UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING

COMMUNICABLE DISEASES
Enrichment Classes
4NUR-2

By:
Maam Ruth Arenas
October 11-12, 2013

Epidemiology science that study the patterns of health and disease, its occurrence and
distribution for the prevention and control of disease. (Dr. Eric Tayag DOH)
Patterns of Disease Occurrence:
1.a. Sporadic occasional, on and off occurrence of disease (e.g. Meningococcemia)
1.b. Endemic always, constant, continuously happening number of cases in a given locality
(e.g. Filariasis in Bicol, Dengue, Malaria)
1.c. Epidemic sudden increase in number of cases in a short period of time (e.g. Outbreak
Laymans term)
1.d. Pandemic the disease occurs all over the world (e.g. Hepatitis B, SARS, Influenza)
Communicable disease general term that encompasses infectious and contagious; the
disease caused by an infectious agent which is acquired from an infected individual
and transmitted to a susceptible host either by direct or indirect contact, or thru
direct inoculation into a broken skin.
Types:
1. Infectious caused by infectious agent (virus, bacteria), but is not
transmittable/contagious from one person to another; needs direct inoculation,
contact to the body. (e.g. Dengue, Malaria, Tetanus)
2. Contagious transmittable/transferable from one person to another, from infected to
susceptible host. (e.g. thru droplet, airborne, direct, indirect contact)
*All communicable diseases are infectious, in the sense that they are caused by an infectious
agent, but most and not all are contagious.
Epidemiologic/Ecologic Triad Agent, Environment, Host elements that are necessary for a
disease to occur
A. Agent biologic agents (bacteria, virus, fungi, helminthes), aside from presence, they
should possess characteristics that will able them to enter the body
Characteristics:
a.
b.
c.
d.

Infectivity ability of organism to enter and move to the tissues of the body
Infectious Dose the number of organism present, sufficient to cause disease
Pathogenicity the ability to cause disease (Pathogenic, Non-pathogenic)
Virulence refers to the potency (kamandag) that will influence the course of the
disease; the more virulent the microorganism is, the more severe the disease will be)
e. Anti-genecity the ability to stimulate an antibody responses

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B. Environment - medium, mode of transmitting, or spreading the disease

C. Host will either be resistant or susceptible to the microorganism, the susceptibility or
resistance will be influenced by intrinsic or extrinsic characteristics.
Intrinsic Factors - innate, inborn, natural to us, that we have
no
influence susceptibility of the disease (e.g. Age, Gender)

control

at,

but

can

*Leprosy common on males, because males arent meticulous on cleanliness

Extrinsic Factors - characteristics of man that are due to attitude, habits, lifestyle,
with
control. (e.g. smoking, diet, sexual activity, intactness of skin, immune system)

Chain of Transmission/Infectious Cycle series of events involved in the transmission of

disease
1. Agent - causative agent, toxic products (endotoxin inside, dead; exotoxin outside,
alive) (e.g. Typhoid fever, typhoid psychosis toxin will be circulated, affects
brain processes) (e.g. Tetanus spasmin Clostridium tetani)
2. Reservoir environment, area, body where pathogenic organism is found, dependent
for survival, and it multiplies.
a. Human frank cases (with disease already), sub-clinically infected (some
mild signs and symptoms), carrier
b. Animals (Rats Leptospirosis/NOT RABIES; Cats & Dogs Rabies; Chicken
Bird Flu; Cows Mad Cow Disease, Sheep anthrax)
c. Plants (Abaca plant Helminthes causing Filariasis)
d. Soil (Ascaris lumbricoides)
e. Fomites inanimate objects (e.g. Handkerchiefs, fingers
3. Portal of Exit
a. Respiratory tract exhalation, coughing, etc.
b. GIT vomiting, defecation
c. GU voiding, sexual intercourse
d. Wounds boil, scabies, etc.
e. Mechanical escape Incision & Drainage, needle aspiration, bites/stings
4. Mode of Transmission (MOT)
a. Contact - direct (lips to lips, sexual intercourse), indirect (combs, brushes,
glasses, towels), droplet (within 3ft.) more than 5 microns (e.g.
Meningitis, Meningococcemia, Pneumonia, Influenza)
b. Airborne - more than 3ft. (more dangerous than droplet, less than 5
microns) (e.g. chickenpox, smallpox, TB, SARS)

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c. Vehicles of transmission matters, substances (cups, glasses, milk, water)

d. Vectors
e. Fomites BP cuff, stethoscope
5. Portal of Entry corresponds with the portal of exit
a. Respiratory inhalation
b. GIT ingestion
c. GU sexual intercourse
d. Skin needle prick, body piercing
e. Blood blood transfusion, sharing in the works
f. Placental entry mother to fetus (e.g. Rubella, TORCH)
6. Susceptible Host
*easiest way of cutting/preventing the cycle/chain Avoiding Mode of Transmission, Having
Immunization
Immunity the power or ability to resist a specific disease
Immunization process of providing/establishing immunity to an individual
Natural
Acquired a. Natural something that is innate, inborn to us
1. Active by exposure, and experience with the disease itself (chickenpox),
long-lasting and lifetime
2. Passive passage of maternal antibodies; during placental transmission, and
also after birth thru breastfeeding (e.g. IgG) principle of giving tetanus
toxoid immunization to the mother for stimulation of antibodies
b. Artificial
1. Active introduction of antigens that will stimulate antibody production
introduced to the body in the form of vaccines (may contain live
attenuated [weakened] [e.g. OPV, Attenuated Measles Vaccine, BCG],
killed microorganism [e.g. Pertussis component Bordetella Pertussis],
fraction of microorganism [e.g. Hepatitis B vaccine]) and toxoids
(denatured [e.g. DNT component of the DPT; Tetanus toxoid]
2. Passive immuneglobulin passed only to us, came from other sources like
animals (anti-toxin) (Equine [Horse] Rabies Immuneglobulin AntiRabies
serum) (Anti-diptheria serum) or other human beings (immuneglobulin)
(Human Rabies Immuneglobulin) (Tetano-immunoglobulin)
*If from animals, there is a need for skin-testing. If from humans, no need for skin-testing.

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Active it is in our own body that produces the antibody (needs stimulation)
Passive passed only
Active

slow to come and go because it will stimulate our body to create antibodies (e.g.
Verorab)
Passive quick to come and go (e.g. ARS)
STAGES OF A DISEASE
1. Incubation time interval from the first exposure to the disease to the appearance of
the first signs and symptoms (e.g. namaga ang sugat mo)
2. Prodromal time of the appearance of the first signs and symptoms (non-specific) to
the appearance of the characteristic (specific) symptoms of the disease (e.g.
namaga ang sugat ko nagdevelop ako ng lockjaw)
3. Illness full-blown disease observable manifestations (Tetanus)
4. Convalescence period of recovery
GENERAL NURSING CARE OF A CLIENT WITH COMMUNICABLE DISEASES
I.

Prevention
a. Primary
- for the healthy, but are at risk
- health education prevent ignorance
- specific protection EPI
- environmental sanitation
b. Secondary
- case finding; screening
- Early diagnosis
- prompt treatment; prophylaxis (e.g. For Meningococcemia Ciprofloxacin; For
Leptospirosis - Doxycycline)
c. Tertiary
- recovery but has complications
- limitation of disability
- rehabilitation

II.

Treatment
a. Control
- report
- epidemiological investigation
- case finding; early diagnosis; prompt treatment
- quarantine; isolation
- disinfestations; disinfection
- asepsis

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Quarantine limitation of freedom of movement of exposed individuals, animals,

contacts, based on the longest incubation period of the disease
Isolation separation of the infected person based on the longest period of
communicability of the disease
- strict highly contagious, dangerous
- reverse/protective (protecting the patient from us/patients with low
resistance from diseases, e.g. burned victims, chemotherapies)
- respiratory airborne, droplet
- enteric GI, typhoid fever, Hepatitis - handwashing
- wound exudates forceps, gloves, handwashing
- blood and body fluids precaution (universal prec/standard prec)
CDC Isolation Precautions
- Standard Precautions handwashing, gloves, masks/eye, face shields, gowns
- Transmission-based precautions
- Airborne precautions visitors report to nurse before entry,
handwashing, negative pressure room, N95 (95% efficient) mask
- Droplet precautions - visitors report to nurse before entry,
handwashing,surgical mask, eye protection, gloves required
within 3 feet contact
- Contact precautions - visitors report to nurse before entry,
handwashing, gloves, long-sleeved gown required for all
patient/environmental contact
Disinfestation
- insects/cockroaches/mosquitoes/rats
- fogging/fumigation
- spraying
- delousing
Disinfection not including spores
Methods:
- Mechanical boil, burn tissue wipes with phlegm, auto-claving
- Chemical
- Antiseptics inhibit growth of microorganism (e.g. betadine,
mouthwash, Alcohol)
- Disinfectants inanimate objects (e.g. Lysol, Purex, Chlorox)
Techniques:
- Concurrent ongoing, while the patient is still the source of infection
- Terminal when the patient is NO LONGER the source of infection
(patient discharged, terminal disinfection of the room)

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Asepsis
- Surgical Sterile technique peritoneal dialysis, Catheterization to render
an area FREE of pathogenic microorganisms (Fingers to Elbows) (2mins)
- Medical Clean technique cleanliness to reduce the number of
microorganism and prevent the transfer of these in the environment
(Handwashing quality, friction, time, water most impt element,
soap) (10-15secs) (Elbow to Fingers)
Medical Asepsis
- handwashing
- concurrent disinfection
- personal protective equipments
- barrier cards/placarding
Particulate filter mask (N95)
Respirators with HEPA filter (Gas Mask)
Replacement filter

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COMMUNICABLE DISEASES AFFECTING THE INTEGUMENTARY SYSTEM

Viral: Measles, German Measles, Chickenpox, Herpes zoster
Bacteria: Anthrax
Parasitism: Scabies, Pediculosis
Eruptive fevers
- eruption either on the skin or the mucous membranes
- Skin (exanthem) eruption/rashes on the skin
a. macule small flat/unraised eruption (freckles)
b. papule prickly heat
c. vesicle blister
d. pustule pus-filled
e. crust/scab langib
- mucus membrane (enanthem)
Measles (Tigdas)

German Measles

Rubeola

Rubella

Paramyxo-virus

Toga virus

Mode of Transmission

Airborne

Droplet; Placental

Age of Susceptibility

Childhood

Childhood

4 days before/5days after

rashes appear
Kopliks spots
(Buccal cavity bluish white
spots)

Entire course (3-5days

duration only)
Forscheimers spots
(Can be found on soft palate,
Petechial reddish spots)
Maculo-papular
(pinkish, lighter in color, may
or may not be itchy, cold and
moist to touch)

Synonym
Causative Agent

Period of Communicability
Enanthem

Exanthem

Direction of spread of rashes

Maculo-papular
(reddish, itchy, hot and dry
to touch)
Cephalo-caudal

Cephalo-caudal

MEASLES
Symptoms:

Pre-eruptive:
o Fever, Stimsons sign (measles EYE sign, like sore eyes, photophobia,
nagmumuta-muta), Catarrhal (watery-nasal discharges, dry
cough), Kopliks,
stomatitis (singaw)
Eruptive:
o Rashes + Previous symptoms

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Desquamation:
o Drying Brownish staining Peeling off Normal

Diagnosis: NO specific exam

Treatment: Symptomatic & supportive
Nursing Care:
1.
2.
3.
4.
5.
6.
7.

Strict Isolation
Cooling measures
Eye care cotton balls moistened with water, inner to outer canthus
Ear care complications of otitis media
Oral care Mycostatin, Nystatin TID, etc
Skin care Calamine lotion; Kolantro boiled, for bathing to relieve itchiness, etc.
Giving of Vitamin A for healthy skin, and mucous membrane of GI and Respi tract, to
prevent pneumonia, and diarrhea (Red = 200,000 u = 6gtts, >12months; Blue =
100,000 u)

Prevention:
AMV = 9months, O.5, SubQ, Upper Arm fever and rashes after 3-7days, give Paracetamol/TSB
MMR = Measles, Mumps, Rubella = 1year old, 0.5, SubQ, Upper Arm
GERMAN MEASLES
Symptoms:

With post-auricular, post-cervical, sub-occipital lymph nodes enlargement

Will have teratogenic effect on the fetus is acquired by a pregnant mother
- microcephaly
- cataract blindness
- congenital deafness mutism
- Patent Ductus Arteriosus still birth
Blueberry muffin-skin lesions

Dx: Rubella Titer test pregnant women exposed to German Measles (if pregnant)
to determine the level of antibodies present
- 1:8-10 (Antigen:Antibodies)
Txt: Symptomatic/Supportive
Nursing care: symptomatic/supportive
Prevention: Rubella vaccine (if received last week, wait for 3 months for full protection),
MMR

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Chicken Pox (Bulutong)

Herpes Zoster

Varicella

Shingles

Varicella zoster virus

Dormant VZV or HZV

Mode of Transmission

Airborne

Droplet

Age of Susceptibility

Childhood

35y/o and above

Until all lesions have crusted

Until all lesions have crusted

Enanthem

None

None

Exanthem

Vesiculo-pustular crust

Vesiculo-pustular crust

Synonym
Causative Agent

Period of Communicability

Direction of Spread
Affectation

Centrifugal
Generalized distribution
(whole body), itchy, kalatkalat

Follows peripheral nerve

pathway
Limited Distribution (one
area only) on the unilateral,
painful, clustered

CHICKEN POX
Symptoms:

Low-grade fever
Colds-like symptoms
Vesiculo-pustular lesions

Diagnosis: No specific
*Most contagious during the catarrhal stage
*In US, they use baking soda to relieve itchiness
Tx: Symptomatic, Acyclovir (anti-viral, to hasten healing, and lessen lesion)
Nursing care: Skin Care to prevent secondary skin infection and also prevent scarring
Prevention:
1. Avoid Mode of Transmission
2. Vaccine: Varivax; Oka 0.5cc, SQ
3. 2 doses of 4-8 weeks interval
HERPES ZOSTER
Symptoms:

Painful vesiculo-pustular lesions

Fever

Dx: No Specific

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Tx: Corticosteroid, Analgesic

Nursing Care: Same as Chicken Pox
Prevention: Avoid Mode of Transmission
Complications: Post-Herpetic neuralgia intermittent (on an off) pain/discomfort at the site
involved in the infection, which can disappear in time
ANTHRAX
Causative agent: Bacillus anthracis
- disease of herbivorous animals occupational disease in farmers & in workers in the wool &
hide industries
- Woolsorters disease
- Ragpickers disease
TYPES:
1. Cutaneous Anthrax malignant pustule or eschar
Macule Papule Pustule (boil-like) Eschar Septicemia
2. Pulmonary Anthrax Woolsorters disease, necrosis of Lungs
Dangerous form of pneumonia Septicemia Death
3. Intestinal/GI
Dx: Culture examinations from the lesions
Tx: Chloramphenicol, Penicillin, Erythromycin, Tetracycline, Ciprofloxacin
Nursing Care: Symptomatic
Prevention:
Vaccines
Sterilizing potentially infected articles manufactured from animals
Wearing PPEs
SCABIES
Causative agent: Sarcoptes scabiei (female itch mite)
Mode of Transmission: Close body contact, contaminated beddings and clothings
Clinical Manifestations

Linear burrows (on warm, moist area of body)

Pruritus at night weeping itch (oozing with sero-sanguinous secretions)

Dx: Clinical manifestations

Tx:

Eurax (Crotamiton) Applied topically, Observe proper hygiene

Kwell (Gamma benzene hexa-chloride)

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PEDICULOSIS/LOUSINESS
Causative agent:

Pediculosis capitis scalp hair

Pediculosis humanus body hair
Pediculosis pubis pubic louse

Itchiness
Macular rash

Sx:

Home remedy: Shaving, Vinegar (1:1 Dilution) Cotton balls-Moistened with gas

CIRCULATORY SYSTEM
DENGUE FEVER
Viral: Dengue Fever
Protozoan: Malaria
Helminth: Filariasis
Infectious mononucleosis
Causative Agent: Arbovirus (Dengue virus I, II, III, IV)
MOT: Mosquito bites
Vector: Aedes aegypti day biting, clear stagnant waters, urban and crowded
Incubation period: uncertain; 6days 1week
*Biting part of the mosquito Proboscis used for sucking blood
Signs and Symptoms:
a. Grade I: Fever, abdominal pain, Herman sign (Flushing of skin, whitish hue of the
skin), (+) Torniquet test, Rash
b. Grade II: Grade I + Bleeding (bleeding on the eyes, epistaxis, gingival bleeding,
hematemesis, hematochezia, melena)
c. Grade III: Grade II + beginning symptoms of circulatory failure (hypotension, weak &
thread pulse, cold & clammy skin)
d. Grade IV: Grade III + Shock

*Petechiae small (pinpoint)

*Purpura medium
*Ecchymosis large

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Dx:

Torniquet test (presumptive) (BP cuff, hold it for 5mins, look for petechiae, 20/sq.in.)
Platelet count (confirmatory)
Dengue Blot test (Dengue IgM test there is present infection)
Hematocrit count
Prothrombin time
CTBT

Tx: Symptomatic and supportive (Avoid foods that may discolor stool, avoid iron preparations,
avoid ASA, because of anticoagulant properties, Tawa-tawa herbs [boil, drink to
treat Dengue)
*Kaissel-Bach plexus for epistaxis, vascular area of the nose, lean forward, and pinch the
bridge of the nose
*Gingival bleeding chew ice chips
Nursing Care management of bleeding, contraindications
Prevention
1.
2.
3.
4.
5.

Chemically-treated mosquito net

Larvae-eating fish
Environmental sanitation
Anti-mosquito soap
Natural mosquito repellant

*Melena upper GI
*Hematochezia lower GI
Prevention:
4S
1.
2.
3.
4.

Search and Destroy

Self-protection measures
Seek early consultation
Stop indiscriminate fogging

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CHIKUNGUNYA FEVER (to stoop, because of the pain)

*Lifetime immunity if acquired
Causative agent: Chikungunya virus
Vector: Aedes mosquitoes
Symptoms:

Sudden onset of high fever

Headache
Back pain
Myalgia
Arthralgia (of the small joints)

MALARIA (Ague)
*King of tropical diseases
Causative agent: Plasmodium (affects the bloodstream, and the livers RBC, and systemic RBC
[massive destruction of RBCs that gives black color of urine]
Mode of transmission: Mosquito bite, Anopheles mosquito (night biting, slow-flowing water,
mountains/rural areas)
Incubation Period: 12-30 days
Plasmodium types:
a. Vivax (common in Phils.)
b. Falcifarum, (common in Phils.) (Falcifarum most dangerous in the world, because it
leads to blackwater fever, an cerebral malariae brain now is affected convulsive
seizures- obstructed blood vessel to the brain)
c. Ovale
d. Malariae
Sx:

Cold stage chills

Hot stage fever
Wet stage diaphoresis
Symptoms of Anemia palor, easy fatigability

Dx:
a. Clinical findings
b. History of travel/residency in a malaria-endemic area (If you are new to the place, a
greater risk of malaria is at reach)
c. Laboratory Exam (Malarial smear (wait for fever), QBC Quantitative Buffy Coat
faster method of malarial test, ONLY for Falciparum)

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Tx:

Artemether Lumefantrine (1st line)

Chloroquine (Aralen)
Fansidar (Pyrimethamine + Sulfadoxine) used to kill plasmodium that are inside the
RBCs
Primaquine destroy those that are left behind in the liver
Quinine - abortifacient
Nursing care: Symptomatic and supportive
Prevention: CLEAN

FILARIASIS
Causative Agent: Wuchereria bancrofti, Brugia malayi/timori
Mode of Transmission: mosquito bites
Vectors:

Aedes poecillus
Aedes albopictus
Culex quiquefasciatus
Anopheles flavirostris
Mansonna mosquitoes (cross breed)

Incubation period: 8-16months

Signs and Symptoms:

fever, chills, and body malaise

lymphangitis (limbs and scrotum) Edema Elephantiasis; Hydrocoele
skin of affects thickens, rough, coarse

Nocturnal Blood exam (NBE) (10pm 2-4AM, the helminthes is active

time period)
Immunochromatographic test (ICT)

Dx:

during

this

Tx:
1. Chemical
Hetrazan/DEC (Diethylcarbamazine citrate)
Ivermectin purga
2. Surgical
(lympho-venous anastomosis; Stripping; Ligation)

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Nursing care with Elephantiasis:

1. Elevate affected part (pillow with plastic)
2. Wash skin with plain soap and water and dry
3. Inspect for entry wounds; treat with anti-bacterial
Prevention of Filariasis
1. Avoid MOT
2. Use of salt (fortified with DEC)
INFECTIOUS MONONUCLEOSIS/MONO/KISSING DISEASE

Epstein-barr virus, herpes virus

4-7 weeks incubation
Contact with saliva
Similar to: Influenza, Streptococcal sorethroat, drug rash, hepatitis

Symptoms:

Peri-orbital edema
Headache
Sore throat
Cervical lymphadenopathy Neckpain
Petechiae > Palate
Rashes > Skin
Splenomegaly
Conjunctival hemorrhage secondary to the disease

Dx: EBV specific antibody test

Tx: Analgesic, Corticosteroid
Health teaching:

observe for abdominal pain (upper quadrant pain, radiating to the shoulder
avoid strenuous activities (possible rupture of spleen)
RESPIRATORY INFECTIONS

DIPHTHERIA
- is an acute contagious disease characterized by: generalized toxemia pseudo-membrane
- removal of the pseudo-membrane is NOT encouraged, because it will facilitate bleeding,
and a possible regrowth and extension of bacteria
Causative agent: Corynebacterium diphtheriae/Klebs-Loeffler bacilli
MOT: droplet; direct and indirect contact
Source of infection: Naso-pharyngeal secretions
Incubation: 2-5days

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Symptoms:
1. Nasal
- dryness and excoriation of upper lip with sero-sanguinous secretions
- pseudo-membrane in nasal turbinate
2. Pharyngeal/Faucial
- pseudomembrane in oro-pharynx
- bullneck appearance
3. Laryngeal
- sorethroat hoarseness aphonia
- laryngeal stridor
- respiratory difficulty
4. Cutaneous/Extra pulmonary diphtheria
Diagnostic exams:

Nose and throat culture - common

Schicks test susceptibility/resistance
Moloney test a test of hypersensitivity to Diphtheria toxin

Treatment:

Anti-diphtheria serum neutralize the toxin

Erythromycin; Ampicillin
Supportive

Nursing care:
1. Strict isolation
2. Complete Bed Rest limit circulation of toxin, and prevent attachment to the heart
(myocarditis, pneumonia, peripheral neuritis)
3. Diet
4. Concurrent disinfection
Prevention: DPT IM, vastus lateralis, 6, 10, 14 week old, Fever is an expected outcome
within 24 hours
*PentaHIB Haemophilus influenzae type B to prevent bacterial meningitis

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PNEUMONIA
- inflammation consolidation solidification filling up alveolar sacs
Stages of Inflammation:
1.
2.
3.
4.

Engorgement heavy, dark, full, pit upon pressure

Red hepatization (liver)
Gray hepatization (gray granite)
Resolution

Types:
a. Community-acquired
b. Hospital-acquired
c. Atypical
Causative agent
a. Infectios: bacteria, virus, fungi, Pneumocystis carina
b. Non-infectious
- hypostatic pneumonia
- aspiration pneumonia
- inhalation of toxic fumes/gases
MOT: droplet
Incubation period: 1-3days
Symptoms:
Fever and chills
Chest pain
Respi. Difficulty
- nasal flaring
- circum-oral pallor > cyanosis
- sterna retraction
- chest indrawing
- tachypnea
Shortness of breath, dyspnea
Productive cough:
- scanty sputum (atypical pneumonia)
- rusty sputum (streptococcus) (pathogmonic sign of Pneumonia)
- greenish (pseudomonas & H. Influenzae
Dx:

Sputum exam
Chest x-ray

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Tx:

Antibiotic
Mucolytic/Expectorant
Inhalation txt (O2, Nebulization, steam
PVDs/Chest Physiotherapy
Deep breathing/coughing
Suctioning
Fluid therapy (IVF; increase oral fluid)
CBD
DAT

Nursing care:

Keep back dry for perspiration

Turn to sides q2-3hrs.
Proper care of colds and influenza cases

Prevention: Pneumonia vaccine

PTB/KOCHS/PHTHISIS/CONSUMPTION
Tubercle Hard = Fibrosis Calcification Scar
Soft = Caseation (Cheese-like) Liquefaction spills out to trachea-bronchial tree
Phlegm empty sac cavity
Tubercle circumscribed amorphous lesion
Causative Agent: Mycobacterium tuberculosis
- Hominis (human)
- Bovine (Cows)
- Avis (birds)
Modes of Transmission: Airborne
Incubation: 4-8 weeks
Symptoms:
A. Primary TB (non-contagious) first time TB infection during childhood years, weak lungs
B. Adult TB cough with hemoptysis, reactivation of a formerly controlled TB
C. Miliary TB spread of infection to other parts of the body (Millet seed;spread) (e.g.
TB meningitis, Potts, Scrofula/TB lymphadenitis, Gibbus deformity of the spine)
Laboratory exams:
1. Sputum for Acid Fast B (Gold Standard) (Sputum of 3-5cc)
2. Chest X-ray
- Determine clinical activity of TB (active and inactive)
- Determination of lesion size (minimal, moderately advance, far advance)
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3. Tuberculin Test Mantoux test

Purified Protein Derivative (PPD) skin test for reaction (exposure)
Mantoux Test
- most reliable skin test
- 0.1 cc PPD
- volar aspect of arm
- 48-72hrs
- size of wheal/bleb
- < or = 4mm (-)
- 5-9mm (D)
- >10mm (+)
Treatment DOTS Treatment partner, Records, Anti-TB drugs, Microscope, Support
Hepatotoxic drugs needs SGPT liver enzyme
Rifampicin (discoloration of body fluids orange, thrombocytopenia, anuria, flu-like
symptoms, nephrotoxic)
Isoniazid (INH, given with Vit. B6 Pyridoxine, because it causes peripheral neuritis
tingling sensation)
Pyrazinamide (PZA, most hepatotoxic drug, hyperuricemia, contraindicated to
pregnant women)
Ethambutol (Optic Neuritis, visual acuity, color blindness to red & green)
Streptomycin SO4 (56 injections, IM, 750mg) (cranial nerves damage,
vestibulocochlear, causing vertigo, loss of balance, difficulty of hearing, tinnitus,
nephrotoxic, contraindicated to pregnant women congenital deafness)
Treatment:
Tranexamic Acid (Hemosten
Vitamin K for massive hemoptysis
Nursing Care:

Do not perform bronchial tapping, percussion

O2, Ice cap to chest
Anti-hemorrhagic agent
Refer to Dr
Cover nose/mouth; if not, use mask
Proper disposal of sputum
Separate children from TB-infected adult
Hygiene

Prevention:

Avoid MOT
BCG (0.05), intradermal, right

INFLUENZA/FLU
Causative agent: Type A: Most severe, B: Less severe, C: Rare
MOT: Droplet

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Incubation: 24-72hrs
Symptoms:

Fever, chills
Headache, dizziness, nausea, vomiting
Myalgia, Arthralgia
Abdominal pain, diarrhea/constipation
Productive cough, rales (abnormal breath sounds)

Diagnosis: based on clinical findings

Nursing care: Symptomatic/Supportive
Prevention: Avoid MOT, Influenza vaccine (Flu-Jab)
Prevention: Nasal spray
AVIAN FLU/SWINE FLU
Causative agent: H5N1 (avian flu), AH1N1 (swine flu)
Source of infection: Saliva, Feces
MOT: Droplet
People at risks: Poultry workers/Piggery workers
Symptoms: same as human flu
Tx: Tamiflu (Oseltamivir)
Prevention: Influenza vax
DISEASES AFFECTING THE NERVOUS SYSTEM
TETANUS/LOCKJAW
Causative agent: Clostridium tetani
- anaerobic
- non-mobile
- spore-forming
- soil, gut herbivorous
- 2 forms 1. Spore form 2. Vegetative (T. lysin, T. Spasmin)
Tetanospasmin acts on inhibitory neurons located at the myoneural junctions of skeletal
muscles and internuncial fibers of the spinal cord, and blocks the release of
neurotransmitters, for the simultaneous spasms of both agonist and antagonist
muscles.
Tetanus MOT: thru break in the skin an mucous membrane
Incubation period: 3-14 days
*Infant acquiring Tetanus cord (if mother did not receive tetanus toxoid)
*Children with Tetanus Dental carries
*In neonate, how do you suspect Tetanus neonatarum? moro reflex, excessive crying,
difficulty in sucking
Tonic spasm cannot control the force of the spasm; on infants
Opisthotonus anterior arching of the back

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SIDE-LYING POSITION ON INFANTS!

Trismus - lockjaw
Risus Sardonicus sardonic smile
Opisthotonus anterior arching of the back
Muscular spasm
- flexion of upper extremities
- board-like rigidity of abdomen
- extension of lower extremities
- diaphoresis
- low-grade fever
Respiratory Difficulty
Diagnostic examination
- clinical manifestations (Lockjaw)
- History of wound
Treatment
1. Anti-Tetanus Serum/Tetanus Anti-Toxin (IM/IV, After Negative Skin Test)
Tetanu-ImmunoGlobulin (IM, no ST)
IVF
2. Penicillin G Sodium
3. Diazepam (side drip/IV push PRN)
4. Supportive: O2 inhalation, tracheostomy, suction secretions
Nursing Care
1. Dark, Quiet room
Stimulus: Exteroceptive (loud noise, bright lights), Propioceptive (Applied stimulus,
turning to sides, TSB, Bed bath), Interoceptive
2. Minimal handling
3. Lockjaw management NPO, Strict Aspiration Precaution
4. Management of spasm Do not restrain, side rails up, observe for: Duration,
Frequency, muscles involved)
*If patient is affected with tetanus, cognitive ability is NOT affected.
Prevention:
1. Proper wound care
2. Immunization
LEPROSY: HANSENOSIS/HANSENS DISEASE
- slow-advancing disease
- initially affecting the skin, mucous membrane, and peripheral nerves
- that may lead to deformity/disability
- social isolation

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Causative Agent: Mycobacterium Leprae

Mode of Transmission: Skin to skn contact, Droplet
Incubation Period: 3-5 years
*Armadillo & Humans
Signs and Symptoms
EARLY

Reddish or whitish change in skin color

Loss of sensation at site of discolored skin
Enlargement of peripheral nerves
(+) slit skin smear (cardinal symptoms of Leprosy)
Loss of sweat (anhydrosis)
Loss of hair growth
Redness/Painful eyes
Epistaxis/Nasal obstruction
Skin lesion that do not heal

LATE

Madarosis
Lagopthalmos inability to close the eyes
Sinking of the bridge of the nose
Leonine face
Gynecomastia
Clawing/Contracture of fingers/toes
Ulcerations

Diagnostic Exam

Slit skin smear presence of mycobacterium (ear lobes, any most active lesion)
Lepromin test determine susceptibility of resistance to Leprosy

Patient Classification
A. Paucibacillary a few bacilli are present, less than 5 lesions are present
1. Indeterminate
2. Tuberculoid
B. Multibacillary more bacilli are present, more than 5 lesions are present
1. Borderline
2. Lepromatous
Treatment
1. Mono-therapy (old tx for Leprosy, Daxone, Avlosulfone)
2. Multi-drug therapy (MDT)
Advantages:
a. Reduces degree of infectiousness
b. Shortens duration of treatment
c. Prevents resistance

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d. Treatments dapsone-resistant infection

e. Home treatment possible
A. Paucibacillary (PB6)
Rifampicin 600mg
Dapsone 100mg
Dapsone 100mg
B. Multibacillary (MB12-18)
Rifampicin 600mg
Dapsone 100mg
Lamprene 300mg
(clofazimine)
Dapsone 100mg
Lamprene 50mg

- once a month
- health center; supervised
- daily, self-administered, house tx
- once a month
- health center
- supervised
- daily
- self-administered, house tx

Single-lesion Paucibacillary (SLPB)

Single dose of three drugs (ROM)
Rifampicin 600mg
Ofloxacin 400mg
Minocycline 100mg
Nursing Management
1.
2.
3.
4.
5.

Correct Misconceptions (nabarang)

Provide psychological and emotional support
Eye Care (dryness of the eyes)
Hand and Feet Care
Hygienic measures

Prevention
1. Avoid MOT (BCG)

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MENINGITIS inflammation of the protective membrane of the brain and the spinal cord
Causative Agent:
1. Bacteria staphylococcus, streptococcus, tubercle bacilli (TB Meningitis), Haemophilus
Influenzae (most common cause of bacterial cause of meningitis on children <5years
old), Neisseria Meningitidis (not selective, for all ages, bacterial meningitis, seldom
occurrence, poor prognosis)
2. Virus (Aseptic) enterovirus; echovirus; mumps virus; HSV (good prognosis)
3. Fungi Cryptococcus neoformans fungus growing on the manure of birds
MOT: Droplet (Droplet precaution)
Incubation: 2-10 days
Symptoms:
i.
ii.
iii.

Implantation into the nasopharynx

Systemic Infasion septicemia bacteremia meningococcemia rash (skin
bleeding) petechiae purpura ecchymoses
Symptoms of meningeal irritation
a. Nuchal rigidity pathogmonic sign of meningitis
b. Increased ICP close compartment, no allowance for expansion, brain
compression (frontal headache, projectile vomiting, increased BP, low PR)
c. (+) Brudzinski, Kernigs sign (Brudzinki BATOK - bend your head, if (+), raised
legs) (Kernigs sign bend your KNEE, extend your leg, if (+), patient is unable
to extend lower leg upward with thigh flexion, accompanied by pain)
d. Convulsive seizures
e. III, VIII cranial involvement oculomotor and vestibulocochlear affectation
leading to nystagmus, diplopia (double vision)
f. ALOC
g. Opisthotonus
h. Decortication; Decebration decerebrate poor prognosis; affected cerebrum,
decorticate affected cortex

*Ciprofloxacin 100mg prophylaxis (meningococcemia) for people who are considered as

exposed like Doctors, relatives, friends who visited the client, staff nurses.
*to check for nuchal rigidity on infants/children test for head movements using your fingers
Diagnosis:
1. Hemoculture to determine the specific organism
2. Lumbar puncture/LP/Spinal tap (L3L4/L4L5) contraindicated to INCREASED ICP
Pre-op informed consent
During instruct pt to void first, lateral recumbent position (side lying - fetal or
knee-chest position)
Post-op FOB for 6-8hours to prevent spinal headache, NPO for 6-8hrs to
prevent nausea and vomiting, and post 1-2 days, check for any signs of
leak or infection
Treatment:

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Anti-microbial
Anti-inflammatory
Osmotic diuretic
Anti-convulsant
CNS stimulant
Symptomatic/supportive

*Dexamethasone chosen over Prednisone, because Prednisone doesnt cause the blood-brain
barrier
*Dilantine anti-convulsant - oral care, gingival hyperplasia
*Pyritenol CNS Stimulant, non-addicting
*Piracetam
*20% Mannitol check BP, do not give if with hypotension
*If patient is suffering from Increased ICP, what position should you place the client?
- 30 degree angle
Nursing care:
Symptomatic/Supportive
If with increased ICP
o Elevate head at 30 degree angle
o No suctioning via the nose
o Maintain head and body alignment
o Maintain regular bowel movement
ENCEPHALITIS

Primary (Arthropod-borne encephalitis) insect carrier

o e.g. St. Louis, Equine; Australian X
Secondary (Post-infectious encephalitis) (minalas dahil sa complication sa vaccine)
o e.g. mumps, influenza post-vaccination
Toxic Encephalitis
o e.g. lead, mercury

RABIES: HYDROPHOBIA; LYSSA; LE RAGE (MADNESS) can lead to acute encephalitis

*preventable but NOT curable once signs and symptoms are presented
Causative agent: Rhabdovirus neurotropic
Source of infection: Saliva
Mode of Transmission: Bite, non-bite (licking; scratch; organ transplant; inhalation
Incubation Period: 10-14days
Symptoms:
Dog dumb/paralytic/withdrawn (lethargic dog, will stay in one corner; paralysis starts from
the hind leg), furious (ferocious, aggressive, will bite you without provocation)
Man prodromal, excitement, paralytic
Early sings and symptoms: Sore throat, headache, unusual salivation, unusual perspiration,
low grade fever, anxiety without obvious reason for being anxious

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Prominent symptoms: aerophobia (laryngospasm), hydrophobia (pharyngospasm), agitation,

hyperexcitability
Diagnostic: Brain biopsy of the affected dog (Direct Fluorescent Antibody staining test will
look for negri bodies)
*Lucid interval
Treatment: Preventable but not curable once s & sx develop
A. For dog bite:
1. Wash with soap and water
2. Seek consultation (Sight [neck up, neck down], Nature (provoked: Natakan ba ang
buntot?/unprovoked: dumaan ka lang, kinagat ka na, condition of dog after bite
[dead/alive], Whereabouts {where is the dog], date of bite)
3. A. Tetanus prophylaxis
B. Rabies prophylaxis
Rabies prophylaxis
A. Tetanus prophylaxis: seek 2nd opinion if this ONLY given
1. Cleansing, suturing
2. ATS, IM, ANST, gluteus
3. Tetanus toxoid, IM, deltoid
4. Amoxicillin, oral
B. Anti-Rabies vaccine
i. Active
Verorab (PVRV) IM, ANST, deltoid
Rabipir (PCEC) ID, no ST, deltoid area
Schedule:
a. D0 (2) D7 (1) D21 (1)
b. D0 (1/2) D3 (1/2) D7 (1/2) D28-30 (1/2)
ii. Passive
ARS (Hyperab; Favirab) Animal serum 1.7k 5cc vial
- IM, ANST, gluteus
HRIG (Imogam; Rabuman) Human Serum 7k 2cc vial
- IM, no ST, gluteus
Nursing care:
1. Standard precaution
2. Avoid site and sound of water
3. Provide food and water, if requested
4. Restrain
5. Emotional & Psychological support for family
Prevention
1. Immunization
2. Be a responsible pet owner

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POLIOMYELITIS (Infantile paralysis/Heine-Medin disease)

Causative agent: Legio debilitans
Type I Brunhilde
Type II Lansing
Type III Leon
MOT: Fecal Oral
Incubation period: 7-21 days
Signs and symptoms:
Types:
1. Abortive flu-like symptoms, condition didnt continue, but the CNS is not involved
2. Non-Paralytic slight CNS affectation
- 2-hump (bi-phasic) temperature curve
- Poker spine stiffness of the spine
- tightness and spasm of the hamstring
- hypersensitiveness of the skin
- (+) babinski (fanning of toes)
- paresis - weakness
3. Paralytic Hoynes sign (head drop, an attempt to hold the head into upright position)
a. Bulbar
- cranial nerves
- medulla oblongata respi center, DOB (dysphagia, dysphonia, ptosis)
b. Spinal
- anterior horn cells of the spinal cord, asymmetric paralysis, either the arm or
the leg
c. Bulbo-spinal
- ascending paralysis, thus mistaken as Guillian-Barre
Diagnostic examination:
1. Blood and Throat culture
2. Stool examination
3. Lumbar tap Pandys test (CSF Analysis)
4. EMG (electro-myelography spine exam)
Treatment: Symptomatic & supportive
Nursing care:
1.
2.
3.
4.

Isolation
Bed rest
Hot moist compress
Protective devices (Hand roll, trochanter roll, etc, to prevent claw hand, to maintain
body alignment)
5. Rehabilitation
6. Iron Lung machine (for mgt of Bulbar poliomyelitis from the past)
Prevention: OPV Immunization (2 drops, 6, 10, 14 weeks, with DPT and HepB [PentaHIB])

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SEXUALLY-TRANSMITTED DISEASES
DISCHARGES:
TRICHOMONIASIS
Causative agent: Trichomoas vaginalis
- grows in alkaline pH (5.5 5.8)
- e.g. Oral contraceptives, pregnancy, frequent douching
Symptoms:

Foul, profuse, yellow-green, frothy discharge with itchiness (wash with vinegar to
make the environment acidic)

CANDIDIASIS
Causative agent: Candida albicans
- use of antibiotics
- DM
- pregnancy
- aging
Symptoms:

Whitish, thick, clumpy discharge, severe itchiness

CHLAMYDIA (USA)
Causative Agent: Chlamydia trachomatis
Symptoms:

Muco-purulent, whitish discharge, dysuria, dyspareunia

GONORRHEA (Philippines)
Causative Agent: Neisseiria gonorrhea a great scar former if obstructive, can lead to
secondary sterility, it can also lead to PID, which can predispose to
ectopic pregnancy
Symptoms:

Thick, yellowish, purulent discharge, dysuria, burning voiding sensation

Newborn: Ophthalmia Neonatorum/Gonorrheal conjunctivitis Credes prophylaxis

(ophthalmic antibiotic ointment Erythromycin)
Dx: Grams stain; Swab; Culture
Tx:
Trichomoniasis Metronidazole
Candidiasis Miconazole, Clotrimazole, Nystatin vaginal suppository
Gonorrhea Penicillin, Ciprofloxacin, Ceftriaxone, Doxycycline, Spectinomycin
Chlamydia same as Gonorrhea

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GENITAL ULCERS
SYPHILIS
Causative Agent: Treponema pallidum
Adult:
1.
2.
3.
4.

Primary chancre painless, pimple-like ulceration, found on the genitalia

Latent NO symptoms
Secondary condylomata wart-like lesions usually found on the anal-genital area
Tertiary gumma necrotic tissues that usually are found on the skin, mucous
membranes or blood vessels

Congenital:
1. Abortion
2. Stillbirth
3. Lung: Pneumonia alba (syphilitic infection of the lungs of the fetus), difficulty
initiating inspiration upon birth
4. NB:
Early: Snuffles (colds-like symptoms, bloody nasal discharge); Condylomata
(found on the palm of hands and soles of the feet)
Late: Interstitial keratitis (can lead to blindness); saddle nose (pango); cleft
lip/palate (bingot); Hutchinsons teeths (saw-like teeth)
Secondary syphilis: Rashes
Condylomata lata wartlike lesions
Condylomata acuminate Human Papilloma Virus mas malaki kesa sa lata
Saber shin
HPV: Venerial Warts
STDs
Herpes Simplex
HSV1 Labialis (Cold sores/Fever blisters) thru kissing, located at the corner of the lips
HSV2 Genitalis thru sex
Symptoms: Multiple, painful vesicular lesions
*Stress can trigger recurrence
*Herpes whitlow usually in the fingers
Dx:
Syphilis
a. Darkfield illumination test
b. Serologic exams
- VDRL
- FTA Abs (Flourescent Treponemal Antibody absorb test) more reliable test
for Syphilis, because it is very sensitive
c. Herpes simplex Tzancks test

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Tx
Syphilis
- Penicillin, Doxycycline, Tetracycline, Erythromycin
Herpes Simplex
- Acyclovir
HIV (AIDS)
- AIDS is the end stage of the infection
- Human Immunodeficiency virus, also known as Retrovirus
- source of infection: blood, semen, cervical discharges, breastmilk, CSF
- 6months to 5years or more
- MOT: Person to person, Percutaneous (tattooing, ear piercing), Parenteral (needle-prick),
Placental
HIV, the virus
Retrovirus converts into DNA-virus (enzyme: Reverse transcriptase) attacks T-helper cell
(surface receptor: CD4) causes irreversible damage to immune system
T-helper cell, the target cell
Normal value: 800-1000 and above
Functions:
1. Identifies pathogenic microorganisms, CA agents
2. Mobilizes other elements of immune system
3. Aids fight against infection
Clinical stages:
1.
2.
3.
4.

Window phase initial exposure, no lab diagnostics yet

Primary HIV infection flu-like symptoms, ideally, undergone screening tests
Asymptomatic phase 1-20 years
ARC (Aids-related complex) a group of symptoms that will make one suspect that
someone has aids.
5. AIDS
Asymptomatic phase
1. Status of immune system at the time of exposure
2. Healthful living lifestyle
3. Treatment regimen to delay the progress of HIV infection
AIDS-related complex (ARC) (CD4 = 200-800)

10% BWL
Fever of Unknown Origin, night sweats
Repeated, chronic water diarrhea
Lymphadenopathy (armpit; inguinal)
Flu-like symptoms

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AIDS (CD4 = <200)

Oral (Candidiasis, Oral Hairy Leukoplakia, Kaposis Sarcoma) *BOLD = AIDS DEFINING
DISEASE
Nervous (Encephalitis, Meningitis, AIDS- dementia, Toxoplasmosis, Cryptococcus
neoformans)
Respiratory (TB, Pneumocystis Carini Pneumonia, Coccidioidomycosis)
GIT (Diarrhea, Hepatitis, Isospora belli, Cryptosporidium)
Skin (Scabies, Herpes Zoster, Kaposis Sarcoma)
Senses (Blind/deaf)

HIV-associated malignancy:
Kaposis sarcoma
- affects vascular endothelium
- more common among homo/bisexual men
- characterized by purplish-red lesions, not painful or pruritic, flat or indurated
Dx
ELISA (screening)
- detets antibodies to HIV
Western Blot
- confirms presence of antibodies
Tx
A. Nutritional rehabilitation
B. Treat the different opportunistic infections
C. Delay the progress of the disease
HAART (Highly Active Anti-Retroviral Therapy)
A. Nucleoside reverse transcriptase inhibitors (NRTIs)
1. Zidovudine (AZT)
2. Didanosine (dl)
3. Zalcitabine (ddc)
B. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
1. Nevirapine (Viramune)
2. Delavirdine (Rescriptor)
C. Protease Inhibitors (PIs)
1. Saquinavir (Fortovace)
2. Ritonavir (Norvir)
3. Indinavir (Crivixin)
Nursing care:
1. Psychological/emotional support
2. Isolation:
a. Reverse/Protective
b. Blood and body fluids precaution

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3. Medical asepsis
Prevention:
Screening, Education, Counseling, Training of Commercial Heath Worker (Proper use of
condom)
*Steven-Johnson Syndrome Mupirucin

COMMUNICABLE DISEASES AFFECTING THE GIT

Hep B

Hep C

Serum Hepatitis

Post-transfusion
Hepatitis

HBV

HCV

Person-person;
percutaneous;
parenteral
Blood, semen,
cervical discharges

Blood transfusion;
sex; sharing in the
works
Blood, semen,
cervical discharges

2-6weeks

6weeks-6mos

5-8weeks

People at Risk

Lack of Hygiene

Health workers,
blood recipients, drug
addicts, promiscuous
individuals

Blood recipients,
drug addicts

Carrier State

NONE

YES

YES

Cleanliness,
Immunization

Immunization, Blood
screening, Use of
sterile needles,
Monogamous
relationship

Same as Hep B except

Vaccine

0-1%

2-10%

No data

Synonyms
Causative Agent
Mode of
Transmission
Source of infection
Incubation

Prevention

Prognosis

Hep A
Infectious, Epidemic,
Catarrhal Jaundice,
Short IP Hepatitis
HAV
Fecal-Oral
Feces, Saliva

*Twinrix Hep A & B

Symptoms:
Pre-icteric:
- flu-like sxs
- slight RUQ pain
Icteric:
- jaundice EARLY objective manifestation
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pruritus deposition of bile salts on the skin

tea-colored urine
acholic stool
RUQ pain, palpable liver
abdominal enlargement

Post-icteric
Pre-coma Hepatic encephalopathy Asterixis liver flap, Fetur Hepaticus (frothy odor)
Lab Examinations:
1. Liver Function tests:
Total bilirubin (direct, indirect)
Serum Enzymes:
- SGOT (AST)
- SGPT (ALT)
- Alk. Phos.
2. Hepatitis Markers:
Anti-HAV
HBsAg
Anti-HCV
3. Liver Biopsy chronic Hepatitis
4. Ultrasound
Tx (symptomatic, supportive)
Essentiale phospholipid
Cholestyramine or ursidiol
Lamivudine (Zeffix) OD for one year, alpha-interferon (for Caucasians, 3-6mos)
Nursing care:
Diet (high-CHO, hi-CHON, Lo-fat)
- Rest, oral, skin, etc
LEPTOSPIROSIS
(Weils disease, Mud fever; Rat fever; Japanese 7-days fever; Swineherds disease, Canicole
fever)
Causative agent: Leptospira interrogans
Mode of transmission: Inoculation
Incubation period:7-19 days
- common during rainy season
- a zoonotic disease
- at risk: farmers; miners; veterinarians; sewer workers
- liver is also affected leading to jaundice, redness and jaundice of eyes leads to
orange colored eyes
- calf pain
Symptoms:
Fever
Orange Eyes
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Muscle pain (calf)

Diagnostics: Leptospira Agglutination Test; Leptospira Antigen Antibody Test
Treatment: Penicillin; Doxycycline
Nursing are: symptomatic/supportive
Preventon: Environmental sanitation
TYPHOID FEVER
Causative agent: Salmonella typhosa
Source of infection: Feces and urine
Mode of Transmission: Fecal-Oral
Incubation Period: 1-3weeks; average: 2 weeks
Period of communicability: As long as stool is (+) of bacilli
*Peyers patches (patches of lymphoid tissue lining the intestinal wall) of the ileum of the
small intestine
*Occult/Guiac test no red/lean meat
Symptoms:
A. Prodromal flu-like sxs
B. Fastigial/Pyrexial
- ladder-like temperature curve
- rose spots pathogmonic sign, maculo-papular rashes in the abdomen
- typhoid state typhoid psychosis
C. Defervescence
- fever subsides
- if does not recur, start of convalescence
- if recurs, start of complications
D. Convalescence
Dx

Hemoculture diagnostic of typhoid fever

Typhi Dot test IgG, IgM
Fecalysis for occult blood
Rectal swab determine whether if still positive

Tx: Chloramphenicol
Nursing Care: Observe for bleeding
Prevention: Vivotif; Cholera, Dysentery, Typhoid
PARASITISM
Schistosomiasis/Bilharziasis/Snail Fever/Lagnat Suso
Causative agent: Schistosoma (blood fluke)
Intermediary host: Oncomelania quadrasi (snail)
Mode of Transmission: Inoculation,

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Symptoms:
A. Early:

B. Late:

Dermatitis
Low-graed fever
Abdominal pain
Pallor
On and off dysenteric attacks lasting for several weeks
Abdominal enlargement
Emanciation (malnourish-like)
Hepatomegaly
Splenomegaly
Portal Hypertension

Dx
Stool Exam (Katokatz)
COPT Circum-ovale-precipitine test
Tx:
Praziquantel Anti-helminthic (Oral)
Fuadin (injectable)
TAENIASIS (tapeworm)
Taenia Saginata
Taenia Solium
Diphyllobothrium latum
ENTEROBIASIS/Pinworm/Seatworm/Oxyuriasis
Causative agent: Enterobius vermicularis
Mode of Transmission: Fingers (easiest way of getting Pinworm), Food, Seat, Inhalation
Symptoms: Nocturnal Anal Itchiness
TAPE TEST = EARLY IN THE MORNING, BEFORE TAKING A BATH
WHIPWORM
- diarrhea with tenesmus (painful straining on defecation)
- rectal prolapse
HOOKWORM Ancylostomiasis
Causative agent: Ancylostoma duodenale, Necatur americanus
MOT: Walking barefooted
Sx: Dermatitis, Iron Deficiency Anemia, Mental or Growth Retardation

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ASCARIASIS (Giant worm)

Emerging Disease: Ebola Virus Infection
Massive bleeding
Symptomatic and supportive, Standard precaution
Causative agent: E. Zaire, E. Sudan, E. Tai (Humans); E. Reston (Monkey)
Dx: Antigen-antibody test
Tx: Not specific

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