Common Communicable Diseases

What is Communicable Disease?
 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:
 2.

3. 4.

He/she must be knowledgeable of the following: The nature of the specific microorganism and its capacity for survival both within and outside the body. The most effective method of destruction of the specific organism. 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 virus”.

Pathophysiology of AIDS: HIV Antibodies Lymphocytes, macrophages, Langerhans & neurons

CD4 ---------T4 cells

T4 cell dies

Signs & symptoms will manifest

Signs and Symptoms:
 AIDS-related  Memory

Complex (ARC)

loss  Altered gait  Depression  Sleep disorders  Chronic diarrhea

     

Minor Signs: Persistent cough for one month Generalized pruritic dermatitis Recurrent herpes zoster Oropharyngeal candidiasis Chronic disseminated herpes simplex Generalized lymphadenopathy

Major Signs
 Loss

of weight – 10% of body weight  Chronic diarrhea for more than one month  Prolonged fever for one month

Common Opportunistic Infections
 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 lymphoma)

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.

Amoebiasis
- 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”.

Pathology
    

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 constipation b. diarrhea, watery and foul-smelling stool often containing blood-streaked mucus c. colic and gaseous distention of the lower abdomen 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 defecate 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 & lassitude 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

Hepatic 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
Stool exam (cyst, white and yellow pus with plenty of amoeba) 2. Blood exam ( leukocytosis) 3. Proctoscopy/Sigmoidoscopy
1.

Treatment Modalities
 Metronidazole  Tetracycline  Ampicillin,

(Flagyl)

quinolones, sulfadiazine  Streptomycin SO4, Chloramphenicol  Lost fluid and electrolytes should be replaced.

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

Ascariasis
 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.

Pathogenesis Ascaris Lumbricoides Hatches & releases larvae Intestinal wall 10 days Pulmonary capillaries & alveoli Swallowed and returned to the intestine (mature & mate)

Lungs through the blood stream

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 eosinophelia

Treatment
 Albendazole

or Mebendazole  Piperazine Citrate  Pyrantel Pamoate

Nursing Interventions
 Isolation

is 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 explained.

Candidiasis
- 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 darkened. 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 pain

Diagnosis
 Stool

culture  Gram staining of skin, vaginal discharge or scrapings Treatment:  Nystatin, for oral thrush  Clitrimasole, fluconasole, ketoconasole – for mucous membrane & vaginal infection  Fluconasole or Amphotericine for systemic infection.

Chickenpox
(Varicella)
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 virus - Electron Microscopic Exam of the vesicular fluid

Clinical Manifestations
 pre-eruptive

& 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.

manifestations are mild fever

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 fluid. *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.

Complications
 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 pruritus.

(Breakbone Fever/Hemorrhagic Fever/Dandy Fever/Infectious Thrombocytopenic Purpura)

Dengue Fever

- an acute febrile disease caused by infection with one of the serotypes of dengue virus which is transmitted by mosquito genus Aedes. - 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 RNA.  Arboviruses group B Incubation Period: 3 – 14 days; commonly 7 – 10 days

Mode of Transmission
1.

By bite of an infected mosquito (Aedes Egypti) - 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.

Incidence
 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 season.  Location – more prevalent in urban communities.

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, & arthralgia.

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 headache 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 skin. 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 Severity
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. 2. 3. 4. 5.

Analgesic drugs other than aspirin may be required for relief of headache, ocular pain, and myalgia. Initial phase may require intravenous infusion to prevent dehydration and replacement of plasma. Blood transfusion is indicated in patient with severe bleeding. Oxygen therapy is indicated to all patients in shock. Sedatives maybe needed to allay anxiety and apprehension.

Nursing Management
a.

b. c. d.

e.

Patient should be kept in mosquito-free environment to avoid further transmission of infection. Keep patient at rest during bleeding episodes. Vital signs must be promptly monitored. For nose bleeding, maintain patient’s position in elevated trunk, apply ice bag to the bridge of nose and to the forehead. Observe signs of shock, such as slow pulse, cold clammy skin, prostration, and fall of blood pressure.

f. Restore blood volume by putting the patient in Trendelenberg position to provide greater blood volume to the head part.

Prevention and Control
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.
1.

Filariasis
(Elephantiasis) 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 disfigurement.
-

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 vessels. Mode of Transmission – by mosquito bite.

Pathology/Pathogenesis
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.
1.

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 Filariasis. 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.

Symptoms
 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 minutes. 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 reproduce 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 chest. Etiologic Agent: lipophilic fungi (Malassezia furfur)

Incidence
 The

disease affects young people around the puberty age due to hormonal changes & increase in cebum secretion.  Both male & female can equally be affected.  Tropical areas can have a prevalence as high as 40%.

Clinical Manifestation
Has cosmetically disturbing, abnormal pigmentation 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.
1.

Treatment Modalities
 Topical

agents include: - Micoconazole - Ciclopirox colamine - Propylene glycol lotion - Topical terbinafine - Benzoyl peroxide

Nursing Management
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.
1.

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 desquamation. e. Testicular pain in young adults. f. Transient polyarthralgia and polyarthritis may occur in adults and occasionally in children.

Nursing Management
1. 2. 3. 4. 5.

The patient should be isolated. The patient should be advised to rest in bed until fever subsides. The patient’s room must be darkened to avoid photophobia. The patient must take mild liquid but nourishing diet. The patient’s eyes should be irrigated with warm normal saline to relieve irritation.

Prevention
 Administration

of live attenuated vaccine

(MMR).  Pregnant women should avoid exposure to patients infected with Rubella virus.  Administration of Immune Serum Globulin one week after exposure to Rubella.

Gonorrhea
(Clap/Flores Blancas/Gleet)
-

sexually transmitted bacterial disease involving the mucosal lining of the genitourinary tract, the rectum, and pharynx.

Causative Agent: Neisseria gonorrhoeae Incubation Period: 3-21 days average: 3-5 days

Mode of Transmission
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.
1.

Clinical Manifestations
1.

In females a. Burning sensation and frequent urination. 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
In female – culture of specimen taken from the cervix and anal canal (use of Thayer-Martin medium) 2. In male – gram stain
1.

Treatment Modalities
 Ceftriaxone

– for uncomplicated gonorrhea

in adults  Ceftriaxone & Erythromycin – for pregnant women  Aqueous procaine Penicillin  Direct fluorescent antibody test

Nursing Management
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.
1.

Hepatitis
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 symptoms.

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-like

illness 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
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 transaminase SGPT – serum glutamic pyruvic transaminase ALT – serum alanine transaminase 5. IgM level
1.

Treatment Modalities
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 Tlymphocytes.
1.

Nursing Management
1. 2. 3. 4. 5.

The patient must be isolated (enteric isolation). Patient should be encouraged to rest during acute or symptomatic phase. Improve nutritional status. Utilize appropriate measures to minimize spread of the disease. 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. 2. 3. 4. 5.

Hands should be washed thoroughly every after use of toilet. Travelers should avoid water and ice if unsure of their purity. Food handlers should carefully be screened. Safe preparation and serving of food must be practiced. The public should be educated on the mode of transmission.

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 years.

Mode of Transmission
 Direct

contact via infected body fluids.  Through contaminated needles and syringes.  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. 2. 3. 4. 5. 6. 7.

Compliment Fixation test Radio-immunoassay-hemaglutinin test Liver function test Bile examination in blood and urine Blood count Serum transaminase – SGOT, SGPT, ALT HbsAg

Prevention
 Blood

donors must be screened to exclude carriers.  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.

Influenza
-

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 populations. 5. Droplet 3. Influenza virus persists for hours in dried mucus.

Pathology/Pathogenesis Influenza virus

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

Passage with serosanguinous discharge complications

Other organisms give rise to severe reactions – producing 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 manifest.  Sometimes there are gastrointestinal elements with vomiting.

 The

worst symptoms usually last from 3 to 5 days before the condition begins to improve.  Influenza makes everybody feel terrible , but most people recover.

Management
1. 2. 3.

Stay at home Drink plenty of fluids Take the following to relieve fever and headache: 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 others 6. Limit strenuous activity specially in children 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 hygiene

 People

who should receive the vaccine annually: a. the elderly b. people who have poor immunity c. those with DM, lung disease, kidney disease, heart disease or liver disease

Leprosy
-

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 deformities.

Incubation Period: 5 ½ months – 8 years Mode of Transmission 4. Through respiratory droplet 5. Through the skin break & mucous membrane

Clinical Manifestations
1.

2. 3.

Clawhand, footdrop, and ocular manifestations such as corneal insensitivity, and ulceration, conjunctivitis, photophobia, and blindness develop. Lepromatous leprosy can invade tissues in every organ of the body. 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 glands. 6. Epistaxis, ulceration of the uvula and tonsils, septal perforation and nasal collapse.

Diagnostic Procedures
 Identification  Tissue

of the signs and symptoms

biopsy  Tissue smear  Blood tests show increased RBC and ESR; decreased Ca, albumin, and cholesterol level.

Modalities of Treatment
 Sulfone

therapy  Multiple Drug Therapy  Rehabilitation, recreational and occupational therapy

Prevention
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.
1.

Leptospirosis
-

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 interrogans) Incubation Period: 6 – 15 days

Period of Communicability
Leptospira is found in the urine between 10 to 20 days after the onset. SOURCES OF INFECTION: 3. Rats 4. Dogs 5. Mice

Mode of Transmission
Through ingestion or contact with the skin and mucous membrane of the infected urine or carcasses of wild and domestic animals. 2. Leptospira enters the blood to cause damage, thereafter, in the kidneys, the liver, meninges, and conjunctivae.
1.

Clinical Manifestation
Fever lasting 4 – 7 days 2. Chills, headache, anorexia, abdominal pain 3. With or without jaundice 4. Convulsions
1.

Management
 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

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.

in homes, workplaces, and farms

Malaria
acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is confined mainly to tropical and subtropical areas. Etiologic Agent: Four species of protozoa: c. Plasmodium falciparum d. Plasmodium vivax e. Plasmodium malariae f. Plasmodium ovale
-

 The

primary 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. 2. 3. 4. 5. 6.

Paroxysms with shaking chills. Rapidly rising fever with severe headache Profuse sweating Myalgia, with feeling of well-being in between Splenomegaly, hepatomegally 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 occur

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.

Pathogenesis
 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 mosquito.  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.
anemia Pulmonary & cerebral edema coma death

Coagulation defect

Liver and renal failure

shock

Management
 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.

 b. c.

Nursing Management The patient must be closely monitored. 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 electrolyte.

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 destroyed.  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.

Measles
(Rubeola/Morbilli)
-

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
Through direct contact with the droplets spread through coughing & sneezing 2. Indirect contact (articles or fomites freshly contaminated with respiratory secretions of infected patients.
1.

Pathognomonic Sign
 2.

3.

Koplik’s spots - inflammatory lesions of the buccal mucous glands with superficial necrosis. 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. 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 erupted. b. fever subsides as eruption disappears. c. when the rashes fade, desquamation begins. d. symptoms subside and appetite is restored.

Diagnostic Procedures
 Nose

and throat swab  Urinalysis  Blood exams (CBC, leukopenia, leukocytosis)  Complement fixation or hemogglutinin test

Modalities of Treatment
 Anti-viral

drugs (Isoprenosine)  Antibiotics if with complication  Supportive therapy (oxygen inhalation, IV fluids)

Unfavorable Signals
1. 2. 3. 4. 5.

Violent onset with high grade fever Fading eruption with rising fever Hemorrhagic or black measles Persistence of fever for 10 days or more Slight eruptions accompanied by severe symptoms, especially those of encephalitis.

Nursing Management
1.

2. 3. 4. 5.

Isolation of the patient is necessary (the room must be quiet, well ventilated, and must have subdued light) Control the patient’s high temperature with warm or tepid sponges. Skin care is utmost. Provide oral and nasal hygiene. 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 dose  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 system.

Meningitis
-

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
Respiratory droplets through nasopharyngeal mucosa 2. Direct invasion through otitis media 3. After skull fracture, a penetrating head wound, lumbar puncture & ventricular shunting procedures.
1.

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

Classifications:
1.

Acute meningococcemia a. invade the bloodstream without involving the meninges 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 symptoms. - 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
Antibiotic therapy & vigorous supportive therapy - ampicillin - cephalosporin (ceftriaxone) - aminoglycosides 2. Digitalis glycoside (Digoxin) is administered to control arrythmias
1.

3. Manitol is given to decrease cerebral edema. 4. Anticonvulsant or sedative is needed to reduce restlessness & convulsions. 5. Acetaminophen is helpful to relieve headache & fever.

Nursing Management
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 & elimination.
1.

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 fractures. 8. Isolation is necessary if nasal culture is positive.

Mumps
(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 communicability.

Clinical Manifestations
1. 2. 3. 4. 5.

Sudden headache earache loss of appetite fever 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 singleoccupancy room b. susceptible individuals must use mask and must wash hands regularly. c. oral care and personal hygiene is a must.

2. General Management of the disease a. bedrest is encouraged to avoid complications b. diversional activities for less ill patient 3. Diet a. soft & semisolid foods b. avoid acid foods, like fruit juices.

Pediculosis
-

flattened, wingless insects commonly attack man.

Etiologic Agent: 4. Pediculus humanos var. capitis (head lice) 5. Pediculus humanos var. corporis (body lice) 6. Pdiculus pubis or pubic lice (crab lice)

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.
a.

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 polonica)

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 region b. Maculae caeruleae – grayish pigmented spots – found in the surface of the inner thighs or the abdomen, pea-size to a small coin.

Treatment
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 & beddings b. good body hygiene must be observed always.

3. Crab lice a. apply Kwell or Gamene (Lindane) cream or lotion b. Rub crotaminon (Eurax, Geigy) into the affected area. c. repeat the application of crotaminon after 1 week. d. simultaneously treat the person who had sexual contact with the patient e. remove remaining nits mechanically.

Pertussis
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 paroxysms.

Mode of Transmission
 Direct

contact & droplet  Indirect through soiled linens & other articles contaminated by respiratory secretions. Sources of infection: secretions from the nose & throat of infected persons - extremely contagious

Diagnostic Procedures
 Nasopharyngeal  Sputum

swabs

culture  CBC (Leukocytosis)

Modalities of Treatment
Supportive therapy a. Fluid & electrolyte replacement b. adequate nutrition c. oxygen therapy 2. Antibiotics (erythromycin & ampicillin) 3. DPT vaccine
1.

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.

Poliomyelitis
(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 debilitans)
-

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 day 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 patient.  Apply hot packs to affected limb to relieve pain and muscle shortening.  Dispose excreta & vomitus properly.  Provide emotional support both to patient & family.  Maintain good personal hygiene, oral & skin care.

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