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Communicable Disease Part 2
BACILLARY DYSENTERY (Shigellosis)
• An acute bacterial infection of the
intestine characterized by diarrhea,
fever, tenesmus and in severe cases
bloody mucoid stools.
• Severe infections are frequent in infants
and in elderly debilitated persons.
Causative agent:
Shigella, there are four main groups:
• Shigella sonnei
• Shigella boydii
• Shigella flexneri
• Shigella dysenteriae
Source of Infection:
• Feces of infected persons, many in
apparent mild and unrecognized
infection
Mode of transmission:
• Eating of contaminated foods or
drinking contaminated water and by
hand to mouth transfer of contaminated
materials; by flies, by objects soiled
with feces of a patient or carrier.
Susceptibility, Resistance and Occurrence:
• Disease is more common and more
severe in children than in adults
Methods of prevention and Control:
• Sanitary disposal of human feces
• Sanitary supervision of processing,
preparation and serving of food
particularly those eaten raw
• Adequate provision for safe washing
facilities
• Fly control and screening to protect
foods against fly contamination
• Protection of purified water supplies
• Control of infected individual contacts
and environment
• Isolation of patient during acute illness
TYPHOID
• Systemic infection characterized by
continued fever, slow pulse,
involvement of lymphoid tissue,
Splenomegaly, rose spots on trunks and
diarrhea.
• Many mild typical infections are often
unrecognized.
Causative agent:
• Salmonella enterica serotype TYPHI
Source of infection:
• Feces and urine of infected person.
Family contact may be transient carrier.
Carrier state is common among person
over 40 years of age especially female.
Mode of transmission:
• Direct or indirect contact with patient or
carrier. Principal vehicles are food and
water. Contamination is usually by
hands of carrier. Flies are vectors.
Method of Prevention and Control:
• Same as preventive and control
measures as in Dysentery in addition,
immunization with vaccine of high
antigenicity.
• Education of the general public and
particularly the food handlers.
HEPATITIS A (Infectious hepatitis, Epidemic
hepatitis, Catarrhal jaundice)
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• A form of hepatitis occurring either • Proper disposal of urine and feces

sporadically or in epidemics and caused
• Washing hands very well before eating
by virus introduced by focally
and after using the toilet
contaminated water or food.
• Separate and proper cleaning of articles
• Young people especially school children
used by patient.
are most frequently affected
CAUSATIVE AGENT:
PARALYTIC SHELLFISH POISONING
• Hepatitis A virus
• A syndrome of characteristic symptoms
Predisposing factors:
predominantly neurologic which occur
• Poor sanitation within a minute or several hours after
ingestion of poisonous shellfish.
• Contaminated water supplies
Causative agent:
• Unsanitary method of preparing and
serving of food • Single-celled organism called
Dinoflagellates: it is commonly referred
• Malnutrition
as plankton
• Disaster and War time condition
• The organism that causes red tide in the
Signs and Symptoms seas around Manila bay, Smar, Bataan
and Zambales is the Pyromidium
• Influenza-like symptom and headache bahamense var. compressum
• Malaise and easy fatigability
• Anorexia and abdominal discomfort  Mode of Transmission
• Nausea and vomiting • Ingestion of raw or inadequately cooked
• Fever seafood usually bi-valve shellfish or
mollusk during red tide season
• Lymphadenopathy
 Signs and Symptoms
• Jaundice
• Numbness of face especially around the
• Bilirubinemia with clay colored stool mouth
Management: • Vomiting and dizziness
• Prophylaxis- IM injection of gamma • Headache
globulin
• Tingling sensation and eventually
• Complete bed rest paralysis of hands and feet
Prevention and Control: • Floating sensation and weakness
• Ensure safe water or drinking • Rapid pulse
• Sanitary method in preparing, handling • Difficulty of speech (ataxia) and
and serving food difficulty in swallowing (dysphagia)

• Total muscle paralysis with respiratory
arrest and death occur in severe cases
 Management and Control
• No definite medication indicated
• Drinking pure coconut milk and sodium
bicarbonate solution weakened the toxic
effect of red tide. It is advised to take
these solutions in early stage of
poisoning only.
• Shellfish affected by red tide must not
be cooked with vinegar as the Toxin
Pyromidium increases when mixed
with acid.
• Toxin of red tide is not totally destroyed
upon cooking hence consumers must be
educated to avoid bi-valve mollusk such
as tahong, talaba, halaan, kabiya when
red tide warning has been issued by
proper authority.
LEPTOSPIROSIS
• (Weil’s disease, Mud fever, Trench
fever, Flood fever, Spiroketal jaundice,
Japanese seven days fever)
• It is a Worldwide zoonotic disease. Rat
is the main host of the disease although
pigs, cattle, rabbits and other wild
animals can also serve as reservoir
hosts.
• It is an occupational disease affecting
veterinarians, miners, farmers, sewer,
workers, abattoir workers, etc.
Causative agent
• Leptospira interrogans
Mode of transmission
• Through contact of skin, especially
open wounds with water, moist soil or
vegetation contaminated with urine of
infected host
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Signs and Symptoms:
1. Leptospiremic phase-
 Leptospires present in blood and
CSF. Onset of symptoms are
abrupt with fever, headache,
myalgia, nausea, vomiting,
cough and chest pain
2. Immune phase
 correlates with the appearance
of circulating IgM.
Treatment
 Penicillin
 Tetracycline
 Erythromycin
Prevention and Control
 Improved education of people at particular
risk
 Use of protective clothing boots and
gloves especially by worker with
occupational hazards
 Rats and other potential hosts control
 Investigation of contacts and source of
infection
RABIES (Hydrophobia, Lyssa)
 Is an acute viral encephalomyelitis
caused by the Rabies virus, a
rhabdovirus of the genus Lyssavirus
 It is fatal once the signs and symptoms
appear
 There are two kinds urban or canine
rabies is transmitted by dogs while
sylvatic rabies is a disease of wild
animals and bats which sometimes
spread to dogs, cats, and livestock

 Rabies remains a public health problem
in the Philippines. Approximately 300-
600 Filipinos die of rabies every year
 Philippines has the highest prevalence
rate of rabies in the world.
Mode of Transmission:
 Usually by bites of a rabid animal
whose saliva has the virus, The virus
may also be introduced into a
scratch or in fresh breaks in the skin
(very rare) transmission from man to
man is possible.
Incubation period:
• The usual incubation period is 2 to 8
weeks. It can be as long as a year or
several years depending on the severity
of wounds, site of the wound as distance
from the brain, amount of virus
introduced and protection provided by
clothing.
 Susceptibility and Resistance
 All warm blooded mammals are
susceptible. Natural immunity in man is
unknown
 Signs and Symptoms
 Headache
 Fever
 Sensory change near the site of animal bite
 Spasm of muscles or deglutition on
attempt to swallow (fear of water)
 Paralysis
 Delirium and convulsion
 Without medical intervention, the rabies
victim would usually last only 2 to 6 days.
Death is often due to respiratory paralysis
 Management and Prevention
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 The wound must be immediately and
thoroughly washed with soap and water.
Antiseptic such as povidone iodine or
alcohol may be applied.
 The patient must be given antibiotics and
anti-tetanus immunization
 Post exposure treatment is given to persons
who are exposed to rabies. It consists of
local wound treatment, active
immunization and passive immunization.
 Consult a veterinarian or trained personnel
to observe your pet for 14 days for sign of
rabies
 Be a responsible pet owner
 Consult for rabies diagnosis and surveillance
of the area
 Mobilize for community participation
NATIONAL RABIES PREVENTION AND
CONTROL PROGRAM
• Goal: Human rabies is eliminated in the
Philippines and the country is declared
rabies-free.
General objectives:
• To reduce the incidence of human rabies
from 7 per million to 1 per million
population by 2010 and eliminate
human rabies by 2015
• To reduce the incidence of canine rabies
from 70 per 100,000 to 7 per 100,000
dog by 2010, and eliminate canine
rabies by 2015.
SCABIES
• A communicable disease of the skin
characterized by eruptive lesions
produced by the burrowing of the female
parasite into the skin.

Causative organism
• Sarcoptes scabiei, itch mite. The female
parasite is easily visible with a
magnifying glass. Burrows beneath the
epidermis to lay her eggs, and set up an
intense irritation.
Mode of transmission:
• The disease is transmitted by direct
contact with infected individuals or their
clothing and bedding,
 Predisposing factors
 Close crowding as in tenement
districts
 Lack a personal cleanliness
 Signs and Symptoms
• Itching
• Minor discomfort-skin may feel hot and
burning
• When large areas are involve and
secondary infection is severe, there will
be fever, headache and malaise
• Secondary dermatitis is common
 Diagnosis
 Appearance of the lesion, and
the intense itching and finding
the causative mite
 Scraping from its burrow with a
hypodermic needle or curette,
and then examined under low
power objective or hard lens.
 Treatment
 The whole family must be
examined before undertaking
treatment, as long as one
member of the family remains
infected, other members will get
the disease
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 Treatment is limited entirely to
the skin
 Benzyl benzoate emulsion to
clean the lesion and it has a
more rapid effect
Prevention and Control
 Good personal hygiene- daily bath,
washing of hands before and after eating
and after using the toilet, cutting of
fingernails
 Regular changing of clean clothing
beddings and towel
 Eating the right kind of food and taking
plenty of fluids
 Keeping the house clean
 Improving sanitation of the surroundings
ANTHRAX
 An acute bacterial disease usually affecting
the skin but which may vary rarely involves
the oropharynx. Lower respiratory tract,
mediastinum or intestinal tract.
 ac agent
 Bacillus anthracis
 Mode of transmission
 Cutaneous infection is by contact
with tissues of animals (cattle,
sheep, goats, horses, pigs) dying of
the disease
 Possibly by biting flies that had
partially fed on such animals;
contaminated hair, wool, hides or
products made from them such as
drums or brushes; contact with soil
associated with infected animals.
Signs and Symptoms:
 Cutaneous anthrax
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 Most common and is contracted

by contact with infected animals
MENINGOCOCCEMIA
 The exposed part of the skin
 The disease is usually sporadic (cases
begins to itch and a papule
occur alone or may affect household
appears in the inoculation site
members with intimate contact)
 This papule becomes a vesicle
 Although primarily a disease of
and then evolves into depressed
children, It may occur among adult
black eschars
especially in condition of forced
 The lesion is not painful and overcrowding such as institution, jail
often intreated which will result and barracks.
to septicemia and death when
 There is an increase rate in smokers,
not treated early.
overcrowded households and military
 Pulmonary anthrax recruits.
 Become acute, with fever, shock Causative agent
and death results
 Neisseria meningitidis
 Contracted by inhalation of
Source of infection
spores of Bacilllus anthracis
 Respiratory droplets from nose and
 At the onset of illness, the
throat of infected persons
symptoms are mild and
resemble that of common upper Mode of transmission
respiratory tract infection
 Direct contact with respiratory
 Gastrointestinal anthrax droplets from nose and throat of
infected persons. Carrier may exist
 Contracted by ingestion of meat
without cases of meningitis.
from infected animals and is
manifested as violent
gastroenteritis with vomiting
and bloody stools  Signs and Symptoms

 Methods of Control  High grade fever for first 24 hours

 Immunize high-risk persons  Weakness, joint and muscle pain

 Educate employees handling  Hemorrhagic rash, progressing from

potentially contaminated articles few petichiae to widespread purpura
about modes of anthrax  Headache, nausea and vomiting, stiff
transmission neck, seizure or convulsion and
 Personal cleanliness sensorial changes

 Control dusts and proper  Methods of Prevention and Control

ventilation in hazardous  Respiratory isolation of patients for the
industries especially those that first 24 hours upon admission to
handle raw animal materials prevent exposure of hospital staff.

 Respiratory clothing for hospital staff
with patient suspected of
meningococcemia
 Public should be educated to avoid
overcrowded placed to reduce the risk
of exposure particularly among children
and elderly.
“BIRD FLU” or AVIAN INFLUENZA
 It is an infectious disease of birds
ranging from mild to severe form of
illness. All birds are thought to be
susceptible to infection with avian
influenza, though some species are more
resistant than others
 Some forms of bird flu infections can
cause illness to humans. It is due to
highly pathogenic influenza virus H5N1.
It is the subtype that can be transmitted
from infected poultry to human.
 Source of Infection
 Viruses that normally infect only
birds and less commonly pigs
 Signs and Symptoms
 Fever
 Body weakness and muscle pain
 Cough
 Sore throat
 May have difficulty in breathing in
severe cases
 Sore eyes
 Preventive Measure in Human
 All workers directly or indirectly
involved in handling live poultry
should be given the curren t season’s
influenza vaccine to reduce the
possibility of dual infection with
human and influenza viruses.
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 Yearly vaccination of poultry
workers with regular of periodic
direct contact with poultry.
SARS (Severe Acute Respiratory Syndrome)
 It is a newly recognized form of a
typical pneumonia that had been
described in patient in Asia, North
America and Europe. The earliest
known cases were identified in
Guangdong Province, China in
November 2002
 The WHO issued the global alert on the
outbreak on March 2003 and instituted
worldwide surveillance.
Causative agent
 It is a novel human corona virus based on
serological and molecular tests done on
specimens from SARS patients
Mode of Transmission
 Close contact with respiratory droplet
secretion from SARS patient
 Transmission occurs when another
person’s mucous membrane are exposed to
droplet secretions when a SARS patient
coughs, sneezes or talks.
FILARIASIS
 Public health concern in many endemic
areas ( 45 out of 78 provinces are
endemic)
 Chronic parasitic infection caused by
nematode parasite
 Wuchereria bancrofti
 Brugia malayi and/or Brugia timori
 Loa loa
Mode of Transmission

 The disease is transmitted to a person
through bites from an infected female
mosquito.
Vectors
 Wuchereria bancrofti
 Aedes poecilus, Anopheles
minismus flavirostris
 Brugia malayi
 Mansoni bonnaea, Mansoni
uniformis
 Asymptomatic stage
 Characterized by the presence of
microfilariae in the peripheral blood
 No clinical signs and symptoms of
the disease
 Acute stage
 Lympadenitis- inflammation of the
lymph nodes
 Lymphangitis- inflammation of
lymph vessels in some cases, the
male genitalia is affected.
 Chronic stage
• Developed 10-15 years from the
onset of first attack
• Hydrocoele- swelling of the scrotum
• Lymphedema- swelling of the upper
and lower extremities
• Elephantiasis- enlargement or
thickening of the skin of the lower
and/or upper extremities, scrotum,
MALARIA
breast
 Laboratory examinations
• Blood examination
Infectious agents
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 Thick smear about the size of
25 centavo coin, blood is
taken from the patient 10pm
to 2 am for Wuchereria and
anytime Brugia but more
preferred at night (due to
parasite periodicity)
 Treatment
• The drug of choice is
Diethylcarbamazine (DEC)
 Supportive care for Filariasis
 Patients are advised to observe
personal hygiene by washing the
affected area with soap and water
twice a day or prescribe antibiotics or
anti-fungal for super infection.
 Prevention and Control
 A. Measures aimed to control the
vector
 Environmental sanitation such as
proper drainage and cleanliness of
the surroundings
 Use of insecticides.
 B. Measures aimed to protect the
people in endemic areas
• Use of mosquito nets
• Application of insect repellants
• Screening of houses
• Health education
 Continue to be a major Public health
concern having an annual parasite
incidence of 5.1 per 1000 population
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 Plasmodium falciparum starting from 1-2 weeks before

entering endemic areas.
 Plasmodium vivax
 Plasmodium ovale
Prevention and Control
 Plasmodium malariae
 Sustainable preventive and vector
 The severity and characteristic
control
manifestation of the disease are govern
by the infecting species  Insecticide-treatment of mosquito nets
Mode of Transmission  House spraying
 Through the bite of an infected female  Protective clothing
mosquito or directly from one person to
 Educate the people on endemic areas
another by passage of blood containing
erythrocytic parasites  Chemoprophylaxis
Signs and Symptoms Etiologic agent
 Recurrent chills  Dengue virus types 1,2,3, and 4
 Fever Source of Infection
 Profuse sweating  Immediate source is a vector mosquito,
the Aedes aegypti or the common
 Anemia
household mosquito.
 Hepatomegaly
Mode of transmission
 Splenomegaly
 Through bite of infected female
Laboratory Examinations mosquito
 Thick and Thin blood smear- look for the Signs and Symptoms
presence of malarial parasite
 An acute febrile infection of sudden
 Para Sight F Test- dipstick test for simple onset with clinical manifestation of 3
and rapid diagnosis of Plasmodium stages.
falciparum
 First 4 days- invasive stage starts
 Serological test- IHA (indirect abruptly as high fever, abdominal pain
hemagglutination test), ELISA and headache
Treatment  4th to 7th days- toxic or hemorrhagic
stage-lowering of temperature, severe
 Drug of choice is Chloroquine.
abdominal pain, vomiting, frequent
Pyrimethanime/Sulfadoxine combination
bleeding, death may occur
may be used in areas with high levels of
resistance to Chloroquine  7th to 10th day- convalescent or recovery
 Chemoprophylaxis Diagnostic test
 Only Chloroquine should be given.  Torniquet test (Rumple Leede Capillary
It must be taken at weekly interval Fragility Test)
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 Platelet count d. Avoid certain sexual practices involving anal

or fecal contact.
Supportive and Symptomatic treatment
2. Barrier methods of contraception (use of
 Paracetamol, analgesic for fever, muscle
condoms, diaphragms and spermicides)
pain or headache.
3. Prophylactic antibiotics taken before and after
 DON’T GIVE ASPIRIN
exposure should not be done because:
 Rapid replacement of body fluids
a.. No single antibiotic covers all potential STIs
Control measures
b. Allergic reaction may occur
 Vector elimination
c. They may lead to emergence or resistant
 Changing water and scrubbing sides of organism
lover vases once a week
 Destroy breeding places of mosquito
I. BACTERIAL STI
 Keep water container clean and covered
A. Gonorrhea
 Avoid too many hanging clothes inside
Causative agent
the house
 Neisseria gonorrheae
 Spray with insecticides
Mode of transmission
 Health education of the public
• Sexual contact in adult, transmission in
neonates is during birth
SEXUALLY TRANSMITTED INFECTIONS
 Sexually Transmitted Infection (STI)
Signs and Symptoms
and their complications belong to the top
five categories for which adults seek • Genital (penis or cervix), anus, throat
health care in the developing countries. and eyes can be infected
 Many STIs can be treated and cured o Males- burning urination and pus
relatively easily and cheaply if discharges from infection of urethra
diagnosed early enough. From among
the STI, the most common treatable are: o Females- vaginal discharge
Chlamydia, Gonorrhea, Trichomoniasis, Treatment
and Syphilis
Cefriaxone for uncomplicated cases. If resistant,
PRIMARY PREVENTION OF STI spectinomycin is used
1. Modification of sexual activity – this would Prevention
decrease the like hood of exposure to or contact
with infectious agents No drugs or vaccine. Condom offer protection.
Trace contacts and treat to interrupt
a. Engage in mutually monogamous relationship transmission.
b. Limit the number of sexual partners B. Syphilis
c. Inspect and question new partners
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Causative agent  In females

 Treponema pallidum
Signs and Symptoms
 Primary syphilis
o (Chancre)painless sore at the site of
entry of germs, swollen glands
 Secondary syphilis
o (condylomata lata)- maculopapular
rash notably on the palms and soles,
or as moist papules on the skin and
mucous membranes. Moist lesion of
the genitals
 Tertiary syphilis
o (Gummas)- varies from no
symptoms to indication of damage
to body organs such as brains, heart
and liver
Treatment
 Penicillin is effective in all stages of
syphilis
Prevention
 Same as other bacterial STI. No vaccine
available. Benzathine penicillin s given
to contacts.
C. Chlamydia
Causative agent
 Chlamydia trachomatis
Mode of Transmission
 Through sexual contact and birth
Signs and Symptoms
 In males
o discharge from penis, burning and
itching of the urethral opening,
burning sensation during urination
o slight vaginal discharge, itching and
burning sensation of vagina, painful
intercourse, abdominal pain.
Treatment
 Tetracycline and Erythromycin
Prevention
 No vaccine available. Erythromycin is
effective in infected mother to prevent
neonatal disease.
II. PARASITIC STI
A. Trichomoniasis
Causative agent
 Trichomonas vaginalis
Mode of transmission
 Usually passed by direct sexual contact.
Can be transmitted through contact with
wet objects such as towels, wash
clothes, etc.
Signs and Symptoms
 Males
• slight itching of penis, painful
urination, clear discharge from penis
 Females
• white or greenish-yellow odorous
discharge, vaginal itching, painful
urination
Treatment
 Metronidazole for both partners
Prevention
 Condoms limit transmission
III. VIRAL STI
A. AIDS (Acquire Immunodeficiency
Syndrome)

 The first case of AIDS in the Philippines
was reported in 1984. As of May 2000
based on the Philippine National AIDS
council record, there were 1,385 HIV
positive and AIDS cases, 206 deaths.
Causative agent:
 HIV (Human Immunodeficiency Virus)
Mode of Transmission
 Sexual contact, Transfer of body fluids
(blood, semen, discharges), contaminated
syringe, transplacental
Signs and Symptoms
 Physical
 Rashes
 Loss of appetite
 Weight loss
 Fever of unknown origin
 Pneumocystis carinii pneumonia
(Pneumocystis jiroveci)
 Persistent diarrhea
 Esophageal candidiasis
 Kaposi’s Darcoma (skin cancer)
Treatment
 Azidothymidine (AZT) and Didanosine
inhibit HIV replication by inhibiting
reverse transcriptase. Clinical
improvement occurs but the virus persists.
Treatment of opportunistic infection
depends on the organism
Prevention
 Screening of blood prior to transfusion,
safe sex. There is no vaccine
B. Genital herpes
Causative agent
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• Herpes simplex Virus type 2 (HSV2)
Mode of transmission:
• Sexual contact in adult and during
passage through the birth canal in
neonates
Signs and Symptoms
• Painful vesicular lesion of the male and
female genitals and anal area.
Treatment
• Acyclovir is useful in the treatment of
both primary and recurrent diseases.
Prevention
• Primary disease can be prevented by
protection from exposure to vesicular
lesion. There is no vaccine.
C . Hepatitis B
Causative agent:- Hepatitis B Virus (HBV)
Mode of Transmission:
• Sexual intercourse, also transmitted
through blood and during birth
Signs and Symptoms:
a. Loss of appetite
b. Easy fatigability
c. Joint and muscle pain
d. Low grade fever
e. Right sided abdominal pain
f. Jaundice
g. Dark colored urine
Treatment:
• No specific treatment
Prevention:
a. Vaccine that contains HBsAg as the
immunogen
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b. Hyper immune serum globin obtained from

donors with high titers of HBsAb
c. Education of chronic carriers regarding
precautions