SYNONYMS CAUSATIVE MODE OF INCUBATION CLINICAL DIAGNOSTIC NURSING MEDICAL MANAGEMENT

AGENT TRANSMATION MANIFESTATION INTERVENTIONS

TYPHOID • Enteric fever • Salmonella • Fecal-oral • 1-3 weeks, Prodromal Stage- • Blood culture- • Maintenance of • Antibiotics:
FEVER enterica serotype route average of 2 microorganism travel in done during fluid and electrolyte chloramphenicol – drug of
• Infection of typhi and, to a ingestion of weeks bloodstream prodromal stage imbalance choice. 100mg/kg in 4 doses
lymphoid lesser extent, S contaminated • Period of • Fever, dull (1st week). show - Proper regulation of for 14 days. (Side effect is
tissue enterica food, milk, Communicability headache, S typhi bacteria IVF bone marrow depression)
(Peyer’s serotypes Para and water variable (if the abdominal pain, • CBC- will show a - Adequate fluids • Ceftriaxone- injectable
patches) typhi A, B, and C • 7 F’s – patient is nausea and high number of - Assess for the sign of antibiotic is an alternative in
• Endemic and • Salmonella fingers, feces, excreting the vomiting, diarrhea, white blood cells. dehydration more complicated or serious
epidemic typhosa flies, food, microorganism) or constipation. • Widal Test – • Maintenance of infections and for people
fomites, antibody test nutrition who may not be candidates
fluids/water, Fastidial/Pyrexial - Becomes - High calorie, low for ciprofloxacin, such as
and Stage- organism has positive on the residue diet children.
fields/floor. reached Peyer’s 2nd week. Range - Do not give milk • cefixime
patches is more than or which can lead to • Ciprofloxacin- often
• 3 Clinical Features equal to 1:160 increase acidity and prescribe this for non-
of Typhoid titre for antigen O diarrhea pregnant adults.
Presence of Rose and antigen H, • Isolation of patients • Azithromycin- used if a
Spots (abdomen and then it indicates • Vital signs must be person is unable to take
chest)- only symptom typhoid infection. recorded ciprofloxacin or the bacteria
specific to typhoid. • Typhidot- ELISA accurately. is resistant to ciprofloxacin.
-Blanching pink kit that detects • Intake and output • IVF to correct dehydration or
macular spots 2-3 mm IgM and IgG must be accurately fluid imbalance.
over trunk antibodies. measured • Paracetamol for the fever
Ladderlike fever Becomes positive • Concurrent • Oral therapy rehydration
Splenomegaly after 2-3 days of disinfection. (oresol, hydrates).
infection
Defervescence Stage • Stool culture – PREVENTION: PREVENTION:
• Intestinal done on the 2nd • Protect / Purify • An injectable typhoid
Hemorrhages- week. water supplies conjugate vaccine (TCV),
melena, • Fluorescent • Proper excreta consisting of Vi
hematochezia antibody- study disposal polysaccharide antigen
- Avoid dark-colored to look for • Hand washing linked to tetanus toxoid
foods substances that • Proper preparation protein licensed for children
• Intestinal are specific to S and handling of from 6 months of age and
Perforation- typhi bacteria. food adults up to 45 years of age.
peritonitis • Avoid eating fresh • An injectable unconjugated
- Sudden, severe, and uncooked polysaccharide vaccine
abdominal pain, vegetables and based on the purified Vi
persistence of fever, fruits in endemic antigen (known as Vi-PS
rigid abdomen areas vaccine) for persons aged
• Do not put anything two years and above.
Lysis/Convalescence- • An oral live attenuated
in your mouth.
s/s will subside Ty21a vaccine in capsule
 • patient should be formulation for those over
watched because six years of age.
patient may • CDT Immunization
develop relapses. -adults: 0.5 cc IM deltoid
-children: <10 years old 0.25cc
MODULE: IM deltoid
• A-anorexia *6 months immunity.
• B-bradycardia • Vivotif- in capsule form
• C-constipation - 3 doses: 1 hour before meal q
• D-diarrhea other day.
• D-develop skin - 3 years immunity
eruption on the •
abdomen, back and
chest (ROSE
SPOTS)
• E-enlarge spleen
• F-fever and chills
• G-generalize body
weakness
• H-headache

(3) cardinal signs of

Pyrexial stage of
Typhoid Fever are:
• Rose Spots
• Enlargement of the
Spleen
(Splenomegaly)
• Fever (REF).
CHOLERA • El Tor and • Vibri coma or • Fecal oral • Few hours to 5 • Mild diarrhea that • Stool or vomitus • Assess patient for • Correct of dehydration and
• Infection of Violent Vibrio cholerae route days (average becomes culture signs of fluid imbalance and
intestine Dysentery serogroup • 7 Fs – foods, of 3 days) voluminous • Serum dehydration and antibiotics of tetracycline as
• Major fluids, fingers, • Symptoms • Rice-watery stool electrolytes complications. drug of choice.
epidemic feces, typically appear (pathognomonic • Dark field or • Observe enteric • CDT immunization
fomites, in 2-3 days. sign) phase precautions • Single-dose live oral cholera
fields, flies • Period of • Washer woman’s microscopy (feces). vaccine called Vaxchora®
communicability hands (wrinkled) • Increase oral fluid (lyophilized CVD 103-HgR)
is as long as • Effortless vomiting intake. for adults 18 – 64 years old
microorganisms • Cramping of the who are traveling to an area
are present in extremities of active cholera
the bowel (hypokalemia)
excreta. • Signs of severe PREVENTION:
dehydration. All people (visitors or residents)
• Oliguria in areas where cholera is
occurring or has occurred
 • Glassy or sunken should observe the following
eyes recommendations:
• Weak and thready • Drink only bottled, boiled, or
• Somnolence chemically treated water and
(sleepiness) bottled or canned
• Coma carbonated beverages.
• When using bottled drinks,
3 deficits during make sure that the seal has
Cholera: not been broken
• Severe dehydration • To disinfect the water to
and ECF volume drink: boil for 1 minute or
deficit filter the water and add 2
• Hypokalemia drops of household bleach
• Metabolic acidosis or ½ an iodine tablet per liter
of water
• Avoid tap water, fountain
drinks, and ice cubes.
• Wash the hands often with
soap and clean water
• If no water and soap are
available, use an alcohol-
based hand cleaner (with at
least 60% alcohol)
• Clean the hands especially
before eating or preparing
food and after using the
bathroom
• Eat foods that are packaged
or that are freshly cooked
and served hot.
• Do not eat raw or
undercooked meats and
seafood, or raw or
undercooked fruits and
vegetables unless they are
peeled.
• Dispose of feces in a
sanitary manner to prevent
contamination of water and
food sources
DYSENTERY • Bacillary • Bacillary • Fecal oral Amoebic Bacillary Dysentery: Amoebic • Control of fever Amoebic dysentery:
Dysentery- Dysentery: route dysentery: • +/- fever dysentery: • Maintenance of • Antibiotics of metronidazole
Shigellosis/ Shigella • 7 Fs – foods, • Symptoms • +/- vomiting • Fecal samples- fluid and electrolyte as drug of choice for treating
bloody flux dysenteriae fluids, fingers, within 2-4 • Abdominal pain several stool balance infection.
-three (3) strains feces, weeks (colicky or samples from Oral Rehydration Salt • Practices good personal
Shigella flexneri, cramping) (ORS) hygiene.
• Violent Shigella boydii, and fomites, Bacillary • Diarrhea with several different • NaCl, Sodium • Thorough handwashing with
Dysentery- Shigella sonnei. fields, flies dysentery: tenesmus days Bicarbonate, soap and water after using
Cholera • Violent • 1 to 4 days. • Mucoid stool • Blood test- only Potassium the toilet
• Amoebic Dysentery: vibrio • Blood streaked if recommended Chloride, Glucose • Shigellosis: Co-trimoxazole
Dysentery- cholerae/comma Acute - can severe when the health • Given in large (drug of choice),
Amoebiasis • Amoebic present as diarrhea • Rectal prolapse care provider amounts as ciprofloxacin
Dysentery: (watery foul • Diarrhea which thinks that there tolerated and the • Cholera: Co-trimoxazole,
entamoeba smelling) with often bloody is an infection amount of intake Tetracycline, Ciprofloxacin
histolytica tenesmus, may spread and loss should be • Amoeba: Metronidazole
frequent, small, and Violent Dysentery: beyond intestine. recorded.
often blood • Massive or profuse • Stool Mild dehydration- Preventive Measures:
streaked stools. diarrhea, Examination mild oral mucous • CDT Vaccine
continuous Amoebiasis membranes and (Cholera/Dysentery/Typhoid)
Chronic- can • Rice watery stool (stool should be increased thirst- -6 months immunity – given
present with • Signs of severe fresh within 30 • 50ml/kg over a 4- only on outbreaks.
gastrointestinal dehydration: minutes to one hour interval • Personal hygiene -
symptoms plus sunken eyeball, hour to find Moderate handwashing
fatigue, weight loss +skin fold sign, trophozoites) dehydration- sunken • Environment sanitation –
and occasional wrinkling of • Cholera – dark eyes, loss of skin boiling of water, protect food
fever, fingertips (Washer- field microscopy turgor, increased from flies
hepatomegaly woman’s hand) of fresh stool thirst, dry oral mucous
• Vomiting, • Rectal Swab – membrane- 100ml/kg To prevent the spread of
Extraintestinal- for cholera and over a 4-hour interval shigella:
Abdominal cramps
can occur if the
• Shock, acidosis, shigellosis Severe dehydration – • Wash hands frequently and
parasite spreads to IVF thoroughly.
hypokalemia
other organs, most
• Supervise small children
commonly the liver NURSING ALERT-
Amoebic Dysentery: when they wash their hands.
where it causes Sports drinks do not
• Often mild • Dispose of soiled diapers
amoebic liver replace fluid losses
abscess • +/- fever properly.
correctly and should
Abcess may break • +/- vomiting • Disinfect diaper changing
not be used.
through the lungs • Abdominal pain areas after use.
• Diarrhea with • Don't prepare food for others
by coughing • Avoid drugs
“anchovy sauce” tenesmus if you have diarrhea.
intended to treat
sputum alternated with • Keep children with diarrhea
diarrhea, such as
constipation home from childcare, play
loperamide
• Muco-purulent (Imodium) or
groups or school.
blood-streaked atropine (Lomotil) • Avoid swallowing water from
stool. ponds, lakes or untreated
• May affect brain, pools.
liver, lungs • Avoid sexual activity with
• Stomach cramping anyone who has diarrhea or
who recently recovered from
diarrhea.
VERAL Hepatitis A: • Viral infection Hepa A: Hepa A: Hepa A: • Liver function Hepa A: Hepa B:
HEPATITIS • Infectious • Autoimmune • Fecal oral • 15–50 days • with or without Test- determine • rest • alpha-interferon as the
• Inflammatory hepatitis, hepatitis route, water Average: 30 symptoms, low extent of liver • CHO diet single modality of therapy
condition of Catarrhal- and food days. grade fever, damage that offers the most promise.
liver jaundice borne • Acute no nausea, fatigue, • ALT/SGPT- Hepa B: A regimen of 3x weekly for
hepatitis • Contaminated tendency to be hepatomegaly
Alanine • Rest 16 to 24 weeks result in
food, water chronic
Aminotransferase • Nutrition remission
Hepatitis B: • Oral anal • 2-7 weeks 3 Stages of • No alcohol • Antiviral agents-
• Serum Manifestations: • Hepatitis Profile lamivudine (Epivir) and
contact during
• Pre-icteric - fever, • Abdominal • Adefovir (Hepsera), oral
Hepatitis, sex Hepa B: • CBR
DNA virus • 6 weeks- 6 RUQ pain, ultrasound
• Nutrition: inc CHO nucleoside analogs,
Hepa B: months fatigability, weight • Liver biopsy- an in diet • HEP B Vaccine for pre –
Hepatitis C • percutaneous, • (28-160 days)- loss, anorexia, N/V, invasive exposure
• Post- sexual average- 70-80 headache procedure that MANAGEMENT: POST EXPOSURE
transfusion contact, days • Icteric- jaundice, involves the • H- HAND PROPHYLAXIS
hepatitis, mother to • Has tendency to itchiness/pruritis- doctor taking a WASHING • Hep B immunoglobulin and
multiple drug child (time at go chronic, bile salts in skin, tea sample of tissue • E- EAT LOW FAT, vaccine ASAP to 72hrs post
use, the birth) cirrhotic, CA colored urine, from the liver. HIGH CARB exposure.
Transmission stools-clay-colored, • P- PERSONAL
possible with Hepa C: Hepa C: hepatomegaly, HYGIENE NO • Symptomatic and supportive
sex with • percutaneous • 2 weeks- 6 tender liver SHARING • Antiviral: lamivudine- OD x 1
infected months- • Post -Icteric stage- • A- ACTIVITY yr.
partner Hepa D: • 15–160 days- jaundice subsides • Interferon – 3x a week for 6
CONSERVATION-
• direct contact Average: 50 REST months
Hepatitis D: with infected Hepa B:
days • T- TOXIC
• delta blood • Tendency to go • jaundice, Preventive:
PRODUCTS
hepatitis • only occurs in Chronic > CA hepatomegaly (12- AVOIDANCE- 1. Immunization
conjunction 14 cm vertically), ALCOHOL, 2. Universal precaution
Hepatitis E: with hepatitis pale stools, ASPIRIN,
• Alcoholic B infection. lethargy, nausea, SEDATIVES,
hepatitis arthralgia ACETAMINOPHEN
• water borne Hepa E: • I- INDIVIDUAL
disease • fecal oral • Bilirubin is one of BATHROOM
route those toxins that
• T- TESTING
• No chronicity cause pruritus.
RESULTS (ALT,
AST, BILIRUBIN,
AMMONIA)
• I- INTERFERON/
IMMUNIZATION
• S- SMALL
FREQUENT
MEALS
 Disease alternate name Signs and symptoms
causative agent “pathognomonic sign”
TETANUS ➢ Spasms and stiffness in the
jaw muscles (trismus)
Alternate name: ➢ Stiffness of neck muscles
➢ Also known as ‘lockjaw’ ➢ Difficulty swallowing
➢ Stiffness of abdominal
Causative agent: muscles
➢ ‘Clostridium tetani’ ➢ Painful body spasms lasting
for several minutes
Mode of transmission: ➢ Typically triggered by minor
➢ Acquired thru the wound occurrences, such as a
(any kind of wound) draft, loud noise, physical
➢ Laceration, burn, bite, touch or light
umbilical stump ➢ Risus sardonicus (sardonic
➢ Crush injuries, surgical smile) – pathognomonic
procedures, and dental sign
procedures ➢ Opisthotonus- muscle spine
➢ Does not spread from or arching of the back
person to person ➢ Low grade fever
➢ Diaphoresis
➢ Respiratory muscle-
dyspnea and chest
heaviness
➢ Abdominal muscle-
abdominal rigidity(1st)
➢ Extremity muscles- stiffness
of extremities
➢ Tetanus neonatorum as
difficulty sucking as the first
sign and excessive crying
later leading to a strangled
soundless and voiceless
noise.
MENINGITIS Possible signs and symptoms
in anyone older than the age of
Alternate name: 2 include:
➢ Also known as ➢ Sudden high fever
‘cerebrospinal fever’ ➢ Petechial/purpuric rashes
(sometimes, such as in
Etiologic agents: meningococcal meningitis)
➢ Neisseria meningitides ➢ Young babies- bulging
➢ Streptococcus pneumonia fontanelle or abnormal
➢ Haemophilus influenza reflexes.
Incubation period/period of
communicability
Incubation period:
➢ 3 to 21 days (average 10
days)
➢ 3 days to 3 weeks in adults
➢ 3 days to 30 days in
newborn or a period of 3-4
weeks.
➢ May range from one day to
several months, depending
on the kind of wound.
➢ Most cases occur within 14
days.
Incubation period:
➢ 3 to 4 days, with a range of
2 to 10 days.
➢ 3 – 6 days
Period of communicability
➢ As long as the
microorganism is present in
the discharges.
Diagnostic examination
➢ Clinical manifestation
➢ History of wounds
➢ Immunization status
➢ Blood culture
➢ Tetanus antibodies test
➢ Spatula test
➢ Blood culture
➢ Computerized tomography
(CT) or magnetic
resonance imaging (MRI)
➢ X-rays or CT scans
➢ Spinal tap (lumbar
puncture)- secure consent,
fetal position during, flat on
bed after. Increase WBC;
Nursing intervention
➢ Preventing seizure by
keeping the room dim and
quiet.
➢ Avoid stimuli of spasm.
➢ Avoid unnecessary
handling.
➢ Close monitoring of v/s and
muscle tone.
➢ Raise side rails.
➢ Promote rest.
➢ Provide adequate airway by
inhalation of oxygen as per
doctor’s order.
➢ Monitor for possible
complications like
aspiration pneumonia and
cardiac dysrhythmias.
➢ Promote bed rest and
safety
➢ Plenty of fluid
➢ Over the counter
medication for pain
➢ Respiratory Isolation: 24
hours after onset of
antibiotic therapy
➢ Provide non-stimulating
environment
Medical management
➢ Care in the hospital
➢ immediate treatment with
medicine called human
tetanus immune globulin
(TIG), ATS, TAT as passive
immunization and TT and DPT
as active immunization
➢ Aggressive wound care
➢ Drugs to control muscle
spasms and sedative
(Diazepam).
➢ Antibiotics (Pen G,
Metronidazole)
➢ Emergency equipment at
bedside tracheostomy set, ET
tube and mechanical
ventilator.
3 Objectives of Medical
Management
1. To neutralize the toxin with
ATS- antibodies to prevent/treat
tetanus
-Prepare epinephrine and
corticosteroid in cases of delayed
hypersensitivity reaction
2.To kill the microorganism with
Penicillin, Metronidazole,
Cephalosporin
3.To prevent and control
spasms with muscle relaxant
(Diazepam- Valium)
➢ Antibiotic with Penicillin G
as a drug of choice
➢ With alternative of
chloramphenicol, ampicillin,
ceftriaxone, and
aminoglycosides
➢ Diuretics (Mannitol) to prevent
cerebral edema
➢ CNS stimulant
(Pyritinol/Encephabol)
➢ Streptococcus agalactae
➢ Listeria monocytogenes
Mode of transmission:
➢ Respiratory droplets
through nasopharyngeal
mucosa
➢ Direct invasion through
otitis media and may result
after a skull fracture
➢ Penetrating head wound
➢ Direct contact with
discharge of nose and
throat of infected person
➢ Rashes (petechial-
purpuric)- striking feature
of N. Meningitides
➢ Signs of increased ICP -
severe frontal headache
➢ Altered level of
consciousness (confusion
or difficulty concentrating
and sleepiness or difficulty
waking)
➢ Restlessness
➢ Projectile vomiting
➢ Blurring of vision
➢ Papilledema
➢ Diplopia
➢ Seizures
➢ Sensitivity to light
(photophobia)
➢ No appetite or thirst.
➢ Stiff neck
➢ Nausea
➢ Headache
Symptoms of meningeal
irritation:
➢ Kernig’s sign- pain in the
hamstring muscle when the
hip is flexed then extended
➢ Nuchal rigidity –
pathognomonic sign
➢ Opisthotonus- arching of
the back
➢ Brudzinski’s sign (flexion at
the hip and knee in
response to forward flexion
of the neck) with late signs
of decerebration and
decortications
➢ Increase ICP
➢ Altered level of
consciousness
➢ Convulsive seizure
➢ Severe headache- steady
and throbbing
increase protein; decrease ➢ Initiate seizure precaution
sugar ➢ Avoid factors that increase
➢ DNA-based test known as ICP
a polymerase chain ➢ Assess for signs of
reaction (PCR) increased ICP
➢ Watch out for deterioration
of condition
➢ Monitor fluid balance
➢ Watch out for reactions of
antibiotics
➢ Position carefully to prevent
joint stiffness
➢ Maintain adequate nutrition
and elimination
➢ Follow strict aseptic
technique with head
wounds and skull fractures.
➢ Monitor VS and neurologic
status
➢ Fever – provide TSB
➢ Convulsions – protect from
injury
➢ Anticonvulsant (Diazepam,
Phenytoin (Dilantin) to reduce
restlessness and convulsion
➢ Corticosteroid
(Prednisone/Dexamethasone),
Digitalis glycoside (Digoxin) to
control arrhythmias
➢ Acetaminophen to relieve
fever and pain
➢ Osmotic diuretics- mannitol to
reduce the CFS fluid
Prevent meningitis:
➢ Avoid mode of transmission
➢ Prophylactic treatment of
Rifampicin with alternative of
Ciprofloxacin
➢ Wash hands
➢ Practice good hygiene
➢ Stay healthy
➢ Cover the mouth
➢ If the patient is pregnant, take
care with food
➢ Avoid cheeses made from
unpasteurized milk.
➢ Immunizations
➢ Meningococcal conjugated
vaccine help protect against
N. meningitidis
➢ Pneumococcal vaccines help
protect against S. pneumoniae
➢ Hib vaccines help protect
against Hib

POLIOMYELETIS
Alternate name:
➢ Also known as ‘Infantile
paralysis’ or ‘Heine-
medin disease’
Causative agents:
➢ Legio Debilitans
3 strains of Legio Debilitans
1. Type 1 - L.D. Brunhilde-
permanent immunity; most
paralytogenic
2. Type 2 - L.D. Lansing-
temporary immunity
3. Type 3 - L.D. Leon-
temporary immunity
Mode of transmission:
➢ Fecal-oral through saliva
➢ Vomitus and feces
➢ Direct contact from one
person to another
➢ Ingestion through of
contaminated food, water,
and utensils (fecal-oral
route)
➢ Droplets- nasopharynx is
the portal entry (respiratory
system)
Signs in newborns and
infants may show these
signs:
➢ High fever
➢ Constant crying
➢ Excessive sleepiness or
irritability
➢ Inactivity or sluggishness
➢ Poor feeding
➢ Bulge in the soft spot-on top
of a baby's head (fontanel),
stiffness in a baby's body
and neck.
Inapparent/ subclinical stage Incubation period:
➢ where some patients are in ➢ 7-21 days
asymptomatic stage (90-
95%)
Abortive or invasive (Minor
Illness Stage)
➢ Fever
➢ Sore throat
➢ GI symptoms (vomiting)
➢ Low lumbar backache/
cervical stiffness on ante-
flexion of spine
➢ Headache
➢ Pain or stiffness in the arms
or legs
➢ Muscle weakness or
tenderness
➢ Constipation
➢ Diarrhea
➢ Abdominal pain
➢ Anorexia
Non paralytic/ Pre- paralytic
stage (major illness stage)
➢ Recurrence of fever
➢ Poker spine (stiffness of the
back)
➢ Tightness and spasm of
hamstring
➢ Hypersensitiveness of the
skin
➢ Blood and throat culture
➢ Lumbar tap (pandy’s test)
➢ EMG- to determine extent
Period of communicability: of muscle involvement
➢ is not accurately known ➢ Stool exam with culture and
sensitivity
➢ Sample of throat secretions
➢ Stool or a colorless fluid
that surrounds your brain
and spinal cord
(cerebrospinal fluid) is
checked for poliovirus
➢ Lumbar Puncture – protein
content of CSF is increase:
(+) Pandy’s test -NR range
of protein in CSF is 0.20-
0.45 g/litre.
➢ The Pandy test is positive
when protein is superior to
0.45 g/litre.
➢ Muscle Testing – to
determine specific muscle
affected
➢ Strict isolation, enteric
precaution
➢ CBR / Firm and non-
sagging bed
➢ Rest
➢ ROM (range of motion)
exercise
➢ Relief of muscle spasm
with analgesics / hot moist
compress
➢ Protective devices like
hand roll for claw hand,
trochanter roll for outer
rotation of the femur and
footboard
➢ Monitor for possible
complications like
respiratory paralysis and
hypertension,
➢ Promote rehabilitation by
referring to physical and
occupational therapy for
braces and orthopedic
shoes
➢ In case of respiratory
paralysis, px is placed in
mechanical ventilator called
iron lung machine
Supportive treatments:
➢ Pain relievers (aspirin and
codeine)
➢ Sedatives (phenobarbital)
➢ Ventilator supports to assist
breathing (O2 therapy,
tracheostomy and mechanical
ventilation)
➢ Moderate exercise (physical
therapy) to prevent deformity
and loss of muscle function
Preventive Measures:
➢ Immunization – OPV (oral
polio vaccine) or Sabin
(3doses @ 6wks with 1 month
interval) IPV (inactivated polio
vaccine)- IM
➢ Avoid mode of transmission –
droplet
a. Proper disposal of
secretions
b. Proper handling of food
c. Handwashing
 ➢ Deep reflexes are
exaggerated and paresis
➢ Involvement of the CNS but
w/out paralysis
➢ Severe muscle pain
➢ Hoyne’s sign: head falls
back when in supine
➢ Poker’s sign: stiffness or
rigidity of spinal column

LEPROSY
Alternate name:
➢ Also known as ‘Hansen’s
disease’
➢ Hansenosis and Lepra
Causative agent:
➢ Mycobacterium leprae
Mode of transmission:
➢ Droplet
➢ Intimate skin to skin contact
(inoculation through the
skin break)
Paralytic stage
➢ Characterize by FLACCID
PARALYSIS (flabby, loss of
tone, loss or diminution of
motion)
➢ Patches in the skin (lighter
or darker)
➢ Reddish
➢ Loss of feeling these skin
patches
➢ Affect the nerves, skin,
eyes, and lining of the nose
(nasal mucosa)
➢ Affected skin changes color
and either becomes lighter
or darker, often dry or flaky,
with loss of feeling, or
reddish due to inflammation
of the skin
➢ Corneal ulcers and
blindness
➢ Saddle-nose deformity
resulting from damage to
the nasal septum
Early Manifestation
➢ Change in skin patch
➢ Pain and redness of the
eyes
➢ Loss of sensation, hair
growth and anhidrosis
➢ Slit skin smear test- to
demonstrate M. leprae
➢ Skin lesion biopsy
➢ Lepromin skin test- detect
hypersensitivity to leprosy
➢ Health education: Sulfone
therapy like Dapsone that
cause cutaneous eruptions,
and iritis, orchitis.
➢ Lamprine can cause
brownish black skin
discoloration, dryness and
flakiness that need to
explain to the patient.
➢ Skin care to prevent injury.
➢ Separate newborns from
leprous mothers and report
cases and suspects of
leprosy
➢ BCG vaccine and
education on mode of
transmission
➢ Supervise patient when
handling sharp & warm
objects
➢ Active and passive exercise
to avoid contractures
Monotherapy: Dapsone
Multi drug therapy (MDT)
RA4073
➢ Dapsone with rifampicin, and
clofazimine
➢ prevent drug resistance
➢ to hasten recovery
➢ to lessen the period of
communicability
Treatment approach: depends
on microorganisms in skin
lesions
➢ Paucibacillary: Rifampicin
once a month & Dapsone OD
(6-9 mos)
➢ Multibacillary: Rifampicin
once a month, Dapsone OD
(24-30 mos) & Lamprene OD
(24-30 mos) (clofazimine)

Late Manifestation
➢ Lagophthalmos – inability to
close eyelids

RED TIDE
Alternate name:
➢ Also known as ‘harmful
algal bloom’ or HAB
Etiologic agent:
➢ Dinoflagellate Gonyaulax-
produces saxitoxin and
gonyautoxins which
accumulate in shellfish and
if ingested may lead to
paralytic shellfish poisoning
(PSP) and can lead to
death.
➢ Saxitoxin blocks sodium
channels movement in
tissues affecting neurons
and muscles ingestion can
cause paralysis within 30
minutes.
➢ Madarosis – falling of
eyebrows
➢ Sinking of the bridge of the
nose due to absorption of
the small bones (nose,
fingers, ears)
➢ Leonine face
(pathognomonic sign)
➢ Contractures (clawing of
fingers and toes)
➢ Gynecomastia – for males
Initial signs ➢ Saxitoxin in urine/ feces ➢ Pumping stomach
➢ tingling of the lips and within 24 hours ➢ Induce vomiting
tongue ➢ Detection of saxitoxin in ➢ Charcoal lavage- (a process
➢ Symptoms start quickly, shellfish involving the pumping of
median time between arterial blood through an
ingestion and onset is 1 activated charcoal filter to
hour (between 30 minutes remove the poison)
to 3 hours). ➢ Alkaline fluids- sodium
➢ Headache, nausea, bicarbonate (helpful in treating
vomiting, dizziness – can symptoms, as the toxin is
be mistaken as the patient unstable in alkaline
is drunk conditions)
➢ Severe cases- muscular ➢ Respirator use
paralysis
➢ Diaphragm paralysis -DOB NO VACCINE
may occur 5-12 hours NO ANTIDOTE
➢ THE TOXIN CANNOT BE
KILLED BY COOKING.