalation of the virus
Signs and Symptoms

Sudden onset of fever

Headache
Vomiting
Signs of Meningeal irritation
Neuronal damage
Coma
Diagnostic Test
CSF Analysis
Serum Analysis
EEG
CT Scan

Treatment
Antiviral and Foscarnet
(effective for Herpes Encephalitis)
Treatment for all other forms of
encephalitis is entirely SUPPORTIVE
Antiseizure
Diuretics
Aspirin
Anti-inflammatory
Antibiotic
Fluid replacement
Isolation of the patient
Scarlet Fever
- is an infectious disease caused by
GAS that most commonly arises from
tonsilar and pharyngeal infections,
although it may follow stretococcal
infections of the skin, soft tissue,
surgical wound or the uterus.
- common for children 5 to 15 years old
- common during winter and spring
months
Signs and Symptoms
Reddened tonsils and pharynx
Fever, headache, vomiting
Rash (starts from the trunk and spreads,
but becomes prominent in the skin
folds of the axilla, groin and buttocks
producing PATIA’s LINE)
WHITE STRAWBERRY TOUNGE
RED STRAWBERRY TOUNGE after 2
days
 Complications:
RHD
Glomerulonephritis
Diagnostic Test
THROAT CULTURE – most definitive
Rapid Antigen Test (RAT) (+)
ASO Titer
Treatment
Penicillin or Erythromycin (10days)
Supportive Care
Fluid replacement

Nursing Special Considerations:

7. Stress the importance of prompt and
complete antibiotic therapy.
8. Watch for complications
3. Care should be taken when
disposing of purulent discharges.
4. Provide comfort measures.
5. Stress the importance of
completing the treatment regimen.
Histoplasmosis
- also called Ohio Valley Disease,
Central Mississippi Valley Disease,
Appalachian Mountain Disease and
Darling’s Disease
- it is a fungal infection caused by
Histoplasma Capsulatum
- common in Asia, Africa, Europe, North
and South America
Cause:
H. Capsulatum is found in the feces of
birds and bats or in soil contaminated
by their feces. Transmitted through
inhalation or direct invasion after minor
skin trauma or injury.
Signs and Symptoms:
Symptom vary with each form of this
disease.
Primary Acute Histoplasmosis
Maybe asymptomatic or cause
symptoms of mild RTI
Progressive Disseminated Histoplasmosis
Hepatosplenomegaly, general
lymphadenopathy, anorexia, weight
loss, cardiac abnormalities, ulceration
Chronic Pulmonary Histoplasmosis
PTB manifestations
African Histoplasmosis
Lymphadenopathy, lesions of the skull
and long bones, visceral involvement
but without pulmonary lesions, nodules

Diagnosis
Tissue biopsy
Culture Testing
Treatment
Antifungal (Amphotericin B or
Fluconazole)
Supportive
Oxygen administration
Corticosteroids
NO NEED for isolation
Nursing Special Considerations
2. Administer medications as ordered.
3. Patients with chronic pulmonary or
disseminated histoplasmosis also
need psychological support because
of long term hospitalization.
4. As needed, refer the patient to a social
worker or an occupational therapist.
Kawasaki Disease
- also called Mucocutaneous Syndrome
- an autoimmune inflammatory problem
of the vessels characterized by fever,
rash, swollen hands and feet, irritation
and redness of the sclera, swollen
lymph glands in the neck and
inflammation of the mouth, tongue
(strawberry tongue), lips and may affect
the heart.
Diagnosis
Elevated ESR
Tissue biopsy
Echocardiography

Treatment
Aspirin
Gamma globulin
Legionnaire’s Disease
- an acute bronchopneumonia
- caused by Legionella Pneumophila
- DOC: Erythromycin
Rifampin
Lyme Disease
- a multisystem disorder caused by
Borrelia Burgdorferi, which is carried by
the minute tick called Ixodes Scapularis.
- common in:
Northeast, from Massachusetts to
Maryland
Midwest, in Wisconsin and Minnesota
West, in California and Oregon
Signs and Symptoms
1. Stage 1
Redness or macule on the site of the
bite
Itchiness on the lesion and may feel
hot
Malaise, fatigue, fever, chills, regional
lymphadenopathy, persistent sore
throat and dry cough
2. Stage 2
Neurologic abnormalities
Cardiac abnormalities
3. Stage 3
Characterized by ARTHRITIS

Diagnostic Test
Based on the manifestations
Serum testing
Treatment
Tetracycline (drug of choice)
- given at 28-day cycle
Penicillin
Erythromycin
Ceftriaxone –Late Stage
Vaccine (Lymerix) – 3 injections (US)
 Nursing Special Considerations
2. Take a detailed patient history
3. Check for drug allergies, and
administer carefully
4. Care for patients with arthritis
5. Assess patient’s neurologic status and
LOC frequently
6. Check for cardiac abnormalities
Pediculosis
- is caused by parasitic forms of lice,
Pediculosis Humanus. These lice feed
on human blood and lay their eggs (nits)
in body hair or clothing fibers. When a
louse bites, they inject a toxic substance
that produces mild irritation and a
pruritic spot.
Causes:
P. Capitis
- most common
- feeds on scalp
P. Corporis
- lives in the clothing
P. Pubis
- primarily found in the pubic hairs and
may extend in the eyebrows, eyelashes
and axillary or body hair
Signs and Symptoms:

P. Capitis
itching; excoriation
foul-smelling hair
occipital and cervical
lymphadenopathy
P. Corporis
Small red papules
Wheals (late stage)
Fever
Malaise
Bacterial infection
P. Pubis
skin irritation
Small gray-blue spots (maculae
caerulae)

Diagnostic Test:
Inspection
Treatment
Permethrin Cream (Head lice)
Treated comb with vinegar
10% Lindane Powder (Clothing)
0.5% Malathion Emulsion (Pubic Lice)
Good personal hygiene
Environmental sanitation
Rocky Mountain Spotted Fever (RMSF)
- is a febrile, rash-producing illness
caused by Rickettsia rickettsii. The
disease is transmitted to humans by
tick bite.
- endemic problem in the United States
- common in the southeast and
southwest areas
Signs and Symptoms
Fever (38.9° to 40°C)
Headache
Nausea and vomiting
Aching in the bones/ muscles
Thick white coated tongue and
eventually turns brown as the fever
rises
Skin eruptions
Diagnosis
Based on the history
Positive Complement Fixation Test
Blood cultures

Treatment
Removal of the tick
Antibiotic ( Chloramphenicol or
Tetracycline)
Ascariasis
- also known as roundworm infection
caused by the parasitic worm Ascaris
Lumbricoides
- common in south part of United States
particularly among 4 to 12 years old
- may lead to intestinal obstruction and
pulmonary disease
Signs and Symptoms
Vague abdominal discomfort
Vomiting a worm
Passing a worm in the stool
Restlessness
Disturbed sleeping
Intestinal obstruction
Diagnostic Test
Stool Exam – confirms the diagnosis
Serum Test (eosinophilia)
X-ray

Treatment
Mebendazole
Pyrantel or Piperazine
Surgery
Hookworm Disease
- Also known Uncinariasis
- an infection of the upper intestine
caused by Ancylostoma Duodenale or
Necator Americanus
- most common in Southeast part of
United States
Signs and Symptoms
Earliest signs/ symptoms
irritation, pruritus, edema at the site
of entry
Late signs/ symptoms
Chronic infection, anemia,
cardiomegaly, heart failure,
generalized edema
Diagnosis
Stool exam
Serum test

Treatment
Antihelminthic (Mebendazole)
Iron supplements
Blastomycosis
- also called Gilchrist’s Disease
- a yeastlike fungal, Blastomyces
Dermatitidis, infection that infects the
lungs and produces bronchopneumonia.
- generally found in North America and
is endemic to the southeastern United
States
Signs and Symptoms
Pulmonary Blastomycosis
mimics URTI
Cutaneous Blastomycosis
small painless, nonpruritic macules
that may progress to draining skin
abscess
Skeletal Involvement
swelling, tenderness and warmth
over the bony lesion
 CNS Involvement
Meningitis
Cerebral Abscess
decreased LOC
Lethargy
Diagnostic Tests
Culture Test
Tissue Biopsy
Treatment:
Administration of Amphotericin B
Ketoconazole or Fluconazole

Nursing Special Considerations

5. In severe pulmonary blastomycosis,
check for hemoptysis.
6. For skeletal involvement, elevate the
joint and apply cold compress.
3. In CNS infections, watch the patient
carefully for decreasing LOC and
unequal pupillary response.
4. Administer medications as ordered.
ALERT:
Infuse IV amphotericin B SLOWLY
MONITOR VS (temperature)
WATCH for renal toxicity
Coccidiodomycosis
- also known as Valley Fever, San
Joaquin Valley Fever
- a primary respiratory infection caused
by a fungus, Coccidioides Immitis
- is usually self-limiting and rarely fatal
- endemic in southwestern United
States, especially San Joaquin Valley in
California and southwestern Texas
Cause:
Inhalation of the fungus found in the soil
in endemic areas or from inhalation of
spores from dressing or plaster casts of
infected person. It is common during
warm, dry months.
Signs and symptoms
Respiratory Tract infection symptoms
Diagnostic Test:
Culture Testing
X-Ray

Treatment
Bed rest
Supportive
Administration of Amphotericin B
Croup
- a severe inflammation and obstruction
of the upper airway that may occur as
acute laryngotracheobronchitis,
laryngitis, and acute spasmodic
laryngitis.
- a childhood disease (3 months – 3
years) common during winter time
Causes:
Croup usually results from a viral
infection (Influenza virus) and in some
cases bacterial infection.

Signs and Symptoms

Clinical Features:
Inspiratory stidor, hoarse or muffled
vocal sound, respiratory distress and a
sharp barking-like cough
Additional characteristics:
Laryngotracheobronchitis
Symptoms worsen at night
Difficulty during expiration
Laryngitis
Mild symptoms
No respiratory distress EXCEPT for
infants
Acute Spasmodic Laryngitis
common in children (1-3y.o.)
Associated with allergic reactions

Diagnosis
Based on the manifestations
Throat culture
X-ray (STEEPLE SIGN)
Treatment
Bed rest
Cool humidification during sleep
Antipyretics
Hospitalization (Respiratory distress)
Nursing Special Consideration
2. Monitor and support respiration and
control fever.
3. Carefully monitor cough and breath
sounds, hoarseness and
characteristics.
4. Keep the child as quiet as possible, but
avoid sedation
5. Position the patient in Fowler’s
position
5. Maintain a calm, quiet environment and
offer assistance
ALERT:
To relieve croupy spells, tell parents to
carry the child into the bathroom, shut
the door, and turn on the hot water.
Epiglotitis
- an acute inflammation of the epiglotis
that tends to cause airway obstruction.
- strikes children (2 to 8 y.o.)
- usually results from infection with
Haemophilus Influenzae Type B and
Pneumococci and GAS
Signs and Symptoms
Usually preceded by an URTI
High fever, stidor, sore throat,
dysphagia, irritability, restlesness,
inflammation of the epiglotis, Upper
airway obstruction (2 to 5 hours)
Hyperextension of neck, sit-up and
lean forward with mouth open,
tongue protruding and nasal flaring
Diagnosis
Throat examination (large, edematous,
bright red epiglottis)
Low Lateral Neck X-ray

ALERT: Have LARYNGOSCOPE and ET

TUBE available during the test. A trained
personnel should be on hand.
Treatment:
Antibiotic
Cephalosphorins
Penicillin
Quinolones
ET tube intubation
Tracheostomy
Oxygen therapy
Respiratory Support
Ebola Virus Infection
- a hemorrhagic fever due to an Ebola
virus that causes headache, malaise,
myalgia, and high fever, progressing
diarrhea, vomiting and internal and
external hemorrhage.
STRAINS: Ebola Zaire
Ebola Sudan
Ebola Tai
Ebola Reston
 - the prognosis for Ebola infection is
very poor, with mortality rate of 90%.
Incubation: 2 to 21 days
Cause:
Ebola Virus that is transmitted by direct
contact. The virus remains contagious
even after the patient has died.
Signs and Symptoms
Flu-like signs and symptoms
(appears first 3 days of infection)
Signs of mild thrombocytopenia
Maculopapular eruption (5th day)
Blisters slough off and blood seeps
from all body orifices and the patient
will vomit his own liquefied organs.
DEATH is common on the 2nd week
Diagnostic Test
Serum Testing

Treatment: NO CURE exists

Supportive Treatment only
Nursing Consideration
2. Follow the guidelines for strict
isolation precaution formulated by the
CDC
3. Check the results of CBC
4. Assess the patient daily for petechiae,
ecchymoses and oozing blood.
5. Protect all areas of petechiae and
ecchymoses from further injury
5. Test stools, urine, and vomitus for
occult blood.
6. Watch for frank bleeding
7. Monitor the patient’s family and other
close contact for fever and other signs
of infection.
CDC Guidelines :
2. Keep the patient in isolation
throughout the course of the disease
3. If possible, place the patient in a
negative pressure room at the
beginning of the hospitalization.
4. Restrict nonessential staff members
from entering the patient’s room.
4. Make sure that anyone who enters the
patient’s room wears gloves and a gown
to prevent contact with any surface in
the room that may have been soiled.
5. Use barrier precaution to prevent skin
and mucous membrane exposure to
blood or other body fluids, secretions
when caring for patients.
6. If you must come within 3 feet or 1
meter to the patient, also wear a face
shield or a surgical mask and goggles or
eyeglasses with side shields.
7. Don’t reuse gloves or gowns unless
they have been completely disinfected.
8. Make sure that patient who dies of the
disease is promptly buried or cremated.
Enterobiasis
- also called Pinworm, Seatworm,
Threadworm Infection, Oxyuriasis
- a benign intestinal disease caused by
the nematode Enterobius Vermicularis
- the most prevalent helminthic infection
in the United States
- common between 5-14 years old
Signs and Symptoms
Intense perianal pruritus (night)
Insomnia

Diagnosis
Based on the manifestation
Cellophane Tape Swab
Treatment
Pyrantel (discoloration stool & vomitus)
Piperazine
Mebendazole