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What is Communicable
 Communicable disease is an illness caused
by an infectious agent or its toxic products
that are transmitted directly or indirectly to
a well person through an agency, and a
vector or an inanimate object.
Definition of Terms:
 Contagious Disease – term given to a disease that
is easily transmitted from one person to another
through direct or indirect means.
 Infectious Disease – transmitted not only by
ordinary contact but requires direct inoculation of
the organism through a break on the skin or
mucous membrane.
- all contagious diseases are infectious.
What is infection?
 Infection – invasion and multiplication of
microorganisms on the tissues of the host
resulting to signs and symptoms as well as
immunologic response.
The nurse and the
Communicable Diseases:
 He/she must be knowledgeable of the following:
2. The nature of the specific microorganism and its
capacity for survival both within and outside the
3. The most effective method of destruction of the
specific organism.
4. How the organism invades the host and its route
of escape from the body.
4. The incubation period, prodromata, and the
length of communicability.
5. How a specific drug alters the clinical signs
and the infectious course of the disease.
6. The most recent methods and concepts of
prophylaxis for communicable diseases.
7. The rationale and control measures,
including isolation techniques.
Acquired Immune Deficiency
Syndrome (AIDS)
Human Immunodeficiency Virus (HIV) –
causes AIDS.
- retrovirus
- belongs to lentevirus, also called “slow
Pathophysiology of AIDS:


Langerhans & neurons

CD4 ---------T4 cells T4 cell dies

Signs & symptoms will manifest

Signs and Symptoms:
 AIDS-related Complex (ARC)
 Memory loss
 Altered gait
 Depression
 Sleep disorders
 Chronic diarrhea
Minor Signs: Major Signs
 Persistent cough for one  Loss of weight – 10%
month of body weight
 Generalized pruritic  Chronic diarrhea for
more than one month
 Recurrent herpes zoster
 Prolonged fever for
 Oropharyngeal candidiasis
 Chronic disseminated one month
herpes simplex
 Generalized
Common Opportunistic
 Pneumocystis carinii peumonia
 Oral candidiasis
 Toxoplasmosis of the CNS
 Chronic diarrhea/wasting syndrome
 Pulmonary/extra-pulmonary tuberculosis
 Cancers (Kaposi’s sarcoma, cervical
dysplasia & cancer, Non-Hodgkin’s
Mode of Transmission
 Sexual intercourse
 Blood transfusion and sharing of infected
syringes and needles among intravenous
drug users
 Vertical or perinatal transmission (from a
pregnant woman to the fetus during
pregnancy, child delivery, or breastfeeding)
Diagnostic Examinations
 EIA or ELISA – Enzyme link
immunosorbent assay
 Particle Agglutination (PA) test
 Western Blot analysis – confirmatory
diagnostic test
 Immunofluorescent test
 Radio immuno-precipitation assay (RIPA)
Treatment Modalities
“AIDS Drugs” – medicines used to treat but
not to cure HIV infection.
- referred to as “anteroviral drugs”.
- inhibits the reproduction of the virus.
Nursing Management
1. Health Education
- know the patient
- avoid fear tactics
- avoid judgmental and moralistic messages
- be consistent and concise
- use positive statement
- give practical advice
2. Practice universal/standard precaution
b. Thorough medical hand washing after
every contact with patient and after
removing the gown and gloves, and before
leaving the room of an AIDS suspect or
known AIDS patient.
c. Use of Universal barrier or Personal
Protective Equipment (PPE).
3. Prevention
b. Avoid accidental pricks from sharp
instruments contaminated with potentially
infectious materials from AIDS patient.
c. Wear gloves when handling blood
specimens and other body secretions
d. Label blood and other specimens with
special warning “AIDS Precaution”.
4. Blood spills should be cleaned immediately using
common household disinfectants, like “chlorox”.
5. Needles should not be bent after use, but should
be disposed into a puncture-resistant container.
6. Personal articles should not be shared with other
members of the family.
7. Patients with active AIDS should be isolated.
- protozoal infection of human beings initially
involves the colon, but may spread to soft
tissues, most commonly to the liver or
lungs, by contiguity or hematogenous or
lymphatic dissemination.
Etiologic Agent
 Entamoeba histolytica
 - prevalent in unsanitary areas
- common in warm climate
- acquired by swallowing
- cyst survives a few days outside of the body
- cyst passes to the large intestine and hatch into
trophozoites. It passes into the mesenteric veins, to
the portal vein, to the liver, thereby forming
“amoebic liver abscess”.
 When the cyst is swallowed, it passes through the
stomach unharmed and shows no activity while in
an acidic environment.
 In the alkaline medium of the intestine, metacyst
begins to move within the cyst wall.
 The quadrinucleate amoeba emerges and divides
into amebulas that are swept down into the cecum.
 Mature cyst in the large intestines leaves the host
in great numbers.
 The cyst can remain viable and infective in moist
and cool environment for at least 12 days and in
water for 30 days.
 The cysts are resistant to levels of chlorine
normally used for water purification.
 They are rapidly killed by putrifaction,
desiccation, and temperatures below 5 and
above 40 degrees.

Source: human excreta

Incubation Period
3 days – severe infection
 Several months – subacute & chronic form
 3-4 weeks – average

* The microorganism is communicable for the

entire duration of the illness.
Mode of Transmission
 Fecal-oral transmission
 Direct contact – sexual contact
(orogenital, oroanal & proctogenital
sexual activity)
 Indirect contact – uncooked leafy
vegetables or foods contaminated with E.
histolytica cysts.
Clinical Manifestations
 Acute amoebic dysentery
a. slight attack of diarrhea, altered with periods of
b. diarrhea, watery and foul-smelling stool often
containing blood-streaked mucus
c. colic and gaseous distention of the lower
d. nausea, flatulence, abdominal distention and
tenderness in the right iliac region over the colon.
 Chronic amoebic dysentery
a. attack of dysentery that lasts for several
days, usually followed by constipation.
b. tenesmus accompanied by the desire to
c. anorexia, weight loss, and weakness
d. liver may be enlarged
e. watery stool, bloody and mucoid
f. vague abdominal distress, flatulence,
constipation or irregularity of bowel
g. mild toxemia, constant fatigue &
h. abdomen losses its elasticity when
picked-up between fingers
I. On sigmoidoscopy, scattered ulceration
with yellowish and erythematous border
j. The gangrenous type (fatal cases) is
characterized by the appearance of large
sloughs of intestinal tissues in the stool
accompanied by hemorrhage.
 Extraintestinal forms
a. Pain at the upper right quadrant with tenderness
of the liver
b. jaundice
c. intermittent fever
d. loss of weight or anorexia
e. abscess may break through the lungs, patient
coughs anchovy-sauce sputum.
Diagnostic Exam
1. Stool exam (cyst, white and yellow pus
with plenty of amoeba)
2. Blood exam ( leukocytosis)
3. Proctoscopy/Sigmoidoscopy
Treatment Modalities
 Metronidazole (Flagyl)
 Tetracycline
 Ampicillin, quinolones, sulfadiazine
 Streptomycin SO4, Chloramphenicol
 Lost fluid and electrolytes should be
Nursing Management
 Observe isolation and enteric precaution.
 Provide health education and instruct patient to:
- boil water for drinking or use purified water
- avoid washing food from open drum or pail
- cover leftover food
- wash hands after defecation or before eating
- avoid ground vegetables
 Infection caused by a parasitic roundworm,
Ascaris lumbricoides.

Mode of Transmission:
 Transmitted through contaminated fingers
put into the mouth.
 Ingestion of contaminated food and drinks.

Ascaris Lumbricoides Hatches & releases


Lungs through the Intestinal wall

blood stream

10 days

Pulmonary capillaries &


Swallowed and returned

to the intestine (mature
& mate)
Diagnostic tests
 Stool for Ova – demonstration of a
fertilized or unfertilized eggs in the stool
“Kato Technics”.
 Abdominal X-ray – densed shadow of adult
ascaris which looks like strands of
spaghetti, “dot” sign
 Routine blood counts – significant
 Albendazole or Mebendazole
 Piperazine Citrate
 Pyrantel Pamoate
Nursing Interventions
 Isolationis not needed.
 Preventive measures in each home and in the
community should be enforced.
 All members of the family must be taught of
health matters – must be trained to wash their
hands before handling food, must be taught to was
thoroughly all fruits and vegetables eaten raw, and
must be taught about effective sewage disposal.
 Availability of toilet facilities must be ensured.
 Importance of personal hygiene should be
- mild superficial fungal infection caused by
genus candida.
Signs and Symptoms:
a. The skin is scaly, erythematous, and
papular rash is present, sometimes covered
with exudates appearing below the breasts,
between the fingers, and the axillae, groin,
and umbilicus.
b. Nails are red and swollen; the nailbeds are
c. Oropharyngeal mucosa (thrush) – cream colored
or bluish white patches exude on the tongue,
mouth or pharynx that reveal bloody engorgement
when scraped
d. Vaginal mucosa – white or yellow discharge with
pruritus and local excoriation; white or gray raised
patches on vaginal walls with local inflammation.
e. Renal system – fever, flank pain, dysuria,
hematuria, pyuria
f. Pulmonary – hemoptysis, fever, cough
g. Brain – headache, nuchal rigidity, seizures
h. Eyes – blurred vision, orbital or periorbital
 Stool culture
 Gram staining of skin, vaginal discharge or

 Nystatin, for oral thrush
 Clitrimasole, fluconasole, ketoconasole – for
mucous membrane & vaginal infection
 Fluconasole or Amphotericine for systemic
- an acute and highly contagious disease of viral
etiology, characterized by vesicular eruptions on
the skin and mucous membrane with mild
constitutional symptoms.
Infectious Agent: Herpesvirus varicellae – a DNA
containing virus
Incubation Period – 10-21 days or maybe prolonged
after passive immunization.
Mode of Transmission
 Direct contact – shedding of the virus from
the vesicles
 Indirect contact – through linens or fomites
 Airborne (droplet infection)
Period of Communicability
 The patient is capable of transmitting the disease
about a day before the eruption of the first lesion
up to about five days after the appearance of the
last crop.

Diagnostic Tests:
- Complement Fixation Test – to determine the V-Z
- Electron Microscopic Exam of the vesicular fluid
Clinical Manifestations
 pre-eruptive manifestations are mild fever
& malaise
 Eruptive Stage
a. Rash starts from the trunk, then spread to
other parts of the body.
b. Initial lesions are distinctively red
papules where contents become milky and a
pus-like within 4 days.
c. In adult and bigger children, the lesions are more
widespread and more severe.
d. Vesicular lesions are very pruritic.
e. “Celestial map” – scabs
f. Stages of lesions:
*Macule – lesion that is not elevated above the
skin surface.
*Papule – lesion that is elevated above the skin
surface with a diameter of about 3 mm.
*Vesicle – pop-like eruption filled with
*Pustule – vesicle that is infected or filled
with pus.
*Crust – scab or eschar. Secondary lesion
caused by the secretion of vesicle drying on
the skin. The scars are superficial,
depigmented and take time to fade out.
 Secondary infection of the lesions –
furuncles, cellulitis, skin abscess, erysipelas
 Meningoencephalitis
 Pneumonia
 Sepsis
Treatment Modalities
 Zoverax
 Oral acyclovir
 Oral antihistamine
 Calamine lotion
 Antipyretic
Nursing Management
 Respiratory Isolation is a must until all vesicles
have crusted.
 Prevent secondary infection of the skin lesion
through hygienic care of the patient.
 Linens must be disinfected under the sunlight or
through boiling.
 Cut fingers nails short and wash hands more often.
 Provide activities to keep child occupied to lessen
Dengue Fever
(Breakbone Fever/Hemorrhagic Fever/Dandy
Fever/Infectious Thrombocytopenic Purpura)

- an acute febrile disease caused by infection

with one of the serotypes of dengue virus
which is transmitted by mosquito genus
- Dengue hemorrhagic fever – severe,
sometimes fatal manifestation of dengue
virus infection characterized by a bleeding
diathesis & hypovolemic shock.
Etiologic Agent
 Flavivirus 1, 2, 3, 4 – family of Togaviridae
are small viruses that contain single strand
 Arboviruses group B

Incubation Period: 3 – 14 days; commonly 7 –

10 days
Mode of Transmission
1. By bite of an infected mosquito (Aedes
- day biting mosquito (appear 2 hours
after sunrise and 2 hours before sunset)
- it breeds on stagnant water.
- has limited & low-flying movement.
- has fine white dots at the base of the
wings; with white bands on the legs.
Period of Communicability
 Patients are usually infective to mosquito
from a day before the febrile period to the
end of it.
 The mosquito becomes infective from day 8
to 12 after the blood meal and remains
infective all throughout life.
Sources of Infection
 Infected persons – the virus is present in
the blood of patients during the acute phase
of the disease and will become a reservoir
of virus, sucked by mosquitoes which may
then transmit the disease.
 Standing water – any stagnant water along
the household and premises are usual
breeding places of these mosquitoes.
 Age – may occur at any age, but is common
among children and peaks between four to
nine years old.
 Sex – both sexes can be affected.
 Season – more frequent during the rainy
 Location – more prevalent in urban
Pathogenesis and Pathology
 Infectious virus is deposited in the skin by the
vector and initial replication occurs at the site of
infection and in local lymphatic tissues.
 Within a few days, viremia occurs, lasting until
the 4th or 5th day after onset of symptoms.
 Evidence indicates that macrophages are the
principal site of replication.
 At the site of petechial rash, non-specific
changes are noted which include endothelial
swelling, perivascular edema, and extravasation
of blood.
5. There is marked increase in vascular permeability,
hypotension, hemoconcentration,
thrombocytopenia, with increased platelet
agglutinability, and or moderate disseminated
intravascular coagulation.
6. The most serious pathophysiological abnormality
is hypovolemic shock resulting from increased
permeability of the vascular endothelium and loss
of plasma from the intravascular space.
Clinical Manifestations
A. Dengue fever
1. Prodromal symptoms characterized by:
a. malaise and anorexia up to 12 hours
b. fever and chills accompanied by
severe frontal headache, ocular pain,
myalgia with severe backache, &
2. Nausea and vomiting
3. Fever is non-remitting and persists for
three to seven days.
4. Rash is more prominent on the
extremities and the trunk.
5. Petechiae usually appears near the end of
the febrile period and most common on the
lower extremities.
Phases of the Illness
1. Initial febrile phase lasting from two to
three days
a. fever (39 – 40C) accompanied by
b. febrile convulsions may appear
c. palms and sole are usually flushed
d. positive tourniquet test
e. anorexia, vomiting, myalgia
f. maculopapular or petechial rash maybe present
that usually starts in the distal portion of the
extremities, the skin appears purple with blanched
areas with varied sizes, that’s the Herman’s sign.
g. generalized or abdominal pain
h. hemorrhagic manifestations like positive
tourniquet test, purpura, epistaxis, and gum
bleeding may be present
2. Circulatory Phase
a. there is a fall of temperature accompanied by
profound circulatory changes usually on the 3rd to
5th day.
b. Patient becomes restless, with cool clammy
c. cyanosis is present.
d. profound thrombocytopenia accompanies the
onset of shock.
e. Bleeding diathesis may become more severe
with GIT hemorrhage.
f. shock may occur due to loss of plasma from the
intravascular spaces and hemoconcentration with
markedly elevated hematocrit is present.
g. pulse is rapid and weak; pulse pressure becomes
narrow and blood pressure may drop to an
unobtainable level
h. Untreated shock may result to comma,
metabolic acidosis and death may occur
within two days.
I. With effective therapy, recovery may
follow in two to three days.
Classification according to
Grade I
> There is fever accompanied with non-specific
constitutional symptoms and the only hemorrhagic
manifestation is positive in tourniquet test.
Grade II
> All signs of Grade I plus spontaneous bleeding
from the nose, gums, GIT are present.
Grade III
> There is the presence of circulatory
failure as manifested by weak pulse, narrow
pulse pressure, hypotension, cold clammy
skin and restlessness.
Grade IV
> There is profound shock, undetectable
blood pressure, and pulse.
Diagnostic Tests
 Tourniquet test – screening test, done by
occluding the arm veins for about 5 minutes to
detect capillary fragility.
 Platelet count (decreased) – confirmatory test
 Hemoconcentration – an increase of at least 20%
in hematocrit or steady rise in hematocrit
 Occult blood
 Hemoglobin determination
Treatment Modalities
1. Analgesic drugs other than aspirin may be
required for relief of headache, ocular pain, and
2. Initial phase may require intravenous infusion to
prevent dehydration and replacement of plasma.
3. Blood transfusion is indicated in patient with
severe bleeding.
4. Oxygen therapy is indicated to all patients in
5. Sedatives maybe needed to allay anxiety and
Nursing Management
a. Patient should be kept in mosquito-free
environment to avoid further transmission of
b. Keep patient at rest during bleeding episodes.
c. Vital signs must be promptly monitored.
d. For nose bleeding, maintain patient’s position in
elevated trunk, apply ice bag to the bridge of
nose and to the forehead.
e. Observe signs of shock, such as slow pulse, cold
clammy skin, prostration, and fall of blood
f. Restore blood volume by putting the patient
in Trendelenberg position to provide greater
blood volume to the head part.
Prevention and Control
1. Early detection and treatment of cases will not
worsen the victim’s condition.
2. Treat mosquito nets with insecticides.
3. House spraying is advised.
4. Eliminate vector by:
- changing water and scrubbing sides of
flower bases once a week
- destroying the breeding places of mosquitoes
by cleaning the surroundings
- keeping the water containers covered.
5. Avoid too many hanging clothes inside the house.
- parasitic disease caused by an African eye
worm, a microscopic thread-like worm.
- The adult worm can only live in human
lymphatic system.
- Can cause extensive disability and gross
Causative Organism
Wuchereria bancrofti is the causative agent
of filariasis.
- 4 to 5 cm long thread-like worm that
affects the body’s lymph nodes and lymph
Mode of Transmission – by mosquito bite.
1. When a mosquito bites a person with
lymphatic filariasis, microscopic worms
circulating in the person’s blood enter and
infect the mosquito.
2. The microscopic worms pass from the
mosquito through the human skin and
travel to the lymph vessels where they
grow into adults.
3. An adult worm lives for 7 years in the
lymph vessels. They mate and release into
the bloodstream millions of microscopic
worms known as microfilaria.
4. Once the person has the worms in his or her
blood, these are picked up by the biting
mosquito when it feeds and the disease is
transmitted to another person via the larvae.
5. The larvae migrate to the lymph nodes, reach
sexual maturity, and the cycle is completed.
6. A person needs many mosquito bites over several
months to years to get Filariasis.
7. At first, most people do not know they have
8. The disease damages the kidneys and the lymph
system; fluid collects and causes swelling in the
arms, breasts, legs and for men, the genital area.
9. The entire leg, arms, and genital area may
swell to several times their normal sizes.
10. In advanced stages, the worms can
actually obstruct the vessels, causing the
surrounding tissues to enlarge.
 Chills,headache & fever between 3 months
and 1 year after the insect bite.
 Swelling, redness & pain in the arms, legs
or scrotum.
 Areas of abscesses
Diagnostic Procdures
 Circulating Filarial Antigen (CFA) test is
performed on a finger-prick blood droplet taken
any time of the day and gives result in a few
 The larvae can also be found in the blood, but
mosquitoes which spread the disease are active
at night, the larvae are usually found between
about 10:00 pm to 2:00 am.
 Patient’s history must be taken and pattern of
inflammation and signs of lymphatic obstruction
must be observed.
Modalities of Treatment
1. Ivermectin. Albendazole, or
diethylcarbamazine (DEC) are used to
treat by:
a. eliminating the larvae
b. impairing the adult worm’s ability to
c. by actually killing the adult worms
2. Surgery – to remove surplus tissue &
provide a way to drain the fluid around the
damaged lymphatic vessels.
3. Elevate the legs and providing support with
elastic bandages.
Fungal Infections
 Tinea Flava (Tinea alba/Tinea versicolor)
- common, benign, superficial, cutaneous
fungal infection, characterized by
hypopigmentation or hyperpigmentation
on the skin usually at the back or on the
Etiologic Agent: lipophilic fungi (Malassezia
 The disease affects young people around
the puberty age due to hormonal changes &
increase in cebum secretion.
 Both male & female can equally be
 Tropical areas can have a prevalence as
high as 40%.
Clinical Manifestation
1. Has cosmetically disturbing, abnormal
2. Color of lesion varies from almost white
to reddish brown or fawn colored.
3. A fine, dust-like scale covers the lesions.
4. Patient complains of mild pruritus.
Treatment Modalities
 Topicalagents include:
- Micoconazole
- Ciclopirox colamine
- Propylene glycol lotion
- Topical terbinafine
- Benzoyl peroxide
Nursing Management
1. Instruct patient to use clean towel and
washcloth daily.
2. All skin areas and skin folds that retain the
moisture must be dried thoroughly.
3. Clean cotton clothing should be worn next
to the skin.
German Measles
(Rubella/Three-day Measles)
- mild viral illness caused by rubella virus.
- Causes mild feverish illness associated with
rashes and aches in joints.
- Has a teratogenic effect on the fetus.

Incubation Period: 14-21 days

Period of Communicability
- communicable approximately 1 week before and
4 days after the onset of rashes.
- At its worst when the rash is at its peak.

Mode of Transmission:
5. Direct contact
6. Air droplets
7. Transplacental transmission
Clinical Manifestation
1. Prodromal Period
a. low grade fever
b. headache
c. malaise
d. mild coryza
e. conjunctivitis
2. Eruptive Period
a. Pinkish rash on the soft palate (Forchheimer’s
spot), en exanthematous rash that appears first on
the face, spreading to the neck, the arms, trunk,
and legs
b. Eruption appears after the onset of adenopathy
c. Children usually present less or no
constitutional symptoms.
d. The rash may last for one to five days
and leaves no pigmentation nor
e. Testicular pain in young adults.
f. Transient polyarthralgia and polyarthritis
may occur in adults and occasionally in
Nursing Management
1. The patient should be isolated.
2. The patient should be advised to rest in bed until
fever subsides.
3. The patient’s room must be darkened to avoid
4. The patient must take mild liquid but nourishing
5. The patient’s eyes should be irrigated with warm
normal saline to relieve irritation.
 Administration of live attenuated vaccine
 Pregnant women should avoid exposure to
patients infected with Rubella virus.
 Administration of Immune Serum Globulin
one week after exposure to Rubella.
(Clap/Flores Blancas/Gleet)
- sexually transmitted bacterial disease
involving the mucosal lining of the genito-
urinary tract, the rectum, and pharynx.

Causative Agent: Neisseria gonorrhoeae

Incubation Period: 3-21 days
average: 3-5 days
Mode of Transmission
1. Bacteria is transmitted by contact with
exudates from the mucous membrane of
infected persons.
2. Through direct contact with contaminated
vaginal secretions of the mother as the
baby comes out of the birth canal.
3. May also be transmitted through fomites.
Clinical Manifestations
1. In females
a. Burning sensation and frequent
b. Yellowish purulent vaginal discharge
c. Redness and swelling of the genitals
d. Burning sensation and itching of
vaginal area
e. Urinary frequency and pain on urination
f. Urethritis or cervicitis occurs initially a
few days after exposure
g. Pregnant women with gonorrhea may
infect the eye of her baby during the
passage through the birth canal.
2. In males
a. Dysuria with purulent discharge from the
urethra 2 – 7 days after exposure.
b. Rectal infection is common in homosexuals.
c. Inflammation of the urethra can cause stricture
that can prevent passage of urine.
d. Prostatitis
e. Pelvic pain and fever
Diagnostic Exam
1. In female – culture of specimen taken
from the cervix and anal canal (use of
Thayer-Martin medium)
2. In male – gram stain
Treatment Modalities
 Ceftriaxone – for uncomplicated gonorrhea
in adults
 Ceftriaxone & Erythromycin – for pregnant
 Aqueous procaine Penicillin
 Direct fluorescent antibody test
Nursing Management
1. All information concerning the patient is
considered confidential.
2. The patient should be isolated until he/she
recovers from the disease.
3. Infants born to mothers positive of
gonorrhea should be instilled with
ophthalmic prophylaxis into both eyes at
the time of birth.
Hepatitis A (Infectious Hepatitis/Catarrhal jaundice)
- liver disease caused by the hepatitis A virus.
- inflammation of the liver that is not really
very severe & runs an acute course.
- starts within 2 – 6 weeks after contact with
the virus, lasts no longer than 2 months.
Period of Communicability
 The infected patient is capable of
transmitting the organism a week before
and a week after the appearance of
Mode of Transmission
 Ingestion of contaminated drinking water or
ice, uncooked fruits and vegetables.
 Through oral-fecal pathway.
 By infected food handlers.
Clinical Manifestations
 Flu-likeillness with chills and high fever
 Diarrhea, fatigue, and abdominal pain
 Loss of appetite
 Nausea, diarrhea, and fever
 Jaundice and dark-colored urine
 The infection in young children is often
mild and asymptomatic
Diagnostic Procedure
1. HAV and HBV – complement fixation rate
2. Liver function test – to determine the presence
and extent of liver damage and to check the
progress of the liver
3. Bile examination in stool and urine
4. SGOT – serum glutamic oxaloacetic
SGPT – serum glutamic pyruvic transaminase
ALT – serum alanine transaminase
5. IgM level
Treatment Modalities
1. There is no specific treatment, although
bed rest is essential.
2. Diet must be high in carbohydrate, low in
fat, and low in protein.
3. Patient must take vitamin B complex.
4. Isoprinosine (methisoprenol) – enhance
the cell-mediated immunity of the T-
Nursing Management
1. The patient must be isolated (enteric isolation).
2. Patient should be encouraged to rest during
acute or symptomatic phase.
3. Improve nutritional status.
4. Utilize appropriate measures to minimize spread
of the disease.
5. Observe the patient for melena and check stool
for the presence of blood.
6. Provide optimum skin and oral care.
7. Increase in ability to carry out activities:
a. encourage the patient to limit activity
when fatigued
b. assist the client in planning periods of
rest and activity
c. encourage gradual resumption of
activities and mild exercise during recovery
Prevention and Control
1. Hands should be washed thoroughly every after
use of toilet.
2. Travelers should avoid water and ice if unsure of
their purity.
3. Food handlers should carefully be screened.
4. Safe preparation and serving of food must be
5. The public should be educated on the mode of
Hepatitis B (Serum Hepatitis)
- inflammation of the liver caused by
hepatitis B virus.
- More serious than Hepatitis A due to the
possibility of severe complications such as
massive damage and hepatocarcinoma of
the liver.
Incubation Period
- 50 to 189 days or 2 to 5 months

Period of Communicability:
The patient is capable of transmitting the
virus during the latter part of the incubation
period and during the acute phase.
The virus may persist in the blood for many
Mode of Transmission
 Direct contact via infected body fluids.
 Through contaminated needles and
 Through infected blood or body fluids
introduced at birth
 Through sexual contact
 HBV transmission does not occur:
 By fecal-oral route
 By food-borne or water-borne transmission
 By arthropod (mosquito) transmission
Clinical Manifestations
 Prodromal Period
a. Fever, malaise, and anorexia
b. Nausea, vomiting, abdominal discomfort, fever,
and chills
c. Jaundice, dark urine, and pale stools
d. Recovery is indicated by a decline of fever and
improved appetite
*Fulminant Hepatitis – fatal & manifested by ascitis
and bleeding
Diagnostic Procedures
1. Compliment Fixation test
2. Radio-immunoassay-hemaglutinin test
3. Liver function test
4. Bile examination in blood and urine
5. Blood count
6. Serum transaminase – SGOT, SGPT, ALT
7. HbsAg
 Blood donors must be screened to exclude
 Caution must be observed in giving care to
patients with known HBV.
 Hands and other skin areas must be washed
immediately and thoroughly after contact with
body fluids.
 Avoid injury with sharp objects or instruments.
 Use disposable needles and syringes only once
and discard properly.
 Avoid sharing of toothbrush, razor, and other
instruments that may be contaminated with blood.
 Observe “safe sex”.
 Have adequate rest, sleep, and exercise, and eat
nutritious food.
 Hep B vaccine is recommended for pre-exposure.
 Hepatitis Immune Globulin (HBIg) should be
administered within 72 hours to those exposed
directly to hep B virus either by ingestion, by
prick or by inoculation.
- an acute viral infectious disease affecting
the respiratory system.

Etiologic Agent: RNA containing

myxoviruses, types A, A-prime, B, and C.
Incubation Period: 24 to 48 hours
Period of Communicability
• The disease is communicable until the 5th day of
illness and up to seven days in children.

Mode of Transmission:
4. Through airborne spread among crowded
5. Droplet
3. Influenza virus persists for hours in dried mucus.
Influenza virus

Invades respiratory mucosa

The patient becomes
Damages ciliated epithelium of vulnerable to secondary
the tracheobronchial tree infection

Passage with Other organisms give rise to

serosanguinous severe reactions – producing
discharge edema of the respiratory tree

Clinical Manifestations
 Onset is sudden chilly sensation,
hyperpyrexia, malaise, sore throat, coryza,
rhinorrhea, myalgia, and headache.
 Severe aches and pain usually at the back
associated with severe sweating may
 Sometimes there are gastrointestinal
elements with vomiting.
 The worst symptoms usually last from 3 to
5 days before the condition begins to
 Influenza makes everybody feel terrible ,
but most people recover.
1. Stay at home
2. Drink plenty of fluids
3. Take the following to relieve fever and
a. Paracetamol
b. Aspirin, unless contraindicated; should not to
be given to children below 16 years old
c. Ibuprofen or other anti-inflammatory drugs
4. Sponge down with tepid water
5. Isolate patient to decrease risk of infecting
6. Limit strenuous activity specially in
7. Watch out for complications especially
among people at risk.
Preventive Measures
 Immunization
 Avoidance of crowded places
 Educate the public and health care
personnel regarding the basic personal
 People who should receive the vaccine
a. the elderly
b. people who have poor immunity
c. those with DM, lung disease, kidney
disease, heart disease or liver disease
- chronic systemic infection characterized by
progressive cutaneous lesions.

Etiologic Agent: Mycobacterium leprae – an

acid-fast bacilli that attack cutaneous tissues
and peripheral nerves, producing skin
lesions, anesthesia, infection, and
Incubation Period: 5 ½ months – 8 years

Mode of Transmission
4. Through respiratory droplet
5. Through the skin break & mucous
Clinical Manifestations
1. Clawhand, footdrop, and ocular manifestations
such as corneal insensitivity, and ulceration,
conjunctivitis, photophobia, and blindness
2. Lepromatous leprosy can invade tissues in every
organ of the body.
3. The lesions enlarge and form plagues on nodules
on the earlobes, nose, eyebrows, and forehead,
giving the patient a leonine appearance.
4. Loss of eyebrows and eyelashes.
5. Loss of function of sweat and sebaceous
6. Epistaxis, ulceration of the uvula and
tonsils, septal perforation and nasal
Diagnostic Procedures
 Identification of the signs and symptoms
 Tissue biopsy
 Tissue smear
 Blood tests show increased RBC and ESR;
decreased Ca, albumin, and cholesterol
Modalities of Treatment
 Sulfone therapy
 Multiple Drug Therapy
 Rehabilitation, recreational and
occupational therapy
1. Report all cases and suspects of leprosy.
2. Newborn infants should be separated from
leprous mothers.
3. BCG vaccine may be protective if given
during the first 6 months of life.
4. Health education should be given as to the
mode of transmission.
- zoonotic infectious bacterial disease carried
by animals, both domestic and wild, whose
urine contaminates water or food which is
ingested or inoculated through the skin.

Etiologic Agent: Leptospira (Leptospira

Incubation Period: 6 – 15 days
Period of Communicability
Leptospira is found in the urine between 10 to
20 days after the onset.
3. Rats
4. Dogs
5. Mice
Mode of Transmission
1. Through ingestion or contact with the skin
and mucous membrane of the infected
urine or carcasses of wild and domestic
2. Leptospira enters the blood to cause
damage, thereafter, in the kidneys, the
liver, meninges, and conjunctivae.
Clinical Manifestation
1. Fever lasting 4 – 7 days
2. Chills, headache, anorexia, abdominal
3. With or without jaundice
4. Convulsions
 Medical

1. Penicillin G Na
2. Tetracycline
3. Peritoneal Dialysis
4. Administration of fluid and electrolyte
and blood as indicated.
 Nursing

1. Isolate the patient, urine must be properly

disposed of.
2. Keep patient under close surveillance.
3. For home care, dirty places, pools, and
stagnant water must be cleaned.
4. Eradicate rats and rodents.
Prevention and Control
 Sanitation in homes, workplaces, and farms
is a must.
 There is a need for proper drainage system
and control of rodents.
 Animals must be vaccinated.
 Infected humans and pets should be treated.
 Information-dissemination campaign must
be conducted effectively.
- acute and chronic parasitic disease transmitted
by the bite of infected mosquitoes and it is
confined mainly to tropical and subtropical
Etiologic Agent: Four species of protozoa:
c. Plasmodium falciparum
d. Plasmodium vivax
e. Plasmodium malariae
f. Plasmodium ovale
 Theprimary vector of malaria is the female
Anopheles mosquito.
> breeds in clear, flowing, and shaded streams
usually in the mountains
> bigger in size than the ordinary mosquito
> brown in color
> night-biting mosquito
> usually does not bite a person in motion
> assumes a 36 degree position when it alights on
walls, trees, curtains, and the like.
Incubation Period
 12 days for P. Falciparum
 14 days for P. vivax and ovale
 30 days for P. malariae

Period of Communicability: untreated or

insufficient treated patient may be the
source of mosquito infection.
Mode of Transmission
 Through the bite of an infected female
anopheles mosquito.
 Parenterally through blood transfusion.
 Occasionally, transmitted from shared
contaminated needles.
 Transplacental transmission for congenital
malaria (rare)
Clinical Manifestations
1. Paroxysms with shaking chills.
2. Rapidly rising fever with severe headache
3. Profuse sweating
4. Myalgia, with feeling of well-being in
5. Splenomegaly, hepatomegally
6. Orthostatic hypotension
7. Paroxysms may last for 12 hours, then,
maybe repeated daily or after a day or two.
8. In children:
a. fever maybe continuous
b. convulsions and gastrointestinal
symptoms are prominent
c. splenomegally
9. In cerebral malaria:
a. changes in sensorium, severe headache,
and vomiting
b. Jacksonian or grand mal seizure may
Diagnostic Procedure
 Malarial smear – a film of blood is placed on a
slide, stained, and examined microscopically.
 Rapid diagnostic test (RDT) –blood test for
malaria that can be conducted outside the
laboratory and in the field.
- gives a result within 10-15 minutes.
- detect malarial parasite antigen in the blood.
 The parasite enters the mosquito’s stomach
through the infected human blood obtained by
biting or during blood meal.
 The parasite undergoes sexual conjugation.
 After 10 to 14 days, a number of young parasites
are released and invade the salivary gland of the
 The organisms are carried in the saliva into the
victim when the mosquito bites again.
 The parasites invade the RBC where they
grow and undergo asexual propagation.
 RBC ruptures or bursts releasing tiny
organisms (merozoites)
 Merozoites invade new batch of RBC to
start another schizonic cycle.
 Indefinite malaise and slowly rising fever
occur for several days.
 There is shaking chills, rapidly rising
temperature, and profuse sweating.
Coagulation defect

Pulmonary & shock

Liver and renal cerebral edema

 Medical

a. Anti-malarial drugs
- Chloroquine
- Quinine
- Sulfadoxine for the resistant P. falciparum
- Primaquine for relapse of P. vivax & ovale
b. Erythrocyte exchange transfusion for rapid
production of high levels of parasites in the blood.
 Nursing Management
b. The patient must be closely monitored.
c. Intake and output should be closely monitored to
prevent pulmonary edema.
> daily monitoring of patient’s serum bilirubin,
BUN creatinine, and parasitic count.
> if the patient exhibits respiratory and renal
symptoms, determine the ABG and plasma
c. During the febrile stage, tepid sponges, ice cap on
the head will help bring the temperature down.
d. Application of external heat and offering hot
drinks during chilling stage is helpful.
e. Provide comfort and psychological support.
f. Encourage the patient to take plenty of fluids.
g. As the temperature falls and sweating begins,
warm sponge baths maybe given.
h. The bed and clothing should be kept dry.
ii. Watch for neurologic toxicity (from quinine
infusion) like muscular twitching, delirium,
confusion, convulsion, and coma.
j. Evaluate the degree of anemia.
k. Watch for any signs especially abnormal bleeding.
l. Consider severe malaria as medical emergency that
requires close monitoring of vital signs.
Prevention and Control
 Malaria cases should be reported.
 A thorough screening of all infected
persons from mosquitoes is important.
 Mosquito breeding places must be
 Homes should be sprayed with effective
insecticides which have residual actions on
the walls.
 Mosquito nets should be used especially
when in infected areas.
 Insect repellents must be applied to the
exposed portion of the body.
 People living in malaria-infested areas
should not donate blood for at least 3 years.
 Blood donors should be properly screened.
- an acute, contagious and exanthematous disease
that usually affects children which are susceptible
to URTI.

Etiologic Agent: Filtrable virus that belongs to

genus Morbilivirus of the family paramyxoviridae.
- rapidly inactivated by heat, ultraviolet light,
and extreme degrees of acidity and alkalinity.
Incubation Period
 10 to 12 days
 Single attack conveys a lifelong immunity.

Period of Communicability: usually lasts

about 9 to 10 days, from the beginning of
the prodromal symptoms to the fading of
the rash.
 The disease is communicable 4 days before
and 5 days after the appearance of rashes.
 The disease is most communicable during
the height of rash.

Sources of Infection:
- patient’s blood
- Secretions from the eyes, nose and throat.
Mode of Transmission
1. Through direct contact with the droplets
spread through coughing & sneezing
2. Indirect contact (articles or fomites freshly
contaminated with respiratory secretions
of infected patients.
Pathognomonic Sign
 Koplik’s spots - inflammatory lesions of the
buccal mucous glands with superficial necrosis.
2. They appear on the mucosa of the inner cheek
opposite to the second molars, or near the
junction of the gum and the inner cheek.
3. They usually appear 1 to 2 days before the
measles rash.
Clinical Manifestations
(3 Stages)

1. Pre-eruptive stage
a. fever
b. catarrhal symptoms (rhinitis,
conjunctivitis, photophobia, coryza)
c. respiratory symptoms start from
common colds to persistent coughing
d. enanthema sign (Koplik’s spot)
2. Eruptive stage
a. the rash is usually seen late on the 4th day.
b. maculo-papular rash appears first on
either the cheeks, bridge of the nose, along
the hairline, at the temple or at the earlobe.
c. the rash is fully developed by the end of
the second day and all symptoms are at
their maximum at this time.
d. High grade fever comes on and off.
e. Anorexia and irritability.
f. Abdominal tympanism, pruritus, lethargy
g. The throat is red and often extremely sore.
h. As fever subsides, coughing may diminish,
but more often it hangs on for a week or
two, become looser and less metallic.
3. Stage of Convalescence
a. rashes fade away in the manner as they
b. fever subsides as eruption disappears.
c. when the rashes fade, desquamation
d. symptoms subside and appetite is
Diagnostic Procedures
 Nose and throat swab
 Urinalysis
 Blood exams (CBC, leukopenia,
 Complement fixation or hemogglutinin test
Modalities of Treatment
 Anti-viraldrugs (Isoprenosine)
 Antibiotics if with complication
 Supportive therapy (oxygen inhalation, IV
Unfavorable Signals
1. Violent onset with high grade fever
2. Fading eruption with rising fever
3. Hemorrhagic or black measles
4. Persistence of fever for 10 days or more
5. Slight eruptions accompanied by severe
symptoms, especially those of
Nursing Management
1. Isolation of the patient is necessary (the room
must be quiet, well ventilated, and must have
subdued light)
2. Control the patient’s high temperature with
warm or tepid sponges.
3. Skin care is utmost.
4. Provide oral and nasal hygiene.
5. Care of the eyes. The patient is sensitive to light.
Keep eyes free of secretions.
Preventive Measures
Immunization with:
 Anti-measles at the age of 9 months, as single
 Mumps, measles, rubella (MMR) vaccine to be
given at 15 months, 2nd dose at 11 to 12 years.
 Measles vaccine should not be given to pregnant
women or to persons with active tuberculosis,
leukemia, lymphoma or depressed immune
- inflammation of the meninges of the brain
and spinal cord as a result of viral and
bacterial infection. (dura mater, the
arachnoid & the pia mater)

Etiologic Agent: Neisseria meningitides

Incubation Period: 1 to 10 days
Mode of Transmission
1. Respiratory droplets through
nasopharyngeal mucosa
2. Direct invasion through otitis media
3. After skull fracture, a penetrating head
wound, lumbar puncture & ventricular
shunting procedures.
Diagnostic Procedures
1. Lumbar puncture
a. Diagnostic purposes
- to obtain specimen, the CSF
- to take x-ray of the spinal canal and cord
b. Therapeutic purposes
- to reduce intra-cranial pressure
- to introduce serum and other medications
- to inject an anesthetic agent
2. Gram staining
3. Smear and blood culture
4. Smear from petechiae
5. Urine culture
1. Acute meningococcemia
a. invade the bloodstream without involving the
b. usually starts with nasopharyngitis followed
by sudden onset of high grade fever with chills,
nausea, vomiting, malaise, and headache.
c. petechial, purpuric, or ecchymotic
hemorrhages scatter over the entire body and
mucous membrane.
d. adrenal lesions start to bleed into the
medulla which extends to the cortex.
e. Waterhouse-friderichsen syndrome –
combination of meningococcemia and the
adrenal medullary hemorrhage; rapid
development of petechiae to purpuric, &
ecchymotic spots in association with shock.
f. short course & usually fatal.
2. Aseptic meningitis
- benign syndrome characterized by
headache, fever, vomiting, and meningeal
- begins suddenly with fever, alterations in
consciousness, neck & spine stiffness.
- Characteristic sign of meningeal irritation:
> Stiff neck or nuchal rigidity
> Opisthotonos
> (+) Brudzinski’s sign
> (+) Kernig’s sign
> Exaggerated and symmetrical deep
tendon reflexes
- Sinus arrythmia, irritability, photophobia,
diplopia, & other visual problems
- Delirium, deep stupor, and coma
- Signs of intra-cranial pressure:
> bulging fontanel in infants
> nausea & vomiting (projectile)
> severe frontal headache
> blurring vision
> alteration in sensorium
Modalities of Treatment
1. Antibiotic therapy & vigorous supportive
- ampicillin
- cephalosporin (ceftriaxone)
- aminoglycosides
2. Digitalis glycoside (Digoxin) is
administered to control arrythmias
3. Manitol is given to decrease cerebral
4. Anticonvulsant or sedative is needed to
reduce restlessness & convulsions.
5. Acetaminophen is helpful to relieve
headache & fever.
Nursing Management
1. Assess neurologic signs often. Observe
patient’s level of consciousness and check
for increased intra-cranial pressure.
2. Monitor fluid balance.
3. Watch for adverse reactions of antibiotics
& other drugs.
4. Maintain adequate nutrition &
5. Ensure patient’s comfort.
6. Provide reassurance and support to the
patient and the family.
7. Follow strict aseptic technique when
treating patients with head wounds or skull
8. Isolation is necessary if nasal culture is
(Infectious Parotitis)
- acute viral disease manifested by the
swelling of one or both parotid glands,
occasional involvement of other glandular
structures, particularly the testes in male.

Etiologic Agent: Paramyxovirus found in the

saliva of infected person
Incubation Period: 14-25 days (ave. 18 days)
Period of Communicability
6 days before and 9 days after the onset of
parotid gland swelling;
 48-hour period immediately preceding onset
of swelling is considered the time of highest
Clinical Manifestations
1. Sudden headache
2. earache
3. loss of appetite
4. fever
5. swelling of the parotid gland which is
located in front and below the ear.
Treatment Modalities
 Anti-viral drugs
 Relief of pain from parotid swelling can be
afforded by the application of hot or cold.
Nursing Management
1. Medical Aseptic protective care
a. patient should be cared for in a single-
occupancy room
b. susceptible individuals must use mask
and must wash hands regularly.
c. oral care and personal hygiene is a
2. General Management of the disease
a. bedrest is encouraged to avoid
b. diversional activities for less ill patient
3. Diet
a. soft & semisolid foods
b. avoid acid foods, like fruit juices.
- flattened, wingless insects commonly
attack man.

Etiologic Agent:
4. Pediculus humanos var. capitis (head lice)
5. Pediculus humanos var. corporis (body
6. Pdiculus pubis or pubic lice (crab lice)
a. Feed on human blood & lay their eggs in
body hair & clothing fibers.
b. After the nits hatch, the lice must feed
within 24 hours otherwise it will die.
c. They mature in about 2 – 3 weeks.
d. It injects toxin into the skin that produces
mild irritation & a purpuric spot.
Clinical Manifestations
1. The head louce
a. more common in female than in male. Infects
more children than adults.
b.Itching is the first & predominant symptom.
c. irritation, excoriation & crusting & foul
smelling mass consisting of matted hair, nits,
ova, pus, crusts, & pediculi results (plica
2. Body louse
a. initial lesions are minute red spots
b. spot swells & secondary crust &
excoriation is formed on the surrounding
skin as a result of scratching.
3. Crab lice
a. unusual, persistent itching in the pubic
b. Maculae caeruleae – grayish pigmented
spots – found in the surface of the inner
thighs or the abdomen, pea-size to a small
1. Head lice
a. dusting the scalp with 1% malathion
powder is a reliable & convenient method
b. massage with gamma benzene
hexachloride shampoo in the scalp for 4
minutes, then rinse.
2. Body louse
a. laundry (dry clean) or boil the clothing &
b. good body hygiene must be observed
3. Crab lice
a. apply Kwell or Gamene (Lindane) cream or
b. Rub crotaminon (Eurax, Geigy) into the
affected area.
c. repeat the application of crotaminon after 1
d. simultaneously treat the person who had sexual
contact with the patient
e. remove remaining nits mechanically.
Whooping cough – infectious disease
characterized by repeated attacks of
spasmodic coughing which consists of a
series of explosive expirations, typically
ending in a long-drawn forced inspiration
which produces a crowing sound, the
“whoop” & usually followed by vomiting.
Causative Agent – Bordetella pertussis

Incubation Period: 7 to 14 days

Period of Communicability: 7 days after

exposure to 3 weeks after typical
Mode of Transmission
 Direct contact & droplet
 Indirect through soiled linens & other
articles contaminated by respiratory

Sources of infection: secretions from the nose

& throat of infected persons
- extremely contagious
Diagnostic Procedures
 Nasopharyngeal swabs
 Sputumculture
 CBC (Leukocytosis)
Modalities of Treatment
1. Supportive therapy
a. Fluid & electrolyte replacement
b. adequate nutrition
c. oxygen therapy
2. Antibiotics (erythromycin & ampicillin)
3. DPT vaccine
Nursing Management
 Isolation and asepsis should be carried out.
 Should not leave the patient alone. Suctioning
equipment should be ready at all times for
emergency use to avoid airway obstruction.
 Sunshine & fresh air are important.
 Provide warm baths, keep the bed dry & free from
soiled linens.
 Intake & output should be closely monitored.
(Infantile Paralysis)
- acute infectious disease characterized by
changes in the CNS which may result in
pathologic reflexes, muscle spasm & paresis
or paralysis.
- Disease of the lower motor neurons.
Etiologic Agent: polio virus (Legio
Incubation Period
7 to 21 days for paralytic cases with a
repeated range of 3 to 35 days.

Period of Communicability:
- first 3 days to 3 months of illness
- Most contagious during the first few days of
active disease, & possibly from 3 to 4 days
before that.
Mode of Transmission
 Direct contact with infected oropharyngeal
secretions & feces
 Person to person transmission through
healthy carriers
 Indirect through contaminated articles &
flies, contaminated water, food & utensils.
Diagnostic Procedures
 Throat swab
 Stool culture throughout the disease
 Culture from the CSF
Modalities of Treatment
 Analgesics to ease headache, back pain &
leg spasm
 Moist heat application to reduce muscle
spasm & pain
 Bed rest is necessary
 Paralytic polio requires rehabilitation
Nursing Management
 Carry out enteric isolation.
 Observe patient carefully for signs of paralysis &
other neurologic damage
 Perform a neurologic assessment at least once a
 Check blood pressure regularly
 Watch for signs of fecal impaction due to
dehydration & immobility.
 Prevent the occurrence of bed sores.
 Wash hands after every contact with
 Apply hot packs to affected limb to relieve
pain and muscle shortening.
 Dispose excreta & vomitus properly.
 Provide emotional support both to patient &
 Maintain good personal hygiene, oral &
skin care.