CONDITIONS BEFORE AN INFECTION

DEVELOPS

Sufficient number of microorganisms

Virulence of microorganisms
Resistance of the of the host
Immunity of the host
The cycle of infection must be completed

THE INFECTION PROCESS CYCLE

Agent (bacteria or virus)

Reservoir (fomites or living things)
Portal of Exit
Mode of Transmission (direct or indirect)
Portal of Entry
The Host

STAGES OF AN INFECTIOUS PROCESS

INCUBATION PERIOD
PRODROMAL PERIOD
ILLNESS PERIOD
(PATHOGNOMONIC SIGN)
CONVALESCENT PERIOD

FACTORS AFFECTING RISK OF

AGE
INFECTION

HEREDITY
LEVEL OF STRESS
NUTRITIONAL STATUS
CURRENT MEDICAL THERAPY
PRE-EXISTING DISEASE PROCESSES
IMMUNIZATION STATUS

IMMUNITY
THE QUALITY OF BEING INSUSCEPTIBLE TO
OR UNAFFECTED BY A PARTICULAR
DISEASE OR CONDITION.

Immunity

ACTIVE IMMUNITY
ANTIBODIES ARE PRODUCED BY THE
BODY IN RESPONSE TO INFECTION.
LONG DURATION

NATURAL ACTIVE
ANTIBODIES ARE FORMED IN THE
PRESENCE OF ACTIVE INFECTION IN THE
BODY.

Artificial Active

Artificial Active

Artificial Passive

IMMUNIZATION
A PROCESS BY WHICH RESISTANCE TO AN
INFECTIOUS DISEASE IS INDUCED OR
AUGMENTED.

IMMUNOGLOBULINS

Ig G
Ig A
Ig M
Ig E
Ig D

FUNDAMENTALS OF STANDARD
PRECAUTION

HANDWASHING
GLOVES
MASKS, GOGGLES, FACE SHIELDS
AIR FILTERS
GOWNS
ISOLATION
STRICT ISOLATION
CONTACT ISOLATION
RESPIRATORY ISOLATION
TUBERCULOSIS ISOLATION
ENTERIC PRECAUTION
DRAINAGE/SECRETION PRECAUTION
BLOOD/BODY FLUIDS PRECAUTION

Transmission-Based Precautions
3 Methods

1. Airborne
2. Droplets
3. Contact

Communicable Diseases
Illnesses caused by microorganisms
Transmitted from an infected person or animal
to another person or animal
Passed on by direct or indirect contact with
infected persons or with their excretions
Most bacteria and viruses are airborne passed
through direct contact

CHRONIC COMMUNICABLE
DISEASES

Tuberculosis

Tuberculosis
Definition:
-TB is a highly infectious chronic
disease that usually affects the lungs.
-It is primarily a respiratory disease
common among malnourished individuals
living in crowded areas. It often occurs in
children of underdeveloped and
developing countries in the form of primary
complex

Tuberculosis
Prevalence/Incidence:
- ranks sixth in the leading causes of
morbidity (with 114,221 cases) in the
Philippines
-sixth leading cause of mortality (with
28507 cases) in the Philippines.

Tuberculosis
Causative Agent:
Mycobacterium
Tuberculosis
- a nonmoving, slowgrowing, acid-fast rod
transmitted via the
airborne route

Tuberculosis

Nursing and Medical Management

Ventilation systems
Ultraviolet lighting
Vaccines, such as the Bacillus Calmette
Guerin (BCG) vaccine
- drug therapy

Preventing Tuberculosis:

Leprosy

Leprosy
sometimes known as Hansen's disease
is an infectious disease caused by , an aerobic,
acid fast, rod-shaped mycobacterium
Gerhard Armauer Hansen
Historically, leprosy was an incurable and
disfiguring disease
Today, leprosy is easily curable by multi-drug
antibiotic therapy

Leprosy
Signs and Symptoms:
Early Signs and Symptoms:
CLUMP

Late Signs
and
Symptoms:
MISCG

Leprosy
Prevalence Rate
Metro Manila, the prevalence rate ranged from
0.40 3.01 per one thousand population.

Leprosy
Management
Dapsone
clofazimine and rifampin
Multi-Drug-Therapy (MDT)
six month course of tablets for the milder form
of leprosy and two years for the more severe
form

Leprosy

Leprosy
interaction of M.
leprae with the
complement system
and formation of
large amounts of
immune complexes
(IC)

VECTOR BORNE COMMUNICABLE

DISEASES

Leptospirosis

Leptospirosis
Definition:
- an infectious disease that affects humans and
animals, is considered the most common
zoonosis in the world
-often is referred to as swineherd's disease,
swamp fever, or mud fever, Weils disease,
Trench fever, flood fever, spiroketal jaundice

Leptospirosis
Signs and Symptoms:
-high fever
-severe headache
-chills
-muscle aches
-vomiting
-may include jaundice
(yellow skin and eyes)
-red eyes
-abdominal pain
-diarrhea

Leptospirosis
Prevalence/Incidence:
-affects less than 200,000 people in the US
population (annual incidence of leptospirosis
USA is 100-200 cases which is approximately 1
in 2,720,000 people in USA)

Leptospirosis
Causative
Agent:
Leptospira
interrogans
- a fine spiral
bacteria 0.1 um
in diameter and
6-20 um in
length

Leptospirosis
Nursing and Medical Management
-Treatment: penicillins and other related Blactam antibiotic, tetracycline, erythromycin for
patients allergic to penicillin

Leptospirosis
Prevention and Control:

Improved education of the people at particular risk (farmers,

miners, etc.) to increase their awareness and enable early diagnosis
and treatment
Use of protective clothing boots and gloves especially by workers
with occupational hazards
Stringent community-wide rat eradication program. Remove
rubbish from work and domestic environment to reduce rodent
population
Segregate domestic animals potentially infected from mans living,
working and recreation areas
Isolation of patients and concurrent disinfection of soiled articles
Report all cases of leptospirosis
Investigations of contacts and source of infection
Chemoprophylaxis in groups at high risk of infected host.

Malaria

MALARIA
Malaria (from Medieval Italian: mala aria "bad air"; formerly called ague or marsh fever) is an
infectious disease that is widespread in many tropical
and subtropical regions.

MALARIA
signs and symptoms?
Physical signs that may be noted with malaria
include the following:
Symptoms of malaria include fever, shivering,
arthralgia (joint pain), vomiting, anemia caused by
hemolysis, hemoglobinuria, and convulsions.

MALARIA

MALARIA
causative agent?
Only female mosquitoes feed on blood, thus males do not
transmit the disease.
The females of the Anopheles species of mosquito prefer
to feed at night.
Young mosquitoes first ingest the malaria parasite by
feeding on a human carrier.
Infected female Anopheles mosquitoes carry Plasmodium
sporozoites in their salivary glands.
Other less common routes of infection are through blood
transfusion and maternal-fetal transmission.

Filariasis

Filariasis
name for a group of tropical diseases caused by
various thread-like parasitic round worms
(nematodes) and their larvae
larvae transmit the disease to humans through a
mosquito bite
can progress to include gross enlargement of the
limbs and genitalia in a condition called
elephantiasis

Filariasis
Signs and Symptoms
Asymptomatic Stage
Characterized by the presence of
microfilariae in the peripheral
blood
No clinical signs and symptoms
of the disease
Some remain asymptomatic for
years and in some instances for
life
Others progress to acute and
chronic stages
Microfilariae rate increases with
age and then levels off
In most endemic areas including
the Philippines, men have higher
microfilariae rate than women

Acute Stage
Lymphadenitis (inflammation of
lymph nodes)
Lymphangitis (inflammation of
lymph vessels)
In some cases the male genitalia
is affected leading to funiculitis,
epidydimitis or orchitis (redness,
painful and tender scrotum)
Chronic Stage
Hydrocoele (swelling of the
scrotum)
Lyphedema (temporary swelling
of the upper and lower
extremities
Elephantiasis (enlargement and
thickening of the skin of the
lower and / or upper extremities,
scrotum, breast)

Filariasis
Incidence/Prevalence
Filariasis affects
Filipinos living in the
endemic areas

Filariasis
Management
Either ivermectin, albendazole, or
diethylcarbamazine
the medications can cause severe side effects in
up to 70% of patients as a result either of the
drug itself or the massive death of parasites in
the blood
No treatment can reverse elephantiasis

Filariasis

Schistosomiasis

Schistosomiasis
parasitic disease caused by
a larvae

Swimmer's itch

Schistosomiasis in liver

Schistosomiasis in Bladder

Schistosomiasis
Incidence Rate
estimated annual incidence of infection of > 200
million cases in 74 countries

 Global distribution and control status of

schistosomiasis.
Control unsuccessful
Control successful

Schistosomiasis
Prevalence Rate
World Health Organization expert committee
concluded that yearly deaths could be as high as
200,000

Schistosomiasis
Causative Agent:
Schistosoma haematobium
Schistosoma intercalatum
Schistosoma japonicum
Schistosoma mansoni
Schistosoma mekongi

 Life-cycle of Schistosoma mansoni

Schistosomiasis
Management
Strong infection: a single dose of Praziquantel
10-20 mg./kg
Acute infection:corticosteroid

Schistosomiasis
Pathophysiology
larval forms of the parasites, known as cercariae,
are released from aquatic snails
penetrate the skin during water contact
inside a human host, cercariae transform into
schistosomula
transported to the portal circulation of the liver,
where they mature and mate
Migrate to different organs (e.g. liver, the
bladder and the urinary tract)

Dengue

DENGUE is a mosquito-borne
infection which in recent years
has become a major international
public health concern.
It is found in tropical and subtropical regions around the world,
predominantly in urban and semiurban areas.

SIGNS AND SYMPTOMS:

This infectious disease is manifested by:
A sudden onset of fever
Severe headache
Muscle and joint pains (myalgias and arthralgias severe pain gives it
the name break-bone fever or bonecrusher disease)
Rashes; the dengue rash is characteristically bright red petechia and
usually appears first on the lower limbs and the chest - in some patients, it
spreads to cover most of the body.
Gastritis with some combination of associated abdominal pain, nausea,
vomiting or diarrhea.

TREATMENT
The mainstay of treatment is supportive therapy. The patient is
encouraged to keep up oral intake, especially of oral fluids. If the patient
is unable to maintain oral intake, supplementation with intravenous fluids
may be necessary to prevent dehydration and significant
hemoconcentration. A platelet transfusion is rarely indicated if the
platelet level drops significantly or if there is significant bleeding.

PREVENTION AND CONTROL

Other Communicable Diseases

Chicken Pox

CHICKEN POX
define?
Chicken pox is the common name for Varicella
simplex, classically one of the childhood infectious diseases
caught and survived by most children. Chickenpox is highly
infectious and spreads from person to person by direct
contact or through the air from an infected persons
coughing or sneezing.

CHICKEN POX
signs and symptoms?
Lesions erupt in successive crops, usually beginning on
the trunk and then spreading to the face and scalp.
Lesions frequently involve the pharynx and tonsils.
The rash is most often described as being very itchy.
A patient's temperature can be as high as 39.5C and can
last 3-6 days after the development of the rash.
Prodromal symptoms:
Fever
Malaise
Anorexia
Headache

CHICKEN POX
incidence rate?
Varicella is most commonly observed in children aged 3-6
years.
Though most cases of varicella in the United States occur in
children younger than 10 years, 5% of cases are in persons
older than 15 years.
In tropical climates, varicella is more common in older
children.
The majority of cases in Japan were in children younger
than 6 years. Approximately 9.6% of cases involved
children younger than 1 year, and almost one third of these
were infants younger than 5 months.

CHICKEN POX
prevalence rate?
In the US: Prevalence is seasonal, with annual peaks in
March and April.
Internationally: Varicella is almost universal; an estimated
60 million cases occur worldwide each year.

CHICKEN POX
causative agent?
Human (alpha) herpesvirus 3 (V-Z virus), a member
of the herpesvirus group, is responsible for the development
of varicella.
Direct person-to-person contact with lesions and/or
airborne droplets spreads the V-Z virus. Neonatal varicella
is caused by maternal viremia, leading to spread of the
virus across the placenta.
Risk factors:
No prior history of varicella
Unvaccinated status
Immunosuppression

Herpes Zoster

HERPES ZOSTER
define?
Herpes zoster, colloquially known as shingles, is
the reactivation of varicella zoster virus, leading to a crop of
painful blisters over the area of a dermatome. In Italy and
in Malta, it is sometimes referred to as St. Anthony's fire.

HERPES ZOSTER
signs and symptoms?
Often, pain is the first symptom. This pain can be
characterized as stinging, tingling, numbing, or throbbing,
and can be pronounced with quick stabs of intensity. Then
1-3 crops of red lesions develop, which gradually turn into
small blisters filled with serous fluid. A general feeling of
unwellness often occurs. In some cases, the rash does not
form blisters, but has an appearance much like urticaria
("hives").

HERPES ZOSTER
incidence rate?
Race: Among those patients who have had exposure to
chickenpox, blacks are 25% less likely than whites to
develop herpes zoster.
Sex: Incidence is equal in males and females.
Age: Incidence of shingles increased with advancing age.

HERPES ZOSTER
causative agent?
The causative agent for herpes zoster is varicella
zoster virus (VZV). The exact mechanism of varicella-zoster
reactivation is not known; however, decreased cellular
immunity is a causative factor.

Influenza

Influenza
Definition:
- highly contagious respiratory infection caused
by a virus
-Influenza is caused by a virus transmitted from
one person to another in droplets coughed or
sneezed into the air

Influenza
Signs and

Symptoms:

-body aches
-cough
-extreme coldness
-fatigue
-fever
-headache
-irritated watering eyes
-loss of smell
-nasal congestion
-nausea

-reddened eyes, skin

(especially face), mouth,
throat
-runny nose
-sore joints
-sore throat
-sneezing
-vomiting

Influenza
Prevalence/Incidence
- In 1996, there had been 560168 cases of
influenza, and there had also been
approximately 340 death caused by the said
disease.

Influenza
Causative Agent:
Haemophilus
Influenzae
-small, nonmotile Gramnegative bacterium in the
family Pasteurellaceae
-"loves heme", more
specifically it requires a
precursor of heme in
order to grow

Influenza
Nursing and Medical Management
- Isolate patient during acute stage
- Report the case to local Health Officer
immediately
- During epidemics to minimize severity, to
protect the patient from secondary infections,
thus reducing mortality.
- Patients should be instructed to go to bed at the
beginning of the attack and not to return to work
without approval of the physician.
- Keep patient warm and free from drafts in bed.

Influenza
- Keep patient away from persons suffering from
respiratory tract infections to prevent pneumonia.
- Tepid sponge for fever and use the proper technique as
a teaching tool to a responsible member of the family.
- Teach and demonstrate proper sneezing and cough
techniques by the use of paper tissue to cover the mouth
and nose during cough and sneeze.
- Teach the burning method or disposal of contaminated
tissues and newspaper.
- Clothing soiled with throat and nose discharges should
be boiled for 30 minutes before laundering.

Rabies

Rabies
Latin, rabies, "madness,rage,fury"
viral zoonotic disease that causes acute
encephalitis in animals and people
In non-vaccinated humans, rabies is almost
invariably fatal
There are two kinds of rabies: urban or canine
rabies and sylvatic rabies

Rabies
Mode of Transmission: Usually by bites of a
rabid animal whose saliva has the virus. The
virus may also be introduced into a scratch or in
a fresh break in the skin (very rare).
Transmission from man to man is possible.
Incubation Period: The usual incubation
period in 2 to 8 weeks.

Rabies
Period of Communicability: In dogs and
cats, for 3 to 10 days before onset of clinical
signs (rarely over 3 days) and throughout the
duration of the disease.
Susceptibility and Resistance: All warmblooded animals are susceptible. Natural
immunity in man is unknown.

Rabies
Signs and Symptoms:
Sense of apprehension
Headache
Fever
Sensory change near site
of animal bite
Spasms of muscles of
deglutition on attempts
to swallow (fear of
water / hydrophobia)
Paralysis
Delirium and convulsions

Rabies
Prevalence Rate
More than 99% of all
human deaths from
rabies occur in Africa,
Asia and South
America; India alone
reports 30,000
deaths annually

Rabies
Management

The wound must be immediately and thoroughly

washed with soap and water. Antiseptics such as
povidone iodine or alcohol may be applied.

The patients may be given antibiotics and antitetanus immunizations.

Post exposure treatment is given to persons who are

exposed to rabies. It consists of local wound treatment,
active immunization (vaccination) and passive
immunization (administration of rabies immunoglobulin)

Active immunization or vaccination aims to induce

the body to develop antibodies against rabies up to 3
years.

Tetanus

Clostridium tetani (bacteria)

Wound setting
IP 3-21 days
Respiratory paralysis to death
Tetanus neonatorum
Umbilical cord
Poor sucking
Active-DPT and tetanus
toxoid
Passive-TIG and TAT,
placental immunity
Dx wound and blood
extraction (non specific)

Risonuus sardonicus-maskface
Risorius-grinsmile
Opistothonus position
Difficulty in swallowing
Urinary & bowel incontinence
Pain, redness & swelling

Measles

SIGNS AND SYMPTOMS

Hacking cough

Runny nose
High fever
Watery red eyes.
Another marker of measles are Koplik's spots, small red spots with
blue- white centers that appear inside the mouth.
The measles rash typically has a red or reddish brown blotchy
appearance, and first usually shows up on the forehead, then spreads
downward over the face, neck, and body, then down to the feet.

PREVENTION
Measles can be prevented through

vaccination.
The measles vaccine is combined
with the vaccines for mumps and
rubella and is known as the MMR
vaccine.
People who have measles should
limit their contact with others.
People exposed to someone who
has measles should consult their
health care provider immediately. If
they have not been vaccinated,
measles vaccine can help prevent
infection if it is given within three
days of exposure. Immune globulin
may help others if it can be given
within six days of exposure.

TREATMENT
Professional Treatment
Rubella cannot be treated with antibiotics because antibiotics do not work against
viral infections. Unless there are complications, rubella will resolve on its own.
Home Treatment
Rubella is typically a mild illness, especially in kids. Infected children usually can be
cared for at home. Monitor your child's temperature, and call the doctor if the fever
climbs too high.
To relieve minor discomfort, you can give your child acetaminophen or ibuprofen.
Avoid giving aspirin to a child who has a viral illness because its use in such cases
has been associated with the development of Reye syndrome, which can lead to liver
failure and death.

Meningitis
Menigococcemia

Neisseria meningitides (bacteria)

Opisthotonus
Brudzinski
Kernigs
Petechia
Can spread to the brain (encephalitis)
Increased ICP
Seizure
Dx CSF analysis

Red Tide Poisoning

Pyromidium Bahamense
Dinoflagellates
Plankton, Algae
Ingestion of contaminated
bi-valve shellfish
IP 30 minutes
Circumoral numbness,
nausea and vomiting
Bulbar paralysis and
metabolic acidosis
Dx gastric siphoning

MGNT:
No definite medication
Induced vomiting
Drinking coconut milk &
sodium bicarbonate weakens
the toxic effect of red tide

Botulism

Clostridium botulinum (bacteria)

Ingestion of contaminated foods (canned foods)
Intoxication from toxins
IP 12-36H (canned food)
IP 4-14 days (wound)
Diplopia, dysphagia, bulbar paralysis
Active and passive immunization are available
Dx gastric siphoning and wound culture

Amoebiasis
Entamoeba Hystolitica protozoan (parasite)

Oral fecal route

Unsafe sexual practices

Oral anal route

Blood streaked, diarrhea and watery mucoid, abdl
cramps (dysenteric)
Diarrhea and constipation (non dysenteric)
Extra amoebiasis-penile, vagina, spleen, liver, anal,
lungs and meninges
Metronidazole (Flagyl)
Dx microscopic stool exam or rectal secretions
(tetra nucleated cyst and trophozoites)

Bacillary Dysentery
Shiga bacillus (bacteria)
Shigellosis
s. dysenterae (fatal)

s. flexneri (common in the Philippines)

s. boydii
s. sonnei
MOT same with amoebiasis
Watery mucoid, bloody with pus and tenesmus
Chloramphenicol, Tetracycline
Dx stool exam

Cholera (El Tor)

Vibrio coma (inaba, ogawa, hikojima), vibrio

cholerae, vibrio eltor (bacteria)
MOT same with amoebiasis
Rice watery stool with fishy odor
Washerwomans appearance
Severe dehydration
Chloramphenicol
Active Immunization
Dx stool exam

Typhoid
Fever
Salmonella typhosa (bacteria)

MOT same with amoebiasis (5 Fs)

Rose spot (abdominal rashes)
Step ladder fever to fastidial (peak
of fever)
May stay in the gallbladder
(hiding area)
1st week step ladder (BLOOD)
2nd week rose spot and fastidial
typhoid pyschosis (URINE &
STOOL)
3rd week (complications)
intestinal bleeding, perforation,
peritonitis, encephalitis,
4th week (lysis) decreasing S?SX
5th week (convalescent)

MGNT
Chloramphenicol
Active Immunization
Dx same with amoebiasis
Blood (typhi dot) 1st week
after
Stool and urine 2nd week after

Hookworm (Roundworm)

Necator Americanus, Ancylostoma Duodenale

Skin entry (sole of the feet to blood steam then into the
lungs then ascends to the pharynx where it is swallowed
thereby it attaches to intestinal mucosa and subsists on
the blood of the host)
Anemia, abdl cramps, abdl distention, perforation to
peritinotis to septicemia
Pyrantel Pamoate and Mebendazole
Note: dont give drug without (+) stool exam
members of the family must be examined and treated
also
Dx microscopic exam (stool exam)

Ascariasis (Roundworm)
Ascaris Lumbricoides
MOT same with hookworm also by ingestion of
foood contaminated by ascaris lumbricoides
Agent will stay in the lungs and will go out into
the mouth, ears, nose, eyes, anus and may even
infiltrate other organs
Coughing, wheezing and hemoptysis
Drug: same with hookworm
Dx same with hookworm

Tapeworm
Taenia Saginata (cattle)
Taenia Solium (pigs)
MOT fecal oral route
(ingestion of food contaminated by the agent)
Dx: Stool Exam

Pinworm

Enterobiasis (nocturnal animation/alive)

Vermicularis Enterobius
MOT fecal oral route
S/sx Itchiness at the anal area
(eggs of the agent causes the itchiness)
Dx tape test at night time
(agents release their eggs during night time)

Mumps

Mumps virus/filtrable virus

Droplet/airborne
Unilateral or bilateral parotitis
Orchitis and oophoritis = sterility (puberty)
Active and passive immunity are available
Lifetime Immunity
Stimulating foods cause severe pain

Diphtheria

Corynebacterium diphtheriae
Klebsloefflers bacillus (bacteria)
Airborne/droplets
Catarrhal stage highly contagious
Pseudomembrane
Bullneck
Penicillin or erythromycin
Upper airway obstruction-resp acidosis with hyperoxemia
Active and passive immunization are available
DPT
Shick-susceptibility to diphtheria toxin
Moloney-sensitivity to diphtheria toxoid
Throat swab

Whooping Cough/Pertussis

Bordetella pertussis (bacteria)

B. parapertussis
B. bronchiseptica
Bordet gengao (agar for culture)
Hemophilus bacillus
Ferrous iodide to liquefy thicky secretions
Erythromycin or ampicillin
Catarrhal stage (highly contagious)
Clusters of cough that ends with a whoop
Prostration
Active immunization
DPT
Dx throat swab

SARS
Atypical (progressive respiratory compromise)

Pneumocystis carinii-AIDS

Corona virus
Fever of 38 and above for 7-10 days with productive cough
Respiratory acidosis with severe hypoxemia
Dx

Sputum C&S

ABG

Pulse oximetry

TLF

Chest xray

History taking

IPPA

Anthrax (zoonotic)
Bacillus anthracis (gram negative)
Cattle, sheep, goat and pig
Inhalation-URTI-fever-3-5 days-lower infection
(alveoli)-metabolic acidosis-hypoxia
GIT-ingestion of contaminated carcasses-severe
gastroenteritis-bloody stools-perforationperitoniitis-septicemia
Skin-most common-direct/indirect-itchinesspapule-vesicle-depressed black eschars-painlesssepticemia-death

Pediculosis

Blood sucking lice

Pediculus humanus
p. capitis-scalp
p. palpebrarum-eyelids and eyelashes
p. pubis-pubic hair
p. corporis-body
Drugs:
Lindane (Kwell) topical
Permethrin (Nix) topical
CX impetigo to AGN, RHD, SLE
MOT skin contact