NCMB312 LECTURE: Midterm Week

10
Communicable Disease Concepts
Bachelor of Science in Nursing 3YA
Professor: Dr. Potenciana A. Maroma
BASIC CONCEPTS IN COMMUNICABLE AND CHAIN OF Classification of disease based on severity or duration of
INFECTION DISEASE disease
Communicable Disease Concepts 1) Acute disease which develops rapidly (rapid onset) but
- An illness due to a specific infectious agent or its toxic lasts only a short time
products that arises through transmission of that agent • Measles
directly or indirectly to well person or its products from an • Mumps
infected person, animal (vector) or inanimate reservoir • Influenza
(e.g. from a food source or contaminated water) to a 2) Chronic disease which develops more slowly but lasts for
susceptible host. a long period
Two types of communicable diseases • TB
1) Contagious disease is spread by direct contact w/ • leprosy
infectious agents causing the disease and easily 3) Sub-acute disease which is the intermediate between
transmitted from 1 person to another through direct or acute and chronic, develops rapidly and has long duration
indirect means with the examples of bacterial endocarditis
2) Infectious disease is a disease not only by ordinary 4) Latent disease with causative agent remains inactive for
contact but requires direct inoculation of organism a time but then becomes active to produce symptoms of
through a break on the skin or mucous membrane. the disease, an infection held in check by the defensive
Classification of disease based on occurrence forces of the body but activated when the body resistance
1) Sporadic disease that is intermittent occurrence of few is reduced with examples of chicken pox- shingles zoster.
isolated unrelated cases in given locality disease occurs
occasionally irregularly, no specific pattern and examples Types of infection
are: 1) Recurrent infection is the reappearance of symptoms
• Cancers after infectious disease has been treated or subsided and
• Degenerative diseases. renewed presence of same infectious agent.
2) Endemic disease that continuous occur throughout a 2) Re-infection which after an initial infectious agent has
period of time, of usual number of cases in a given locality, been eliminated, a new infection occurs caused by the
constantly present in population, community or country. same organism or by another strain of same species.
Examples: 3) Super-infection happens during period of the illness,
• STD’s additional infection occurs by another infectious agent.
• diarrheal diseases 4) Autoinfection in which the infected person is his own
• PTB direct source of reexposure. The infection of a primary
• Influenza host with a parasite, particularly helminths in such a way
• different types of pneumonia that the complete life cycle of the parasite happens in a
• Schistosomiasis single organism, without the involvement of another host
• Malaria
• Filariasis Course of infectious process
3) Epidemic disease which the occurrence is of unusually 1) Incubation period extends from entry of microorganism
large number of cases in a relatively short period of time to body to onset of nonspecific signs and symptoms.
• dengue fever 2) Prodromal period extends from the onset of nonspecific
• leptospirosis signs and symptoms to the appearance of specific signs
and symptoms which are the cardinal or the
• mumps
pathognomonic signs.
• chicken pox
3) Illness period which the host experiences maximum
• measles
impact of infectious process and specific signs and
4) Pandemic disease is an epidemic disease that occur
symptoms develop and become evident.
worldwide, simultaneous occurrence of epidemic of same
4) Convalescent period is a recovery period as
disease in several countries and
manifestations subside and signs and symptoms start to
• HIV-AIDS
abate until the client returns to normal state of health.
• MERS-COV
• SARS
• COVID 19

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 312 LECTURE: WK10 – COMMUNICABLE DISEASE CONCEPTS
The Republic Act No. 11332, repealing the act 3573,
otherwise known as the "Law on Reporting of
Communicable Diseases"
- The law hereby declared the policy of the State to protect
and promote the right to health of the people and instill
health consciousness among them. It shall endeavor to
protect the people from public health threats through the
efficient and effective disease surveillance of notifiable
diseases including emerging and re-emerging infectious
diseases, diseases for elimination and eradication,
epidemics, and health events including chemical, radio-
nuclear and environmental agents of public health
concern and provide an effective response system in
compliance with the 2005 International Health
Regulations (IHR) of the World Health Organization (WHO).
- The law have the following objectives:
a) To continuously develop and upgrade the list of
nationally notifiable diseases and health events of
public health concern with their corresponding case
definitions and laboratory confirmation;
b) To ensure the establishment and maintenance of
relevant, efficient and effective disease surveillance
and response system at the national and local levels;
c) To expand collaborations beyond traditional public
health partners to include others who may be involved
in the disease surveillance and response, such as
agricultural agencies, veterinarians, environmental
agencies, law enforcement entities, and
transportation and communication agencies, among
others;
d) To provide accurate and timely health information
about notifiable diseases, and health-related events
and conditions to citizens and health providers as an
integral part of response to public health
emergencies;
e) To establish effective mechanisms for strong
collaboration with national and local government
health agencies to ensure proper procedures are in
place to promptly respond to reports of notifiable
diseases and health events of public health concern,
including case investigations, treatment, and control
and containment, including follow-up activities;
f) To ensure that public health authorities have the
statutory and regulatory authority to ensure the
following:
• Mandatory reporting of reportable diseases and
health events of public health concern;
• Epidemic/outbreaks and/or epidemiologic
investigation, case investigations, patient
interviews, review of medical records, contact
tracing, specimen collection and testing, risk
assessments, laboratory investigation, population
surveys, and environmental investigation; (3)
Quarantine and isolation; and
• Rapid containment and implementation of
measures for disease prevention and control;
g) To provide sufficient funding to support operations
needed to establish and maintain epidemiology and
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surveillance units at the DOH, health facilities and
local government units (LGUs); efficiently and
effectively investigate outbreaks and health events of
public health concern; validate, collect, analyze and
disseminate disease surveillance information to
relevant agencies or organizations; and implement
appropriate response;
h) To require public and private physicians, allied
medical personnel, professional societies, hospitals,
clinics, health facilities, laboratories, pharmaceutical
companies, private companies and institutions,
workplaces, schools, prisons, ports, airports,
establishments, communities, other government
agencies, and nongovernment organizations (NGOs)
to actively participate in disease surveillance and
response; and
i) To respect to the fullest extent preserving public
health and security. possible, the rights of people to
liberty, bodily integrity, and privacy while maintaining
Chain of Infection
Infectious agent
- Which can take the form of viruses, bacteria, fungus,
parasite and protozoa
- Three factors
1) pathogenicity - its ability to produce disease
2) degree of virulence - its severity or harmfulness
3) its invasiveness - its tendency to spread.
Reservoir
- is the principal habitat in which a pathogen lives,
flourishes and is able to multiply.
- infectious agents include humans, animals or insects and
the environment.
- 2 forms in humans
1) Acute clinical cases
- in which someone is infected and is displaying
signs and symptoms of the disease
- more likely to be diagnosed and treated which
means that the patient's contacts and normal
activities will normally be restricted
2) Carriers
- where someone has been colonized with an
infectious agent but is not unwell.
- can present more of a risk to those around them
because they do not display any signs or
symptoms of illness
- Four main types
1) Incubatory carriers - people who are infectious even
before their own symptoms start
2) Inapparent carriers - in which an individual is able to
transmit an infection to others, without ever
developing the infection themselves
3) Convalescent carriers - people who are in the
recovery phase of their illness but who continue to be
infectious
4) Chronic carriers - anyone who has recovered but who
continues to be a carrier for infection.
 312 LECTURE: WK10 – COMMUNICABLE DISEASE CONCEPTS
Portal of exit
- which enables a pathogen to leave the reservoir or host
- Key portals of exit
• Alimentary - via vomiting,
• Diarrhea or biting
• Genitourinary - via sexual transmission
• Respiratory - through coughing,
• Sneezing and talking
• Skin - via skin lesions; trans-placental - where
transmission is from mother to fetus
Mode of transmission
• Can be contact
• Airborne
• Droplet
• Vehicle-borne
• Vector-borne
• Trans-placental
- Two main ways
1) direct transmission
- tends to be instantaneous and occurs when there
is direct contact with the infectious agent.
Examples include tetanus, glandular fever,
respiratory diseases and sexually transmitted
diseases.
2) Indirect transmission
- can occur through animate mechanisms such as
fleas, ticks, flies or mosquitoes or via inanimate
mechanisms such as food, water, biological
products or surgical instruments
- can also be airborne, in which tiny particles of an
infectious agent are carried by dust or droplets in
the air and inhaled into the lungs.
Portal of entry
- usually this path is as the same as port of exit
- means by which an infection is able to enter a susceptible
host inhalation (via the respiratory tract) absorption (via
mucous membranes such as the eyes) ingestion (via the
gastrointestinal tract)
- inoculation (as the result of an inoculation injury)
- introduction (via the insertion of medical devices)
Susceptible host
- the final and the most important link in the chain of
infection
- their age - and in particular if they are very young or very
old
1) whether there is any presence of malnutrition or
dehydration
2) whether there is any underlying chronic disease if the
host suffers from immobility
3) if they are taking any medication which could disrupt
or suppress their immune response
4) if they received immunization
Universal / standard precaution
1) Avoid contact with the patient’s bodily fluids by wearing
gloves, goggles, face mask, gown and shoe cover
2) Medical instruments should be handled carefully and
disposed properly in a sharp’s container.
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3) Proper hand washing.
4) Considering all patients are infectious.
5) Standard precaution goes beyond universal precaution
regardless of diagnosis
6) All personnel protective equipment shall be removed
immediately upon leaving the work area. Used needles
and other sharps shall not be sheared, bent, broken,
recapped by hand.
7) Eating, drinking, smoking, applying cosmetics and
handling contact lenses are prohibited where there is
potential occupational exposure. Food and drinks shall
not be stored in refrigerators or cabinets where blood and
other potentially infectious materials are stored.
8) All procedures involving blood shall be performed in such
a manner as to minimize splashing.
Terminologies
• Communicable Disease Nursing – is the study of an
illness due to a specific toxic substance, occupational
exposure or infectious agent, which affects a susceptible
individual, either directly or indirectly, as from an infected
animal or person, or indirectly through an intermediate
host, vector, or the environment; the significant signs and
symptoms; causative agent; mode of transmission;
diagnostics; pathophysiology; nursing and medical
management through the utilization of nursing process.
• Communicable Disease – is an illness due to a specific
infectious agent or its toxic products that arises through
transmission of that agent or its products from an infected
person, animal or inanimate reservoir (e.g. from a food
source or contaminated water) to a susceptible host.
• Disease control – refers to the reduction of disease
incidence, prevalence, morbidity or mortality to a locally
acceptable level as a result of deliberate efforts and
continued intervention measures to maintain the
reduction
• Disease surveillance – refers to the ongoing systematic
collection, analysis, interpretation, and dissemination of
outcome-specific data for use in the planning,
implementation, and evaluation of public health practice.
A disease surveillance system includes the functional
capacity for data analysis as well as the timely
dissemination of these data to persons who can
undertake effective prevention and control activities
• Infection – invasion of the body tissue by microorganisms
and their proliferation
• Carrier – a person who without apparent symptoms of a
disease, harbors and spread the specific with
microorganisms
• Chain of Infection – is made up of six different links:
pathogen (infectious agent), reservoir, portal of exit,
means of transmission, portal of entry, and the new host.
Each link has a unique role in the chain, and each can be
interrupted, or broken, through various means.
• Contact – any person or animal known to have been in
such association an infected person or animal exposed to
infection
 312 LECTURE: WK10 – COMMUNICABLE DISEASE CONCEPTS

• Communicable period – the period which etiologic agent • Fumigation – any process by which destruction of insects,
may be transferred directly or indirectly from the body of fleas, bugs, etc. and is accomplished by the employment
the infected person to the body of another person of gaseous agents
• Contamination – invasion of surface (wound) or article • Isolation – the separation for the period of
(handkerchief) or matter (water and milk) implies the communicability of infected persons
presence of undesirable substance which may contain • Mandatory reporting – refers to the obligatory reporting of
pathogenic microorganisms a condition to local or state health authorities, as required
• Sterilization – describes a process that destroys or for notifiable diseases, epidemics or public health events
eliminates all forms of microbial life and is carried out in of public health concern
health-care facilities by physical or chemical methods • Notifiable disease – refers to a disease that, by legal
• Disinfection – describes a process that eliminates many requirements, must be reported to the public health
or all pathogenic microorganisms, except bacterial spores, authorities
on inanimate objects • Public health authority – refers to the DOH (specifically
• Concurrent disinfection – ongoing practices that are the Epidemiology Bureau, Disease Prevention and Control
observed in the care of the client, his supplies, Bureau, Bureau of Quarantine and International Health
environment and control of microorganisms Surveillance, Health Emergency Management Bureau,
• Terminal disinfection – practices to remove pathogens Food and Drug Administration, government hospitals.
from the client’s belongings and environment after his Research Institute of Tropical Medicine and other National
illness is no longer communicable Reference Laboratories, and DOH Regional Offices), the
• Disinfectant – substance for inanimate objects that local health office (provincial, city or municipality), or any
destroys pathogens and the spores person directly authorized to act on behalf of the DOH or
• Antiseptic – substance intended for persons that inhibit the local health office;
the growth of pathogens but not necessarily destroy them
• Bactericidal – chemical that kills microorganisms
• Bacteriostatic – chemical that prevents the multiplication
but does not kill all forms of microbes
• Asepsis – absence of disease-producing microorganisms;
free from infection
• Sepsis – presence of infection
• Medical asepsis – practices to reduced the number and
transfer of microorganisms; clean technique.
• Surgical asepsis – practices that render and keep objects
& areas free from pathogens; sterile technique
• Etiology – the study of causes
• Virulence – the vigor with which the organism can grow
and multiply; refers to the degree or intensity of disease
produced
• Nosocomial Infection – infections associated with the
delivery of health care services in a health care facility
• Opportunistic pathogen – causes disease in a
susceptible person
• Resident flora – microorganisms that are always present
in specific areas of the body; normally lives on a person’s
skin
• Transient flora – microorganisms picked up by the skin as
a normal activities that can be removed easily
• Pathogens – a disease producing-microorganism
• Pathogenecity – the ability to produce a disease; the
ability of microbes to overcome the defensive powers of
the host to induce disease
• Quarantine – limitation of freedom of movement of such
susceptible persons or animals as have been exposed to
communicable diseases
• Colonization – a process by which strains of
microorganisms become resident flora, but their presence
does not cause disease

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 NCMB312 LECTURE: Midterm Week

10
Immunization
Bachelor of Science in Nursing 3YA
Professor: Dr. Potenciana A. Maroma
IMMUNIZATION as senior citizen immunization, school-age immunization,
- Is the process by which vaccines are introduced into the and adolescent immunizations.
body before the infection sets in. - 2018 - there are a total of 13 recommended vaccinations
- It promotes health and protects children from disease- on the updated childhood immunization schedule for
causing agents. Filipino children, ages 0 to 18 years old. It's one less
Vaccines vaccine compared to last year's — the dengue vaccine
- The causative agent of a disease so modified as to be was removed.
incapable of producing the disease yet at the same time
so little changed that it is able, when introduced into the Vaccines in the Philippine National Immunization Program
body, to elicit production of specific antibodies against (NIP)
the disease. The following vaccines are in the 2018 NIP:
- These are always antigens, therefore they always induce - BCG, monovalent Hep B, Pentavalent vaccine (DTwP-Hib-
active immunity when administered thereby causing the HepB), bivalent OPV, IPV, PCV, MMR, MR, Td and HPV.
recipient’s immune system to react to the vaccine that Recommended Vaccines
produces antibodies to fight infection, and are most - These are vaccines not included in the NIP which are
useful in the prevention of disease. recommended by the Philippines Pediatric Society (PPS),
Pediatric Infectious Disease Society of the Philippines
Expanded Program on Immunization (EPI) (PIDSP) and the Philippine Foundation for Vaccination
- Launched in July 1976 by DOH in cooperation with the (PFV).
World Health Organization (WHO) and UNICEF to ensure
that infants/children and mothers have access to
routinely recommended infant/childhood vaccines.
- Vaccination among infants and newborns (0-12 months)
against seven vaccine-preventable diseases: tuberculosis,
poliomyelitis, diphtheria, tetanus, pertussis, hepatitis and
measles.
- Presidential decree No. 996 (September 16, 1976).
“Providing for compulsory basic immunization for infants
and children below eight years of age.”
Mandates:
- Republic Act No. 10152 “Mandatory Infants and Children
Health Immunization Act of 2011” Signed by President
Benigno Aquino III in July 26, 2010. The mandatory
includes basic immunization for children under 5
including other types that will be determined by the
Secretary of Health.
EPI Routine Schedule of Immunization:
- Wednesday – designated immunization day in all parts of
the country.
- Monthly – in a Barangay Health Station (BHS)
- Quarterly – in far flung areas
Updates
- 2012 - Rotavirus and Pneumococcal vaccines were
introduced in the EPI. Immunization will be prioritized
among the infants of families listed in the National
Housing and Targeting System (NHTS) for Poverty
Reduction nationwide.
- 2014 - Pneumococcal Conjugate Vaccine 13 was included
in the routine immunization of EPI.
- 2016 - the Expanded Program on Immunization had a
transition to become the National Immunization Program
(NIP). It includes immunizations of other populations such

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 312 LECTURE: WK10 – IMMUNIZATION
Tetanus Toxoid Immunization Schedule for Women
Administration of Vaccines
The EPI vaccines and its Characteristics
EPI COLD CHAIN and LOGISTICS:
- Cold Chain Manager = Public Health Nurse
- Temperature monitoring of vaccines is done in all levels of
health facilities to monitor vaccine temperature.
- Temperature checking is done twice a day early in the
morning and in the afternoon before going home.
- Temperature is plotted every day in monitoring chart to
monitor break in cold chain.
Vaccine can be stored in Refrigerator:
- Regional – 6 months
- Municipal / City – 3 months
- Main Health Center – 1 month
- Transport Box : 5 days
- FEFO ( first expiry and first out ) vaccine is practiced to
ensure that all vaccines are utilized before its expiry date.
- Proper arrangement of vaccines and labelling of vaccines
expiry date are done to identify those near to expire
vaccines
- Vaccine Wastage – Wastage is defined as loss by use,
decay, erosion or leakage or through wastefulness
General Principles in Vaccination
• It is safe and immunologically effective to administer all
EPI vaccines on the same day at different sites of the body.
• The vaccination schedule should not be restarted from the
beginning even if the interval between doses exceeded the
recommended interval by months or year.
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• Giving doses of a vaccine at less than the recommended 4
weeks interval may lessen the antibody response.
Lengthening the interval between doses of vaccines leads
to higher antibody levels.
• No extra doses must be given to children who missed a
dose of DPT/HB/OPV. The vaccination must be continued
as if no time had elapsed between doses.
• Do not give more than one dose of the same vaccine to a
child in one session. Give doses of the same vaccine at
the correct intervals.
• Strictly follow the principle of never, ever reconstituting
the freeze dried vaccine in anything other than the diluent
supplied with them.
• If you are giving more than one vaccine, do not use the
same syringe/needle and do not use the same arm or leg
for more than one injection.
• Repeat BCG vaccination if the child does not develop a
scar after the first injection.
• It is safe and effective with mild side effects after
vaccination. Local reaction, fever, and systematic
symptoms can result as part of the normal immune
response.
• Anaphylaxis or severe hypersensitivity reaction to a
previous dose of vaccine is an absolute contraindication
to subsequent doses of vaccine
• Person with a known allergy to a vaccine component
should not be vaccinated.
• DPT2 or DPT3 is not given to a child who has convulsions
or shock within 3 days after DPT1. Vaccines containing the
whole cell pertussis component should not be given to a
children with an evolving neurological disease
(uncontrolled epilepsy or progressive encephalopathy).
• Do not give live vaccines like BCG to a individuals who are
immunosuppressed due to malignant disease ( child with
AIDS) , going therapy with immunosuppressive agents or
radiation.
• A child with a sign and symptoms of severe dehydration
• Fever of 38.5 C and above
• The following are NOT contraindication. Infants with these
conditions SHOULD be immunized:
• Allergy or asthma ( except if there is a known allergy to a
specific component of vaccine mentioned above )
• Minor respiratory tract infection
• Diarrhea / vomiting
• Temp. below 38.5 C / low grade fever
• Family history of adverse reaction following immunization
• Family history of convulsions/seizures
• Known or suspected HIV infection with no signs and
symptoms of AIDS
• Child being breastfed
• Chronic illness such as diseases of heart, lung, kidney or
live
• Stable neurological condition such as cerebral palsy or
Down’s
• Syndrome
• Premature or low birthweight (vaccination should not be
postponed )
 312 LECTURE: WK10 – IMMUNIZATION
• Recent or imminent surgery
• Malnutrition
• History of jaundice at birth
• Generally, one should be immunized unless the child is so
sick that he needs to be hospitalized.
• Note: If parent strongly objects to an immunization for a
sick infant, do not give it. Ask the mother to comeback
when child is well.
Immunology
- Immunology is a division of biology concerned with the
study of living organisms’ exemption from harmful agents.
Immunity refers to the body’s specific protective response
to an invading foreign agent or organism.
- Susceptibility is the reverse of immunity and the result of
the suppression of factors that produces immunity.
- There are two types of Immunity:
1) Natural immunity which is innate and non-specific
2) Acquired immunity which adaptive and specific.
- Antigens refer to the foreign substances which elicit an
immune response.
- The three functions of immune response are homeostasis,
defense and surveillance.
- The body has its own natural immunity. They provide non-
specific response to any foreign invader, regardless of the
invader’s composition.
- The body has its anatomic and physiologic defenses:
1) Intact skin and mucous membranes which the body’s
first line of defense against microorganism. It has
normal secretions (sweat) that make skin slightly
acidic: Acidity inhibits bacterial growth.
2) Resident bacteria which prevent other bacteria from
multiplying and use up available nourishment.
3) Nasal Passages that moist mucous membrane and
cilia traps microorganism, dusts, foreign materials.
4) Lungs that have alveolar macrophages (large
phagocytes) which are cells that are responsible to
ingest microorganisms and foreign particles.
5) Oral Cavity sheds mucosal epithelium to rid the
mouth of colonizers. The flow of saliva and it’s
partially buffering action help prevent infection.
6) The eyes that being protected from infection by tears
which continually wash microorganisms away.
7) Gastrointestinal Tract with the high acidity of the
stomach that normally prevents bacterial growth. The
resident flora of the large intestines prevents the
establishment of disease producing microorganism.
8) The vagina when girl reaches puberty, lactobacilli
ferment sugars in the vaginal secretions creating a
vaginal pH of 3.5-4.5. This low pH inhibits the growth
of many disease-producing microorganisms.
9) The urethra with the urine use for flushing and
bacteriostatic action keeps bacteria from ascending.
The WBC (Leukocytes) participates both on the
natural and acquired immune response.
- There are two types of WBC:
1) Granulocytes (Granular leukocytes) as classified to:
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a) Neutrophils with polymorphonuclear cells (PMN),
are the first cells to arrive at the site of
inflammation and increased in acute bacterial
infection;
b) Eosinophils which increases during allergic and
parasitic infections.
c) Basophils which are not usually affected by
infection.
2) The other type is Agranulocytes meaning without
granules and classified to:
1) Monocytes (Macrophages) which are phagocytic
cells engulfing, ingesting, and destroying greater
numbers and quantities of foreign bodies or
toxins;
2) Lymphocytes consisting of Bcells and T-cells that
play major role in Humoral and Cell- Mediated
immune response and increases in chronic
bacterial and viral infections. The inflammatory
responses are the inflammation that is local and
nonspecific defensive response of tissues to an
injurious or infectious agent. It is an adaptive
mechanism that destroys or dilutes the injurious
agent, prevents further spread of injury and
promotes the repair of damaged tissue.
- There are five characteristic signs of inflammation:
1) Pain (Dolor)
2) Swelling (Tumor);
3) Redness (Rubor);
4) Heat (Calor)
5) Impaired function of the part.
- The Acquired Immunity is a specific immunity develops
after birth; acquired during life but not present at birth and
occurs after exposure to an antigen like infectious agent.
- The natural immunity comes in two forms:
1) Active immunity which the host produces its own
antibodies in response to natural antigen and these
antibodies produced by himself with long term
effectivity;
2) Passive immunity are antibodies that are produced by
another source, animal or human given to the
individual with long term effectivity and has
immediate protection. An active natural is an
immunity from a recovery of a disease (mumps,
measles, chicken pox), has lifetime protection and
antibodies are formed in the presence of active
infection (disease) in the body. An active artificial is
coming from antigens like toxoids or vaccines that
can be live attenuated or inactivated vaccines are
usually administered to the person to stimulate
antibody production, all kinds of immunization and
has many years of protection but not lifelong. A
passive natural immunity coming from a
transplacental transfer of antibodies like
breastfeeding with colostrums as a yellowish
antibodies that boost the immune system of the baby,
transfer of IgA and with 6 months to 1 year protection.
A passive artificial immunity coming from Immune
serum (antibody) from an animal or another human is
 312 LECTURE: WK10 – IMMUNIZATION
injected like tetanus Ig, gamma globulin, antitoxin,
antiserum administration with 2-3 weeks protection.
- The lymphoid organs that house phagocytic cells and
lymphocytes: Spleen filters blood of bacteria, viruses and
other debris; destroys worn out RBC’s; and stores
lymphocytes.
- Thymus produces thymosin; programs certain
lymphocytes to carry out their protective role. Bone
marrow produces WBC’s.
- Tonsils is a small msses of lymphatic tissue that ring the
pharynx; it traps and remove bacteria or other foreign
pathogens that will enter the throat.
- Peyer’s patches is found on the wall of the small
intestine; this also traps and remove foreign materials in
the intestine.
The components of Immune Response
• Antibody-Mediated Defenses (B-Cells) also known as
Humoral (Circulating Immunity) because the defenses
reside ultimately in the B lymphocytes and are mediated
by antibodies produced by B cells. Defend primarily
against the extracellular phases of bacterial and viral
infections.
• Cell-Mediated Defenses (T-cells) also known as
Cellular Immunity, occurs through the T-cell system. On
exposure to antigen, the lymphoid tissues release large
numbers of activated T-cells into the lymph system. These
Tcells pass into general circulation. When Cell-Mediated
Immunity is lost, as occurs with HIV infection, an
individual is “defenseless” against most viral, bacterial
and fungal infection. The Tcells are lymphocytes that
mature in the thymus. The T helper cells (Th cells), also
known as CD4 cells, are a type of T cell that play an
important role in the immune system, particularly in the
adaptive immune system. They help the activity of other
immune cells by releasing T cell cytokines. These cells
help suppress or regulate immune responses. Helper T-
cells detects the infection and initiates T-cell and B-cell
responses. A cytotoxic T cell (also known as TC, cytotoxic
T lymphocyte, CTL, T-killer cell, cytolytic T cell, CD8+ T-
cell or killer T cell) is a T lymphocyte (a type of white blood
cell) that kills cancer cells, cells that are infected
particularly with viruses. Cytotoxic cells detect and kill
infected body cells. A suppressor T cell is a type of
immune cell that blocks the actions of some other types
of lymphocytes, to keep the immune system from
becoming overactive. Suppressor T-cells stop the
activated Tcell or B-cell when infection has been stopped.
The B-cells mature in the bone marrow; precursor of
plasma cell specialized to recognize some specific
antigens. Plasma cells produce antibodies which are
directed against specific antigens. Memory cells have
been trained to recognize specific antigens, they will
trigger a faster and stronger immune response after
encountering the same antigen and respond immediately.
Memory T cells are a subset of infection- and cancer-
fighting T cells (also known as a T lymphocyte) that have
previously encountered and responded to their cognate
antigen; first proliferated to fight the infection and the
memory cells mainly located in the lymphoid organs and
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spleen. Interferon is a viricidal protein which is capable of
activating other components of the immune system.
Some of the diagnostic procedures to evaluate the
patient’s immune competence:
• Series of blood tests;
• skin tests;
• bone marrow biopsy;
• electrophoresis.
• The nursing considerations when the patient is undergoing
such procedures: the nurse counsel, educate, and
support the patient and safety precaution should be
implemented.
- Immunoglobulin are antibodies defend against foreign
invaders and the type of defense they will be using
depends on the structure and composition of the antigen
and immunoglobulin.
- There are five types of immunoglobulin. They are GAMED.
1) Immunoglobulin G (IgG) which is the most abundant
immunoglobulin in serum (about 80% of the total
serum immunoglobulin) and relatively abundant
extravascularly (interstitial fluid); neutralizes toxins
and viruses; crosses placenta during gestation (hence
responsible for natural passive immunity of newborn
because it crosses placental barrier); assumes major
roles in bloodborne and tissue infections and
enhances phagocytosis.
2) Immunoglobulin A (IgA) is the chief Ig in external
secretions like breastmilk, saliva, tears, and mucus of
the bronchial, genitourinary and digestive tracts; plays
a major role in secretory immune response; has a
protective function on mucosal surfaces exposed to
environment transported across mucous membrane
with secretions.
3) Immunologlobulin M (IgM) is the second most
abundant antibody; the most important Ig; the largest
of the immunoglobulin and appears mostly in the
intravascular serum; provides a rapid protection
because it is the first antibody noted after antigen
injection in an adult; first Ig class produced in primary
response to bacterial and viral infections; first Ig to be
synthesized by the neonate; and the first antibody to
go on the site.
4) Immunoglobulin E (IgE) triggers the release of
histamine; mediates the immediate hypersensitivity
reactions that are responsible for the symptoms of
hay fever, asthma and anaphylactic shock; and takes
part in allergic and combats parasitic infections.
5) Immunoglobulin D (IgD) is a regulatory antibody; an
antigen receptor of B cells; appears in small amount
in serum with it biologic function is unknown; and it is
located on the surface of B lymphocytes that serves
as surface receptors-reaction with antigen influences
lymphocyte activity.
 NCMB312 LECTURE: Midterm Week

Measles, German Measles, etc.
Bachelor of Science in Nursing 3YA
Professor: Dr. Potenciana A. Maroma
MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA,
COVID 19
Measles
- Francis Home (1757) a Scottish physician, who first
discovered measles.
- Murice Hilleman who first discovered measles vaccine
and first available in 1963 and then improved the vaccine
in 1968.
21 strains
- Rubeola
- 7 day Measles
- Morbilli disease
- Heard measles
- Little Red Disease
- the disease still kills more than 100,000 people a year,
most under the age of 5.
- Measles is a highly contagious illness caused by a virus
that replicates in the nose and throat of an infected child
or adult.
- when someone with measles coughs, sneezes or talks,
infected droplets spray into the air, where other people
can inhale them.
- causative agent of measles is Morbilli Virus
(paramyxovirus).
- The virus is sensitive to heat, light, and extreme acidity
and alkalinity.
- transmitted via airborne
- transmitted via direct contact with respiratory secretions
coming from infected patients and indirect contact with
objects contaminated with secretions.
- incubation period is 10-12 days but it can be ranged from
8 to 20 days after the exposure to the virus.
- period of communicability is 4 days before and 5 days
after the appearance of rashes.
Clinical Manifestation
1) Pre-Eruptive Stage
- highly contagious stage
- s/s
- high grade fever
- coryza
- cough
- conjunctivitis
- photophobia (3C1P)
- the enanthema signs (mucous membrane) presence
of tiny white spots with bluish-white centers on a red
background found inside the mouth on the inner lining
of the cheek opposite to the second molar is called
Koplik's spots which is the pathognomonic sign.
- Pathognomonic sign is a cardinal or distinctive sign of
a measles
- Stimson’s line is a line of inflammation along the
margin of lower eyelid and sore throat
11
2) Eruptive Stage
- rashes (exanthema)
- skin rash made up of large, flat blotches that often
flow into one another.
- It is a maculopapular rash (combination of elevated
and non-elevated skin rashes), reddish in color; spots
and bumps in tight clusters give the skin a splotchy
red appearance, warm to touch; the face breaks out
first that is why distributed as cephalocaudal in
distribution
- Pruritus
- Irritability
- Lethargy
- Anorexia
- 2 to 3 wks
- Diagnostic
• Nose and throat swab
• Urinalysis
• Blood examination and viral serology with
complement fixation
• Hemagglutinin inhibition test and neutralization
test
3) Convalescent Stage.
- Leukopenia is a characteristic sign of many viral
infections and the blood picture in measles is typical
of this effect.
- Wright's stain is a hematologic stain that facilitates
the differentiation of blood cell types.
- It is classically a mixture of eosin (red) and methylene
blue dyes. It is used primarily to stain peripheral blood
smears, urine samples, and bone marrow aspirates,
which are examined under a light microscope. In
cytogenetics, it is used to stain chromosomes to
facilitate diagnosis of syndromes and diseases.
- James Homer Wright, who devised the stain, it
distinguishes easily between blood cells, it became
widely used for performing differential white blood
cell counts, which are routinely ordered when
conditions such as infection are suspected.
- The complications of measles are bronchopneumonia
which is the most common and dreaded complication.
- People with compromised immune systems can
develop an especially dangerous variety of
pneumonia that is sometimes fatal.
- Otitis media is another common complication of
measles is a bacterial ear infection. About 1 in 1,000
people with measles develops a complication called
encephalitis.
- Encephalitis may occur right after measles, or it might
not occur until months later. Nephritis is the
inflammation of the kidney. Blindness of a having a
Vitamin A deficiency, don’t have enough vitamin A in

J.A.K.E 1 of 8
 312 LECTURE: WK11 – MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA, COVID 19
the diet more likely to have more severe symptoms
and complication.
- If the mother is pregnant need to take special care to
avoid measles because the disease can cause
preterm labor, low birth weight and maternal death.
The following nursing interventions are supportive and
symptomatic such as isolation because measles is
highly contagious from about four days before to four
days after the rash breaks out, people with measles
shouldn't return to activities in which they interact
with other people during this period. It may also be
necessary to keep non-immunized people, siblings,
for example away from the infected person.
- May give antipyretic and provide tepid sponge bath,
encourage to increases oral fluid intake, promote bed
rest, and provide nasal, oral, eye and skin care.
- The medical management are Pen G – to prevent
secondary bacterial complication; Antiviral of
ISOPRENOSINE.
- Vitamin A for 6 to 12 months of 100,000 IU and more
than 1 year old to 5 years old with 200,00 IU.
- Being unvaccinated is much more likely to develop
measles. The Centers for Disease Control and
Prevention recommends that children and adults
receive the measles vaccine to prevent measles. Live
Attenuated Measles Vaccine for 9 months; MMR for
1st dose: 12- 15 months and booster dose for 11-12
years; exposed: Measles Immune Serum Globulin
with 1 week after exposure. Be sure that anyone who's
at risk of getting the measles who hasn't been fully
vaccinated receives the measles vaccine as soon as
possible.
- If you've already had measles, the body has built up
its immune system to fight the infection. For everyone
else, there's the measles vaccine, which is important
for promoting and preserving widespread immunity
and preventing a resurgence of measles.
German Measles
- George de Malon (1814) was first discovered German
measles.
- German measles has 27 strains. German measles, also
known as rubella or 3 days measles, is a contagious viral
infection that causes a red rash on the body.
- While this infection may cause mild symptoms or even no
symptoms in most people, it can cause serious problems
for unborn babies whose mothers become infected during
pregnancy.
- Rubella isn't the same as measles, but the two illnesses
share some symptoms, including the red rash. Rubella is
caused by a different virus than measles, and rubella isn't
as infectious or as severe as measles.
- Rubella is caused by a Rubivirus (Rubella Virus) that's
passed from person to person. Rubella virus is the only
member of togavirus (with an envelope) family that causes
significant disease in human—German measles.
- The virus can be transmitted through droplet. It can
spread when an infected person coughs or sneezes. It can
also spread by direct contact with an infected person's
J.A.K.E 2 of 8
respiratory secretions, such as mucus. Indirect contact
with objects contaminated with secretions.
- Trans-placental transmission - it can also be passed on
from pregnant women to their unborn children via the
bloodstream. The incubation period is 2 to 3 weeks and
the period of communicability is 7 days before and 5 days
after the appearance of rashes.
The clinical manifestations of measles
1) Pre-Eruptive Stage
- Low grade fever
- Headache
- Malaise
- Anorexia
- Sore throat
- Coryza
- Conjunctivitis
- With presence of lymphadenopathy such enlargement
of the lymph nodes in the oost cervical
- Postauricular and suboccipital.
2) Eruptive stage
- The eruptive stage of measles is the stage of skin
rashes (exanthema). A skin rash made up of large, flat
blotches that often flow into one another. It is a
maculopapular rash (combination of elevated and
non-elevated skin rashes), reddish in color; spots and
bumps in tight clusters give the skin a splotchy red
appearance, warm to touch; the face breaks out first
that is why distributed as cephalocaudal in
distribution.
- There are also signs and symptoms like testicular pain
especially in younger adults, polyarthralgia and
polyarthritis.
- That is why the nurse can easily distinguish measles
from German measles from its pathognomonic and
lymphadenopathy.
- The enanthema signs (mucous membrane) presence
of a red, petechial macule on the surface of the soft
palate is called Froschauer spot which is the
pathognomonic sign. Pathognomonic sign is a
cardinal or distinctive sign of a German measles.
3) Convalescent stage.
- The convalescent stage rashes disappear in the same
manner as they appear in the body and does not
leaves a branny desquamation (shedding of
epidermis). Aside from the physical assessment, the
diagnostic tests are viral isolation from
nasopharyngeal secretions and viral serology with
complement fixation, hemagglutinin inhibition test
and neutralization test. Rubella is a mild infection.
- Once you've had the disease, the body usually
permanently immune. But, still the complications of
German Measles are encephalitis which is the most
common, Otitis media and Rubella syndrome.
- However, if the mother is pregnant and contract with
rubella, the consequences for the unborn child may
be severe, and in some cases, fatal. Up to 80% of
infants born to mothers who had rubella during the
first 12 weeks of pregnancy develop congenital
rubella syndrome.
 312 LECTURE: WK11 – MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA, COVID 19
This syndrome can cause one or more problems,
including:
• Intrauterine
• Growth Retardation
• Mental retardation
• Cardiac defects
• Eye defects with glaucoma and cataract
• Ear defects with hearing loss.
- The highest risk to the fetus is during the first trimester,
but exposure later in pregnancy also is dangerous. The
following nursing interventions are supportive and
symptomatic such as isolation because measles is highly
contagious from about four days before to four days after
the rash breaks out, people with measles shouldn't return
to activities in which they interact with other people during
this period.
- It may also be necessary to keep non-immunized people,
siblings, for example away from the infected person. May
give antipyretic and provide tepid sponge bath, encourage
to increases oral fluid intake, promote bed rest, and
provide nasal, oral, eye and skin care. The medical
management are symptomatic and supportive with
antipyretic and analgesic.
- Being unvaccinated is much more likely to develop
German measles.
- The Centers for Disease Control and Prevention
recommends that children and adults receive the German
measles vaccine to prevent German measles.
- Live Attenuated Rubella Vaccine, Mumps, Measles,
Rubella vaccine (MMR) and if exposed be given with
Immune Serum Globulin, IM within 1 week after exposure
(especially for pregnant women). The rubella vaccine is
usually given as a combined measles-mumps-rubella
(MMR) vaccine.
- It's particularly important that girls receive the vaccine to
prevent rubella during future pregnancies. Babies born to
women who have received the vaccine or who are already
immune are usually protected from rubella for six to eight
months after birth. But children who are vaccinated early
still need to be vaccinated at the recommended ages later.
Widespread concerns have been raised about a possible
link between the MMR vaccine and autism.
- However, extensive reports from the American Academy
of Pediatrics, the National Academy of Medicine and the
Centers for Disease Control and Prevention conclude that
there is no scientifically proven link between the MMR
vaccine and autism. There is also no scientific benefit to
separating the vaccines.
Chicken Pox
- Giovanni Filippo (1500) was first discovered chicken pox.
Chickenpox is also known as varicella, a highly contagious
disease caused by the varicella-zoster virus (VZV), a
herpes virus varicillae that only pathogenic to humans.
The virus can be transmitted through airborne. It can
spread when an infected person coughs or sneezes. It can
also spread by direct contact with an infected person's
J.A.K.E 3 of 8
respiratory secretions, such as mucus. Indirect contact
with objects contaminated with secretions.
- Trans-placental transmission – It can also be passed on
from pregnant women to their unborn children via the
bloodstream. The incubation period is 10 to 21 days and
the period of communicability is 2 days before the rashes
appear until all vesicles have encrusted.
The clinical manifestations of measles
1) Pre-Eruptive Stage
• Fever
• Headache
• Sore throat
• Malaise
2) Eruptive Stage
- stage is exanthema (skin rashes) with vesiculopapular
rashes, centrifugal in distribution (outer to inner –
uncovered to covered) while centripetal in distribution
(inner to outer – covered to uncovered).
- The centrifugal in distribution of chicken pox
predominantly concentrated on face and extremities
with usual involvement of the palms and soles of the
feet going to the chest and abdomen. The chicken pox
is extremely pruritic because of the fluid inside the
vesicular form of rashes.
- It can cause an itchy, blister like rash. The rash
appears first on the chest, back, and face, and then
spreads over the entire body, causing between 250
and 500 itchy blisters.
- The five stages of rashes:
1) Macule - “flat”
2) Papule - “elevated”
3) Vesicle - “fluid-filled”
4) Pustule - “pus-filled”
5) Crust Scab - dry
- The celestial Map is a condition wherein all the stages
of chicken pox rash are simultaneously present.
3) Convalescent Stage
- Rashes disappear in the same manner as they appear
in the body. Aside from physical assessment, the
diagnostic tests are determination of V-Z virus
through: viral Isolation, microscopic examination of
vesicular fluid and viral serology. The complications
are skin infections such as erysipelas, cellulitis and
impetigo.
- Other complication such as pneumonia, encephalitis
and secondary bacterial infection can also occur with
chicken pox. The nursing interventions are
symptomatic and supportive.
- There are several things that the client can do at home
to help relieve chickenpox symptoms and prevent skin
infections. Calamine lotion and a cool bath with
added baking soda, uncooked oatmeal, or colloidal
oatmeal may help relieve some of the itching. Try to
minimize scratching to prevent the virus from
spreading to others and potential bacterial infection
from occurring. Keeping fingernails trimmed short
may help prevent skin infections caused by scratching
blisters. The medical management are antiviral as to
 312 LECTURE: WK11 – MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA, COVID 19
slow down vesicle formation and speed up skin
healing like Acyclovir or Zoverax, meaning acyclovir is
not a cure but only to hasten the acute stage. The
physician will also order for antipyretic: No NSAID or
do not use aspirin or aspirin-containing products to
relieve fever from chickenpox.
- The use of aspirin in children with chickenpox has
been associated with Reye’s syndrome, a severe
disease that affects the liver and brain and can cause
death. Instead, use non-aspirin medications, such as
acetaminophen, to relieve fever from chickenpox.
- The American Academy of Pediatrics recommends
avoiding treatment with ibuprofen if possible because
it has been associated with life-threatening bacterial
skin infections. Antihistamine, Calamine lotion and
Soda bath for pruritus.
- Being unvaccinated is much more likely to develop
Chicken Pox. The Centers for Disease Control and
Prevention recommends that children and adults
receive the Chicken Pox to prevent Chicken Pox. Live
Attenuated Varicella Vaccine for 2 doses at 1 month
apart (MMRV) Chickenpox can be serious, especially
in babies, adolescents, adults, pregnant women, and
people with a weakened immune system. The best
way to prevent chickenpox is to get the chickenpox
vaccine.
- Vaccinated people who get chickenpox may develop
lesions that do not crust. These people are
considered contagious until no new lesions have
appeared for 24 hours.
- The best way to prevent chickenpox is to get the
chickenpox vaccine. Everyone – including children,
adolescents, and adults – should get two doses of
chickenpox vaccine if they have never had chickenpox
or were never vaccinated. Chickenpox vaccine is very
safe and effective at preventing the disease.
- Most people who get the vaccine will not get
chickenpox. If a vaccinated person does get
chickenpox, the symptoms are usually milder with
fewer or no blisters (they may have just red spots) and
mild or no fever. The chickenpox vaccine prevents
almost all cases of severe illness.
Influenza
- Influenza, one of the most common infectious diseases, is
a highly contagious droplet disease that occurs in
seasonal epidemics and manifests as an acute febrile
illness with variable degrees of systemic symptoms,
ranging from mild fatigue to respiratory failure and death.
Influenza causes significant loss of workdays, human
suffering, and mortality.
- In 1892, Dr. Richard Pfeiffer isolated an unknown
bacterium from the sputum of his sickest flu patients, and
he concluded that the bacteria caused influenza. He
called it Pfeiffer's bacillus, or Haemophilus influenzae.
- Influenza, commonly called "the flu," or “La Grippe” is an
illness caused by RNA viruses (Orthomyxoviridae family)
that infect the respiratory tract of many animals, birds,
and humans.
J.A.K.E 4 of 8
- Flu is a contagious respiratory illness caused by influenza
viruses that infect the nose, throat, and sometimes the
lungs. It can cause mild to severe illness, and at times can
lead to death. The best way to prevent flu is by getting a flu
vaccine each year. Flu spreads directly and indirectly;
directly from person to person by droplets produced
during sneezing or coughing, for example, and indirectly
when contaminated droplets land on surfaces that are
subsequently touched by uninfected individuals.
- These droplets can land in the mouths or noses of people
who are nearby. Less often, a person might get flu by
touching a surface or object that has flu virus on it and then
touching their own mouth, nose or possibly their eyes. The
period of contagiousness is 3 to 5 days of illness up to 7
days for the adult and children: up to 10 days from the
onset of symptoms. People with flu are most contagious in
the first 3-4 days after their illness begins. Some otherwise
healthy adults may be able to infect others beginning 1 day
before symptoms develop and up to 5 to 7 days after
becoming sick.
- Some people, especially young children and people with
weakened immune systems, might be able to infect others
for an even longer time. It is very difficult to distinguish flu
from other viral or bacterial respiratory illnesses based on
symptoms alone. There are tests available to diagnose flu.
- The etiologic agent of influenza virus are A, B, C and D.
Human influenza A and B viruses cause seasonal
epidemics of disease (known as the flu season) almost
every winter in the United States. Influenza A viruses are
the only influenza viruses known to cause flu pandemics,
i.e., global epidemics of flu disease.
- A pandemic can occur when a new and very different
influenza A virus emerges that both infects people and has
the ability to spread efficiently between people.
- Influenza type C infections generally cause mild illness and
are not thought to cause human flu epidemics. Influenza D
viruses primarily affect cattle and are not known to infect or
cause illness in people. Influenza A is epidemic and
pandemic cases. Influenza B is epidemic case and
Influenza C is sporadic case.
- Influenza A viruses are divided into subtypes based on two
proteins on the surface of the virus: hemagglutinin (H) and
neuraminidase (N). There are 18 different hemagglutinin
subtypes and 11 different neuraminidase subtypes (H1
 312 LECTURE: WK11 – MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA, COVID 19
through H18 and N1 through N11, respectively). While
there are potentially 198 different influenza A subtype
combinations, only 131 subtypes have been detected in
nature.
- Current subtypes of influenza A viruses that routinely
circulate in people include: A (H1N1) and A (H3N2). For
influenza A viruses, the hemagglutinin and neuraminidase
antigen description are provided in parentheses (e.g.,
influenza A (H1N1) virus, influenza A(H5N1) virus).
- The clinical manifestations of Influenza are hyperpyrexia,
chills, malaise, coryza, headache, myalgia, sore throat
and GI manifestations: nausea and vomiting. Most people
who get the conventional or seasonal flu recover
completely in 1-2 weeks, but some people develop
serious and potentially life-threatening medical
complications, such as pneumonia, the most common
and most dangerous.
- The diagnostic tests for influenza are nose and throat
swab, viral culture, viral serology, WBC – decrease, and
RTPCR (Real Time Polymerase Chain Reaction) – which
the confirmatory test.
- Doctors use a patient's history, physical exam, and
laboratory tests to diagnose the flu.
- The medical treatment for Influenza A: Amantadine HCl
(Symmetrel)- prevention and treatment of RTI caused by
the virus, antibiotics for secondary infection or if with
pulmonary bacterial complication.
- AH1N1 can be given Oseltamivir (Tamiflu) and Zanamivir
(Relenza). Vaporizerreduce irritation to respiratory
mucosa.
- Drug treatments are constantly changing and improving,
but currently, timely vaccination is still considered the
best defense against the flu. However, the U.S. Centers
for Disease Control and Prevention (CDC) considers
antiviral drugs an important adjunct to the flu vaccine in
the control of the disease process.
The Nursing Mnagement are symptomatic and supportive:
• Respiratory Isolations(droplet)
• Bed Rest: Limit strenuous activity
• Keep patient warm and free from drafts in bed
• Watch out for complication
• TSB
• Instruct patient to avoid crowded areas and close contact
with infected persons
• Annual influenza vaccination can prevent much of the
illness and death caused by conventional or seasonal
influenza. Client can be given a live attenuated influenza
vaccine with single dose to people at risk like elderly and
immune-compromised persons. Effectiveness of the flu
vaccine varies year to year because strains causing flu
also to vary yearly.
COVID 19
- The coronavirus disease (COVID-19) is an infectious
disease caused by a newly discovered and a new strain of
coronavirus. This new virus and disease were unknown
before the outbreak began in Wuhan, China, in December
2019. On 30 January 2020, the Philippine Department of
J.A.K.E 5 of 8
Health reported the first case of COVID-19 in the country
with a 38-year-old female Chinese national. On 7 March,
the first local transmission of COVID-19 was confirmed.
- WHO is working closely with the Department of Health in
responding to the COVID-19 outbreak. COVID-19 is
caused by the SARS-CoV-2 virus. This virus, which can
cause mild to severe respiratory illness, has spread
globally, including the Philippines. There is limited
information available to fully describe the different types
of clinical illness associated with COVID-19.
- This illness likely spreads to others when a person shows
signs or symptoms of being sick (e.g., fever, coughing,
difficulty breathing, etc.) or in the few days leading up to
symptoms.
- Most common symptoms: fever, dry cough, and tiredness.
Less common symptoms: aches and pains, sore throat,
diarrhea, conjunctivitis, headache, loss of taste or smell,
rash on skin, or discoloration of fingers or toes. Serious
symptoms: difficulty breathing or shortness of breath,
chest pain, and loss of speech or movement.
- Seek immediate medical attention if someone have
serious symptoms. Always call before visiting the doctor
or health facility. Most people infected with the COVID-19
virus will experience mild to moderate respiratory illness
and recover without requiring special treatment. Older
people, and those with underlying medical problems like
cardiovascular disease, diabetes, chronic respiratory
disease, and cancer are more likely to develop serious
illness.
- The best way to prevent and slow down transmission is be
well informed about the COVID-19 virus, the disease it
causes and how it spreads. Protect yourself and others
from infection by washing the hands or using an alcohol
based rub frequently and not touching the face, primarily
the mouth, eyes and nose.
- The COVID-19 virus spreads primarily through droplets of
saliva or discharge from the nose when an infected person
coughs or sneezes, so it’s important that you also practice
respiratory etiquette (for example, by coughing into a
flexed elbow). Do not touch your mouth, eyes and nose.
- COVID-19 affects different people in different ways. Most
infected people will develop mild to moderate illness and
recover without hospitalization. People with mild
symptoms who are otherwise healthy should manage their
symptoms at home. On average it takes 5–6 days from
when someone is infected with the virus for symptoms to
show, however it can take up to 14 days.
Different tests
1) COVID-19 (Coronavirus) Molecular (Swab) Test (PCR)
Polymerase Chain Reaction Test
- this test uses a long swab to collect material,
including physical pieces of coronavirus, from the
back of the nose where it meets the throat.
- A positive result indicates that viral genetic material is
present, but it does not indicate that bacterial or other
infections also are present.
- A negative result indicates that the SARS-CoV2 virus
that causes the COVID-19 disease was not found. It is
 312 LECTURE: WK11 – MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA, COVID 19
possible to have a very low level of the virus in the
body with a negative test result.
- This test is needed to identify the presence of the
SARS-CoV-2 virus that causes the COVID-19 disease.
2) COVID-19 (Coronavirus) Antibody (Serology) Test
(RDT) Rapid Diagnostic Test
- this is a blood test. It is designed to detect antibodies
(immunoglobulins, IgG and IgM) against the
coronavirus that causes the disease called COVID-19.
- Antibodies are proteins produced by the immune
system in response to an infection and are specific to
that particular infection.
- They are found in the liquid part of blood specimens,
which is called serum or plasma, depending on the
presence of clotting factors. IgM and IgG may either
be ordered together or separately.
- The difference between RDT and PCR, RDT just
detects the antibodies while PCR detects for the virus
itself that is why PCR is the confirmatory test.
- Having an antibody test is helpful if:
• health care provider believes that the patient may
have been exposed to the coronavirus which
causes COVID19 based on the current or previous
signs and symptoms (e.g., fever, cough, difficulty
breathing)
• live in or have recently traveled to a place where
transmission of COVID-19 is known to occur; (3)
have been in close contact with an individual
suspected of or confirmed to have COVID-19; and
(4) have recovered from COVID- 19.
- The Antibody Test for IgG (red line in graph)- this test
detects IgG antibodies that develop in most patients
within seven to 10 days after symptoms of COVID-19
begin. IgG antibodies remain in the blood after an
infection has passed.
- These antibodies indicate that the patient may have
had COVID-19 in the recent past and have developed
antibodies that may protect him from future infection.
- It is unknown at this point how much protection
antibodies might provide against re-infection. The
Antibody Test for IgM (green line in graph) - this test
detects IgM antibodies.
- IgM is usually the first antibody produced by the
immune system when a virus attacks. A positive IgM
test indicates that you may have been infected and
that the immune system has started responding to the
virus. When IgM is detected in the body may still be
infected, or may have recently recovered from a
COVID-19 infection.
- Meaning if IgM positive and IgG positive – the body is
making a long term antibodies but the virus still in the
body and infected. Need hospitalization.
- IgG positive and IgM negative – the body has
antibodies against SARS COV 2, there is already
immunity and not any more infectious.
- No need a confirmatory test and no need for
quarantine. IgM positive and IgG negative – if the
patient is positive in IgM, the patient is infected and
infectious, carrier of SARS Cov 2 and need isolation
J.A.K.E 6 of 8
for 2 weeks because of the chance of transmitting the
virus.
- Confirmatory test is advised. Contact tracing for those
people whom they meet along the way and be tested
and informed the LGU for the results.
- Igm negative and IgG negative – no virus in the body
and its too early for the body to produce antibodies
that RDT detects. Still even if negative result, practice
hand washing, put face mask, physical distancing and
boost the immune system and repeat the RDT after 7-
14 days.
- Antibody tests check your blood by looking for
antibodies, which may tell you if you had a past
infection with the virus that causes COVID-19.
Antibodies are proteins that help fight off infections
and can provide protection against getting that
disease again (immunity).
- Antibodies are disease specific. For example,
measles antibodies will protect you from getting
measles if you are exposed to it again, but they won’t
protect you from getting mumps if you are exposed to
mumps.
- Except in instances in which viral testing is delayed,
antibody tests should not be used to diagnose a
current COVID-19 infection. An antibody test may not
show if you have a current COVID-19 infection
because it can take 1–3 weeks after infection for your
body to make antibodies.
- At this time, there are no specific vaccines or
treatments for COVID-19. However, there are many
ongoing clinical trials evaluating potential treatments.
WHO will continue to provide updated information as
soon as clinical findings become available. There are
no drugs or other therapeutics presently approved by
the U.S. Food and Drug Administration (FDA) to
prevent or treat COVID-19.
- Current clinical management includes infection
prevention and control measures and supportive care,
including supplemental oxygen and mechanical
ventilatory support when indicated.
To prevent infection and to slow transmission of COVID-19
• Wash your hands regularly with soap and water, or clean
them with alcohol-based hand rub.
• Maintain at least 1 meter distance between any individual
and people coughing or sneezing.
• Avoid touching the face.
• Cover the mouth and nose when coughing or sneezing.
• Stay home if feel unwell.
• (6). Refrain from smoking and other activities that weaken
the lungs.
• Practice physical distancing by avoiding unnecessary
travel and staying away from large groups of people.
• Boost the immune system by taking Vitamin C, Vitamin D
and Zinc and eat nutritious foods.
 312 LECTURE: WK11 – MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA, COVID 19
After the onslaught of COVID 19, the paradigm of the “hew
normal” in the public health sector has emerged. At the
core of it, the “New Normal” is a new way of thinking
about deciding on, and doing our usual affairs with an
invigorated sense to remain healthy by:
1) reducing the vulnerability by keeping a healthy lifestyle
2) reducing virus transmission by observing infection control
measures
3) reducing contact with a potential disease carrier
4) reducing the duration of infection by establishing effective
disease management mechanism
5) ensuring governance and accountability by putting in
place strong health regulations and policies.
Ten Clinical Tips on COVID-19 for Healthcare Providers
Involved in Patient Care.
Treatment and Prophylaxis:
• The National Institutes of Health has developed
guidance on treatment which will be regularly
updated as new evidence on the safety and efficacy of
drugs and therapeutics emerges from clinical trials
and research publications.
• There is currently no FDA-approved post-exposure
prophylaxis for people who may have been exposed to
SARSCoV- 2.
Symptoms and Diagnosis
• Non-respiratory symptoms of COVID-19 – such as
gastrointestinal symptoms (e.g., nausea, vomiting,
diarrhea), or neurologic symptoms (e.g., anosmia,
ageusia, headache), or fatigue or body and muscle
aches – may appear before fever and lower respiratory
tract symptoms (e.g., cough and shortness of breath).
• Children with COVID-19 may have fewer symptoms
than adults. Although most children with COVID-19
have not had severe illness, clinicians should
maintain a high index of suspicion for SARSCoV-2
infection in children, particularly infants and children
with underlying medical conditions. CDC is
investigating multisystem inflammatory syndrome in
children, a rare but serious complication associated
with COVID-19. CDC recommends monitoring
children for worsening of COVID-19 illness.
J.A.K.E 7 of 8
• CT scan should not be used to screen for COVID-19 or
as a first-line test to diagnose COVID-19. CT scans
should be used sparingly and reserved for
hospitalized, symptomatic patients with specific
clinical indications for CT scans.
Co-Infections:
• Patients can be infected with more than one virus at
the same time. Co-infections with other respiratory
viruses in people with COVID-19 have been reported.
Therefore, identifying infection with one respiratory
virus does not exclude SARS-CoV-2 virus infection.
• Several patients with COVID- 19 have been reported
presenting with concurrent community-acquired
bacterial pneumonia. Decisions to administer
antibiotics to COVID-19 patients should be based on
the likelihood of bacterial infection (community-
associated or healthcare-associated), illness severity,
and current clinical practice guidelines.
Severe Illness:
• Clinicians should be aware of the potential for some
patients to rapidly deteriorate 1 week after illness
onset.
• The median time to acute respiratory distress
syndrome (ARDS) ranges from 8 to 12 days.
• Lymphopenia, neutrophilia, elevated serum alanine
aminotransferase and aspartate aminotransferase
levels, elevated lactate dehydrogenase, high CRP, and
high ferritin levels may be associated with greater
illness severity.
- The Philippines started classifying coronavirus disease
2019 (COVID-19) cases as either Patients under
Investigation (PUIs) or Persons under Monitoring (PUMs).
However, due to apparent local or community
transmission of the virus and the surge in cases, the
Department of Health (DoH) has decided to shift from
classifying individuals as PUIs or PUMs to using case
definitions following guidelines from the World Health
Organization (WHO).
- PUM is one who may have been exposed to the virus but
shows no symptoms — is no longer included in the new
classification, as residents are assumed to have been
exposed due to local transmission.
- A PUI (mild, severe or critical) who was not tested or
awaiting test results is now classified as Suspect, while a
PUI (mild, severe or critical) with inconclusive test results
is considered a Probable case. A COVID Positive case is
now referred to as Confirmed.
Suspect Case
a) Individuals with influenza-like illness (ILI). Symptoms
include fever of at least 38°C and cough or sore throat,
and either of the following:
• a history of travel to or residence in an area that
reported local transmission of COVID-19 during the
14 days prior to symptom onset
• with contact to a confirmed or probable case of
COVID-19 during the 14 days prior to symptom onset.
b) Individuals with sudden respiratory infection and severe
symptoms such as shortness of breath, difficulty of
 312 LECTURE: WK11 – MEASLES, GERMAN MEASLES, CHICKEN POX, INFLUENZA, COVID 19

breathing or severe pneumonia with unknown cause, and

requires hospitalization.
c) Individuals with fever or cough or shortness of breath or
other respiratory signs or symptoms and under any of the
following conditions:
• aged 60 years and above
• with a co-morbidity
• assessed as having high-risk pregnancy, or (4) a
health worker.
Probable Case
a) Suspect case whom testing for COVID-19 is inconclusive.
b) Suspect case who tested positive for COVID-19 but whose
test was not conducted in a national or sub-national
reference laboratory, or an officially accredited laboratory.
Confirmed Case
a) Any individual who was laboratory-confirmed for COVID19
through RT-PCR in a national or subnational reference
laboratory, or a DoH-certified laboratory testing facility.

J.A.K.E 8 of 8
 NCMB312 LECTURE:
PTB, Pneumonia, Diphtheria, Pertusis, Mumps
Bachelor of Science in Nursing 3YA
Professor: Dr. Potenciana A. Maroma
PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
Pneumonia
- An Inflammation of the lung parenchyma with the
production of alveolar exudates resulting to consolidation
of the air sacs. It is an infection that inflames the air sacs
in one or both lungs.
- The air sacs may fill with fluid or pus (purulent material),
causing cough with phlegm or pus, fever, chills, and
difficulty breathing.
- A variety of organisms, including bacteria, viruses and
fungi, can cause pneumonia. Pneumonia can range in
seriousness from mild to life-threatening. It is most
serious for infants and young children, people older than
age 65, and people with health problems or weakened
immune systems.
- Edwin Klebs was the first to observe bacteria in the
airways of persons having died of pneumonia in 1875.
- The etiologic agents of pneumonia – Streptococcus
pneumonia, Haemophilus influenza, Staphylococcus
aureus, Klebsiella pneumoniae (Friedlander’s bacilli),
Mycoplasma pneumonia.
- The mode of transmissions of pneumonia are droplet
transmission – mouth & nose of an infected person via
nasopharynx, through intimate contact w/ carriers,
indirect contact contaminated objects and Systemic
infection through inhalation of caustic or toxic chemicals,
aspiration of food, fluid, and vomitus. The incubation
period is 1 to 3 days. The period of communicability is not
specified.
The Classification according to where & how the client is
exposed to the disease:
1) Community-acquired PNM
- Acquired in the course of one’s daily life; at work, at
school or at the gym. Hospitalized patient developed
PNM in <36 hours during his stay in hospital.
- Community-acquired pneumonia is the most
common type of pneumonia. It occurs outside of
hospitals or other health care facilities. It may be
caused by: Bacteria.
- The most common cause of bacterial pneumonia in
the U.S. and in the Philippines is Streptococcus
pneumoniae.
- This type of pneumonia can occur on its own or after
you've had a cold or the flu. It may affect one part
(lobe) of the lung, a condition called lobar pneumonia.
- Bacteria-like organisms - Mycoplasma pneumoniae
also can cause pneumonia. It typically produces
milder symptoms than do other types of pneumonia.
Walking pneumonia is an informal name given to this
type of pneumonia, which typically isn't severe
enough to require bed rest.
- Fungi - this type of pneumonia is most common in
people with chronic health problems or weakened
J.A.K.E 1 of 9
Midterm Week
11
immune systems, and in people who have inhaled
large doses of the organisms. The fungi that cause it
can be found in soil or bird droppings and vary
depending upon geographic location.
- Viruses - including COVID-19 and some of the viruses
that cause colds and the flu can cause pneumonia.
Viruses are the most common cause of pneumonia in
children younger than 5 years. Viral pneumonia is
usually mild. But in some cases it can become very
serious. Coronavirus 2019 (COVID-19) may cause
pneumonia, which can become severe.
2) Hospital acquired pneumonia
- some people catch pneumonia during a hospital stay
for another illness. Develops while client is in the
hospital; reflects the kind of nursing care is given to
the patient. Usually, more than 36 hours of hospital
stay. Hospital-acquired pneumonia can be serious
because the bacteria causing it may be more resistant
to antibiotics and because the people who get it are
already sick.
- People who are on breathing machines (ventilators),
often used in intensive care units, are at higher risk of
this type of pneumonia.
3) Health care-acquired pneumonia is a bacterial infection
that occurs in people who live in long-term care facilities
or who receive care in outpatient clinics, including kidney
dialysis centers. Like hospital-acquired pneumonia,
health care-acquired pneumonia can be caused by
bacteria that are more resistant to antibiotics.
4) Aspiration pneumonia occurs when you inhale food,
drink, vomit or saliva into your lungs. Aspiration is more
likely if something disturbs your normal gag reflex, such as
a brain injury or swallowing problem, or excessive use of
alcohol or drugs.
The Anatomical Classifications:
• Bronchopneumonia (Lobular or Catarrhal PNM) - most
common type; infection usually start from bronchus &
bronchioles & spread to alveoli of periphery; lobules
inflamed & consolidated and caused by: Pneumococcus,
Klebsiella pneumoniae, H. influenza.
• Lobar PNM (Croupous Pneumonia) - consolidation of
entire lobe; as disease progresses, prune juice color of
sputum replaced by thinner or yellowish color.
• Primary Atypical Pneumonia (Virus Pneumonia) -
solidification of lung that comes in patches.
The General Classification of Pneumonia
• Primary – direct result of inhalation or aspiration of
pathogen or noxious substances;
• Secondary – develops as complication to a disease.
Sign and symptoms
• The signs and symptoms of pneumonia vary from mild to
severe, depending on factors such as the type of germ
causing the infection, and your age and overall health.
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
• Mild signs and symptoms often are similar to those of a
cold or flu, but they last longer.
• Signs and symptoms of pneumonia may include: Chills
with rising fever lower than normal body temperature (in
adults older than age 65 and people with weak immune
systems), Chest pain (stabbing), Cough (paroxysmal and
choking) which may produce phlegm, Rusty or prune juice
sputum- pathognomonic sign, Abdominal pain, Confusion
or changes in mental awareness (in adults age 65 and
older), Fatigue, Nausea, vomiting or diarrhea, flaring of
nares, labored respirations, rapid and bounding pulse,
diaphoresis. Newborns and infants may not show any sign
of the infection. Or they may vomit, have a fever and
cough, appear restless or tired and without energy, or
have difficulty breathing and eating. The single most
important symptom in the diagnosis of pneumonia is fast
breathing. See the doctor if the client is having difficulty
breathing, chest pain, persistent fever of 102 F (39 C) or
higher, or persistent cough, especially if coughing up with
pus.
The diagnostic tests
• Chest X-ray – confirmatory diagnostic exam, sputum
analysis, sputum smear and culture and blood serologic
examinations. The doctor will start by asking about your
medical history and doing a physical exam, including
listening to your lungs with a stethoscope to check for
abnormal bubbling or crackling sounds that suggest
pneumonia. If pneumonia is suspected, your doctor may
recommend the following tests: Blood tests are used to
confirm an infection and to try to identify the type of
organism causing the infection. However, precise
identification isn't always possible. Chest X-ray helps the
doctor diagnose pneumonia and determine the extent and
location of the infection. However, it can't tell by the
doctor what kind of germ is causing the pneumonia.
• Pulse oximetry measures the oxygen level in the blood.
Pneumonia can prevent the lungs from moving enough
oxygen into the bloodstream. Sputum test - a sample of
secretions is taken after a deep cough and analyzed to
help pinpoint the cause of the infection. The doctor might
order additional tests if you're older than age 65, are in the
hospital, or have serious symptoms or health conditions.
These may include: CT scan. If the pneumonia isn't
clearing as quickly as expected, the doctor may
recommend a chest CT scan to obtain a more detailed
image of the lungs.
• Pleural fluid culture - a fluid sample is taken by putting a
needle between the ribs from the pleural area and
analyzed to help determine the type of infection. It's
especially important that people in these high-risk groups
see a doctor: (1) Adults older than age 65; (2) Children
younger than age 2 with signs and symptoms; (3) People
with an underlying health condition or weakened immune
system; (4) People receiving chemotherapy or taking
medication that suppresses the immune system.
The medical management are antibiotics:
• Pen G Na: Drug of Choice with alternative of
Clotrimoxazole, Tetracycline and Erythromycin,
J.A.K.E 2 of 9
Bronchodilators (aminophylline, salbutamol),
Expectorants, Analgesics for pleuritic pain, High calorie
diet, adequate fluid intake unless contraindicated,
Absolute bed rest, Humidified 02 for hypoxia, Mechanical
ventilation – resp. failure.
• Klebsiela – Aminoglycosides and Cephalosporins;
• Streptococcus – Nfcillin or Oxacillin for 14 days;
• Pneumonitis carinii – Cotrimoxazole.
The nursing management
• isolation, increase oral fluid intake may help liquefy
secretions in order to help expectorate easily, chest
physiotherapy, deep breathing coughing and turning
exercise (DBCTE), elevate head & shoulders of patient by
means of pillow to relieve labored breathing & lessen
coughing and suction secretion when necessary.
• Children may be hospitalized if:
- they are younger than age 2 months;
- they are lethargic or excessively sleepy;
- they have trouble breathing;
- they have low blood oxygen levels; and
- they appear dehydrated.
Even with treatment, some people with pneumonia,
especially those in high-risk groups, may experience
complications, including:
• Bacteria in the bloodstream (bacteremia). Bacteria that
enter the bloodstream from your lungs can spread the
infection to other organs, potentially causing organ failure.
• Fluid accumulation around the lungs (pleural effusion).
Pneumonia may cause fluid to build up in the thin space
between layers of tissue that line the lungs and chest
cavity (pleura). If the fluid becomes infected, patient may
need to have it drained through a chest tube or removed
with surgery.
• Lung abscess. An abscess occurs if pus forms in a cavity
in the lung. An abscess is usually treated with antibiotics.
Sometimes, surgery or drainage with a long needle or tube
placed into the abscess is needed to remove the pus.
To help prevent pneumonia:
• Get vaccinated. Vaccines are available to prevent some
types of pneumonia and the flu. Talk with the doctor about
getting these shots. The vaccination guidelines have
changed over time so make sure to review the vaccination
status with the doctor even if you recall previously
receiving a pneumonia vaccine. Make sure children get
vaccinated. Doctors recommend a different pneumonia
vaccine for children younger than age 2 and for children
ages 2 to 5 years who are at particular risk of
pneumococcal disease. Children who attend a group
child care center should also get the vaccine. Doctors
also recommend flu shots for children older than 6
months.
• Practice good hygiene. To protect yourself against
respiratory infections that sometimes lead to pneumonia,
wash your hands regularly or use an alcohol-based hand
sanitizer.
• Don't smoke. Smoking damages your lungs' natural
defenses against respiratory infections. (4) Keep your
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
immune system strong. Get enough sleep, exercise
regularly and eat a healthy diet.
Diphtheria
- Diphtheria is a serious bacterial infection that usually
affects the mucous membranes of the nose and throat.
Endemic in many countries in Asia, the South Pacific, the
Middle East, Eastern Europe and in Haiti and the
Dominican Republic. Diphtheria is extremely rare in the
United States and other developed countries, thanks to
widespread vaccination against the disease. Diphtheria
can be treated with medications. But in advanced stages,
diphtheria can damage the heart, kidneys and nervous
system. Even with treatment, diphtheria can be deadly,
especially in children.
- Emil Adolf Behring who was a German physiologist who
first discovered a diphtheria antitoxin
- Diphtheria is an acute febrile infection of the tonsil, throat,
nose, larynx or a wound marked by a patch or patches of
grayish membrane from which diphtheria bacillus is
readily cultured.
- Diphtheria is caused by the bacterium Corynebacterium
diphtheria (Klebs-loeffler bacillus). The bacterium usually
multiplies on or near the surface of the throat. C.
diphtheriae spreads via droplets. When an infected
person's sneeze or cough releases a mist of contaminated
droplets, people nearby may inhale C. diphtheriae.
Diphtheria spreads easily this way, especially in crowded
conditions. Indirect contact with contaminated personal
or household items can also be transmitted the bacteria.
- People occasionally catch diphtheria from handling an
infected person's things, such as used tissues or hand
towels that may be contaminated with the bacteria. It can
also transfer diphtheria-causing bacteria by touching an
infected wound. People who have been infected by the
diphtheria bacteria and who haven't been treated can
infect people who haven't had the diphtheria vaccine —
even if they don't show any symptoms.
- The incubation period is 2 – 5 days, occasionally longer
and the period of communicability is 2 weeks and seldom
more than 4 weeks.
People who are at increased risk of contracting diphtheria
include:
• Children and adults who don't have up-to-date
vaccinations;
• People living in crowded or unsanitary conditions, anyone
who travels to an area where diphtheria infections are
more common;
• Diphtheria rarely occurs in the United States and Western
Europe, where children have been vaccinated against the
condition for decades. However, diphtheria is still
common in developing countries where vaccination rates
are low.
The clinical manifestations of respiratory type of
diphtheria:
• Nasal – localized in the nares; excoriation of the upper lip
and alae nasi with serosanguinous secretions which later
becomes bloody and foul smelling.
J.A.K.E 3 of 9
• Pharyngeal or faucial – pharynx (tonsilar, uvular, palatar)
- low grade fever; malaise; headache and sore throat;
pseudomembrane very visible within 24 hrs.
Pseudomembrane is a false membrane, a grayish, white
color and leathery in consistency and irregular in shape,
usually inflamed which decreases the opening of the
nasopharynx; bull neck – a swollen glands (enlarged
lymph nodes) in the neck; difficulty breathing or rapid
breathing.
• Laryngotracheal - more common in infants; presence of
laryngeal stridor; hoarseness of voice and some signs of
respiratory distress. In some people, infection with
diphtheria-causing bacteria causes only a mild illness —
or no obvious signs and symptoms at all. Infected people
who remain unaware of their illness are known as carriers
of diphtheria, because they can spread the infection
without being sick themselves. Skin (cutaneous)
diphtheria is a second type of diphtheria can affect the
skin, causing pain, redness and swelling similar to other
bacterial skin infections. Ulcers covered by a gray
membrane also may be skin diphtheria. Although it's more
common in tropical climates, diphtheria on the skin also
occurs in the United States, particularly among people
with poor hygiene who live in crowded conditions. But in
the Philippines, respiratory type is most common than
skin type of diphtheria.
The diagnostic examinations are nose and throat culture
to detect the etiologic agent.
• Schick’s test – determines susceptibility and immunity to
diphtheria while moloney test – determines
hypersensitivity to diphtheria toxoid. The medical
management are antibiotics which is Penicillin – is the
drug of choice and Erythromycin as alternative if allergy to
penicillin.
• Passive immunization diphtheria antitoxin and
tracheostomy if laryngeal for infant and children are
present.
The nursing management
- Strict isolate the patient (droplet), provide liquid and soft
diet, maintain good oral hygiene and proper airway,
complete bed rest, pasteurization of milk, ice collar for
neck spasms and monitor for respiratory distress.
- Call the family doctor immediately or go to the nearest
hospital if the child has been exposed to someone with
diphtheria. If not sure whether the child has been
vaccinated against diphtheria, schedule an appointment.
- Make sure that the child own vaccinations are current. In
areas where diphtheria vaccination is standard, the
disease is mainly a threat to unvaccinated or inadequately
vaccinated people who travel internationally or have
contact with people from less-developed countries.
Left untreated, diphtheria can lead to:
• breathing problems such as bronchopneumonia since
diphtheria-causing bacteria may produce a toxin. This
toxin damages tissue in the immediate area of infection —
usually, the nose and throat. At that site, the infection
produces a tough, gray-colored membrane composed of
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
dead cells, bacteria and other substances. This
membrane can obstruct breathing.
• Heart damage - the diphtheria toxin may spread through
the bloodstream and damage other tissues in the body,
such as the heart muscle, causing such complications as
inflammation of the heart muscle (myocarditis). Heart
damage from myocarditis may be slight or severe. At its
worst, myocarditis can lead to congestive heart failure
and sudden death.
• Nephritis and
• Nerve damage that can cause peripheral neuritis - the
toxin can also cause nerve damage. Typical targets are
nerves to the throat, where poor nerve conduction may
cause difficulty swallowing. Nerves to the arms and legs
also may become inflamed, causing muscle weakness. If
the diphtheria toxin damages the nerves that help control
muscles used in breathing, these muscles may become
paralyzed. At that point, patient might need mechanical
assistance to breathe. With treatment, most people with
diphtheria survive these complications, but recovery is
often slow. Diphtheria is fatal 5% to 10% of the time,
according to the World Health Organization. Rates of
death are higher in children.
Vaccine
- The diphtheria vaccine is usually combined with vaccines
for tetanus and whooping cough (pertusis). The three-in-
one vaccine is known as the diphtheria, tetanus and
pertusis vaccine. The latest version of this vaccine is
known as the DTaP vaccine for children and the Tdap
vaccine for adolescents and adults. The diphtheria,
tetanus and pertusis vaccine is one of the childhood
immunizations that doctors in the United States
recommend during infancy. In the Philippines,
immunization of DPT in an early age is encouraged. Proper
disposal of nasopharyngeal secretions also part of
prevention of spreading the microorganism causing
diphtheria. Vaccination consists of a series of five shots,
typically administered in the arm or thigh, given to children
at these ages: 2 months; 4 months; 6 months; 15 to 18
months and 4 to 6 years.
- The diphtheria vaccine is effective at preventing diphtheria.
But there may be some side effects. Some children may
experience a mild fever, fussiness, drowsiness or
tenderness at the injection site after a DTaP shot.
Alternative of warm and cold compress is advised to
minimize or relieve these effects. Rarely, the DTaP vaccine
causes serious but treatable complications in a child,
such as an allergic reaction (hives or a rash develops
within minutes of the injection). Some children — such as
those with epilepsy or another nervous system condition
— may not be candidates for the DTaP vaccine. After the
initial series of immunizations in childhood, need booster
shots of the diphtheria vaccine to help maintain the
immunity. That's because immunity to diphtheria fades
with time. Children who received all of the recommended
immunizations before age 7 should receive their first
booster shot at around age 11 or 12.
J.A.K.E 4 of 9
- The next booster shot is recommended 10 years later,
then repeated at 10-year intervals. Booster shots are
particularly important if you travel to an area where
diphtheria is common. The diphtheria booster is
combined with the tetanus booster — the tetanus-
diphtheria (Td) vaccine. This combination vaccine is given
by injection, usually into the arm or thigh. Tdap is a
combined tetanus, diphtheria and acellular pertussis
(whooping cough) vaccine. It's a one-time alternative
vaccine for adolescents ages 11 through 18 and adults
who haven't previously had a Tdap booster. It's also
recommended once during pregnancy, regardless of
previous vaccinations.
Pertusis
- Pertussis (whooping cough) can cause serious illness in
babies, children, teens, and adults. Symptoms of pertusis
usually develop within 5 to 10 days after you are exposed.
Sometimes pertussis symptoms do not develop for as
long as 3 weeks.
- Whooping cough (pertussis) is an acute contagious
disease characterized by intermittent episodes of
paroxysmal cough followed by an explosive expiration
ending in an inspiratory “whoop” and ending in vomiting
(5-10x in succession repeated 20-40x in a day).
- Before the vaccine was developed, whooping cough was
considered a childhood disease. Now whooping cough
primarily affects children too young to have completed the
full course of vaccinations and teenagers and adults
whose immunity has faded.
- Deaths associated with whooping cough are rare but most
commonly occur in infants. That's why it's so important for
pregnant women — and other people who will have close
contact with an infant — to be vaccinated against
whooping cough. Jules Bordet (1906) – discovered
pertusis and Octave Gengou - developed the first serology
and vaccine of pertusis.
- ”Whooping cough” is the entrance of air in the epiglottis.
The causative agent are Haemophillus pertusis, Bordet
Gnegou Bacillus or Bordetella pertussis which is a Gram (-
) coccobacilli.
- Pertussis spreads easily from person to person mainly
through droplets produced by coughing or sneezing and
indirect contact with contaminated object. When an
infected person coughs or sneezes, tiny germ-laden
droplets are sprayed into the air and breathed into the
lungs of anyone who happens to be nearby.
- The disease is most dangerous in infants, and is a
significant cause of disease and death in this age group.
The first symptoms generally appear 7 to 14 days after
infection which is the incubation period. The clinical
manifestations are:
1) Catarrhal Stage– most communicable stage even
until 3 weeks or up to 21 days after the onset of
paroxysmal stage with frequent sneezing, watery
secretions, coryza and dry and hacking cough
increasing in intensity at night.
2) Paroxysmal Stage– most fatal stage with intermittent
episodes of paroxysmal cough followed by an
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
explosive expiration ending in an inspiratory “whoop”
and ending in vomiting (5-10x in succession repeated
20-40x in a day) and cough worsen. Force of coughing
may cause involuntary micturation / defection,
intracerebral hemorrhage and abdominal hernia,
popping of eyeball and protrusion of tongue and
vomiting signals end of attack.
3) Convalescent Stage when frequency of attacks is
reduced. The incidence in infants is highly susceptible
and single attack usually produces lifetime immunity.
People with pertusis are most contagious up to about
3 weeks after the cough begins, and many children
who contract the infection have coughing spells that
last 4 to 8 weeks. Brochopneumonia, hernia and
hemorrhages are relatively common complications,
and seizures and brain disease occur rarely. Because
infants and toddlers are at greatest risk of
complications from whooping cough, they're more
likely to need treatment in a hospital. Complications
can be life-threatening for infants younger than 6
months old. Teens and adults often recover from
whooping cough with no problems. When
complications occur, they tend to be side effects of
the strenuous coughing, such as: bruised or cracked
ribs, abdominal hernias broken blood vessels in the
skin or the whites of the eyes.
Healthcare providers diagnose pertussis (whooping
cough) by considering if you have been exposed to
pertussis and by doing a:
• History of typical signs and symptoms,
• Physical examination,
• Laboratory test which involves taking a sample of mucus
(with a swab or syringe filled with saline) from the back of
the throat through the nose — cough plate or agar plate or
Bordet – Gengou test.
• Obtaining a nasopharyngeal specimen for isolation of
Bordetella pertussis.
Healthcare providers generally treat pertusis with
antibiotics
• Ampicillin, erythromycin (DOC) – given for 5 to 7 days and
anti-tussives: sinecod – for extremely dry cough and early
treatment is very important.
• Treatment may make the infection less serious if the
patient start it early, before coughing fits begin.
• Treatment can also help prevent spreading the disease to
close contacts (people who have spent a lot of time
around the infected person).
• Treatment after three weeks of illness is unlikely to help.
The bacteria are gone from the body by then, even though
the patient usually will still have symptoms. This is
because the bacteria have already done damage to the
body.
The nursing management
• Bed rest;
• NPO in attacks (paroxysmal and catarrhal stage –
aspiration;
• Positioning – prone for infants and upright for older
persons;
J.A.K.E 5 of 9
• Isolate the patient;
• Provide a quiet, non-stimulating environment;
• Keep patient warm and out of wind;
• Small frequent feedings;
• Encourage abdominal support when coughing;
• Clothing contaminated with discharges should be boiled
for 30 minutes before laundering; and
• Adequate ventilation.
- The whooping cough vaccine the patient receives as a
child eventually wears off. This leaves most teenagers and
adults susceptible to the infection during an outbreak —
and there continue to be regular outbreaks. Infants who
are younger than age 12 months who are unvaccinated or
haven't received the full set of recommended vaccines
have the highest risk for severe complications and death.
As prevention, avoid mode of transmission and
immunization of DPT. The best way to prevent whooping
cough is with the pertusis vaccine, which doctors often
give in combination with vaccines against two other
serious diseases — diphtheria and tetanus. Doctors
recommend beginning vaccination during infancy. The
vaccine consists of a series of five injections, typically
given to children at these ages: 2 months, 4 months, 6
months, 15 to 18 months and 4 to 6 years.
If the child gets treatment for pertusis at home:
• Do not give cough medications unless instructed by the
doctor. Giving cough medicine probably will not help and
is often not recommended for kids younger than 4 years
old.
• Manage pertusis and reduce the risk of spreading it to
others by:
- Following the schedule for giving antibiotics exactly as
the child’s doctor prescribed.
- Keeping the home free from irritants – as much as
possible – that can trigger coughing, such as smoke,
dust, and chemical fumes.
- Using a clean, cool mist vaporizer to help loosen
mucus and soothe the cough.
- Practicing good hand washing.
- Encouraging the child to drink plenty of fluids,
including water, juices, and soups, and eating fruits to
prevent dehydration (lack of fluids). Report any signs
of dehydration to the doctor immediately. These
include dry, sticky mouth, sleepiness or tiredness, or
thirst. They also include decreased urination or fewer
wet diapers, few or no tears when crying, muscle
weakness, headache, dizziness or lightheadedness.
- Encouraging the child to eat small meals every few
hours to help prevent vomiting (throwing up) from
occurring.
Pulmonary Tuberculosis
- Pulmonary tuberculosis is defined as an active infection of
the lungs (latin pulmo = lung). It is the most important TB
infection, because an infection of the lungs is highly
contagious due to the mode of airborne transmission.
- It can be life-threatening to the patient: if left untreated,
more than 50% of patients with pulmonary tuberculosis
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
die. Worldwide, 87% of all tuberculosis cases that were
reported in 2004 were either only pulmonary TB or
included pulmonary TB.
- Pulmonary TB, also known as consumption, spread widely
as an epidemic during the 18th and 19th centuries in
North America and Europe. After the discovery of
antibiotics like streptomycin and especially isoniazid,
along with improved living standards, doctors were better
able to treat and control the spread of TB. Tuberculosis is
considered as the world’s deadliest disease and remains
as a major public health problem in the Philippines and is
a chronic bacterial infection characterized by granuloma
formation, necrosis and calcification of involved tissues.
The other names of PTB are Koch’s Disease, Consumption
and Phthisis. Robert Koch (1882) - a German physician
and scientist, discovered of Mycobacterium tuberculosis,
the bacterium that causes tuberculosis (TB). The germs
can stay in the air for several hours. It’s possible to inhale
them even when the infected person isn’t in the room. But
usually you have to be close to someone with TB for a long
period of time to catch it.
- The bacterium Mycobacterium tuberculosis causes
tuberculosis (TB), a contagious, airborne infection that
destroys body tissue. Direct invasion through mucous
membranes or breaks in the skin may occur, but
extremely RARE. Pulmonary TB occurs when M.
tuberculosis primarily attacks the lungs. However, it can
spread from there to other organs. Pulmonary TB is
curable with an early diagnosis and antibiotic treatment.
Mycobacterium africanum, Mycobacterium bovis and
Mycobacterium cannettii are other etiologic agent of PTB.
Bovine tuberculosis results from exposure to tuberculosis
cattle: Ingestion of unpasteurized milk or dairy products.
- The incubation period is 2 to 10 weeks. The period of
communicability is in the active phase of the patient. The
factors affecting the communicability are (1) number of
bacilli discharge; (2) bacilli virulence; (3) adequate
ventilation; and (4) exposure of bacilli to sun and UV lights.
The classification of PTB as Class 0 – no exposure, no
infection; Class 1 – (+) exposure, (-) infection; Class 2 – (+)
infection, (-) disease; Class 3 – (+) symptoms, PTB active
Class 4 – disease, not clinically active; and Class 5 –
diagnosis pending; suspect.
The clinical manifestations of PTB
• Fever – low grade in late afternoon or early evening;
• chronic cough of more than 2 weeks,
• anorexia,
• body malaise and
• weight loss,
• nocturnal sweating,
• chest and back pains,
• dyspnea,
• hoarseness of voice,
• hemoptysis
• sputum positive for AFB.
- During the examination, the doctor will conduct a physical
exam especially the lungs, ask about the medical history,
J.A.K.E 6 of 9
schedule a chest X-ray, order a medical test to confirm
pulmonary TB.
The diagnostic tests
• Mantoux Test/ PPD/ Tuberculin Test – an intradermal
injection of PPD (Purified Protein Derivatives to detedt for
exposure; results are read after 48-72 hours of injection;
(+) for not immunocompromised is 10 mm or more
induration; and (+) for immunocompromised is 5 mm or
more induration.
• Direct Sputum Smear Microscopy is a primary diagnostic
tool.
• Chest X-Ray determines the lesion.
• Sputum Culture or Sputum analysis for AFB is a
confirmatory test.
• Gene Xpert diagnoses TB by detecting the presence of TB
bacteria, as well as testing for resistance to the drug
Rifampicin. The tine test is a multiple-puncture tuberculin
skin test used to aid in the medical diagnosis of
tuberculosis (TB). The tine test is similar to the Heaf test,
although the Mantoux test is usually used instead. To
diagnose pulmonary TB specifically, a doctor will ask a
person to perform a strong cough and produce sputum up
to three separate times. The doctor will send the samples
to a laboratory. At the laboratory, a technician will
examine the sputum under a microscope to identify TB
bacteria. In addition to this test, a doctor can also “culture”
a sputum sample. This means they take a portion of the
sputum sample and put it in a special material that makes
TB bacteria grow. If TB bacteria grow, this is a positive
culture. Doctors can also order a polymerase chain
reaction (PCR) assay to be performed. This tests the
sputum for the presence of certain genes from the germs
that cause TB. The CT scan is an imaging test to check
lungs for signs of an infection.
Treatment
• Isoniazid with common side effect of peripheral neuritis
and hepatotoxicity, pyrazinamide with common side
effect of gouty arthritis and hyperurecemia, ethambutol
(Myambutol) with side effect of optic neuritis, rifampin
(Rifadin) with side effects of hepatotoxicity, nephrotoxicity,
purpura and orange colored secretions and streptomycin
with side effect of vestibular ototoxicity. The doctor might
recommend an approach called directly observed therapy
(DOT) to ensure that complete treatment is encouraged
and no failures.
• Stopping treatment or skipping doses can make
pulmonary TB resistant to medicines, leading to MDR-TB.
With DOT, a healthcare professional meets with the
patient every day or several times a week to administer
the medication so that the patient doesn’t have to
remember to take it on his own. Multi-drug resistant TB
(MDR-TB) is TB that is resistant to the typical antibiotics
used to treat the condition, which are isoniazid and
rifampin.
Some of the factors that contribute to MDR-TB include:
• Healthcare providers prescribing an incorrect drug to treat
TB;
• people stopping treatment early;
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
• people taking poor-quality medications;
• Improper prescribing is the leading cause of MDR-TB,
according to WHO. However, it’s possible a person who
hasn’t ever taken TB medications can have a strain that is
drug-resistant. People who develop MDR-TB also have
fewer options for treatment. The second-line treatments
can be expensive and take as long as two years. It’s also
possible for MDR-TB to develop even further into
extensively drug-resistant TB (XDR-TB). This is why it’s
important to finish the medications, even if the patient
feel better before the patient finish the dosage.
Most cases of pulmonary TB are post-primary TB
infections.
- This means that after the initial, primary infection has
healed, the granuloma (the mass of immune cells
surrounding the TB infection preventing it from doing
further damage) that was formed during that process still
contains TB bacteria, which can survive for years.
- If the immune system of the person with a TB granuloma
deteriorates, these bacteria can be reactivated and TB
may break out again. Once the TB bacilli become
reactivated, they rapidly destroy the lung tissue around
the granuloma.
- This causes major damage to the tissue, which gets
destroyed. Lung tissue is usually very thin and almost
sponge-like because it is filled with air in the alveoli,
where oxygen is exchanged from the air into the blood.
- The lung tissue affected by TB bacilli first becomes hard,
making the oxygen exchange impossible. This is called
fibrosis. As a second step, the cells that make up the lung
tissue die. This is called necrosis.
J.A.K.E 7 of 9
- Dead, or necrotic, tissue tends to tear and break down. In
the lung, this is called 'cavitation', after the latin word for
cave. It is thought that the TB bacilli destroy the lung
tissue in a cave formation, where more and more of them
sit in the middle and slowly destroy more tissue at the
edges. These cavitations can be seen on X-rays to
diagnose pulmonary TB (see picture).
- A cavitation contains sputum with about 1 million TB
bacilli per milliliter. The danger of cavitations, besides the
destruction of the healthy lung tissue, is that through
progressive destruction they eventually reach a part of an
airway. If that happens, the TB bacilli destroy the wall of
the airway and thus have a connection to the outside.
- Through the airway, they can be transported up into the
trachea, through the mouth and nose of a coughing
person, and be transmitted to other people through
droplet infection.
- People with pulmonary TB cough a lot, because the
destruction of tissue in the lungs and airways leads to
inflammation. The body reacts to inflammation by trying to
eliminate the particle that caused it – if this happens in
the airway, the easiest way to eliminate the cause is to
cough it up. Initially, people with pulmonary TB have a dry,
persistent cough. This cough is often worse at night. This
symptom shows in about 85% of people with pulmonary
TB. Often the cough is accompanied by fever, also worse
at night, and in combination with excessive sweating.
People with pulmonary tuberculosis lose weight, because
the body uses a big part of its energy to fight the infection
in the lungs – and this means that energy cannot be stored
in the body to gain weight and stay healthy. As the
destruction of lung tissue becomes worse, the sputum
that people with pulmonary TB cough up starts to have
blood stains in it – a sign of the tissue destruction and
inflammation in the airway. From the first cavitation in the
lung tissue, the TB bacilli can spread through the
destructed tissue. If they have reached an airway, they will
spread to other parts of the lung, travelling up and down
the airway and finding new places to settle and form a
new cavitation. This is called bronchogenic spread
(bronchus = the airway, -genic = coming from). If they gain
access to a blood vessel (blood vessels are spread out
throughout the lung tissue to provide oxygen and other
nutrients transported in the blood), they can travel in the
bloodstream and be disseminated all over the lungs and
into other parts of the body. The result of this
dissemination is called 'disseminated TB' or 'miliary TB',
and it usually happens when the body's immune system is
not able to contain the infection, for example when it is
weakened by HIV.
- The risk for getting pulmonary TB is highest for people who
are in close contact with those who have TB.
- This includes being around family or friends with TB or
working in places such as the following that often
house people with TB:
• correctional facilities;
• nursing homes;
• hospitals;
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS
• shelters.
- People also at risk for developing pulmonary TB
disease are:
• older adults;
• small children;
• people who smoke;
• people with an autoimmune disorder, such as lupus
or rheumatoid arthritis;
• people with lifelong conditions, such as diabetes or
kidney disease;
• people who inject drugs;
• people who are immunocompromised, such as those
living with HIV, undergoing chemotherapy, or taking
chronic steroids.
The nursing management
• Isolation precaution;
• Provide patient with adequate rest periods;
• Promote adequate nutrition;
• Advise to cover nose and mouth when sneezing and
coughing and dispose secretions properly;
• Provide frequent oral hygiene and hand washing;
• Encourage to stop smoking;
• Be alert for signs of drug reaction;
• Monitor drug compliance;
• Teach the patient all about PTB;
• encourage questions to air feelings;
• Emphasize the importance of follow-up;
• Check sputum for blood and purulent expectoration.
The common preventive measures
• Submit all babies for BCG immunization;
• Avoid overcrowding and mode of transmission;
• Nutritional and health status improvement;
• Advise those who have been exposed to receive tuberculin
test.
Mumps
- Mumps is a viral infection that primarily affects saliva-
producing (salivary) glands that are located near your ears.
Mumps can cause swelling in one or both of these glands.
Mumps was common in the United States until mumps
vaccination became routine. Since then, the number of
cases has dropped dramatically. However, mumps
outbreaks still occur in the United States, and the number
of cases has crept up in recent years.
- These outbreaks generally affect people who aren't
vaccinated, and occur in close-contact settings such as
schools or college campuses. People who have had
mumps are usually protected for life against another
mumps infection. However, second occurrences of
mumps do rarely occur. While various studies into the
disease had been carried out across the 19th and 20th
centuries, the viral etiology of mumps was finally
discovered and documented by Claud D. Johnson and
Ernest W. Goodpasture in 1934. Other names of mumps
are Viral Parotitis, Epidemic Parotitis and Infectious
Parotitis.
J.A.K.E 8 of 9
- The incubation period is 14 to 25 days and the period of
communicability is 7 days before and 9 days after the
onset of parotid swelling. Some people infected with the
mumps virus have either no signs or symptoms or very
mild ones. When signs and symptoms do develop, they
usually appear about two to three weeks after exposure to
the virus. The primary sign of mumps is swollen salivary
glands that cause the cheeks to puff out due to blocked
salivary gland.
- Other signs and symptoms may include:
• Pain in the swollen salivary glands on one or both
sides of the face;
• Pain while chewing or swallowing;
• Low-grade fever;
• Headache;
• Earache;
• Muscle aches;
• Weakness and fatigue;
• Loss of appetite; and
• Dysphagia. The diagnostic tests are: Viral Isolation,
Blood Exam, Viral Serology and Serum Amylase
Determination Test. Mumps is caused by a
Paramyxovirus, a virus that spreads easily from
person to person through infected saliva as a source
of infection. If the patient does not immune, the
patient can contract mumps by breathing in saliva
droplets from an infected person who has just
sneezed or coughed. The patient can also contract
mumps from sharing utensils or cups with someone
who has mumps. The mode of transmissions are
direct contact with respiratory secretions coming
from infected patients and indirect contact with
objects contaminated with secretions.
Complications of mumps
• Orchitis which is the most dreaded complication in males;
oophoritis which is the most dreaded in females; mastitis;
pancreatitis; myocarditis and hearing loss, are potentially
serious but rare.
• There's no specific treatment for mumps only supportive
and symptomatic medical treatment like analgesic,
antipyretic and moist heat and cold application. Rest as
much as possible. Try to ease symptoms with cold
compresses and overthe-counter pain relievers such as
ibuprofen (Advil, Motrin IB, others) and acetaminophen
(Tylenol, others).
The best way to prevent mumps
• To be vaccinated against the disease. Most people have
immunity to mumps once they're fully vaccinated. The
mumps vaccine is usually given as a combined measles-
mumps-rubella (MMR) inoculation, which contains the
safest and most effective form of each vaccine. Two
doses of the MMR vaccine are recommended before a
child enters school. Those vaccines should be given when
the child is: between the ages of 12 and 15 months; and
between the ages of 4 and 6 years. College students,
international travelers and health care workers in
particular are encouraged to make sure they've had two
doses of the MMR vaccine. A single dose is not completely
 312 LECTURE: WK11 – PTB, PNEUMONIA, DIPHTHERIA, PERTUSIS, MUMPS

effective at preventing mumps. A third dose of vaccine

isn't routinely recommended. But the doctor might
recommend a third dose if the patient are in an area that
is experiencing an outbreak.
• A study of a recent mumps outbreak on a college campus
showed that students who received a third dose of MMR
vaccine had a much lower risk of contracting the disease.
• The patient don't need the MMR a vaccination if:
- Had two doses of the MMR vaccine after 12 months of
age
- Had one dose of MMR after 12 months of age and
you're a preschool child or an adult who isn't at high
risk of measles or mumps exposure;
- Have blood tests that demonstrate the immunity to
measles, mumps and rubella;
- Were born before 1957 — most people in that age
group were likely infected by the virus naturally and
have immunity;
- Also, the vaccine isn't recommended for: people who
have had a life-threatening allergic reaction to the
antibiotic neomycin or any other component of the
MMR vaccine; pregnant women or women who plan to
get pregnant within the next four weeks; people with
severely compromised immune systems. Most people
experience no side effects from the vaccine. Some
people experience a mild fever or rash or achy joints
for a short time. Rarely, children who get the MMR
vaccine might experience a seizure caused by fever.
But these seizures haven't been associated with any
long-term problems. Extensive reports — from the
American Academy of Pediatrics, the Institute of
Medicine and the Centers for Disease Control and
Prevention — conclude that there's no link between
the MMR vaccine and autism.

J.A.K.E 9 of 9
 NCMB312 LECTURE: Final Week
Communicable Diseases
Bachelor of Science in Nursing 3YA 13-14
Professor: Gerardo A. Nicolas RN, RM, RPT, MAN
COMMUNICABLE DISEASES Clinical Manifestations
Hepatitis - Mild diarrhea that becomes voluminous
Hepatitis A - Rice-watery stool (pathognomonic sign)
- Infectious hepatitis, Catarrhal-jaundice hepatitis - Washer woman’s hands
- Mode of Transmission: fecal-oral, oral-anal sex - Effortless vomiting
Hepatitis B - Cramping of the extremities (hypokalemia)
- Serum Hepatitis - Signs of severe dehydration
- MOT: percutaneous, sexual contact, mother to child. 3 Deficits During Cholera
Hepatitis C • Severe dehydration and ECF volume deficit
- Post-transfusion hepatitis • Hypokalemia
- MOT: percutaneous, sexual intercourse • Metabolic acidosis
Clinical Manifestations: Diagnostic Exams
- Preicteric phase: anorexia, nausea, RUQ pain, • Stool or vomitus culture
malaise, headache, low grade fever • Serum electrolytes
- Icteric phase: dark urine (increase bilirubin), pruritus, • Dark field or Phase Microscopy
clay-colored stools, jaundice Medical Management
- Post icteric phase: malaise, fatigue, hepatomegaly for - Correction of dehydration and fluid imbalance
several weeks - Antibiotics- Tetracycline (drug of choice)
Diagnostic exams: Nursing Management
• Hepatitis Profile • Assess patient for signs of dehydration and
• Liver function test complications
• Liver UTZ • Observe enteric precautions
Complications: • Increase oral fluid intake
• chronic hepatitis
Violent Bacillary Amoebic
• cirrhosis
Dysentery Dysentery Dysentery
Meds for chronic hepatitis B:
Cholera Shigelosis Amoebiasis
- Antivirals: lamivudine, interferon
Vibrio cholera Shigella Entamoeba
Nursing Interventions:
dysenteriae histolitica
1. Bed rest
2. SFF, high CHO Rice watery +/- fever +/- fever
3. Avoid alcohol and OTC drugs stool +/- vomiting +/- vomiting
4. Implement Standard precaution Signs of severe Abdominal pain Abdominal pain
Prevention: dehydration: (colicky or Diarrhea with
- Hepatitis B vaccination (0, 6, 14 weeks 0.5 cc IM) sunken eyeball, cramping) tenesmus
Washer- Diarrhea with Muco-purulent
Cholera woman’s hand, tenesmus blood streaked
- Filippo Pacini discovered of Vibrio cholera. metabolic Mucus and Blood stool
- Russian-Jewish bacteriologist Waldemar acidosis, shock streaked stool Tx: Metronidazole
Haffkine developed the first cholera vaccine in July Tx: Tetracycline Tx: Cotrimoxazole
1892.
- Dr. John Snow is regarded as one of the founding
fathers of modern epidemiology and discovered how Typhoid Fever
cholera was spread in London. - The first effective vaccine for typhoid was developed
- Cholera has been nicknamed the "blue death" by Almroth Edward Wright and was introduced for
because a person dying of cholera may lose so many military use in 1896.
body fluids that their skin turns bluish gray. - Georg Gaffky was a pathologist that confirmed the
Causative Agent bacillus Eberthella typhi, which is known today as
- Vibrio coma or vibrio cholera Salmonella enterica.
Incubation Period Causative Agent
- From a few hours to 5 days (average of 3 days) - Salmonella
Period of Communicability Incubation Period
- As long as microorganisms are present in the bowel - Variable
excreta
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 312 LECTURE: WK13-14 – COMMUNICABLE DISEASES

- Usually 1 – 3 weeks, average: 2weeks Leprosy

Period of Communicability
- As long as the bacilli appears in the excreta
Mode of Transmission
- Fecal – oral route
- Ingestion of contaminated food and water 5 F’s –
fingers, feces, flies, food, fomites
- Synonym: Hansen’s disease
- Chronic disease of the skin, peripheral nerves and
nasal mucosa
- “Living dead”, Was perceived to be caused by sin
- Causative agent: Mycobacterium leprae
Mode of transmission:
a. Intimate skin to skin contact
b. Droplet Infection

Types:
1. Multibacillary (MB) – infectious, malignant -
Numerous macules, papules and nodules
2. Paucibacillary (PB)– hypopigmented macule
Late Manifestation
- Lagophthalmos – inability to close eyelids
- Madarosis – loss of eyebrows
- Sinking of the bridge of the nose
- Leonine face
- Contractures (clawing of fingers and toes)
- Gynecomastia – for males
• Slit Skin smear – to demonstrate M. leprae
o (-) in all site = Paucibacillary
Clinical Manifestations o (+) in all sites = Multibacillary
- Gradual onset o Number of lesions = 2-5 PB / > 5 MB
- A-norexia and abdominal pain Treatment:
- B-radycardia Multi drug therapy (MDT) RA 4073
- C-onstipation A. Paucibacillary: Rifampicin(600mg) /once a month and
- D-iarrhea, D-evelop skin eruptions on the abdomen, Dapsone (100mg) OD (6-9 mos)
back and chest (ROSE SPOTS) B. Multibacillary: Rifampicin, dapsone, lamprine
- E-nlarged spleen • Day 1: R-600 D-100 C-300 once month
- F-ever and chills
• Day 2-28: Dapsone 100 OD Clofazimine
- G-eneralized body weakness
(Lamprine) 50
- H-eadache
Health education
- What are the three cardinal signs of Pyrexial stage?
- Dapsone: cutaneous eruptions, also iritis, orchitis
Rose Spot
- Lamprine: Brownish black skin discoloration, dryness
- red spots that scattered all over the body
and flakiness
Diagnostic Exams
- Skin care: Prevent injury
- CBC
Nursing Diagnosis
- Widal test
o Altered body image
- Typhidot exam
o Social stigma
- Blood culture
Preventive: BCG at birth
- Urine and stool culture
Medical Management
Pediculosis
- Antibiotics: chloramphenicol – drug of choice
Types:
- IVF to correct dehydration or fluid imbalance
a. Pediculosis capitis – head lice
- Paracetamol for the fever
b. Pediculosis corporis – body lice
- Oral therapy rehydration (oresol, hydrites)
c. Phthirus pubis – pubic or crabs lice
Nursing Management
Mode of transmission: direct contact, beddings, towel,
• Enteric isolation clothes and hairbrush
• Vital signs must be recorded accurately Clinical manifestations:
• Intake and output must be accurately measured - Intense pruritus, leads to secondary excoriation
• Concurrent disinfection - Eggs (nits) attached to the hair shaft
• Isolation Parasitic Infestations
• Increase oral fluid intake - Scabies: an infestation of the skin by Sarcoptes
scabiei mites
a. Intense itching

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 312 LECTURE: WK13-14 – COMMUNICABLE DISEASES

b. Superficial burrows, especially between - No accepted prophylactic regimens have been

fingers, the surface of the wrist and in axilla developed and no vaccines are currently available
c. Redness, swelling may be noted - Eradication of snails
Treatment
A. Pediculosis Helminthes
1. Permethrin 1% (Nix) MOT: ingestion
2. Pyrethrine compunds (Rid) 1. Pinworm- Enterobius, Seatworm
B. Scabies - s/s: Nocturnal itchiness of anus (female pinworm lays
1. Permethrin 5% cream (Elimite) eggs on the anal sphincter)
Home care: 2. Giant Roundworm (Ascariasis) Potbelly
1. All family members and close contacts need to be 3. Whipworm (Trichuriasis)
treated 4. Tapeworm
2. Concurrent Disinfection • Taenia saginata- raw beef
a. Daily washing of recently worn clothes, towels • Taenia solium- raw pork
and bedding. • Diphyllobotrium latum – raw fish
b. Areas such as shared toilet and shared commode 5. Lung fluke – Paragonimiasis
chair seats need to be thoroughly wiped after MOT: Raw mountain crab
each use MOT: Skin penetration
1. Hookworm (Ancyclostomiasis)
Schistosomiasis 2. Threadworm (Strongyloidiasis)
- Is an endemic protozoan infection that affects the
liver and GIT Leptospirosis
- Capable of producing obstructive jaundice and liver - Adolf Weil of Heidelberg reported the clinical entity of
cirrhosis fever, jaundice, hemorrhage, and renal failure in 1886.
Other Name Other Names
- Bilharziasis • Weil’s disease
- The etiology of schistosomiasis in humans was first • Canicola Fever
discovered in 1851 by the German physician Theodor • Mud Fever
Bilharz. • Hemorrhagic jaundice
Causative Agent
• Swineherd’s Disease
- Schistosoma japonicum
Etiologic Agent
- Schistosoma mansoni
- A spirochete of genus Leptospira (Leptospira
- Schistosoma haematobium
interrogans)
Stages
Incubation Period
- Adult female and male parasites
- 6-15 days
- Ova
Period of Communicability
- Miracidium – infective stage in snails
- Leptospira is found in the urine between 10 to 20 days
- Cercaria – infective stage in man and animals
after the onset
Intermediate Host
Modes of Transmission
- Snail (Oncomelania quadrasi)
1) Ingestion or contact with the skin and mucous
Mode of Transmission
membrane of the infected urine or carcasses of wild
- About 2-6 weeks from skin penetration by cercaria
and domestic animals.
Clinical Manifestations
2) Through the mucous membrane of the eyes, nose, and
- Abdominal pain
mouth, and through a break on the skin.
- Diarrhea with bloody stools
3) Direct human to human transmission is rare.
- Portal hypertension and signs of liver cirrhosis
- Anemia
Diagnostic Exams
- Kato-katz – specimen is stool
- Circumoval precipitin test (COPT) – specimen is blood
- HBT – UTZ
- Liver function tests
Medical Management
- Praziquantel (biltricide) – drug of choice
- Oxamniquine (vansil), metrifonate
Prevention
- Travelers to endemic areas should avoid exposure to
fresh water that is likely to be contaminated

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Peritoneal Dialysis
- Administration of fluid and electrolyte and blood as
indicated.
Nursing Management
- Isolate the patient, urine must be properly disposed of.
- Darken patient’s room.
- Observe meticulous skin care
- Keep clients under close surveillance.
- For home care, clean near dirty places, pools, and
stagnant water.
- Facilitate health education on the modes of
transmission of the disease.
- Encourage oral fluid intake.
Prevention and Control
- Sanitation in homes, workplaces, and farms is a must.
- There is a need for proper drainage system and
Clinical Manifestations control of rodents (40 to 60 percent infected).
a) Septic Stage - Animals must be vaccinated (cattle, dogs, cats, and
- This stage is marked with febrile lasting for four to pigs).
seven days.
- Abrupt onset of remittent fever Poliomyelitis
- chills Causative Agent
- headache - Legio debilitans
- anorexia • Type I – Brunhilde: permanent immunity; most
- abdominal pain paralytogenic
- severe prostration • Type II – Lansing: temporary immunity
- respiratory distress and fever subsides by lysis
• Type III – Leon: temporary immunity
b) Immune or Toxic stage
Predisposing Factors
- Iritis
- Age. About 60% of patient are under 10 years of age.
- Headache
- Sex. Males are more prone to the disease than females.
- Meningeal manifestations
Death rate is proportionately higher in males.
• Disorientation - Heredity. Not heredity
• Convulsions - Environment and hygienic condition. The rich are more
• with CSF findings of aseptic meningitis. often spared than the poor. Excessive work, strain and
• Oliguria and anuria with progressive renal failure. marked overexertion are also factors causing the
• Shock, coma, and congestive heart failure are disease.
also seen in severe cases Mode of Transmission
c) Convalescent Stage - fecal-oral: through saliva, vomitus and feces
- At this stage, relapse may occur during the 4th to 5th - Direct contact from one person to another
week - Ingestion through of contaminated food (fecal-oral
Diagnostic Test route)
- Blood urea-nitrogen and urea Incubation Period
- Enzyme Link Immuno-sorbent Assay (Elisa) - 7 – 14 days
- Leptospira Antigen-antibody test (LAAT)
- Leptospira Antibody Test (LAT)
- Liver function test
Complications
- Meningitis
- Respiratory Distress
- Renal interstitial tubular necrosis that result to renal
failure (Weil’s disease)
- Cardiovascular problems
Management
- Medical Treatment of leptospirosis is geared toward:
• Suppressing the causative agent Period of Communicability
• Fighting possible complications - Not accurately known
- Penicillin G – drug of choice - Polio virus can be found in throat secretions as early as
- Ampicillin, Amoxicillin 36 hours and in the feces 72 hours after exposure to
- For prophylaxis, doxycycline infection.
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- Risk of spreading the microorganism is highest during Diagnostic Exams

the prodromal period - Blood and throat culture
Signs and Symptoms - Lumbar tap (pandy’s test)
1) Inapparent/ Subclinical Stage - asymptomatic stage - EMG
(90-95%) - Stool exam
2) Abortive (Minor Illness Stage) Nursing Management
- Fever - Strict isolation, enteric precaution
- Sore throat - CBR / Firm and non-sagging bed
- GI symptoms - ROM exercises
- Low lumbar backache/ cervical stiffness on ante- - Analgesics / Hot moist compress
flexion of spine - Protective devices
3) Major Illness Stage - Hand roll – claw hand
- Non-paralytic/ pre-paralytic or meningitic type - Trochanter roll – outer
- Recurrence of fever - rotation of the femur
- Poker spine (stiffness of the back) - Footboard
- Tightness and spasm of hamstring - There are two vaccines for polio:
- Hypersensitiveness of the skin - Oral Polio Vaccine (OPV) and the Inactivated Polio
- Deep reflexes are exaggerated Vaccine (IPV).
- Paresis - In the Philippines still using OPV, IPV does not replace
4) Paralytic the OPV vaccine, but is used with OPV to strengthen a
- With paralysis depending on the part affected child's immune system and protect them from polio.
- Positive hoyne’s sign: head drop Two Types of Polio Vaccine
- (+) kernig’s and brudzinki signs paralysis IPV (Salk)
Types of Paralysis - Killed formulized virus
• Bulbar - Given SC or MI
- Respiratory paralysis - Include circulating antibodies but not local (intestinal
• Spinal immunity)
- Paralysis of the upper and lower extremities and - Prevents paralysis but does not prevent re-infection
intercostal muscles - Difficult to manufacture and costly
• Bulbospinal - Not useful with controlling epidemics
- Involvement of neurons both in brainstem and the OPV (Sabin)
spinal cord - Live attenuated virus
- Given orally
- Immunity is both humoral and intestinal. Induces
antibody quickly.
- Prevents paralysis and prevent re-infection
- Easy to manufacture and cheaper
- Can be effectively use in controlling epidemics

Rabies
Republic Act 9482
- The national government has implemented the Anti-
Rabies Act of 2007, which mandates the creation of
the National Rabies Prevention and Control Program
(NRPCP). It is the goal of the NRPCP to
eliminate rabies in the country and declare
the Philippines rabies-free by the year 2020.
Executive Order No. 84 series of 1999
- March is Rabies Awareness Month
Other Names
- Lyssa
- Hydrophobia
- The origin of the word rabies from the Latin "rabere"
(to rage). The ancient Greeks called rabies "lyssa"
(violence). Today, the virus causing rabies is classified
in the genus Lyssa Virus".
- Louis Pasteur developed the earliest effective vaccine
against rabies on 6 July 1885.

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- Nine-year-old Joseph Meister (1876–1940), who had

been mauled by a rabid dog, was the first human to
receive this vaccine.
Causative Agent
- Rhabdo virus
o a bullet-shaped virus with strong affinity to
CNS tissues

Clinical Manifestations
Rabid animal
- Dumb stage – quiet, stays in corner with copious
salivation
- Furious stage – easily agitated, hydrophobia
Rabid Man
1) Prodromal / Invasion stage
- Mental depression, headache, sore throat,
low-grade fever
Modes of Transmission - Copious salivation
- Bite of an infected animal - Quiet
- Licking of open wounds by a rabid animal 2) Excitement stage
- Scratch of a rabid animal - Restless, irritable
- Man to man transmission (10%) - Hydrophobic
Source of Infection - Aerophobic
- Saliva of infected animals or human - Drooling of saliva
Incubation Period 3) Paralytic
- 10-14 days (dogs) - Flaccid ascending symmetric paralysis
- 1 day – 5 yrs. (humans) - Coma, death
Incubation period depends on the following factors
1. Distance of the bite to the brain
2. Extensiveness of the bite
3. Species of the animals
4. Richness of the nerve supply in the area of the bite
5. Resistance of the host

Diagnostic Exams
- Fluorescent rabies anti body (FRA)- Confirmatory test
- Brain biopsy of the animal (Negri bodies)
- 14 days observation of the animal
Medical Management
- No specific treatment
- Prevention is the best treatment
- Anti – rabies vaccination of animal and exposed
individual
Nursing Management
- Provide a dim, quiet and non-stimulating room for the
patient

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- Wear gown, mask and goggles Prevention

- All noises no matter how minor should be avoided - Immunization
- Restrain the patient when needed - Keep away from stray animal
- Stimulation of any senses by fluids must be avoided
- Anti – rabies vaccine Tetanus
Other Names: Lock jaw
Causative Agent
- Clostridium tetani
Two types of toxin:
• tetanospasmin
• tetanolysin
Incubation Period
- 3 days – 3 weeks in adult
- 3 – 30 days in new born
Mode of Transmission
- Through breaks in the skin and mucous membranes
Sources of Infection
- Soil
- Street dust
- Animal and human feces
- Rusty materials
- How effective is the rabies vaccine? Clinical Manifestations
- The rabies vaccine works remarkably well. Studies Neonates
indicate that if the vaccine is given immediately and - Malaise, high fever
appropriately to someone who was bitten by a rabid - Difficulty in sucking
animal, it is 100 percent effective. - Excessive of crying
- A vaccine can confer active immunity against a - Stiffness of jawAdult
specific harmful agent by stimulating - Trismus – lock jaw
the immune system to attack the agent. - Risus sardonicus (sardonic smile) – pathognomonic
- A serum can confer passive immunity sign
- (rabies immune globulin) is commonly used after a - Opisthotonus
certain type of wild animal bites an individual. - Muscular spasm
- A person who is exposed and has never been - Low grade fever, diaphoresis
vaccinated against rabies should get 4 doses of rabies Diagnostic Exam
vaccine – one dose right away, and additional doses - Clinical manifestations
on the 3rd, 7th, 21st days and 5 doses of rabies - History of wound
vaccine – one dose right away, and additional doses Medical Management
on the 3rd, 7th, 14th and 28th days. They should also - ATS, TAT, TIG
get another shot called Rabies Immune Globulin at - Pen G,Metronidazole
the same time as the first dose. - Diazepam
Dosage: - Muscle relaxant
- Human Rabies Immune-globulin (HRIG) Nursing Management
- 20 IU/kg body weight
• Keep the room dim and quiet. Avoid stimuli of spasm
- Equine Rabies Immune-globulin (ERIG)
• Avoid unnecessary handling
- 40IU/kg body weight
• Close monitoring of v/s and muscle tone
Skin testing
• Provide adequate airway
Nursing Diagnoses
- Ineffective breathing pattern related to muscles
spasm and neurologic impairment.
- Risk for injury related to muscle spasms.
Prevention
- Immunization with tetanus toxoid for adults
- DPT for babies and children

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Meningitis Nursing Management

Other name: Cerebrospinal fluid - Respiratory Isolation: 24 hours after onset of
Etiologic Agent antibiotic therapy
- Neisseria meningitides - Provide non-stimulating environment
- Streptococcus pneumonia - Initiate seizure precaution
- Haemophilus influenza - Avoid factors that increase ICP
- Streptococcus agalactae and Listeria monocytogenes Preventive Measures
Mode of Transmission - Vaccination: Hib- for children
- Respiratory droplets through nasopharyngeal mucosa - Avoid MOT
- Direct invasion through otitis media - Rifampicin- prophylactic treatment
- May result after a skull fracture, penetrating head - Alternative: Ciprofloxacin
wound
Incubation Period Dengue
- 3 – 6 days Other Names
Period of Communicability - Breakbone fever
- As long as the microorganism is present in the - Dandy fever
discharges - Infectious Thrombocytopenic purpura
Clinical Manifestations - H-fever
- Fever Etiologic Agent
- Petecchial/purpuric rashes - Group B Arbovirus (I,II,II,IV)
- Signs of increased ICP - Flavivirus
o Severe frontal headache - The dengue viruses, of which four serotypes are
o Altered level of consciousness known (DV-1, -2, -3, and -4), are the most widespread
o Restlessness arthropod-borne viruses (arboviruses). They also are
o Projectile vomiting the only known arboviruses that have fully adapted to
o Blurring of vision; papilledema; diplopia the human host and lost the need of an enzootic cycle
o Bulging fontanel in infants for maintenance.
- Signs of meningeal irritation • Mode of Transmission
o Kernig’s sign - Bite of infected female aedes aegypti mosquito
o Nuchal rigidity – pathognomonic sign • Incubation Period
o Opisthotonus - 3 – 14 days
o Brudzinski’s sign Clinical Manifestations
o Late Signs • Grade I: Symptomatic and Supportive
o Decerebration o Fever
o Decortication o Headache
Diagnostic Tests o Malaise
- Cerebrospinal fluid drawn from between two vertebrae o Anorexia
Complications o Chills
• Bronchitis o Pain (Abdominal, Bone and Joint, and Ocular)
• Pneumonia o Rashes
• Otitis media/ Mastoiditis o + Herman’s Sign: Flushing of the skin
• Blindness o + Tourniquet Test (Rumple Leeds Test)
• Hydrocephalus
Medical Treatment
- Antibiotic
o Penicillin G- drug of choice
o Alternative: Chloramphenicol
- Mannitol
- Pyrentinol/Encephabol
- CNS stimulant
- Anticonvulsant
o Diazepam
o Phenytoin (Dilantin)
o Corticosteroid
o Prednisone
o Dexamethasone

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• Grade II: Manifestations of grade I plus spontaneous - Self-protection measures

bleeding – BED REST - Seek early consultation
o Epistaxis - Say no to indiscriminate fogging
o Gingival Bleeding - Sustain Hydration
o Petechiae or ecchymosis - Cyclical variation is the number of cases usually
o Gastro intestinal bleeding increases towards the ends of the rainy season.
o Ground coffee colored vomitus
o Hematemesis Malaria
o Melena Other names:
o Hematochezia - “ague”
• Grade III: Manifestations of Grade II plus Beginning - King of Tropical and Sub-tropical Diseases
symptoms of circulatory failure -Monitor V/S and Watch - Charles Louis Alphonse Laveran discovered that
out for complication of shock malaria was caused by a protozoan parasite in 1880
o Hypotension & narrowing of pulse pressure
o Weak and thready pulse
o Cold, clammy skin
o Restlessness
• GRADE IV: Manifestations of Grade III plus Shock-
PROPER POSITIONING
o Undetected BP and pulse
Classifications:
- Mild DHF: slight fever, with or without petechial
hemorrhage
- Moderate DHF: high fever, but less hemorrhage, no
shock
- Severe DHF: frank type: flushing, sudden high fever,
severe hemorrhage, followed by sudden drop of
temperature, shock and terminating in recovery or
death.
Diagnostic Tests
- Tourniquet Test- Presumptive diagnosis; detects
capillary fragility
- Platelet Count: Confirmatory test Result: <100,000
cells/mm3
- Hemoconcentration- Increase in 20% Hematocrit
Count
- Dengue NS1 Ag
- Dengue Duo • Vector
• Complications - Anopheles mosquito
- Shock led to death • Mode of Transmission
Medical Treatment - Bite of infected female anopheles mosquito
- Antipyretic/ Analgesic: Do not administer NSAID for - Through blood transfusion
Fever - Contaminated needles and syringes
- Intravenous Fluid Therapy - Congenital transmission (rare)
a) Protocol for Fluid correction with NO SHOCK Clinical Manifestations
- IVF Crystalloids- D5LR or D5 0.9 NaCl or PLR at 5-7 - Cold stage: severe recurrent chills
ml/kg/hr - Hot stage: fever 4-6 hrs.
b) Protocol for fluid correction with SHOCK - Wet stage: profuse sweating 2-4 hrs.
- IVF Crystalloids- PLR or P 0.9 NSS at 20ml/KBW IV - Early signs of anemia: repeated chronic symptoms:
bolus in <20 minutes CBQ
c) if no improvement o Pallor
- Colloids- Dextran, Haemacel, Haesteril at 10ml/kg o Easy fatigability
bolus in <10 minutes o Dizziness
d) Still no improvement - Malaise
- Fresh Frozen Plasma at 15cc/kg in 2 hours and start - Splenomegaly
inotropes Dopamine 7-15 ug/kg/m - Hepatomegaly
5’s
- Search and destroy

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Diagnostic Exams Prevention

Malarial smear: Confirmatory test • Chemoprophylaxis
o detects malaria parasite - Doxycycline: 1 day before going and 4 weeks after
o best done during the height of fever leaving malaria endemic area
o The (quantitative)thick blood smear - Chloroquine: 1 week before going and 4 weeks after
determines the presence and percentage of leaving malaria endemic area
parasite in the blood, while the (qualitative) - Mefloquine: 2-3 weeks before going and 4 weeks
thin blood smear determines the specific after leaving malaria endemic area
species in the blood. • Zooprophylaxis
Quantitative Buffy Coat (QBC)/ Rapid Diagnostic Test - Typing of domestic animals to divert attention of
(RDT) mosquitoes
o Detects malarial antigen taken anytime, the faster Preventive Measures
test - No vaccine yet
Complications - Chemically treated mosquito nets
• Cerebral Malaria: - Larvae-eating fish
- most severe neurological complication of infection with - Environmental Sanitation
Plasmodium falciparum malaria. It is a clinical syndrome - Anti-mosquito soap
characterized by seizures and coma - Natural anti-mosquito plants
• Blackwater fever:
- also called malarial hemoglobinuria, one of the less Filariasis
common yet most dangerous complications of • Causative Agent
malaria. - Wuchereria bancrofti
- The distinctive color of the urine (dark) is due - Brugia malayi
- to the presence of large amounts of hemoglobin, - Brugia timori
released during the extensive destruction of the - Loa loa
patient's red blood cells by malarial parasites that • Mode of Transmission:
leads to kidney failure. - Bite of Aedes poecilius
Medical Management • Incubation Period:
- Antimalarial drugs - 8-16 months
o For P.Vivax – Chloroquine, Primaquine Manifestations
o For P.Facipanum – Pyrimethamine, Primaquine Acute Stage:
o For mixed causative agents – Quinine, - Lymphadenitis
Primaquine - Lmphangitis
o Chloroquine - DOC - Funiculitis, orchitis, epididymitis
o Primaquine – prevents relapse Chronic Stage:
o Pyrimethamine – good for pregnant mother but - H-ydrocele
used with more folic acid - E-lephantiasis
- The antimalarials that can be used in pregnancy include: - L-ymphedema
1. Chloroquine Diagnostic exams
2. amodiaquine - Nocturnal blood exam
3. quinine - Immunochromatographic test (ICT)
4. azithromycin Management
5. sulfadoxine-pyrimethamine - Diethlycarbamazine citrate (Hetrazan)
6. mefloquine - Red tide is a phenomenon caused by algal blooms
7. dapsone-chlorproguanil during which algae become so numerous that they
8. artemisinin derivatives discolor coastal waters. The algal bloom may also
9. atovaquone-proguanil deplete oxygen in the waters and/or release toxins
10. Lumefantrine that may cause illness in humans and other animals.
• First line: Artemether-lumefantrine combination tablet - Cooking or freezing does not destroy the red tide toxin.
• Second line: Chloroquine, Primaquine Pyrimethamine - Individuals who ingested shellfish during red tide
and Sulfadoxine season should be monitored for:
- For Complicated Malaria: Multi drug resistant o numbness of face especially the mouth
Falciparum: *Artemether 20mg/ Lumefantrine 120mg o tingling sensation, paresthesia and eventually
(C0-Artem) paralysis of the hands and feet
- Erythrocyte Exchange Transfusion o floating sensation and weakness

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Acquired Immunodeficiency Syndrome (AIDS) Symptoms

- Red Ribbon - Is a symbol of solidarity with HIV positive
people and those living with AIDS.
What is AIDS?
- Acquired immune deficiency syndrome or acquired
immunodeficiency syndrome (AIDS) is a disease of
the human immune system caused by the human
immunodeficiency virus (HIV)
What is HIV?
- refers to the Human Immunodeficiency Virus which
causes AIDS
Causative Agent
Virus classification Minor Signs:
Group: Group VI (ssRNA-RT) 1. Persistent cough for one month
2. Generalized pruritic dermatitis
Family: Retroviridae
3. Recurrent herpes zoster
Genus: Lentivirus 4. Oropharyngeal candidiasis
Anatomy of Aids Virus 5. Chronic disseminated herpes simplex
6. Generalized lymphadenopathy
Major Signs:
1. Loss of weight – 10 percent of body weight
2. Chronic diarrhea for more than one month
3. Prolonged fever for one month
• Adult : 2 major & 1 minor
• Child: 2 major & 2 minor

Common Opportunistic Infections

1. Pneumocystitis carinii pneumonia
2. Oral candidiasis
3. Toxoplasmosis of the CNS
4. Oropharyngeal candidiasis
5. Pulmonary / extra – pulmonary tuberculosis
History of AIDS
6. Cancer
• Origin a. Kaposi’s sarcoma
- HIV is thought to have originated in non-human b. Cervical dysplasia and cancer
primates in sub-Saharan Africa and transferred to c. Non-Hodgkin’s lymphoma
humans early in the 20th century How can it be Transmitted?
- The first paper recognizing a pattern of opportunistic - Blood transfusion
infections was published on 4 June 1981. - Breastfeeding
HIV primarily infects vital cells in the human immune - Perinatal transmission
system such as: - Homosexual relationship
• Helper T cells(specifically CD4+ T cells) - Sexual contact
• macrophages - Contaminated syringes
• Dendritic cells. • Incubation Period
HIV infection leads to low levels of CD4+ T cells through - Variable
three main mechanisms: - Time from infection to the development of detectable
• Firstly, direct viral killing of infected cells; antibodies is generally 1 -3 months, the time from HIV
• Secondly, increased rates of apoptosis in infected infection to diagnosis of AIDS has been observed
cells; and range of less than 1 year to 15 years or longer
• Thirdly, killing of infected CD4+ T cells by CD8 • Diagnosis
cytotoxic lymphocytes that recognize infected cells. • Enzyme Linked Immuno – Sorbent Assay (ELISA)
• *When CD4+ T cell numbers decline below a critical • Western Blot
level, cell-mediated immunity is lost, and the body
becomes progressively more susceptible to
opportunistic infections.

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• Practice universal / standard precaution

- Wash
- Prevention comes first
- Play safe
- Safe sex
- Condoms
- Circumcision
- Monogamous relationship
The Four Cs in the Management of HIV/AIDS
• Compliance

• Counseling/Education
- Contact tracing
- Condoms

Gonorrhea
• Causative agent:
- Neisseria gonorrheae (GC)
- Gram negative diplococci
• Mode of transmission
- Contact with exudates from the mucous membrane of
infected persons, usually as a result of sexual activity
Is there any treatment? - May occur in the uterus upon rupture of the
Reverse transcriptase inhibitors: membranes
• Zedovudine (ZDV) – Retirvir - Direct contact with contaminated vaginal secretions
• Zalcitabine – Havid of the mother as the baby passes comes out of the
• Stavudine – Zerit birth canal
• Lamivudine -Epivir - Also be transmitted through fomites
• Nevirapine – Viramune • Incubation Period
• Didanosine - Videx - 2-3 days with most symptoms occurring between 4-6
Protease inhibitors: days
o Saquinavir – Invarase Clinical Manifestation
o Ritonavir – Norvir In women
o Indinavir – Crixivan • 30-60 % are asymptomatic
• Non- reverse transcriptase inhibitors: • Red swollen vulva
o Efavirenz • Erythema of the cervix
o Delavirdine • Abnormal menstrual bleeding
- Current treatment for HIV infection consists of highly • Dysuria and dyspareunia
active antiretroviral therapy, or HAART. • Yellowish-green purulent discharges
- Current HAART options are combinations (or Less advanced symptoms
"cocktails") consisting of at least three drugs • Infection can affect the:
belonging to at least two types, or "classes," of o Uterus
antiretroviral agents. o Fallopian tubes
Nursing Management o Ovary
1. Health Education
• Development of Pelvic Inflammatory Disease (PID)
2. Know the patient
o Cramps and pain
3. Avoid Fear tactics
o Bleeding between menstrual periods
4. Avoid judgmental and moralistic messages
o Vomiting
5. Be consistent and concise
o Fever
6. Use positive statement

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In men
• Yellowish discharge from the penis
• Epididymitis
• Dysuria and discharges
• Urethritis
• Infection may affect the:
o Prostate
o Seminal vesicles
o Epididymis
o Testicles

Ophthalmia Neonatorum
Diagnostic Exams
In Female
- Thayer martin medium
In Male
- Gram Staining
Medical Treatment
• Ceftiaxone (Rocephin) Doxycycline
- For uncomplicated gonorrhea in nonpregnant patients
• Ceftriaxone (Rocephin) Erythromycin
- For pregnant women with gonorrhea
• Ceftriaxone with doxycycline or azithromycin
- In areas with coinfection with Chlamydia
Prevention and Control
- Sex education
- Case finding
- Contact tracing
Syphilis (Lues Venereal Morbus Gallicus)
• Causative Agent
- Treponema pallidum- a Gram (-), motile spirochete
• Incubation Period
- 10-90 days, average of 3-6 weeks
• Mode of transmission
- Almost always through sexual contact
- Through indirect contact with articles freshly soiled
with discharges or blood containing the organism
- Congenitally through the placenta of a syphilitic
mother
- Accidentally, from a syphilitic baby to a wet nurse or
to anyone carelessly handling diapers
Clinical Manifestations
 Primary Syphilis
- Typically via direct sexual contact with the infectious
lesions of a syphilitic person
- 10-90 days after the initial exposure, a skin lesion
appears at the site of contact usually the genitalia
- Chancre
- A firm, painless skin ulceration localized at the point
of initial exposure to the spirochete
- Often on the penis, vagina, or rectum
- May persist up to 4-6 weeks and usually heals without
treatment
- Chancre associated with lymphadenopathy
 Secondary Syphilis
- Occurs approximately 1-6 months after the primary
infection
- Development of mucocutaneous lesions and
generalized lymphadenopathy
• Rashes
- Symmetrical, reddish-pink, non-itchy
- Usually on the trunk and extremities and can involve
the palms of the hands and soles of the feet
- Mucous patches may also appear on the genitals or in
the mouth
- Flu-like symptoms
 Condyloma Lata
- Highly contaminated pink, or grayish-white lesions
- Commonly seen on the moist areas of the body, like
the perineum, vulva, rolls of fats in the scrotum.
 Latent Syphilis
- No clinical symptoms, but serologic test proves to be
reactive
 Late (Tertiary) Syphilis
• Late Benign
- Develops 1-10 years after infection
- May appear on the skin, bones, mucous membranes,
upper respiratory tract, liver, or stomach
• GUMMA
- A chronic, superficial nodule, or deep granulomatous
lesion that is solitary, assymetric, painless, and
endurated
• Neurosyphilis
• Cardiosyphilis
- Aorta is the most affected part
- Aortitis and Aortic regurgitation
- Aneurysm
Diagnostic Tests
 Dark Field Illumination Test
 Venereal Disease Research Laboratory (VDRL) Test
 Fluorescent treponemal antibody absorption (fta-abs)
Medical Treatment
• Penicillin G
• Benzathine IM
- First choice treatment for all manifestations of
syphilis
• Oral tetracycline or doxycycline

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 312 LECTURE: WK13-14 – COMMUNICABLE DISEASES

- Given to nonpregnant patients who develop allergy to

penicillin

Red Tide
- is a phenomenon caused by algal blooms during
which algae become so numerous that they discolor
coastal waters. The algal bloom deplete oxygen in the
waters and release toxins that causes illness in
humans
- The most common human health problems
associated with red tides and other
harmful algae blooms are various types of
gastrointestinal, respiratory, and
neurological disorders.
Modalities of Treatment:
1. Induce vomiting
2. Charcoal hemoperfusion
3. Alkaline fluids
4. Artificial respiration

Herpes Simplex / Herpes Zoster

- The main difference between the two strains is that HSV-1
(oral herpes) usually causes sores on or around the mouth,
while HSV-2 genital herpes) generally causes sores on
genitals. Herpetic keratitis is ocular herpes.
- Herpes zoster is caused by reactivation of the varicella-
zoster virus (the cause of chickenpox) from its latent
phase. A painful rash usually crops of vesicles. Herpes
zoster ophthalmicus.
Medication
- Medication can decrease the pain related to an outbreak
and can shorten healing time. They can also decrease the
total number of outbreaks.
- There are three major drugs commonly used
to treat genital herpes symptoms: acyclovir (Zovirax),
famciclovir (Famvir), and valacyclovir (Valtrex). These are
all taken in pill form. Severe cases may be treated with the
intravenous (IV) drug acyclovir.

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