MEDICINE (Smallpox, Cholera, Dengue, SARS, MERS CoV…) Dr.

Sumagaysay
by: mayoung XD
Smallpox
 Found in laboratories
 Incidence in Alimodian.
 Extinction is because of vaccination.
 The only human infectious disease that have been COMPLETELY ERADICATED.

Plague
 Caused by Yersina pestis
 Flue like symptom: fever, headache, vomiting
 Associated with swollen and painful lymph node
 Causes BLACK DEATH

Cholera
 Explosive diarrhea sometimes people excrete 30-40L of diarrheic stools per day
 Patients’ death is due to dehydration and or electrolyte imbalance.
 Associated with rice water diarrheic stools - whitish fluid
 Early 20th century in the Philippines killed more than a million of people
 SIGNAL FLAG - "yellow flag" ship is under quarantine

Malaria
 Pre-emerging infection
 Factors: climate change, over population and modification of bacteria or parasite

Great Influenza Pandemic

 SPANISH FLU 1918
 An influenza pandemic is an epidemic of an influenza virus that spreads on a worldwide scale
 June 11 2009, new strain of H1N1 was declared a global pandemic (stage 6)

H1N1
 Influenza H1N1 in humans
 No vaccine to protect human from this virus but there are medicines effective in treating - supportive therapy
 Fatal to humans
 Complications: acute respiratory failure, eldery, comorbidity (DM), chemo, steroid
 Presentation: flu, fever, co…
 Can be differentiated since more severe cough
 S/S: similar to symptoms of regular flu:
 No pathognomic S/S
 MOT: DROPLET infection is the main source from cough, sneeze – (3ft -5ftspread more commonly in a closed
environment)
 H1N1 is not transmitted by eating thoroughly cooked pork.
 MEDICINE (Smallpox, Cholera, Dengue, SARS, MERS CoV…) Dr. Sumagaysay
by: mayoung XD
 Prevention:
 Cover nose when sneezing or coughing
 Always wash hands with soap and water
 Use alcohol based sanitizers
 Avoid close contact with sick people
 Increase your body's resistance
* treat all ptx as potential source of infection

SARS 2003
 Respiratory problem which first appeared in Guandong, China (Taiwan or hongkong)

SARS:
 SARS CoV
 Self limiting disease
 MOT: person to person through respiratory droplets and direct contact of body fluid of person with SARS,
fomites (e.g. Comb) of orofecal spread
 Incubation period: 2-7 days after exposure to SARS, with a maximum of 10-13 days
 Prodromal Period: or incubation period, about 2-7 days
First sign of manifestation
Sudden onset of fever >38
No pathognomic symptom
Manifestation is similar to other diseases and low risk of transmission, night sweats, rash, confusion,

 Lab:
 CXR may be normal
 Respiratory phase (cough symptom) CXR may show infiltrates
 May show areas of consolidation
 Severe cases may show acute respiratory disease syndrome ARDS a/w congestion
 Low white cell count
 Abnormal liver function
* Renal function is NORMAL
* Important is history of exposure, travel and occupation
 Treatment
 Supportive
 Emperic broad spectrum antibiotic for CAP and atypical pneumonia

 Suspect for SARS (kulang na di)

 Fever >38 and one or more of the ff : (respiratory symptom) and one of the ff exposure within 10 days
onset: close contact, history of travel to areas affected, resident of area affected with disease
A person with an ARDS
 MEDICINE (Smallpox, Cholera, Dengue, SARS, MERS CoV…) Dr. Sumagaysay
by: mayoung XD
 Close Contact: having cared, lived and had direct contact with respiratory secretions or body fluids of people
probable with SARS
 Probable SARS: suspect with CXR infiltartes consistent with pneumonia or autopsy findings consistent pathology
of ARDS without unidentifiable cause
 Case Fatality: 7-13% below 6 years old; 50% in aged 60%
 Prognostic Factor: Age (The older you are the worse the prognosis)

MERS COV
 Middle East Respiratory Disease Syndrome Corona Virus
 A viral respiratory illness in Saudi Arabia
 Sever acute respiratory Illness
 "Crown"
 Transmission: i
 infects the LUNGS ONLY in 20% of respiratory epithelial cells *SPECIFIC VIRUS
 No strong evidence that camels are the source
Possible source: egyptian bats
 Incubation: 14 days
 Symptoms: fever, cough, SOB, RENAL FAILURE, diarrhea
 Can contaminate the person in close contact
 Prevention and Treatment:
 proper hand washing,
 wearing of mask,
 and sneezing into sleeve, flexed elbow or tissue
 N95 is effective for protection while nursing a MERSCOV patient
 No specific medicine or vaccine against MERSCOV. Do preventive measures.
 if you develop symptoms in 2 weeks time get a PCR.
 Daignosis: PCR

Guide for Healthcare Facilities

 TRIAGE
Should be near screening area, separate form general triage
 ISOLATE
Admit px to a single room,
 REPORT
 MEDICINE (Smallpox, Cholera, Dengue, SARS, MERS CoV…) Dr. Sumagaysay
by: mayoung XD
CHIKUNGUNYA
 Virus is passed to humans by two species of mosquito of the genus Aedes: A. Albopictus and A.aegypti.
 Animal reservoirs: monkeys, birds, cattle
 Prevention: mosquito control
 Symptoms: sudden onset of high grade fever, joint pain, headache, fatigue, and conjunctivitis
 Treatment: supportive, no specific treatment

EBOLA
 Caused by Ebola Virus formerly know EBOLA HEMORRHAGIC FEVER
 First appeared in 1976
 African Continent: mostly in Western side (Guinea)
 Highly fatal disease
 Periodic disease
 Transmission: human to human transmission via direct contact through broken skin or mucous membrane with
the blood, secretions, organs
 Incubation: 2-21 days
 S/S: gets worse, causes bleeding,
 First symptom: day 7-9
 Lab: not specific - low platelet
 Diagnosis: hard to diagnose by S/S , ELISA, PCR, cell culture
 Treatment and Vaccine: no specific treatment
 Prevention: reducing the wildlife to human transmission, outbreak containment

* people remain infectious as long as their blood and body fluids contain the virus
* men who have recovered can still transmit the virus through semen up to 7 weeks after recovery
* not as contagious as common cold, influenza or measles - NOT THROUGH DROPLET
* person with EBOLA but no symptoms can not transmit the virus

ZIKA FEVER
 Belongs to Flaviridae ang genus Flavivrus
 First isolated from: RHESUS MONKEY
 Vector: Aedis Aegypti
 Tropical disease - tropical countries
 Transmission: daytime active mosquito as vector *rarely from mother to child during pregnancy - VERTICAL
TRANSMISSION; * can be transmitted through sex - not known how long virus stays in the semen
 Incubation: up to 2 weeks
 Diagnosis: clinical , serology or PCR
 Symptoms the same with Dengue and Chikungunya
 Treatment: supportive, *do not give ASPIRIN which may cause bleeding
 once infected, lifetime protection from the disease; *one mosquito carry the disease
 MEDICINE (Smallpox, Cholera, Dengue, SARS, MERS CoV…) Dr. Sumagaysay
by: mayoung XD
DIPHTHERIA
 China and Russia mostly affected
 Vaccine preventable disease
 S/S vary from mild to severe
 Starts 2-5 days after exposure
 Begins with sore throat and fever
 In severe cases, grey or white patch develops in the throat
 Systemic complications:
 Myocarditis - abnormal heart rate
 Abnormal nerve - paralysis
 MOT: direct contact or DROPLET CONTACT, contaminated objects
 Cutaneous Diphtheria
 Due to a toxin
 Diagnosis: culture, or appearance of the throat
 Treatment: Pen G
 S/S: bull neck
 Mechanism: Corynebacterium diptheria with bacteriophage
 Diagnosis: both laboratory and clinical (culture), staining (ALBERTS's STAIN)
 Clinical Criteria
 URTI
Low grade fever
Adherent dense, grey pdeusomembrnaous covering the posterior throat
 Confirmed: laboratory confirmed or epidemiologically..
 Treatment: empirical, start immediately
 Anti-toxin treatment
Intubation or trachesotomy
ICU
Diphtheria anti-toxin
Antibiotics: Metro, Erythromycin
Pen G if allergic Rifampicin or Clindamycin
 Prevention: standard precaution and immunization
 Close Contact
 Should have throat and nasal specimen cultured for C. Dip, should receive 7-10 days Benzathine Pen G
and should promptly receive anti-toxin
 Contact whose immunizations status in inadequate should receive toxoid
 Considered for prophylaxis
 Kissing
 CPR
 Intubated index case
 MEDICINE (Smallpox, Cholera, Dengue, SARS, MERS CoV…) Dr. Sumagaysay
by: mayoung XD
 Unlikely pro
 Friends, regularly visit the home
 School contact
 Co worker
 Index case without droplet or wound

*some people carry the bacteria without the symptom but can carry the disease to others.