BRUCELLOSIS

Other Name(s):

 Undulant Fever
 Malta Fever
 Gibraltar Fever
 Mediterranean Fever

Signs & Symptoms

Clinical Features:

 Dry Cough
 Headache
 Fever
 Lymphadenopathy
 Night Sweats
 Hepatosplenomegaly
 Weight Loss
 Malaise and Myalgia
 Arthralgia

Complications:

 Orchitis
 Meningoencephalitis
 Endocarditis
 Osteomyelitis
 Arthritis

Vector:

 Cattle
 Sheep
 Goats
 Pigs

Mode of Transmission:

1. Contact Infection
- Direct inoculation into skin by contact with infected
 Tissues
 Blood
 Urine
 Vaginal discharges & placenta
  Direct conjunctival inoculation
2. Food-borne
- Ingestion of contaminated raw milk
 Cheese (unpasteurized milk)
 Raw meat
 Raw vegetables
3. Air-borne
- Inhalation of infectious aerosols

INCUBATION PERIOD: Usually 1-3 weeks

Medical Management:

ANTIBIOTIC THERAPY

 Regimen A: Doxycycline (100mg) orally b.d. for 6 weeks +

Streptomycin (1g) intramuscularly o.d. for the first 14 – 21 days
 Regimen B: Doxycycline (100mg) orally b.d + Rifampicin (15 mg/kg)
orally o.d. for 6 weeks

Prevention in Humans:

: Protective measure
Personal hygiene
Pasteurization of milk
Vaccination: B. abortus strain 19-BA
Early diagnosis and treatment

Prevention in Animals:

: Environmental hygiene

Test and slaughter

Vaccination: B. abortus strain 19

Nursing Management:

 If the patient has draining lesions, perform wound care as ordered; keep suppurative
granulomas and abscesses dry.
 Adhere to standard precautions and appropriate infection control precautions as
indicated.
 Provide meticulous skin care as appropriate.
 Administer prescribed medications, such as oral rifampin and doxycycline. Give rifampin
on an empty stomach with a full glass of water 1 hour before or 2 hours after eating.
 Administer I.M. streptomycin deeply into a large muscle mass.
 Reassure the patient that the infection is curable.
  Encourage intake of fluids to maintain fluid balance; suggest intake of high-calorie foods
to prevent weight loss.
 Provide frequent rest periods to combat fatigue.
 Obtain specimens for laboratory testing, such as cultures and complete blood count.

BURULI ULCER

Transmission. The exact mode of transmission of M. ulcerans is still unknown.

Causative Agent. Mycobacterium ulcerans grows at temperatures between 29–33 °C The

organism produces a unique toxin mycolactone which causes tissue damage and inhibits the
immune response.

Signs and symptoms.Buruli ulcer often starts as a painless swelling (nodule). It can also initially
present as a large painless area of induration plaqueor a diffuse painless swelling of the legs,
arms or face edema. Local immunosuppressive properties of the mycolactone toxin enable the
disease to progress with no pain and fever. Without treatment or sometimes during antibiotics
treatment, the nodule, plaque or edema will ulcerate within 4 weeks with the classical,
undermined borders. Occasionally, bone is affected causing gross deformities.

Medical Management

Treatment consists of a combination of antibiotics and complementary treatments under

morbidity management and disability prevention/rehabilitation.

Antibiotics.Different combinations of antibiotics given for 8 weeks are used to treat the
Buruli ulcer irrespective of the stage. One of the following combinations may be used depending
on the patient:

a combination of rifampicin (10 mg/kg once daily) and streptomycin (15 mg/kg once daily); or

a combination of rifampicin (10 mg/kg once daily) and clarithromycin (7.5 mg/kg twice daily).

Nursing Management

Assess patient’s condition specifically wound healing process. Comfort the patient and family
members thus improve treatment compliance and outcome. Educate patient regarding diet and
personal hygiene. Register malnourished patient for supplementary nutrients. Encourage patient
to eat high calorie and protein foods. Encourage patient to increase fluid intake in not
contraindicated. Psychological support and education.

AFRICAN SWINE FEVER

-African swine fever (ASF) is a highly contagious hemorrhagic viral disease of domestic and wild
pigs, which is responsible for serious economic and production losses.

-It is caused by a large DNA virus of the Asfarviridae family, which also infects ticks of the
genus Ornithodoros.

-ASF is a disease listed in the World Organization for Animal Health (OIE) Terrestrial Animal
Health Code and must be reported to the OIE.

Signs and Symptoms

Clinical signs of African swine fever can be very variable. Most outbreaks are of mild to severe
disease. In severe outbreaks the incubation period is 5 to 7 days and pigs rapidly become
feverish. Many die after 7 to 10 days of illness with a variety of non-specific clinical signs
including haemorrhage. In "per acute" infections, the pigs die so rapidly that the only sign of
disease is sudden death.

Milder strains of the virus can cause less severe illness with a longer incubation period (5 to 19
days). The most serious “chronic” form is not usually seen in outbreaks - it is more likely to be
found in areas where the disease is endemic.

Signs are variable but will include some or all of the following:

 Vomiting

 Diarrhoea (sometimes bloody)

 Reddening or darkening of the skin, particularly ears and snout

 Gummed-up eyes

 Laboured breathing and coughing

 Abortion, still births and weak litters

 Weakness and unwillingness to stand

Although signs of ASF and classical swine fever (CSF) may be similar, the ASF virus is
unrelated to the CSF virus.

Vector / MOT:

African swine fever results from infection by the African swine fever virus, which belongs to the
genus Asfivirus in the family Asfarviridae. More than 20 genotypes of ASFV have been
identified, most from wildlife cycles in Africa.
African swine fever can be transmitted either with or without tick vectors as intermediaries. After
direct (non-tickborne) contact with the virus, ASFV is mainly thought to enter the body via the
upper respiratory tract. This virus has been found inall secretions and excretions of sick
domesticated pigs, with particularly high concentrations in oronasal fluid. There may, however,
be species differences among the Suidae. For instance, concentrations of ASFV appear to be
much lower in adult warthogs, compared to pigs, and adult warthogs might not transmit the virus
by direct contact. In pigs, aerosolized viruses may contribute to transmission within a building or
farm, although current evidence suggests that this only occurs over relatively short distances.
Because ASFV can persist in blood and tissues after death, it is readily spread by feeding
uncooked swill that contains tissues from infected animals.

Vector-mediated transmission is through the bites of Ornithodoros spp. soft ticks. In some
regions of Africa, ASFV is thought to cycle between juvenile common warthogs (Phacochoerus
africanus) and soft ticks of the Ornithodoros moubata complex, that live in their burrows.
Transstadial, transovarial and sexual transmission have been demonstrated in these ticks. A
similar cycle is thought to exist between domesticated pigs and the Ornithodoros moubata
complex ticks that colonize their pig pens in Africa. Ornithodoros erraticus acted as a biological
vector during an outbreak on the Iberian Peninsula in Europe, and additional species of
Ornithodoros have been infected in the laboratory. Ornithodoros spp. ticks are long-lived, and
colonies have been demonstrated to maintain ASFV for several years (e.g., 5 years in O.
erraticus).

Management:

There is no treatment for African swine fever, other than supportive care.

As no vaccine for ASF is available, the control of this disease is based on rapid laboratory
diagnosis and the enforcement of strict sanitary measures. Depending on the epidemiological
status of disease in a particular region, different measures are recommended.

Epizootiological studies have shown that the most frequent source of ASF contamination in
infection-free countries is refuse from international airports or ports. All leftover food from
aeroplanes and ships should be routinely incinerated or efficiently sterilised. Import policy for
animals and animal products should consider the disease status of the exporting nation. In
infected European areas such as Sardinia (Italy) where the disease is enzootic and where mild
or non-apparent clinical signs can be observed, the most important aspects of ASF prevention
are the control of animal movement and the use of extensive serological surveys to detect
carrier pigs. In endemic areas of Africa, the most important factor is to control the natural tick
vectors and wild pig reservoirs, and/or limit their contact with domestic pigs.
AMERICAN TRYPANOSOMIASIS (Chagas Disease)

Also called:
 New World Trypanosomiasis
 South American Trypanosomiasis
 Mal de Chagas
 Chagas-Mazza Disease
History:
- Discovered by DR. CARLOS CHAGAS on 1909.
- Geographically distributed in SOUTH and CENTRAL AMERICA

People at risk:
- Impoverished people
- Veterinarians, laboratory personels
- Wildlife handlers
- Hunters
- Travellers to endemic areas

Causative Agent: PROTOZOAN PARASITE --- Trypanosomacruzi

-susceptible to disinfectants, direct sunlight and other harsh environments

VECTOR-BORNE
Vectors:Triatomine insects
 Reduviid insects, kissing beetle/bug, assassin bug
- Multiple species capabale of transmission:
 Triatoma
 Rhodnius
 Panstrongylus

TRANSMISSION:
 Congenital – from pregnant woman to her baby
 Blood transfusions
 Organ Transplantation
 Consumption of uncooked food that is contaminated with feces from infected triatomine
bugs
 Accidental laboratory exposure
TAKE NOTE:
 ( breastfeeding is SAFE as long as no bleeding or wound on the nipples)
 NOT transmitted from person-person like cold, flu or casual contact with infected people

INCUBATION PERIOD:
- 5-14 days after exposure to the bugs infected feces
- 20-40 days after blood transfusion
- 5-40 years after infection (Chronic stage)
SIGNS/SYMPTOMS:
Acute Phase Chronic Phase
Asymptomatic or mild symptoms a few weeks Asymptomatic or mild symptoms for decades
or months or even lifetime
 Fever
 Fatigue 20-30 % may develop:
 Body aches
 Headache Cardiac complications
 Rash - Cardiomegaly
 Loss of appetite - Heart failure
 Diarrhea - Arrhythmias
 Vomiting - Cardiac arrest
Romañas Sign- the swelling of the eyelid Which may lead to death
- Swelling is due to bug feces
accidentally rubbed into the eye or the GI complications:
bite wound was on the same side of -Megaesophagus
the face as the swelling -Megacolon
Chagoma- swelling at the site of the bite
(where parasite entered the body) Which can lead to difficulties in eating and
Other signs: eliminating.
Mild enlargement of liver and spleen
Swollen glands

MEDICAL MANAGEMENT:
(NO VACCINES AVAILABLE YET)
- ANTIPARASITIC DRUGS
to kill the parasite
 Benznidazole (children 2-12 y.o) FDA approved
 Nifurtimox (still in CDC investigational protocol)
- SYMPTOMATIC TREATMENT
to manage the symptoms and signs of infection

NURSING MANAGEMENT:

- Proper assessment of disease prognosis.

- Sanitation and cleanliness in body, environment and food preparation/ingestion.
- Health education regarding disease prevention
FILARIASIS

Other Names:

 BancroftianFilariasis
 Filarial Elephantiasis
 FilariasisMalayi
 Malayi Tropical Eosinphilia
 Wuchereriasis

Signs and Symptoms:

 Some people with filariasis have no symptoms.

 Other affected individuals may have episodes of acute inflammation of lymphatic vessels
(lymphangitis) along with high temperatures, shaking chills, body aches, and swollen
lymph nodes.
 Excessive amounts of fluid may accumulate (edema) in the affected areas (i.e., arms
and/or legs), but the accumulation typically resolves after the other symptoms are gone.
 Attacks may also be accompanied by acute inflammation of the genitalia leading, in
males, to inflammation, pain and swelling of the testes (orchitis), sperm track (funiculitis),
and/or sperm ducts (epididymitis). The scrotum may become abnormally swollen and
painful.
 Bancroftianfilariasis affects both the legs and the genitals. The Malayan variety affects
the legs below the knees.
 Some people with filariasis have abnormally high levels of certain white blood cells
(eosinophilia) during acute episodes of symptoms. When the inflammation resolves,
these levels return to normal.
 Filariasis may cause chronic lymph node swelling (lymphadenopathy) even in the
absence of other symptoms.
 Longstanding obstruction of the lymphatic vessels may lead to several other conditions.
These include accumulation of fluid in the scrotum (hydrocele), the presence of
lymphatic fluid in the urine (chyluria), and/or abnormally enlarged lymphatic vessels
(varices).
 Other symptoms may include progressive edema (elephantiasis) of the female external
genitalia (vulva), breasts, and/or arms and legs. Chronic edema may result in skin that is
abnormally thick and has a “warty” appearance.

Vector/ Mode of Transmission:

 Most cases of filariasis are caused by the parasite known as Wuchereriabancrofti.

Culex, Aedes and Anopheles mosquitoes serve as vector for W.bancroftiin transmission
of the disease. Another parasite called Brugiamalayialso causes filariasis is transmitted
by the vector Mansonia and Anopheles mosquitoes.
 When an infected mosquito bites a healthy person, the larvae called microfilariae move
into the lymphatics and lymph nodes. Here, they develop into adult worms and may
persist for years.
  The adult parasite, in turn, produces more microfilariae. These microfilariae circulate in
the peripheral blood usually in the night, and are sucked by the mosquitoes during a bite.
The same cycle is then repeated in another healthy individual.

Medical Management:

 The recommended regimen for treatment of filariasis is mass drug administration

(MDA) in which a single dose of two medicines are given together – albendazole (400
mg) with either ivermectin (150-200 mcg/kg) in areas where onchocerciasis (river
blindness) is also endemic or diethylcarbamazine citrate (DEC) (6 mg/kg ) in areas
where onchocerciasis is not endemic. These medicines clear microfilariae from the
bloodstream.
 Though Lymphatic filariasis is treated with medicines, there is persistent abnormal
enlargement of body parts causing pain and severe disability. Associated social stigma
makes patients to suffer mentally, socially and financially. Elimination of lymphatic
filariasis is possible by stopping the spread of infection with mass drug administration
(MDA) and protection from mosquito bites and vector control measures.
 Surgery: In lymphatic filariasis, large hydroceles and scrotal elephantiasis are
manageable with surgical excision. Correcting gross limb elephantiasis with surgery is
less successful and may necessitate multiple procedures and skin grafting.
 In onchocerciasis, nodulectomy with local anesthetic is a common treatment to reduce
skin and eye complications.

Nursing Management:

 Educate Patient and relatives about the importance off the maintenance of good hygiene
of the affected part prevent the worsening of the lymphoedema and secondary bacterial
skin infections.
 The affected limb should be kept elevated and regular exercises should be done to
improve the lymph flow.

LEGIONELLOSIS

Other names:Legionellapneumophila or Legionnaires' disease

Signs and symptoms:The legionnaire’s disease symptoms usually begin 2 to 14 days after
exposure and include cough, shortness of breath, high fever, muscle aches, headaches, chest
pain, coughing up blood, fever, gastrointestinal symptoms (e.g., diarrhea, nausea, vomiting,
abdominal pain), general discomfort, joint pain, lack of coordination, loss of energy, shaking
chills, and muscle aches and stiffness. Because many of these symptoms resemble those of
pneumonia, the legionnaire’s disease may be difficult to diagnose. Possible complications
include lung failure and death
Vector/mode of transmission:Legionella spp. are found in water sources and can multiply in
stagnant water at some temperatures, usually between 25°C and 45°C. People become
infected by inhaling droplets, mist, or steam containing these bacteria species. The legionnaire’s
disease cannot not be spread from one person to another.Legionella spp. responsible for the
Legionnaire’s disease do not have animal reservoirs and/or vectors. As previously
specified, Legionella spp. grow best in warm water. For instance, these bacteria species are
likely to be found in hot tubs, cooling towers, hot water tanks, large plumbing systems, and
decorative fountain.

Medical management: There are three major classes of antibiotics that are effective in treating
a Legionella infection. These include the fluoroquinolones such as levofloxacin (Levaquin),
and moxifloxacin (Avelox), the macrolides such as erythromycin, azithromyocin (Zithromax),
and clarithromycin (Biaxin), and the tetracyclines including doxycycline (Vibramycin). A new
class of antibiotics (glycylcyclines) are also effective. The choice of antibiotic is often dependent
on the patient's clinical state, tolerance to the medication, and a health care professional's
degree of certainty as to the diagnosis. Zithromax and Levaquin are particularly effective
because of decreased gastrointestinal irritation, higher potency, better penetration into tissue,
and once-daily dosing.In severe cases of Legionnaires' disease that seem more resistant to a
single antibiotic, a second drug called rifampin (Rifadin) may be added. Hospitalization is

Nursing Management: Administer antibiotics, such as azithromycin or a quinolone, as ordered.

Monitor the patient for signs of respiratory distress. If he smokes, encourage him to stop. Teach
him how to manage the disease's potential long-term effects (joint pain, myalgia, loss of energy,
and difficulty concentrating), which can last up to a year.

LYMPHATIC FILARIASIS

Other Names: ELEPHANTIASIS/HUMAN LYMPHATIC DISEASE

3 CATEGORIES:

 Asymptomatic
 Acute
 Chronic

ASYMPTOMATIC

Signs and Symptoms:

 Showing no external signs of infection.

 Altered bodyimmune system.
 CHRONIC

Signs and Symptoms:

 Lymphoedema (tissue swelling)

 Elephantiasis (skin/tissue thickening of limbs)
 Hydrocele (scrotal swelling).
 Body deformities (breasts and genital organs)
 Permanent disorder
ACUTE

 Skininflammation
 Lymph nodes
 Chronic lymphoedemaor elephantiasis
 Orchitis ( testes)

VECTOR: Aedes mosquito, Culexmosquito and Anopheles.

Breeding Site: Leaf avils (water lilies),

Gabi, abaca & banana trees

MODE OF TRANSMISSION: Infected mosquitoes bite.

MEDICAL MANAGEMENT:

Mass Drug Administration (MDA) Recommended By WHO

 Albendazole (400 mg) alone twice per year for areas co-endemic with loiasis
 Ivermectin (200 mcg/kg) with albendazole (400 mg) in countries with onchocerciasis
 Diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg) in countries
without onchocerciasis
 Chemotherapy (recommended by WHO)

Dx Test:

 Immunochromatographic test (ICT)

 Filariasis Test Strip (FTS)
NURSING MANAGEMENT:

 Promote good hygiene

 Proper skin care
 Exercises
 Elevation of affected limbs
 Avoid mosquito bites

MYCOPLASMA INFECTIONS

Source: Mycoplasma bacteria

Causative Agent:

 Mycoplasma pneumoniae
 Mycoplasma genitalium
 Mycoplasma hominis
 Ureaplasmaurealyticum
 Ureaplasmaparvum

Mycoplasma pneumoniae

SYNONYM OR CROSS REFERENCE: Eaton agent, walking pneumonia, primary atypical

pneumonia, pleural atypical pneumonia

EPIDEMIOLOGY: M. pneumoniae occurs worldwide, but there are more cases in temperate
climates. There is a slight gender difference in certain age groups. Elderly individuals and
infants are less susceptible to pneumonia. Outbreaks tend to occur in late summer and early
fall, and there are cyclic epidemics every 3-5 years in civilian and military populations.

PATHOGENICITY/TOXICITY:M. pneumoniae is the cause of many upper respiratory tract

infections (50% of cases), including primary atypical pneumonia and tracheobrontitis. Those
infections may be followed or preceded by complication in 25% of patients. The majority of
infected patients are asymptomatic. The disease gradually develops, with a disease onset of
days to almost one month, and clinical manifestations include sore throat, hoarseness, fever,
cough (may be purulent), headaches, coryza, earache, myalgias, chills, and general malaise.
There may also be dyspnea and, in some cases, the cough may take on a pertussis-like
character. Some children may develop inflammation of the throat, cervical adenopathy,
conjunctivitis, and myringitis. Progression to pneumonia is rare for children under five years of
age, but common for those between 5 and 15 years old. Adults usually develop mild disease or
are asymptomatic; however, infection can be severe in the elderly or immunocompromised.
Individuals with co-morbid conditions, such as functional asplenia, sickle cells disease, and
other immunosuppressive states are at greater risk to develop more fulminant pneumonia and
joint infection. Complications may occur before, during, or after respiratory symptoms, and may
also occur without any respiratory syndrome. The most common complications involve the
central nervous system, and may include encephalitis (the most common), coma, optic neuritis,
diplopia, acute disseminated encephalomyelitis, mental confusion, cerebellar syndrome and
polyradiculitis, cranial nerve palsy, aseptic meningitis and meningoencephalitis, and acute
psychosis. Complications affecting the motor system include brachial plexus neuropathy, ataxia,
chorioathetosis, and ascending paralysis (Guillain-Barré syndrome). Erythematous
macropapular and vesicular rashes (25%), nonspecific myalgia, arthralgias and
polyarthropathies (14%), cardiac, gastrointestinal, renal complications, and ears symptoms may
also occur.

HOST RANGE: Humans are the only known host for M. pneumonia.

MODE OF TRANSMISSION: M. pneumoniae is principally transmitted by large droplet from

person-to-person and may be transmitted by fomites to those in close contact with an infected
person. As a result, secondary cases among close contacts are frequent, but since the
shedding period is long, contamination may take weeks.

INCUBATION PERIOD:4 to over 23 days.

COMMUNICABILITY: Transmission rates are high and M. pneumoniae will be shed in upper
respiratory infections for 2 to 8 days before onset of symptoms, and as long as 14 weeks after
infection.

RESERVOIR: Humans.

ZOONOSIS: None.

VECTORS:None.

FIRST AID/TREATMENT:Fluoroquinolones like levofloxacin or moxifloxacin, Macrolides such

as azithromycin or erythromycin, Tetracyclines like doxycycline.

IMMUNIZATION: Different vaccine strains have been used, but none have been successful at
protecting against infection

PROPHYLAXIS: None.

PREVENTION:Help protect yourself and others from Mycoplasma pneumoniae infection by

practicing good hand hygiene.Like many respiratory germs, Mycoplasma pneumoniae spread
by coughing and sneezing. Some tips to prevent the spread of M. pneumoniae include:

 Cover mouth and nose with a tissue when coughing or sneezing.

 Put used tissue in a waste basket.
 If tissue is unavailable, cough or sneeze into the upper sleeve or elbow, not the hands.
 Wash hands often with soap and water for at least 20 seconds.
 If soap and water are not available, use an alcohol-based hand rub.
Mycoplasma genitalium

SYNONYM OR CROSS REFERENCE: G37 strain, non-gonococcal urethritis (NGU), non-

chlamydial non-gonococcal urethritis (NCNGU), mucopurulent cervicitis (MPC).

EPIDEMIOLOGY: M. genitalium is of worldwide prevalence as it can be found in 1% of adults

between 18 and 27 years old and in 7% of women of all age. For women, multiple sexual
partners, miscarriage, smoking, and douching are considered risk factors.

PATHOGENICITY/TOXICITY: M. genitalium is the major cause of NGU and NCNGU in men,

with dysuria and/or non-spontaneous discharge. MPC is the female equivalent of NGU,
characterized by the presence of yellow or green exudates from the cervix. M. genitalium is also
suspected to be a cause of pelvic inflammatory disease, which is an inflammation of the
feminine upper genital tract, with pelvic pain, abnormal vaginal discharge, itching, bleeding
and/or odour. M. genitalium infections may be asymptomatic. M. genitalium may play a minor
role in bacterial vaginosis, adverse outcomes of pregnancy, and infertility. M. genitalium is also
known to facilitate HIV transmission.

HOST RANGE:Humans are the only known host for M. genitalium, although colonization in
other animals is theoretically possible.

MODE OF TRANSMISSION: M. genitalium is principally transmitted by sexual contact.

INCUBATION PERIOD:Unknown.

COMMUNICABILITY:Person-to-person transmission occurs primarily through sexual contact,

although the transmission rates are low.

RESERVOIR: Humans; animals may theoretically contain the pathogen.

ZOONOSIS: No zoonotic transmissions have been reported for this pathogen, but it is
theoretically possible.

VECTORS: None.

FIRST AID/TREATMENT:Administer appropriate drug therapy. Azithromycin treatment is often

well-tolerated by patients and yields good results in eradicating pathogens for nongonococcal
urethritis.
IMMUNIZATION:None available.

PROPHYLAXIS: None available.

PREVENTION:Use a condom during sex.The partner may need to get treated, too.

Mycoplasma hominis

SYNONYM OR CROSS REFERENCE:Pelvic inflammatory disease (PID).

EPIDEMIOLOGY: This pathogen occurs worldwide. Immunocompromised patients and patients

with agammaglobulinemia or who are receiving immunosuppressive drugs are particularly at
risk. M. hominis does not usually persist in children after birth, but 17% of prepubescent girls are
infected with this bacterium. Most infections are acquired by sexually active adults, and the risk
of colonization increases with the number of partners. Women are more frequently colonized
(80%) than men (50%).

PATHOGENICITY/TOXICITY: M. hominis may be implicated in several diseases, although its

role is unclear for most of them. There is evidence indicating that M. hominis may be implicated
in pelvic inflammatory disease, which may cause ectopic pregnancy. This bacterium prospers in
the environment created by other gram negative bacteria implicated in bacterial vaginosis and
may be a cause of preterm delivery and miscarriage. It may also be implicated in postpartum
fever, because it may be a cause of endometritis. M. hominis is also suspected to be the cause
of neonatal infections, including conjunctivis, respiratory distress, fever, meningitis, abscesses,
and congenital pneumonia, which occurs a few hours after birth. In adults, M. hominis may be
implicated in pharyngitis, septicaemia, lung infections, central nervous system infections, other
respiratory tract infections, joint infection, and wound infections. M. hominis infections are rare
for healthy adults.

HOST RANGE: M. hominis can colonize humans and non-human primates.

MODE OF TRANSMISSION: M. hominis is principally transmitted by sexual contact and

cervical and vaginal contact during birth. Infections in utero are rare but possible.

INCUBATION PERIOD:Unknown.

COMMUNICABILITY:Vertical transmission from mother to baby is high.

RESERVOIR:Humans and non-human primates may contain the pathogens.

ZOONOSIS: No zoonosis have been reported for this pathogen, but it is theoretically possible.

VECTORS: None.

FIRST AID/TREATMENT: Tetracycline family, like doxycycline.

IMMUNIZATION:None available.
PROPHYLAXIS: Clindamycin may be given early in pregnancy for infected women in order to
avoid neonatal infection, but the efficacy of this treatment is disputable.

PREVENTION:To help keep this infection away, always use a condom during sex and limit sex
partners.

Ureaplasmaurealyticum and Ureaplasmaparvum

SYNONYM OR CROSS REFERENCE:Non-gonococcal urethritis (NGU), non-specific urethritis

(NSU), genital mycoplasma.

EPIDEMIOLOGY:Worldwide – can be found in the genitourinary tract (mucosal surfaces of the

cervix or vagina) of 40 – 80% of sexually active women, many of whom are healthy and
asymptomatic. They can also be found in the urethra of males, but at lower prevalence.
Colonization is associated with young age (under 20), lower socioeconomic status, sexual
activity with multiple partners, African-American ethnicity, and use of oral contraceptives.

PATHOGENICITY/TOXICITY: U. urealyticum and U. parvum are etiologic agents of persistent

non-gonococcal urethritis (characterized by urethral discharge), non-chlamydial urethritis,
stillbirth or premature delivery, postpartum bacteremia, postpartum endometritis,
chorioamnionitis, spontaneous abortion, perinatal morbidity and mortality, pneumonia, and
wound infection post-caesarean section. Common symptoms include dysuria, hypogastric
pains, meatal swelling in both sexes, and urethrorrhoea. Infection has also been linked to the
development of neonatal pneumonia, chronic pyelonephritis, infertility, prostatitis, epididymitis,
chronic urethrocysititis, urinary calculi, low weight in neonates, meningitis, chronic lung disease
(also known as bronchopulmonary dysplasia, BPD), aortic graft infection, extragential diseases
(including arthritis), subcutaneous intrarenal abscess in adults, and there is a speculated
connection to Reiter’s syndrome.

HOST RANGE:Humans.

MODE OF TRANSMISSION:Spread of the bacteria is commonly through sexual contact.

Infected females may transmit the bacteria to the fetus or neonate by three routes: ascending
intrauterine infection, through a haematogenous route by the umbilical cord, or passage through
an infected maternal birth canal that can result in colonization of the neonate skin.

INCUBATION PERIOD:10-20 days after sexual transmission.

COMMUNICABILITY: May be transmitted for person-to-person, including from mother to

neonates through birthing process.

RESERVOIR:Humans, women may be asymptomatic reservoirs.

ZOONOSIS:None.

VECTORS:None.

FIRST AID/TREATMENT:Administer proper drug therapy. Erythromycin in divided doses can

be used as intravenous treatment for preterm neonates. A pilot study showed 11 neonates
completing the treatment in 7 days; however, side effects may include hypertrophic pyloric
stenosis, cardiac toxicity, and hepatotoxicity. A minimum treatment of 10 – 14 days is optimal.

IMMUNIZATION:No vaccines are currently available.

PROPHYLAXIS:None currently available. Antibiotics such as erythromycin can be used to

decrease incidence of diseases caused by infection, such as histologic chorioamnionitis, and
increase the latency period.

PREVENTION:The only way to prevent a Ureaplasma infection is abstinence. Practicing safe

sex will significantly reduce your risk of infection from this and other sexually transmitted
diseases (STDs). Birth control doesn't prevent STDs. You'll need to use barrier methods
like condoms and dental dams to help prevent infection.

NIPAH VIRUS

Other NAMES: Family of Paramyxoviridae, genus Henipavirus

Signs and Symptoms:

Earliest:

 fever

 headache

 drowsiness and disorientation characterized by mental confusion respiratory symptoms

early on.

Late:

 inflammation of the brain (encephalitis)

 progress to coma within 24 to 48 hours and then death.

 causing long term illness in some patients that survive, including persistent convulsions
and personality changes.

Vector mode or Transmission:

Transmission has occurred in humans through direct contact with infected bats, pigs, horses,
infected tissues and infected people. Person-to-person spread is most likely to occur in
family members and caregivers of sick individuals. Modes of transmission are still being
investigated

Medical Management:

 No drug treatment has been proven to be effective in treating Nipah infection.

 Health care providers may offer supportive therapy (i.e., rest, fluid intake) to help
manage symptoms.

 Antiviral drug, ribavirin, can reduce the duration of fever and the severity of disease.
However, how well this treatment cures the disease or improves survival is still
uncertain.

Nursing Management:

 Educate to avoid animals that are known to be infected

 Use appropriate personal protective equipment devices

 People in affected countries should also avoid eating or drinking date palm sap.

RABIES

Other names:

- mad dog disease

- Hydrophobia

Signs and symptoms

Incubation period for rabies is typically 2–3 months but may vary from 1 week to 1 year,
dependent upon factors such as the location of virus entry and viral load.

- Tingling
- Prickling
- itching feeling around the bite area

(flu- like symptoms such as )

- fever
- headache
- muscle aches
- loss of appetite
- Nausea
- Tiredness

As the virus spreads to the central nervous system, progressive and fatal inflammation of the
brain and spinal cord develops
 -Hyperactivity
-excitable behavior
-hydrophobia (fear of water)
-Aerophobia (fear of drafts or of fresh air).
-Death occurs after a few days due to cardio-respiratory arrest.

This form of rabies runs a less dramatic and usually longer course than the furious form.
Muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly
develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed,
contributing to the under-reporting of the disease.

Mode of transmission

 Through the bite and virus-containing saliva of an infected host.

Saliva – comes into direct contact with human mucosa or fresh skin wounds
 contamination of mucous membranes (i.e., eyes, nose, mouth)

Medical management:

 A fast-acting shot (rabies immune globulin)

to prevent the virus from infecting you. Part of this injection is given near the
area where the animal bit you if possible, as soon as possible after the bite.

Nursing management

Assessment:

 Ask for a history of bite by an animal

 Assess whether he has undergone immediate prophylactic measures
 Assess for characteristics like photophobia hydrophobia etc.
 Check for the presence of antigen/
SEXUALLY TRANSMITTED DISEASE

 Gonorrhea ( Neisseria Gonnorhea, Gonococal Infection )

 Sign and Symptoms: ( Women)

 Increased vaginal discharge
 Painful urination
 Vaginal bleeding
 Painful intercourse
 Abdominal or pelvic pain

 Sign and Symptoms: (Men)

 Burning with urination
 Discharge form the penis
 Testicular pain

 Mode of Transmission:
 Through sexual contact

 Medical Management:
 Ceftriaxone
 Cefixime
 Spectinomycin
 Partner should also get treatment for gonorrhea, even if he/she has no
signs or symptoms.

 Nursing Management
1. Administer ceftriaxone IM as ordered.
2. Emphasize the need regular of Papsmear and pelvic examinations because the
family history of ovarian cancer.
3. Discuss the feelings and concern about the diagnosis of gonorrhea.
4. Teach how to talk with future sexual partner about condom use.

 Syphilis ( Treponemmapallidum )

 Sign and Symptoms:

 PRIMARY STAGE
 Chancres on the vulva ( outside the vagina) or on the cervix
 Chancres on the penis in men
 Chancres around the anus and mouth
 The sores may also hide deep in your vagina, under your foreskin, inside
your rectum, and other places that are hard to see.
 SECONDARY STAGE
 Non- itchy rash
 Oral, anal, and genital warts-like sores
 Muscle aches
 Fever
 Sore throat
 Swollen lymph nodes
 Patchy hair loss
 Headaches
 Weight loss
 Fatigue

 LATE OR TERTIARY STAGE

 Damage to the heart, blood vessels, liver, bones and joints
 Gums or soft tissues swelling that occur anywhere in the body.

 Mode of Transmission: Direct Contact

 Medical Management

1. Penicillin drug of choice to treat syphilis.

2. Doxycycline drug of choice for treating primary, secondary and tertiary
syphilis.

 Nursing Management
1. Establish a sexual history, including the number of sexual partners and whether the
patient wasprotected by a condom.
2. Question the patient about intravenous (IV) drug use and previous STIs.
3. Establish a history of fever, headaches, nausea, anorexia, weight loss, sore throat,
mild fever,hair loss, or rashes, symptoms of the primary and secondary stages.
4. Carefully inspect the patient’s genitalia, anus, mouth, breasts, eyelids, tonsils, or
hands for aprimary lesion. With female patients, be sure to determine if chancres
have developed oninternal structures such as the cervix or the vaginal wall.
5. Also inspect the scalp, skin, and mucous membranes for hair loss, rashes, or mucoid
lesions,which are characteristic of the secondary stage.
6. Assure the patient that her or his privacy and confidentiality will be maintained
duringexamination, diagnosis, and treatment, although all sexual partners need to be
notified so thatthey can be examined and treated as needed.
 Candidiasis ( Candida Albicans )
 Sign and Symptoms:

 White patches on the tongue

 Esophagitis
 Cutaneous Candidiasis
 Vaginal yeast infections
 Deep candidiasis

 Mode of Transmission: Mother to infant through childbirth

 Medical Management
1. The use of antibiotics or birth control pills can promote yeast infections.
2. Doctors treat thrush with topical, antifungal medications such as nystatin
(Mycostatin and others) and clotrimazole. For mild cases, a liquid version of
nystatin can be swished in the mouth and swallowed, or a clotrimazole
lozenge can be dissolved in the mouth. For more severe cases, fluconazole
(Diflucan) can be taken once a day by mouth.
3. Candida esophagitis is treated with an oral anti-fungal drug such as
fluconazole.
4. Can be effectively treated with a variety of antifungal powders and creams.
The affected area must be kept clean and dry and protected from chafing.

 Nursing Management
1. Avoid soap and just rinse with water to clean.
2. Avoid douching.
3. Allow more air to reach the genital area. Wear clean, preferably white,
cotton underwear. Wearing loose-fitting clothes and not wearing panty
hose.
4. Not wearing underwear at night when sleeping.

 Herpes Simplex Virus ( HSV-1, HSV-2)

 Sign and Symptoms:
 fever and flu-like symptoms.
 nausea or feeling sick.
 muscle aches.
 painful urination.
 tingling, burning or itching sensation in the area where blisters will appear

 Mode of Transmission: Direct skin to skin contact

 Medical Management
 1. Acyclovir ( Zovirax)
2. Famciclovir ( Famvir)
3. Valacyclovir ( Valtrex)

 Nursing Management
1. Assess the client’s description of pain or discomfort: severity, location,
quality, duration, precipitating or relieving factors.
2. Assess for nonverbal signs of pain or discomfort.
3. Wear loose, nonrestrictive clothing made of cotton.
4. Apply cool, moist dressings to pruritic lesions with or without Burrow’s
solution several times a day. Discontinue once the lesions have dried.
5. Avoid temperature extremes, in both the air and bathwater.
6. Avoid rubbing or scratching the skin or lesion.
7. Use topical steroids (anti-inflammatory effect), anti-histamines (anti-
itching effect, particularly useful at bedtime), and analgesics

HIV/AIDS

 Sign and Symptoms:

 Rapid weight loss.
 Recurring fever or profuse night sweats.
 Extreme and unexplained tiredness.
 Prolonged swelling of the lymph glands in the armpits, groin, or neck.
 Diarrhea that lasts for more than a week.
 Sores of the mouth, anus, or genitals.
 Pneumonia

 Mode of Transmission:
 Unprotected sex( anal sex)- men having sex with men.
 Blood transfusion
 Needle sharing
 Trans placental
 Breastfeeding
 Needle pricks

 Medical Management
 Antibody Test
 ELISA- diagnostic only
 Western Blot- confirmatory
  CD4 T cell count- CD4 T cells are white blood cells that are specifically targeted
and destroyed by HIV. Even if you have no symptoms, HIV infection progresses
to AIDS when your CD4 T cell count dips below 200.

 Viral load (HIV RNA)-This test measures the amount of virus in your blood. A
higher viral load has been linked to a worse outcome.

 Nursing Management
1. Reverse Isolation with blood precaution and standard precaution.
2. Monitor for viral load. <400-normal, no circulating virus, not contagious.
>400-with circulating virus. Highly communicable.
3. Health teaching on lifestyle
 Exercise can increase CD4
 Healthy diet
 Avoid smoking/ alcoholism
 Avoid stress.
3. Perform contact tracing. Trace partner so that they can undergo treatment.
4. Do not allow breastfeeding.
5. For infants infected- do not vaccinate with live vaccines.
6. Give Bactrim ( Sulfamethazole).

CHIKUNGUNYA VIRUS

 Sign and Symptoms:

 Fever
 Joint pain
 Muscle aches
 Joint swelling
 Rash
 Headache
 Mode of Transmission:Human by infected Aedes mosquitoes

 Medical Management:

1. Get plenty of rest.

2. Drink fluids to prevent dehydration.

3. Take medicine such as acetaminophen (Tylenol®) or paracetamol to reduce fever and pain.

4. Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS until dengue
can be ruled out to reduce the risk of bleeding).
5. If you are taking medicine for another medical condition, talk to your healthcare provider
before taking additional medication.

6. Administration of non-steroidal anti-inflammatory drugs help in relieving pain. Antiviral drugs

like acyclovir are also given (but given only in complicated cases as prescribed by doctor).

 Nursing Management:
1. Wear long sleeves and pants.
2. Secure screen on windows and doors to keep mosquitoes out.
3. Monitor vital sings carefully and keep record.
4. Obtain frequent temperature reading and record it.
5. Check color, features of rash and temperature of skin.
6. Observe for shivering and diaphoresis.
7. Ensure tepid sponging of whole body to reduce temperature.
8. Maximize heat loss by minimizing external covering of patient’s body and ensuring
adequate ventilation.
9. Give antipyretic as per doctor order and check persons with no preexisting liver or
kidney disease.
10. Inform patient to avoid self-medication with aspirin or other pain killers

RUBELLA AND RUBEOLA

Other name: Measles

Sign and Sypmtoms: Fever, rashes and symptoms of referable to upper respiratory tract; the
eruption is preceded by about 2 days of coryza, during which stage grayish pecks (koplik spots)
may be found on the inner surface of the cheeks. A morbilliform rash appears on 3rd or 4th day
affecting face, body and extremities ending in branny desquamation.

Vector/ Mode of transmission: Filterable virus of measles. Mode of transmission is by droplet

spread or direct contact with infected persons or indirectly through articles freshly soiled with
secretions of nose and throat.

Medical Management:

Emphasize the need for immediate isolation when early catarrhal symptoms appear.

 Observe closely the patient for complications during and after the acute stage.

 Teach concurrent and terminal disinfection.

Nursing Management: Protect eyes of patients from glare of strong light as they are appointed
to be inflamed. Keep the patient in an adequate ventilated room but free from drafts and
chilling to avoid complications of pneumonia. Teach, guide and supervise correct technique of
giving sponge bath for comfort of patient. Check for corrections of medication and treatment
prescribed by the physician.
YELLOW FEVER
 is an acute viral haemoorhagic disease transmitted by infected mosquitoes.

Other Names: Flaviviridae

Signs and Symptoms:

Fever
Headache
Muscle aches, particularly in the back and knees
Sensitivity to light
Nausea and Vomiting
Loss of Appetite
Dizziness
Red eyes, face or tongue

Signd and symptoms of illness appears abruptly 3 to 6 days after the bite of an infected
mosquito. Characterized by the following 3 stages: Period of infection, prriod of remission, and
period of intoxication.

Ist stage: 3-4 days

Patient is febrile and presents with malaise, headaches, photophobia, lumbosacral pain, pain in
the lower extremities and nause/vomiting

2nd stage: Last up to 48 hours.

Fever and other signs and symptoms typically subside. Although many patients recover after
this stage, about 15% will progress to the third stage.

3rd stage:
Beginning on day 3 to 6 after the onset of infection, the period of intoxication is characterized by
returning signs and symptoms including fever, nausea and vomiting, epigastric pain, jaundice,
oliguria, hemorrhagic diathesis and possibly organ failure.

Vector/ Mode of transmission:

The female Aedes and Haemagogus mosquitoes transmit the virus via saliva entering a bite
wound. In the first 3 to 4 days following an infectious bite, the virus can be spread to other
mosquitoes that bite the infected host. From there, the cycle of infection continues. Yellow fever
isn't directly passed from person to person. Monkeys and humans serve as the primary hosts for
the virus.

Medical Management:

Care for the patient with yellow fever is mainly supportive because no specific antiviral therapy
is currently available. Rest, fluids, analgesics and antipyretics as early interventions may
improve the patient's prognosis. However, medications that increase the risk of bleeding, such
as aspirin and nonsteroid anti-inflammatory drugs should always be avoided as they may
compound the disease's hemorrhagic effects. Additional treatment options can include
supplemental oxygen, endotracheal intubation, enteral or parenteral nutrition, vasoactive
medications, fresh frozen plasma, dialysis and treatment for secondary infections if necessary.
Nursing Management:

1. Recommend using insect repellent

2. Wearing protective clothing and vaccination
3. Remind patients the importance of vaccinations alerts when traveling
4. Assess patients with a history of travel or recent immigration for signs and symptoms of
yellow fever such as fever, headache, myalgia, nausea and vomiting and fatigue.

HERPES SIMPLEX VIRUS

Sign and Sypmtoms:

 a blister or as multiple blisters on or around affected areas, usually the mouth, genitals, or
rectum. The blisters break, leaving tender sores.

Vector/ Mode of transmission:

 Type 1 - contact with saliva of carriers, infection of hands of health care personnel
 Type 2 - usually by sexual contact; infected secretions from symptomatic or
asymptomatic individuals

INCUBATION PERIOD: HSV-1: 7-10 days; Primary genital HSV-2: 2 -12 days

Medical Management:

Although there is no cure for herpes, treatments can relieve the symptoms. Medication can decrease
the pain related to an outbreak and can shorten healing time.

 Famvir (Famciclovir)
 Acyclovir (Zovira)
 Valtrex (Valacyclovir)

Warm baths may relieve the pain associated with genital sores.

Nursing Management:

Health Teaching for the following:

1. abstain from sexual activity whilst experiencing symptoms of genital herpes

2. The consistent and correct use of condoms can help reduce the risk of spreading genital
herpes
3. Pregnant women with symptoms of genital herpes should inform their health care
providers. Preventing acquisition of a new genital herpes infection is particularly
important for women in late pregnancy, as this is when the risk for neonatal herpes is
greatest.
4. Additional research is underway to develop more effective prevention methods against
HSV infection, such as vaccines or topical microbicides