Communicable Communicable Disease NursingDisease Nursing

Florence V.QuintanaFlorence V.Quintana RNRN

We occasionally come into contact with people or animals that are infected and thus expose ourselves to the pathogens of their diseases. In fact, our environment is such that everyday we live with some risk of exposure to diseases.

INTRODUCTION

Although most microorganisms live in harmony with the human body, some—called pathogens—can infect the body and cause disease. Infectious diseases range from mild illnesses, such as a cold, to fatal illnesses, such as AIDS.

Host and Microbial Interaction

Communicable Disease Communicable Disease = = any disease that spreads from one any disease that spreads from one

host to another, either directly or host to another, either directly or indirectlyindirectly

Contagious DiseaseContagious Disease = disease that easily spreads directly = disease that easily spreads directly

from one person to anotherfrom one person to anotherInfectiousInfectious DiseaseDisease

= = disease not transmitted by ordinary disease not transmitted by ordinary contact but require a direct inoculation contact but require a direct inoculation through a break in a previously intact through a break in a previously intact mucous membrane. On the other hand, all mucous membrane. On the other hand, all contagious diseases are infectious. contagious diseases are infectious.

Examples of communicable diseases Examples of communicable diseases include herpes, malaria, mumps, include herpes, malaria, mumps, HIV/AIDS, influenza, chicken pox, HIV/AIDS, influenza, chicken pox, ringworm, and whooping cough. ringworm, and whooping cough.

Cancer, on the other hand, is not a Cancer, on the other hand, is not a communicable disease. communicable disease.

CarrierCarrier – is an individual who – is an individual who harbors the organism and is capable harbors the organism and is capable of transmitting it to a susceptible of transmitting it to a susceptible host without showing manifestations host without showing manifestations of the disease.of the disease.

Contact Contact - is any person or animal - is any person or animal who is in close association with an who is in close association with an infected person, animal, or freshly infected person, animal, or freshly soiled materialsoiled material

Based on Occurrence of Disease:Based on Occurrence of Disease:

1. 1. Sporadic DiseaseSporadic Disease

== disease that occurs only disease that occurs only occasionally & irregularly with no occasionally & irregularly with no specific patternspecific pattern

i.e. botulism, tetanusi.e. botulism, tetanus

2. 2. Endemic DiseaseEndemic Disease

= constantly present in a = constantly present in a population, country or communitypopulation, country or community

i.e. Pulmonary Tuberculosis; i.e. Pulmonary Tuberculosis; malariamalaria

Classification of Infectious Diseases:

3. 3. Epidemic DiseaseEpidemic Disease = patient acquire the disease = patient acquire the disease

in a relatively short period of in a relatively short period of time ; greater than normal time ; greater than normal number of cases in an area within number of cases in an area within a short period of timea short period of time

i.e, cholera; typhoid i.e, cholera; typhoid 4. 4. Pandemic DiseasePandemic Disease = = epidemic disease that occurs epidemic disease that occurs

worldwideworldwide i.e. HIV infection; SARSi.e. HIV infection; SARS

Based on Severity or Duration Based on Severity or Duration of Diseaseof Disease

1. 1. Acute DiseaseAcute Disease

== develops rapidly (rapid develops rapidly (rapid onset) but lasts only a short onset) but lasts only a short time time

i.e. measles, mumps, i.e. measles, mumps, influenza influenza

2. 2. Chronic DiseaseChronic Disease = develops more slowly (insidious onset)= develops more slowly (insidious onset) disease likely to be continual or recurrent disease likely to be continual or recurrent

for for long periodslong periods i.e. TB, Leprosyi.e. TB, Leprosy3. 3. Subacute DiseaseSubacute Disease = intermediate between acute and chronic= intermediate between acute and chronic i.e. bacterial endocarditisi.e. bacterial endocarditis4. 4. Latent DiseaseLatent Disease = causative agent remains inactive for a = causative agent remains inactive for a

time but time but then becomes active to produce symptoms then becomes active to produce symptoms

of of the diseasethe disease i.e. chickenpox → shingles (zoster); i.e. chickenpox → shingles (zoster);

amoebiasisamoebiasis

Based on State of Host ResistanceBased on State of Host Resistance::

1. 1. Primary InfectionPrimary Infection = acute infection that causes the = acute infection that causes the

initial illnessinitial illness 2. 2. Secondary InfectionSecondary Infection = one caused by an opportunistic = one caused by an opportunistic

pathogen after primary infection has pathogen after primary infection has weakened the bodyweakened the body’’s defensess defenses

3. 3. Subclinical (Inapparent Infection)Subclinical (Inapparent Infection) = does not cause any noticeable = does not cause any noticeable

illnessillness

Stages of DiseaseStages of Disease Incubation PeriodIncubation Period - time interval between the initial - time interval between the initial

infection and the 1infection and the 1stst appearance of any s/sx appearance of any s/sx - patient is not yet aware of the disease- patient is not yet aware of the disease

Prodromal PeriodProdromal Period - early, mild appearance of symptoms of - early, mild appearance of symptoms of

the diseasethe disease Period of IllnessPeriod of Illness

Time of greatest symptomatic experience Time of greatest symptomatic experience ( pt. is sick( pt. is sick))

- overt s/sx of disease- overt s/sx of disease WBC may increase or decreaseWBC may increase or decrease can result to death if immune response can result to death if immune response

or medical intervention failsor medical intervention fails

Period of DeclinePeriod of Decline

s/sx subsides/sx subside

pathogen replication is brought pathogen replication is brought under controlunder control

vulnerable to secondary infectionvulnerable to secondary infection Period of ConvalescencePeriod of Convalescence

Replication of pathogenic organisms is Replication of pathogenic organisms is stoppedstopped

regains strength and the body regains strength and the body returns to its returns to its

pre diseased statepre diseased state

= recovery has occurred= recovery has occurred

Note that in the case of Note that in the case of acquired immunityacquired immunity against a pathogen the progress of disease against a pathogen the progress of disease may end during the may end during the prodromal periodprodromal period as a as a consequence of the rapid immune system consequence of the rapid immune system response to the infection. response to the infection.

For example, acquired immunity might be For example, acquired immunity might be as a consequence of vaccination or as a consequence of vaccination or previous natural exposure to the previous natural exposure to the pathogen.pathogen.

Nurse Alert!!!!

MICROBES against HUMANMICROBES against HUMANDefinitions:Definitions: SymptomsSymptoms subjectivesubjective evidenceevidence of disease that is of disease that is

experienced or perceived experienced or perceived subjective changes in body function noted subjective changes in body function noted

byby patient but not apparent to an observer patient but not apparent to an observer SignsSigns objective evidenceobjective evidence of a disease the of a disease the

physician can physician can observe and measureobserve and measure SyndromeSyndrome a specific a specific group of signs and symptomsgroup of signs and symptoms

that that accompany a particular diseaseaccompany a particular disease

IncidenceIncidence the number of people in a the number of people in a

population whopopulation who develop a disease develop a disease during a during a

particular time particular time periodperiod PrevalencePrevalence = the number of people in a = the number of people in a

population who develop a disease, population who develop a disease, regardless of when it regardless of when it

appearedappeared = refers to both old and new = refers to both old and new

casescases

INFECTIONINFECTION

- condition caused by the entry and - condition caused by the entry and multiplication of pathogenic multiplication of pathogenic microorganisms within the host bodymicroorganisms within the host body

CONDITIONS THAT AFFECT CONDITIONS THAT AFFECT INFECTION DEVELOPMENTINFECTION DEVELOPMENT

PathogenicityPathogenicity – – ability to cause diseaseability to cause disease InfectiveInfective dosedose (sufficient number (sufficient number of of

microorganisms needed to initiate infection) microorganisms needed to initiate infection) VirulenceVirulence ( disease severity) and ( disease severity) and

InvasivenessInvasiveness of microorganisms ( ability to of microorganisms ( ability to enter and move through tissue) enter and move through tissue)

Organisms specificity ( host preference) Organisms specificity ( host preference) ResistanceResistance of the host of the host ImmunityImmunity of the hostof the host **Cycle**Cycle of infection must be completed** of infection must be completed**

Chain of Infection

The chain begins with the existence of a specific pathogenic microorganism

The second link is the reservoir, an environment where the pathogen can survive.

Chain of Infection

The third link is the means of escape from the reservoir. ( Mode of Exit )

The fourth link is the mode of transmission from the reservoir to the host.

Chain of Infection

The fifth link is the means of entry into the host ( Mode of entry)

And the last link is the host's susceptibility to the pathogenic microorganism

Chain of Infection

Infection control: 1Infection control: 1stst line line of defenseof defense

Hand hygieneHand hygiene, first line of defense , first line of defense and the most important practice in and the most important practice in preventing infection.preventing infection.

Handwashing – Handwashing – single most important single most important way of preventing transfer of way of preventing transfer of microorganismsmicroorganisms

IMMUNITYIMMUNITY- is the condition of being secure - is the condition of being secure against any particular disease, against any particular disease, particularly the power which a living particularly the power which a living organism possesses to resist and organism possesses to resist and overcome infectionovercome infection

- is the resistance that an individual - is the resistance that an individual has against disease has against disease

IMMUNEIMMUNE SYSTEMSYSTEM

PROTECTION AGAINST INFECTIVE OR PROTECTION AGAINST INFECTIVE OR ALLERGIC DISEASES BY A SYSTEM OF ALLERGIC DISEASES BY A SYSTEM OF ANTIBODIES, IMMUNOGLOBULINS ANTIBODIES, IMMUNOGLOBULINS AND RELATED RESISTANCE FACTORSAND RELATED RESISTANCE FACTORS. .

ANTIBODYANTIBODY

- a specific immune substance produced - a specific immune substance produced by the lymphocytes of the blood of by the lymphocytes of the blood of tissue juices of man or animal in tissue juices of man or animal in response to the introduction into the response to the introduction into the body of an antigenbody of an antigen

ANTIGENANTIGENTRIGGERING AGENT OF THE TRIGGERING AGENT OF THE IMMUNE SYSTEM; FOREIGN IMMUNE SYSTEM; FOREIGN SUBSTANCE INTRODUCED INTO THE SUBSTANCE INTRODUCED INTO THE BODY causing the body to produce BODY causing the body to produce antibodiesantibodies

TYPES OF ANTIGENSTYPES OF ANTIGENS::1.1. INACTIVATEDINACTIVATED ( ( KILLEDKILLED ORGANISMORGANISM))

1.1. Not long lastingNot long lasting2.2. Multiple doses neededMultiple doses needed3.3. Booster dose neededBooster dose needed

2. 2. ATTENUATEDATTENUATED ( ( LIVELIVE WEAKENEDWEAKENED ORGANISMORGANISM))1. single dose needed1. single dose needed2. long lasting immunity2. long lasting immunity

** all vaccines lose their potency after a ** all vaccines lose their potency after a certain time.certain time.

TYPES OF IMMUNITYTYPES OF IMMUNITY

NATURALNATURAL =innate; within the =innate; within the HOST;HOST;Immune SystemImmune System

ACQUIREDACQUIRED = outside the HOST = outside the HOSTNatural = active or passiveNatural = active or passiveArtificial = active or passiveArtificial = active or passive

Types of ImmunityTypes of Immunity

A. A. NATURAL :NATURAL :

1. 1. Natural activeNatural active – through – through exposure or diseases; had the exposure or diseases; had the disease & recovereddisease & recovered

2. 2. Natural PassiveNatural Passive – maternal – maternal antibodies; acquired through antibodies; acquired through placental transferplacental transfer

B. B. ARTIFICIALARTIFICIAL ( Laboratory ) ( Laboratory )1. Artificial active1. Artificial active – introduction of – introduction of

antigenantigen Ex. Vaccines ; toxoidsEx. Vaccines ; toxoids

( No exposure yet; preventive measure)( No exposure yet; preventive measure)= gives long immunity – months to = gives long immunity – months to yearsyears

2. Artificial passive-2. Artificial passive- introduction of introduction of antibodiesantibodies Ex. Antitoxins; Ex. Antitoxins; immunoglobulin ( gammaglobulin), immunoglobulin ( gammaglobulin), antiserum, convalescent serumantiserum, convalescent serum

Ex. TAT ( tetanus antitoxin)Ex. TAT ( tetanus antitoxin) ( w/ exposure to the causative agent)( w/ exposure to the causative agent)

= gives short immunity – 3-4 weeks= gives short immunity – 3-4 weeks

Immunity

NATURAL ACQUIRED

- INHERENT BODY TISSUES

1. NATURAL 2. ARTIFICIAL

( HUMAN) ( LABORATORY)

A. ACTIVE B. PASSIVE A. ACTIVE B. PASSIVE

-HAD THE DISEASE & - MATERNAL - VACCINES - ANTITOXINS

-RECOVERED ANTIBODIES - TOXOIDS - IG’S

Outside the host

Infection control and Infection control and preventionprevention

ImmunizationImmunization ActiveActive PassivePassive

IMMUNIZATIONIMMUNIZATION

- - is the induction or is the induction or introduction ofintroduction of specific protective antibodiesspecific protective antibodies in a in a susceptible person or animal, or the susceptible person or animal, or the production of cellular immunity in production of cellular immunity in such a person or animal.such a person or animal.

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

Active ImmunizationActive Immunization

1.1. BCGBCG

2.2. DPTDPT

3.3. OPV/IPVOPV/IPV

4.4. MeaslesMeasles

5.5. MMRMMR

6.6. TBTB

7.7. Hepatitis BHepatitis B

8.8. VaricellaVaricella

9.9. Hemophilus influenzae B (Hib)Hemophilus influenzae B (Hib)

Active immunization not Active immunization not routinely givenroutinely given

1.1. Cholera vaccineCholera vaccine

2.2. Rabies Rabies

3.3. TyphoidTyphoid

4.4. Influenza A & BInfluenza A & B

5.5. MeningococcalMeningococcal

6.6. Pneumococcal vaccinePneumococcal vaccine

7.7. HPV vaccineHPV vaccine

Passive immunizationPassive immunization

1.1. Diphtheria antitoxinDiphtheria antitoxin

2.2. Hepatitis B immunoglobulin (HBIG)Hepatitis B immunoglobulin (HBIG)

3.3. Measles immunoglobulinMeasles immunoglobulin

4.4. Varicella immunoglobulin (VZIG)Varicella immunoglobulin (VZIG)

5.5. Rabies Human immunoglobulin (RIG)Rabies Human immunoglobulin (RIG)

6.6. Tetanus human immunoglobulin (TIG)Tetanus human immunoglobulin (TIG)

7.7. Tetanus Toxin ( ATS)Tetanus Toxin ( ATS)

NURSE ALERT !!!NURSE ALERT !!!

ALL VACCINE LOSE THEIR POTENCY AFTER A CERTAIN TIME.

EXPIRY DATE SHOULD BE NOTED ON THE LABEL

What damages

vaccine ??

Heat and sunlight damages vaccineEsp. LIVE VACCINE

Freezing damages the KILLED vaccineAnd TOXOID

Use water only in cleaning the refrigeratorOr freezer.

( antiseptics, disinfectants and detergentsOr alcohol lessen potency of vaccine )

KEEP VACCINES IN CORRECT COLD TEMPERATURE(0-8 c)

Cold Chain System

ImmunizationImmunization EPI : PPD 996EPI : PPD 996 GOAL : universal child immunization GOAL : universal child immunization

( Proc. No. 6)( Proc. No. 6) Common Goal to Prevent childhood diseases Common Goal to Prevent childhood diseases

covered by the EPI covered by the EPI ( expanded program ( expanded program immunization)immunization)

1.1. TbTb2.2. MeaslesMeasles3.3. Diphtheria, PertussisDiphtheria, Pertussis4.4. Polio , Polio , 5.5. TetanusTetanus6.6. HepatitisHepatitis

IMMUNOGLOBULINSIMMUNOGLOBULINS( IG’S)( IG’S)

IgGIgGMOST PREVALENT ANTIBODY 80%, MOST PREVALENT ANTIBODY 80%, PRODUCED LATERPRODUCED LATER IN IN THE IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS THE IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS PLACENTAPLACENTA

IgAIgAFOUND IN COLOSTRUM, TEARS, SALIVA, SWEATFOUND IN COLOSTRUM, TEARS, SALIVA, SWEAT

IgMIgMPRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN IN RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL IMMUNIZATIONIMMUNIZATION

IgEIgERESPONDS TO ALLERGICRESPONDS TO ALLERGIC REACTION REACTION

IgDIgDUNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B CELLSSURFACE OF B CELLS

Expanded Program of Expanded Program of ImmunizationImmunization

BCGBCG At birthAt birth IDID OnceOnce None, mild fever, local rxnNone, mild fever, local rxn

DPTDPT

MMR MMR

6 weeks6 weeks

15 wks15 wks

IMIM 3 x (4weeks int)3 x (4weeks int) Local rxn, acute Local rxn, acute encephalopathyencephalopathy

OPVOPV 6 weeks6 weeks oraloral 3 x (4wks int)3 x (4wks int) NoneNone

MeaslesMeasles 9 mos9 mos SQSQ OnceOnce FeverFever

Hep BHep B At birthAt birth IMIM 3 x ( 2,4,6 )3 x ( 2,4,6 ) Mild local rxnMild local rxn

Special-use VaccineSpecial-use Vaccine

MeningoccocalMeningoccocal Epidemic areasEpidemic areas SQSQ NoneNone

RabiesRabies ExposuresExposures ID/IMID/IM Local rxnLocal rxn

TyphoidTyphoid travellerstravellers IMIM Local rxnLocal rxn

Japanese encepJapanese encep travellerstravellers SCSC AnaphylacticAnaphylactic

PneumococcalPneumococcal immunocomproimmunocompro IM/SQIM/SQ Local rxnLocal rxn

Contraindications when Contraindications when

giving immunizationsgiving immunizations::

Severe febrile illnessSevere febrile illness Live virus vaccine are generally not Live virus vaccine are generally not

administered with altered immune administered with altered immune systemsystem

Allergic reactionAllergic reaction

Permanent C.I.Permanent C.I.

AllergyAllergy Encephalopathy without known Encephalopathy without known

causecause Convulsion within 7 days after Convulsion within 7 days after

Pertussis vaccinePertussis vaccine

Temporary C.ITemporary C.I

PregnancyPregnancy ImmunocompromisedImmunocompromised Very severe diseaseVery severe disease Previously received blood Previously received blood

product/transfusionproduct/transfusion

EPIDEMIOLOGY AND DISEASE EPIDEMIOLOGY AND DISEASE TRANSMISSIONTRANSMISSION

Reservoirs of Infection:Reservoirs of Infection: = = any site where the pathogen can multiply or any site where the pathogen can multiply or

merely survive until it is transferred to the hostmerely survive until it is transferred to the host Human ReservoirHuman Reservoir = principal living reservoir of human disease= principal living reservoir of human disease

1. 1. Direct TransmissionDirect Transmission

= usually associated with signs and = usually associated with signs and symptomssymptoms

2. 2. CarriersCarriers

= harbor the pathogen without = harbor the pathogen without associated signsassociated signs

and symptomsand symptoms

Susceptible HostSusceptible Host

Recognition of high risk patientsRecognition of high risk patients ImmunocompromisedImmunocompromised DMDM SurgerySurgery BurnsBurns ElderlyElderly

17% 17% Surgical Surgical 34% 34% UTI UTI 13% 13% LRI LRI 14% 14% BacteremiaBacteremia 22% 22% Other (incldng Other (incldng skin Infxn) skin Infxn)

Preventing the Spread of Communicable Disease

Community vs. Nosocomial

Community Acquired Infection - infection present or incubating at the time of consultation

Nosocomial Infection or hospital acquired - infection that develop during the course of hospital stay & was not evident at time of admission

Percentage of Nosocomial Infections

Factors for Nosocomial InfectionFactors for Nosocomial Infection

Microorganism/Hospital EnvironmentMicroorganism/Hospital Environment Most common causeMost common cause Staph aureus, Staph EnterococciStaph aureus, Staph Enterococci E. coli, Pseudomonas, Enterobacter, E. coli, Pseudomonas, Enterobacter,

KlebsiellaKlebsiella Clostridium DifficileClostridium Difficile Fungi ( C. Albicans)Fungi ( C. Albicans) Other ( Gram (-) bacteria)Other ( Gram (-) bacteria) 70% are drug resistant bacteria70% are drug resistant bacteriaCompromised HostCompromised Host One whose resistance to infection is impaired One whose resistance to infection is impaired

by by broken skin, mucous membranes and a broken skin, mucous membranes and a

suppressed immune systemsuppressed immune system

INFECTION INFECTION CONTROL CONTROL

MEASURESMEASURES

General Control MeasuresGeneral Control Measures

Prevention of Airborne ContaminationPrevention of Airborne Contamination

Cover mouth and nose ( coughing or Cover mouth and nose ( coughing or sneezing)sneezing)

Limit number of persons in a roomLimit number of persons in a room Removal of dirt and dustRemoval of dirt and dust Open room to fresh air and sunlightOpen room to fresh air and sunlight Roll linens togetherRoll linens together Remove bacteria from the air (air filters)Remove bacteria from the air (air filters)

Handling of Food and Handling of Food and Eating UtensilsEating Utensils

Use high quality foodsUse high quality foods Proper refrigeration and storage of foodProper refrigeration and storage of food Proper washing, preparing, and cooking of Proper washing, preparing, and cooking of

foodfood Proper disposal of uneaten foodProper disposal of uneaten food Proper hand washingProper hand washing Proper disposal of oral and nasal secretionProper disposal of oral and nasal secretion Cover hair and wear clean clothes and apronCover hair and wear clean clothes and apron Provide periodic health exam for kitchen Provide periodic health exam for kitchen

workersworkers Keep cutting boards cleanKeep cutting boards clean Prohibit anyone with respiratory or GIT Prohibit anyone with respiratory or GIT

disease from handling fooddisease from handling food Rinse and wash utensils with a temperature Rinse and wash utensils with a temperature

above 80above 80°C°C

Handling of FomitesHandling of Fomites

Use disposable equipmentsUse disposable equipments Sterilize or disinfect equipmentSterilize or disinfect equipment Use individual equipment for each Use individual equipment for each

patientpatient Use single use thermometersUse single use thermometers Empty bedpans and urinals properly Empty bedpans and urinals properly

and wash with hot water, store in and wash with hot water, store in dry ,clean area or storagedry ,clean area or storage

Place used linens and personal care Place used linens and personal care equipments, and soiled laundry in a bagequipments, and soiled laundry in a bag

Medical AsepsisMedical Asepsis CLEANCLEAN TECHNIQUETECHNIQUE:: Involves procedures Involves procedures

and practices that reduce the number and practices that reduce the number and transfer of pathogensand transfer of pathogens

Will exclude pathogensWill exclude pathogens ONLYONLYAttained by:Attained by: Frequent and thorough hand washingFrequent and thorough hand washing Personal groomingPersonal grooming Proper cleaning of supplies and Proper cleaning of supplies and

equipmentequipment DisinfectionDisinfection Proper disposal of needles, Proper disposal of needles,

contaminated materials and infectious contaminated materials and infectious wastewaste

Sterilization Sterilization

Surgical AsepsisSurgical Asepsis STERILESTERILE TECHNIQUETECHNIQUE : : Practices used to Practices used to

render and keep objects and areas sterile render and keep objects and areas sterile Exclude Exclude ALLALL microorganism microorganismAttained by:Attained by: Use strict aseptic precautions for invasive Use strict aseptic precautions for invasive

proceduresprocedures Scrub hands and fingernails before Scrub hands and fingernails before

entering O.R.entering O.R. Use sterile gloves, masks, gowns and shoe Use sterile gloves, masks, gowns and shoe

coverscovers Use sterile solutions and dressingsUse sterile solutions and dressings Use sterile drapes and create an sterile Use sterile drapes and create an sterile

fieldfield Heat Heat ––sterilized surgical instruments sterilized surgical instruments

1. Universal Precaution ( Standard Precaution )1. Universal Precaution ( Standard Precaution ) Defined by center for disease control (CDC) 1996Defined by center for disease control (CDC) 1996 Primary strategy for reducing the risk of & Primary strategy for reducing the risk of &

controlling Nosocomial infectionscontrolling Nosocomial infections Used for care of all hospitalized patients, regardless Used for care of all hospitalized patients, regardless

of diagnosis and are presumed infectiousof diagnosis and are presumed infectious Protect healthcare workers from contamination and Protect healthcare workers from contamination and

infection ( i.e. HIV, HBV)infection ( i.e. HIV, HBV)

Hand WashingHand Washing Routine: Plain (non microbial) soapRoutine: Plain (non microbial) soap Outbreak Control: Antimicrobial/Antiseptic AgentOutbreak Control: Antimicrobial/Antiseptic Agent Wash After: 1.touching blood and other body fluidsWash After: 1.touching blood and other body fluids

2. touch contaminated items2. touch contaminated items

3. removal of gloves3. removal of gloves

4. between patient contact, task, 4. between patient contact, task, procedureprocedure

Infection Control Signage

Universal Precaution Materials

Patient Care EquipmentPatient Care Equipment Prevent contaminating yourself or Prevent contaminating yourself or

transfer microbes to otherstransfer microbes to others Properly clean, disinfect or sterilizeProperly clean, disinfect or sterilize Dispose single Dispose single –– use items use itemsLinensLinens Handled, transported and processed Handled, transported and processed

to prevent contamination and transfer to prevent contamination and transfer of microorganismsof microorganisms

Occupational Health and Blood Occupational Health and Blood ––borne borne PathogensPathogens

Never recap used needlesNever recap used needles Puncture Puncture –– resistant containers resistant containers

Revised C.D.C. Isolation Revised C.D.C. Isolation PrecautionPrecaution

( centers for disease control)( centers for disease control) 2. Transmission-Based Precautions2. Transmission-Based Precautions

The second tier of precaution The second tier of precaution Precaution are instituted for patients who Precaution are instituted for patients who

are known to be or suspected of being are known to be or suspected of being infected with highly transmissible infection.infected with highly transmissible infection.

THREE TYPES OF TRANSMISSION-BASED THREE TYPES OF TRANSMISSION-BASED PRECAUTIONSPRECAUTIONS::

1. Airborne precautions1. Airborne precautions 2.Droplet precautions2.Droplet precautions 3.Contact precautions3.Contact precautions

Infection Control Signage

Infection Control Signage

Infection Control Signage

Personal Protective Personal Protective EquipmentEquipment

( PPE)( PPE)( Barrier Technique)( Barrier Technique) maskmask glovesgloves gowngown shoe covershoe cover gogglesgoggles

Transmission based precautions Transmission based precautions for for Hospitalized Hospitalized

patient :patient :Category Category PrecautiPrecauti

onon

Single Single

RoomRoomMasksMasks GownsGowns GlovesGloves

AirborneAirborne Yes, with Yes, with (-) air (-) air

pressure pressure ventilatioventilatio

nn

YesYes NoNo NoNo

DropletDroplet YesYes Yes, mask Yes, mask for for

persons persons close to close to patientpatient

NoNo NoNo

ContactContact YesYes yesyes yesyes yesyes

IsolationIsolation

- - is a protective procedure that limits is a protective procedure that limits the spread of infectious diseases the spread of infectious diseases among hospitalized clients, hospital among hospitalized clients, hospital personnel, and visitors. It is the personnel, and visitors. It is the separation from other persons of an separation from other persons of an individual suffering from a individual suffering from a communicable disease. communicable disease. - - other terms areother terms are: : protective aseptic protective aseptic technique or barrier technique. technique or barrier technique.

QuarantineQuarantine - - is the limitation of is the limitation of freedom of movement of persons or freedom of movement of persons or animals which have been exposed animals which have been exposed to communicable disease / s for a to communicable disease / s for a period of time equivalent to the period of time equivalent to the longest incubation period of that longest incubation period of that disease.disease.

SurveillanceSurveillance - -

Seven categories Seven categories recommended in isolationrecommended in isolation

1.1. Strict isolationStrict isolation Use mask , gown and gloves (MUST)Use mask , gown and gloves (MUST) Private roomPrivate room For highly contagious or virulent infectionsFor highly contagious or virulent infections

2.2. Contact isolationContact isolation

3.3. Respiratory isolationRespiratory isolation

4.4. TB isolationTB isolation

5.5. Enteric isolationEnteric isolation

6.6. Drainage/secretion precautionDrainage/secretion precaution

7.7. Universal precaution when handling blood Universal precaution when handling blood and body fluidsand body fluids

Type : Type : STRICT STRICT Purpose:Purpose: Prevent Transmission ofPrevent Transmission of highly contagious highly contagious

or virulent infections spread by air and contactor virulent infections spread by air and contact

Specification:Specification: Private Room – necessary Private Room – necessaryHand Washing – XHand Washing – XGown – XGown – XMasks – XMasks – XGloves – XGloves – XArticles – Discard or bag and label and Articles – Discard or bag and label and

send send for decontamination and for decontamination and reprocessing. reprocessing.

Diseases requiring Isolation –Diseases requiring Isolation – Diphtheria (pharyngeal) , Lassa Diphtheria (pharyngeal) , Lassa fever, Smallpox , Varicella.fever, Smallpox , Varicella.

Type :Type : ContactContactPurpose:Purpose: Prevent TransmissionPrevent Transmission of of highly highly

transmissible infections that do not require strict transmissible infections that do not require strict isolation.isolation.

Specification:Specification: Private Room – necessaryPrivate Room – necessaryHand Washing – XHand Washing – XGown – wear if soiling is likelyGown – wear if soiling is likelyMasks – wear in close contact with clientMasks – wear in close contact with clientGloves – wear if touching infective material.Gloves – wear if touching infective material.Articles – Discard or bag and label and send Articles – Discard or bag and label and send

for decontamination and for decontamination and reprocessing. reprocessing.

Diseases requiring Isolation – Diseases requiring Isolation – Acute Resp. infection in Acute Resp. infection in infant and young children, Herpes simplex, Impetigo, infant and young children, Herpes simplex, Impetigo, multiple resistant bacterial infection.multiple resistant bacterial infection.

Type :Type : RespiratoryRespiratory

Purpose: Purpose: Prevent Transmission of infectious diseases Prevent Transmission of infectious diseases primarily over short distances by air droplets.primarily over short distances by air droplets.

Specification:Specification: Private Room – necessaryPrivate Room – necessaryHand Washing – XHand Washing – XGown – not necessarilyGown – not necessarilyMasks – wear in close contact with clientMasks – wear in close contact with clientGloves – not necessarilyGloves – not necessarilyArticles – Discard or bag and label and send Articles – Discard or bag and label and send

for decontamination and for decontamination and reprocessing.reprocessing.

Disease requiring Isolation –Disease requiring Isolation – Measles, Meningitis, Pneumonia, Measles, Meningitis, Pneumonia,

Hemophilus Influenza in children , Mumps.Hemophilus Influenza in children , Mumps.

Type :Type : TuberculosisTuberculosis

Purpose:Purpose: For client with PTBFor client with PTB who has positive who has positive sputum or chest x-ray that indicates sputum or chest x-ray that indicates active diseaseactive disease

Specification: Specification: Private Room – necessary Private Room – necessaryHand Washing – XHand Washing – XGown – Wear if soiling is likelyGown – Wear if soiling is likelyMasks – wear if client is coughing and does Masks – wear if client is coughing and does

not consistently cover not consistently cover mouthmouth

Gloves – not necessarilyGloves – not necessarilyArticles – Rarely involved in transmission of Articles – Rarely involved in transmission of

TB. Should still be thoroughly TB. Should still be thoroughly cleansed and disinfected. cleansed and disinfected.

Disease requiring Isolation – TuberculosisDisease requiring Isolation – Tuberculosis

Type :Type : Enteric Precautions Enteric Precautions

PurposePurpose:: To prevent infections that are To prevent infections that are transmitted bytransmitted by direct or indirect contact with direct or indirect contact with feces.feces.

SSpecification:pecification: Private Room – Indicated if client’s hygiene is poor and Private Room – Indicated if client’s hygiene is poor and there is risk of contamination with infective there is risk of contamination with infective

materials. materials. Hand Washing – XHand Washing – XGown – wear if soiling is likely Gown – wear if soiling is likely Masks – not necessaryMasks – not necessaryGloves – wear if touching infective materialGloves – wear if touching infective materialArticles – Discard or bag and label and send Articles – Discard or bag and label and send for decontamination and reprocessing. for decontamination and reprocessing.

Disease requiring Isolation –Disease requiring Isolation – Hepatitis, viral (type A), Hepatitis, viral (type A), Gastroenteritis caused by highly Gastroenteritis caused by highly

infectious organism cholera, Diarrhea, infectious organism cholera, Diarrhea, acute with infectious etiology.acute with infectious etiology.

Type :Type : Drainage- secretion precautionsDrainage- secretion precautions

Purpose:Purpose: To prevent infections that are transmitted by direct or To prevent infections that are transmitted by direct or

indirect contact with indirect contact with purulent material or purulent material or drainage from infected site.drainage from infected site.

Specification:Specification: Private Room – not necessary Private Room – not necessaryHand Washing – XHand Washing – XGown – wear if soiling is likely Gown – wear if soiling is likely Masks – not necessaryMasks – not necessaryGloves – wear if touching infective materialGloves – wear if touching infective materialArticles – Discard or bag and label and send Articles – Discard or bag and label and send

for decontamination and reprocessing.for decontamination and reprocessing. Disease requiring Isolation –Disease requiring Isolation – Abscess, Burn infection, Abscess, Burn infection,

conjunctivitis, decubitus- ulcer skin or conjunctivitis, decubitus- ulcer skin or wound wound infection.infection.

Type :Type : Blood- body fluid precautionBlood- body fluid precaution

Purpose: Purpose: To prevent infections that areTo prevent infections that are transmitted by transmitted by direct or indirect contact with blood or body fluid. direct or indirect contact with blood or body fluid.

Specification:Specification: Private Room – Only if client’s hygiene is poor Private Room – Only if client’s hygiene is poor Hand Washing – XHand Washing – XGown – Wear if soiling with blood or body Gown – Wear if soiling with blood or body

fluid fluid is likely is likely

Masks – not necessaryMasks – not necessaryGloves – wear if touching blood or body Gloves – wear if touching blood or body

fluid.fluid.Articles – Discard or bag and label and send Articles – Discard or bag and label and send

for decontamination and for decontamination and reprocessing. reprocessing.

Disease requiring Isolation –Disease requiring Isolation – AIDS, Hepatitis, viral (Type B) AIDS, Hepatitis, viral (Type B)

Malaria, Syphilis, primary and Malaria, Syphilis, primary and secondary.secondary.

Reverse IsolationReverse Isolation ProtectiveProtective or or neutropenic isolationneutropenic isolation Used for patients withUsed for patients with severe burnssevere burns, ,

leukemialeukemia, , transplanttransplant, , immuno deficient immuno deficient personspersons, , receiving radiation treatment, receiving radiation treatment, leukopenic patientsleukopenic patients

Those that enter the room must wear Those that enter the room must wear masks and sterile gowns tomasks and sterile gowns to prevent prevent from introducing microorganisms to the from introducing microorganisms to the roomroom

Additional PointersAdditional PointersRegarding Disposal PrecautionRegarding Disposal Precaution

SecretionSecretion: Patient should be instructed to expectorate : Patient should be instructed to expectorate into tissue held close to mouth. Suction catheters and into tissue held close to mouth. Suction catheters and gloves should be disposed of in impervious, sealed gloves should be disposed of in impervious, sealed bags.bags.

ExcretionExcretion: Strict attention should be paid to careful : Strict attention should be paid to careful hand washing; disease can be spread by oral- fecal hand washing; disease can be spread by oral- fecal route.route.

BloodBlood: needles and syringes should be disposable. : needles and syringes should be disposable. Used needles Used needles should not be recappedshould not be recapped. They should . They should be placed in a puncture-resistant container that is be placed in a puncture-resistant container that is prominently labeled “ Isolation “ Specimens should be prominently labeled “ Isolation “ Specimens should be labeled “ Blood Precaution”.labeled “ Blood Precaution”.

Environmental ControlEnvironmental Control

Routine care, cleaning and Routine care, cleaning and disinfection of environmental surfacesdisinfection of environmental surfaces

PRECAUTIONS FOR INVASIVE PRECAUTIONS FOR INVASIVE PROCEDURESPROCEDURES::

wear gloves during all invasive procedure wear gloves during all invasive procedure + goggles + mask+ goggles + mask

Work Practice Work Practice PrecautionPrecaution

Prevent injuries caused by needles, scalpels Prevent injuries caused by needles, scalpels and other sharps instrument or devices when and other sharps instrument or devices when cleaning used instrument, when disposing of cleaning used instrument, when disposing of used needlesused needles Do notDo not recap used needles, bend , break nor recap used needles, bend , break nor

remove them from disposable syringes or remove them from disposable syringes or manipulate them.manipulate them.

Place sharps in puncture resistant containersPlace sharps in puncture resistant containers If gloves tears or a needle-stick or other injury If gloves tears or a needle-stick or other injury

occurs, REMOVE the gloves, wash hands, and wash occurs, REMOVE the gloves, wash hands, and wash sites of the needle stick thoroughly then put new sites of the needle stick thoroughly then put new glovesgloves

Report injuries and mucous membrane exposure to Report injuries and mucous membrane exposure to appropriate infection control officer.appropriate infection control officer.

Waste managementWaste management

is the collection, transport, is the collection, transport, processing, recycling or disposal of processing, recycling or disposal of waste materials.waste materials.

Involves:Involves: 1. sharps1. sharps 2.Solid infectious – cotton swab, dressing2.Solid infectious – cotton swab, dressing 3. Anatomic Infectious – placenta / organ3. Anatomic Infectious – placenta / organ 4.Solid non-infectious – used IV / bottle IV4.Solid non-infectious – used IV / bottle IV 5.General waste – scrap paper / food 5.General waste – scrap paper / food

materialmaterial

Philippines set-upPhilippines set-up

black plastic bags are for non-black plastic bags are for non-biodegradable and noninfectiousbiodegradable and noninfectious wastes such as cans, bottles, tetrabrick wastes such as cans, bottles, tetrabrick

containers, styropor, straw, plastic, containers, styropor, straw, plastic, boxes,boxes,

wrappers, newspapers.wrappers, newspapers.

GreenGreen plastic bags are biodegradable plastic bags are biodegradable wastes such as fruits and vegetables' wastes such as fruits and vegetables' peelings, leftover food flowers, leaves, peelings, leftover food flowers, leaves, and twigs.and twigs.

Philippines set-upPhilippines set-up

YellowYellow plastic bags are for infectious plastic bags are for infectious wastewaste such as disposable materials used for such as disposable materials used for

collection of blood and body fluids like collection of blood and body fluids like diapers, sanitary pads, incontinentdiapers, sanitary pads, incontinent

pads; materials (like tissue paper) with pads; materials (like tissue paper) with blood secretions and other exudates; blood secretions and other exudates; dressings, bandages, used cotton balls, dressings, bandages, used cotton balls, gauze; IV tubings, used syringes; Foleys gauze; IV tubings, used syringes; Foleys catheter/ tubings; gloves and drains.catheter/ tubings; gloves and drains.

Means of controlling the Means of controlling the spread of CDspread of CD

1.1. Elimination of the source of Elimination of the source of infectioninfection

2.2. Interruption of transmissionInterruption of transmission

3.3. Protection of susceptible host.Protection of susceptible host.

INFECTIOUS INFECTIOUS DISEASEDISEASE

INFECTIOUS DISEASESINFECTIOUS DISEASESCLASSIFIED AS: CLASSIFIED AS: Blood/ vector borneBlood/ vector borne Enteric diseasesEnteric diseases Eruptive feverEruptive fever Respiratory diseasesRespiratory diseases CNS infectionCNS infection Diarrheal DiseasesDiarrheal Diseases EMERGING DISEASESEMERGING DISEASES

INFECTIOUS DISEASESINFECTIOUS DISEASESCLASSIFIED ASCLASSIFIED AS : :

1.1. Blood/ vector borneBlood/ vector borne a. DHFa. DHF

b. Malariab. Malaria

c. Leptospirosisc. Leptospirosis

d. Filiariasisd. Filiariasis

2.2. Enteric diseasesEnteric diseases a. Typhoid fevera. Typhoid fever

b. Viral Hepatitisb. Viral Hepatitis

c. Schistosomiasisc. Schistosomiasis

3.3. Eruptive feverEruptive fever

a. Measles (Rubeola)a. Measles (Rubeola) b. Varicellab. Varicella c. German Measles ( Rubella)c. German Measles ( Rubella) d. Small poxd. Small pox

4.4. Respiratory diseasesRespiratory diseases a. Pneumoniaa. Pneumonia b. Diphtheriab. Diphtheria c. PTBc. PTB d. Mumpsd. Mumps

5. 5. CNS Infections CNS Infections a. a. EncephalitisEncephalitis

b. Meningitisb. Meningitisc.Meningococcemiac.Meningococcemiad. Rabiesd. Rabies

e. Tetanuse. Tetanus f. Snake bitef. Snake bite

6.Diarrheal diseases6.Diarrheal diseasesa. E.colia. E.coli

b. Staphyloccus aureusb. Staphyloccus aureus c. Cholerac. Cholera d. Rotavirusd. Rotavirus e. Salmonellae. Salmonella f. Parasitismf. Parasitism

7. 7. Emerging Emerging DiseasesDiseases:: SARSSARS

Birds FLUBirds FLU

VECTOR BORNE DISEASES

Dengue Fever, H-Fever, Dengue Fever, H-Fever, Dandy Fever, Breakbone Dandy Fever, Breakbone

Fever, Phil Fever, Phil Hemorrhagic feverHemorrhagic fever

Acute Febrile DiseaseAcute Febrile Disease Flavivirus, dengue virus 1,2,3,4Flavivirus, dengue virus 1,2,3,4

Incidence: Rainy season, urban areasIncidence: Rainy season, urban areas

IP: 3 to 10 days ( average 4-6 daysIP: 3 to 10 days ( average 4-6 days

** Life span of the mosquito is 4 ** Life span of the mosquito is 4 monthsmonths

Pathognomonic sign: Pathognomonic sign: Herman’s rashHerman’s rash

Dengue Fever, H-Fever, Dandy Dengue Fever, H-Fever, Dandy Fever, Breakbone Fever, Phil Fever, Breakbone Fever, Phil

Hemorrhagic feverHemorrhagic fever

PathogenesisPathogenesis1. increased capillary fragility d/t 1. increased capillary fragility d/t immune complex reactionsimmune complex reactions2. thrombocytopenia d/t faulty 2. thrombocytopenia d/t faulty maturation of megakaryocytes maturation of megakaryocytes 3. decreased blood clotting factors3. decreased blood clotting factors

THE DISEASE PRESENTS WITH FEVER AND HEMORRHAGIC MANIFESTATIONS AND LABORATORY FINDINGS OF THROMBOCYTOPENIA AND HEMOCONCENTRATION

Vector- Vector- Aedes aegyptiAedes aegypti

- Day biting mosquito ( they appear 2 hours after sunrise and 2 hours before sunset. Low flying ( Tiger mosquito – white stripes, gray wings )

- Breeds on clear stagnant water

CRITERIA FOR DIAGNOSISCRITERIA FOR DIAGNOSIS:: Fever ,acute, high continous, Fever ,acute, high continous,

lasting for 2-7 dayslasting for 2-7 days Positive torniquet testPositive torniquet test Spontaneous bleeding Spontaneous bleeding (petechiae,purpura,ecchymoses,pista(petechiae,purpura,ecchymoses,pistaxis,gum bleeding, hematemesis, xis,gum bleeding, hematemesis, melena)melena)

Laboratory: thrombocytopenia </= Laboratory: thrombocytopenia </= 100,000mm3, hemoconcentration- an 100,000mm3, hemoconcentration- an increase of at least 20% in the increase of at least 20% in the hematocrit or its steady risehematocrit or its steady rise

Assessment:Assessment: Tourniquet testTourniquet test ( (Rumpel Leedes testRumpel Leedes test) -) -

screening test, done by occluding the screening test, done by occluding the arm veins for about 5 minutes to arm veins for about 5 minutes to detect capillary fragility.detect capillary fragility. Keep cuff inflated for 6 – 10 minutes ( Keep cuff inflated for 6 – 10 minutes (

child); 10-15 minutes ( adults)child); 10-15 minutes ( adults) Count the petechiae formation 1 Count the petechiae formation 1

square inch ( 20 petechiae/sq.in)square inch ( 20 petechiae/sq.in)(+)TT(+)TT

Platelet countPlatelet count ( decreased) – ( decreased) – confirmatory testconfirmatory test

Classification of Dengue Fever Classification of Dengue Fever according to severityaccording to severity

Grade IGrade I – Dengue fever, saddleback fever – Dengue fever, saddleback fever plus constitutional signs and symptoms plus constitutional signs and symptoms plus positive torniquet testplus positive torniquet test

Grade IIGrade II – Stage I plus spontaneous – Stage I plus spontaneous bleeding, epistaxis, GI, cutaneous bleeding, epistaxis, GI, cutaneous bleedingbleeding

Grade IIIGrade III – Dengue Shock Syndrome, all – Dengue Shock Syndrome, all of the following signs and symptoms plus of the following signs and symptoms plus evidence of circulatory failureevidence of circulatory failure

Grade IVGrade IV – Grade III plus profound shock – Grade III plus profound shock and massive bleeding, undetectable BP and massive bleeding, undetectable BP and pulseand pulse

Laboratory criteria DHFLaboratory criteria DHF:: Platelet count Thrombocytopenia Platelet count Thrombocytopenia

<100,000<100,000 Hct – increased by Hct – increased by 20 %20 % or more or more

11stst 2 clinical criteria plus 2 2 clinical criteria plus 2 laboratory criteria or rising Hct – laboratory criteria or rising Hct – DHF( dengue hemorrhagic fever)DHF( dengue hemorrhagic fever)

Shock w/ high hematocrit and Shock w/ high hematocrit and marked thrombocytopenia – DSS marked thrombocytopenia – DSS ( dengue shock syndrome)( dengue shock syndrome)

Other :Other : PT (Prothrombin Time)PT (Prothrombin Time) APTT (Activated Partial Thromboplastin APTT (Activated Partial Thromboplastin

Time)Time) Bleeding timeBleeding time Coagulation timeCoagulation timePeriod of communicabilityPeriod of communicability – pts. are – pts. are

usually infective to mosquito from a day usually infective to mosquito from a day before the febrile period to the end of itbefore the febrile period to the end of it

The mosquito becomes infective from The mosquito becomes infective from day 8 to 12 after the blood meal & day 8 to 12 after the blood meal & remains infective all throughout liferemains infective all throughout life

pathophysiologyDengue FeverDengue Fever

Vector caries virus (AEDES aegypti)

Bite host ( IP 3-10d)

s/sx : Fever , headache, myalgia ,anorexiaVomiting, sorethroat, rashes

Febrile phase2-7 days

IMPROVE

First 2 daysVascular injuryPlasma leakage

(+) petechiae , (+) TT

3rd day WBC, PLT Ct , Hct >20% (+) Pleural effussion

Dengue progress Circulatory failure-hypotension

-narrow pulse pressure,20mm Hg (shock)

death

DHFDHF

S/sx: S/sx:

Mild dengueMild dengue – abrupt onset of fever, – abrupt onset of fever, headache, muscle and joint pains, headache, muscle and joint pains, anorexia, abdominal pain. anorexia, abdominal pain. Petecchiae, Petecchiae, Herman’s rashHerman’s rash (5 (5thth-7-7thth day; purplish macules w/ blanched day; purplish macules w/ blanched areas on extremities)areas on extremities)

Severe dengue – DHF/DSS Severe dengue – DHF/DSS

*TRIAD: fever, rashes and muscle pain*TRIAD: fever, rashes and muscle pain

Bleeding leading to hypovolemic shockBleeding leading to hypovolemic shock

Medical MXMedical MX There is no effective antiviral therapy for There is no effective antiviral therapy for

dengue fever. Treatment is entirely dengue fever. Treatment is entirely SYMPTOMATICSYMPTOMATIC

Paracetamol for headache ( never give Paracetamol for headache ( never give ASPIRIN)ASPIRIN)

IVF for hydration & replacement of plasmaIVF for hydration & replacement of plasma BT for severe bleedingBT for severe bleeding O2 therapy is indicated to all patients in O2 therapy is indicated to all patients in

shockshock Sedatives for anxiety & apprehensionSedatives for anxiety & apprehension No IM injectionsNo IM injections Nasal packing with epinephrineNasal packing with epinephrine Gastric lavageGastric lavage Giving cytoprotectorsGiving cytoprotectors

Nursing MxNursing Mx

Symptomatic txSymptomatic tx Mosquito free environment to avoid further Mosquito free environment to avoid further

transmission of infectiontransmission of infection Keep patient at rest during bleeding Keep patient at rest during bleeding

episodesepisodes VS must be promptly monitoredVS must be promptly monitored For nose bleeding, maintain pt’s position in For nose bleeding, maintain pt’s position in

elevated trunk, apply ice bag to bridge of elevated trunk, apply ice bag to bridge of nosenose

Observe for signs of shockObserve for signs of shock Restore blood volume ( supine with legs Restore blood volume ( supine with legs

elevated)elevated)

Dengue hemorrhagic Dengue hemorrhagic FeverFever PREVENTION : DOH 1995 ProgramPREVENTION : DOH 1995 Program

CC- - hemically treated Mosquito Nethemically treated Mosquito Net LL – arvae eating fish – Gold fish – arvae eating fish – Gold fish EE – nvironmental Sanitation – 4 0’ clock – nvironmental Sanitation – 4 0’ clock

habithabit AA – antimosquito soap – lanzones peeling – antimosquito soap – lanzones peeling NN – atural mosquito repellant – Neem – atural mosquito repellant – Neem

tree , eucalyptus , oreganotree , eucalyptus , oregano

PREVENTIONPREVENTION Cover water drums and water pails at all Cover water drums and water pails at all

times to prevent mosquitoes from times to prevent mosquitoes from breeding.breeding.

Replace water in flower vases once a week.Replace water in flower vases once a week. Clean all water containers once a week. Clean all water containers once a week.

Scrub the sides well to remove eggs of Scrub the sides well to remove eggs of mosquitoes sticking to the sides.mosquitoes sticking to the sides.

Clean gutters of leaves and debris so that Clean gutters of leaves and debris so that rain water will not collect as breeding rain water will not collect as breeding places of mosquitoes.places of mosquitoes.

Old tires used as roof support should be Old tires used as roof support should be punctured or cut to avoid accumulation of punctured or cut to avoid accumulation of water.water.

Collect and dispose all unusable tin cans, Collect and dispose all unusable tin cans, jars, bottles and other items that can jars, bottles and other items that can collect and hold water collect and hold water

Prevention & ControlPrevention & Control

The 4-S Against DENGUEThe 4-S Against DENGUE

1. Search1. Search and destroy breeding and destroy breeding places of dengue causing places of dengue causing mosquitoes such as mosquitoes such as old tiresold tires, , coconut huskscoconut husks, , roof guttersroof gutters, , discarded bottles, flowerdiscarded bottles, flower vasesvases & other containers that can & other containers that can hold clean stagnant waterhold clean stagnant water

2.2. SelfSelf –– protection protection measures such as measures such as wearing of long sleeve shirts and wearing of long sleeve shirts and long pants and using mosquito long pants and using mosquito repellants are a must during repellants are a must during daytime.daytime.

3.3. SeekSeek early consultation when early early consultation when early signs such as fever and rashes set insigns such as fever and rashes set in

4.4. SaySay NO to indiscriminate fogging NO to indiscriminate fogging except for dengue outbreakexcept for dengue outbreak

MalariaMalaria

MALARIA (Ague)MALARIA (Ague)King of Tropical DiseaseKing of Tropical Disease

Acute and chronic parasitic diseases Acute and chronic parasitic diseases Causative agentCausative agent : Protozoa of genus Plasmodia : Protozoa of genus Plasmodia

4 species of Protozoa4 species of Protozoa::1. 1. Plasmodium falciparumPlasmodium falciparum ( malignant ( malignant tertian)tertian)

Most fatal ; common in the PhilippinesMost fatal ; common in the Philippines2. 2. Plasmodium vivaxPlasmodium vivax ( Benign tertian) ( Benign tertian)

Non-life threatening except for the Non-life threatening except for the very young & old ; manifest chills very young & old ; manifest chills q48H on the 3q48H on the 3rdrd day onward if day onward if untreateduntreated

MALARIA (Ague)MALARIA (Ague)King of Tropical DiseaseKing of Tropical Disease

3. 3. Plasmodium malariaePlasmodium malariae (Quartan)(Quartan)

Less frequently seen ; non Less frequently seen ; non life threatening , fever & life threatening , fever & chills usually occur q72H chills usually occur q72H usually on the 4usually on the 4thth day after day after the onsetthe onset

4. 4. Plasmodium ovalePlasmodium ovale rarerare

VectorVector – – Female Anopheles Female Anopheles mosquitomosquito

Vector:Vector: ( (night biting)night biting) Female anopheles mosquitoFemale anopheles mosquito

or minimus flavirustrisor minimus flavirustris

= infectious but not contagious= infectious but not contagious

= thrives in clear, free flowing shaded = thrives in clear, free flowing shaded streams usually in the mountainsstreams usually in the mountains

= bigger in size than the ordinary = bigger in size than the ordinary mosquitomosquito

= brown in color, usually does not bite a = brown in color, usually does not bite a person in motionperson in motion

= assumes a 36 degree position when it = assumes a 36 degree position when it alights on walls, trees, curtains and the alights on walls, trees, curtains and the likelike

Incubation Period:Incubation Period: 1. 12 days for P. falcifarum1. 12 days for P. falcifarum 2. 14 days for P. vivax and Ovale2. 14 days for P. vivax and Ovale 3. 30 days for P. malariae3. 30 days for P. malariae

Period of Communicability:Period of Communicability: Untreated or insufficiently treated Untreated or insufficiently treated

patient may be the source of patient may be the source of mosquito infection for more than mosquito infection for more than three years in P. malariae; one to two three years in P. malariae; one to two years in P. vivax; and not more than years in P. vivax; and not more than one year on P. falcifarum one year on P. falcifarum

PathogenesisPathogenesis Anopheles mosquito >> gets parasites in Anopheles mosquito >> gets parasites in

the blood of infected person >>parasites the blood of infected person >>parasites multiply in mosquito >>parasites invade multiply in mosquito >>parasites invade the salivary gland of mosquito >> the salivary gland of mosquito >> mosquito bites the individual & thus, mosquito bites the individual & thus, injects the parasites >> parasites invade injects the parasites >> parasites invade RBC where they grow & undergo asexual RBC where they grow & undergo asexual propagation >> RBC ruptures or bursts propagation >> RBC ruptures or bursts releasing tiny organisms ( MEROZOITES) releasing tiny organisms ( MEROZOITES) >> merozoites invade new batch Of RBC >> merozoites invade new batch Of RBC to start another schizonic cycleto start another schizonic cycle

PathologyPathology the most characteristic the most characteristic

pathology of malaria is pathology of malaria is destruction of red blood cells, destruction of red blood cells, hypertrophy of the spleen and hypertrophy of the spleen and liver and pigmentation of organs.liver and pigmentation of organs.

The pigmentation is due to the The pigmentation is due to the phagocytocis of malarial phagocytocis of malarial pigments released into the blood pigments released into the blood stream upon rupture of red cellsstream upon rupture of red cells

Plasmodium Life CyclePlasmodium Life Cycle

MalariaMalaria

Transmission Transmission ::

PATHOPHYSIOLOGY :PATHOPHYSIOLOGY : RBC decreases deformability and oxygen RBC decreases deformability and oxygen

transport, increase adhesion and fragility transport, increase adhesion and fragility leading to anemia leading to anemia

sporozoites, injectedby anopheles mosquito

travel to human liver

mature to be released into a blood stream as merozoites

invade RBC as they undergo sexual reproduction to

produce zygotes

Clinical ManifestationClinical Manifestation uncomplicateduncomplicated fever, chills, sweating every 24 – 36 fever, chills, sweating every 24 – 36

hrshrs ComplicatedComplicated sporulation or segmentation and sporulation or segmentation and

rupture of erythrocytes occurs in the rupture of erythrocytes occurs in the brain and visceral organs.brain and visceral organs.

Cerebral malariaCerebral malaria changes of sensorium, severe changes of sensorium, severe

headache and vomitingheadache and vomiting seizuresseizures

MALARIA (Ague)MALARIA (Ague) Clinical manifestationsClinical manifestations : :

1. 1. Cold stageCold stage Chilling sensation of the body ( 10-15 mins)Chilling sensation of the body ( 10-15 mins) Chattering of lips, shakesChattering of lips, shakes

Keep the patient warmKeep the patient warm Hot water bathHot water bath Expose to heatExpose to heat Warm drinksWarm drinks

Last about 10-15minLast about 10-15min2. .2. . Hot stage (3-4Hrs)Hot stage (3-4Hrs) Recurring high gradeRecurring high grade fever , headache , abdominal fever , headache , abdominal

pain and vomitingpain and vomiting TSB , cold compressTSB , cold compress Light clothing, Light clothing,

MALARIA (Ague)MALARIA (Ague) Clinical manifestation : Clinical manifestation :

I. Cold stage ( 10-15mins)I. Cold stage ( 10-15mins) II. Hot stage (3-4Hrs)II. Hot stage (3-4Hrs) III. III. Wet stageWet stage

Profuse sweatingProfuse sweating Keep patient comfortableKeep patient comfortable Keep them warm and dryKeep them warm and dry Increase fluid intake Increase fluid intake

Diagnostics: Diagnostics:

1. 1. Malarial smear -Malarial smear - Peripheral blood Peripheral blood extraction (extraction (extract blood at the height of extract blood at the height of fever or 2 hrs before chilling ( AGUE)fever or 2 hrs before chilling ( AGUE)

2. Rapid diagnostic test ( RDT) – 2. Rapid diagnostic test ( RDT) – blood blood test for malaria conducted outside the test for malaria conducted outside the lab & in the field- result is within 10-15 lab & in the field- result is within 10-15 mins. This is done to detect malarial mins. This is done to detect malarial parasite antigen in the blood.parasite antigen in the blood.

Pathonomonic sign: Pathonomonic sign: Stepladder feverStepladder fever

Medical Mgmt:Medical Mgmt:

A. IVF’sA. IVF’s

B. Anti- Malarial Drugs B. Anti- Malarial Drugs

Chloroquine ( less toxic); Chloroquine ( less toxic);

PremaquinePremaquine

For chloroquine resistant plasmodium – For chloroquine resistant plasmodium – quininequinine

• Prophylaxis – chloroquine or mefloquine, Prophylaxis – chloroquine or mefloquine, pyrimethamine/sulfadoxine (fansidar)pyrimethamine/sulfadoxine (fansidar)

C. Erythrocyte exchange transfusion for C. Erythrocyte exchange transfusion for rapid production of high levels of rapid production of high levels of parasites in the blood. parasites in the blood.

Nursing ConsiderationsNursing Considerations If entering an endemic area, travellers are If entering an endemic area, travellers are

advised to take chloroquine from 1-2 advised to take chloroquine from 1-2 weeks at weekly interval. Protection is weeks at weekly interval. Protection is good for 1 yeargood for 1 year

Patient must be closely monitoredPatient must be closely monitored Soaking of mosquito nets in an insecticide Soaking of mosquito nets in an insecticide

solutionsolution Bio pond for fishBio pond for fish On stream clearing – cut vegetation On stream clearing – cut vegetation

overhanging stream banks to expose the overhanging stream banks to expose the breeding stream to sunlightbreeding stream to sunlight

Vectors peak biting is at night (9pm-3am)Vectors peak biting is at night (9pm-3am)

Planting of neem tree ( repellant effect)Planting of neem tree ( repellant effect) Zooprophylaxis ( deviate mosquito bite Zooprophylaxis ( deviate mosquito bite

from man to animalsfrom man to animals Wear long sleeves/ pants/SocksWear long sleeves/ pants/Socks Apply insect repellant on skinApply insect repellant on skin Screening of housesScreening of housesNotes:Notes: Malaria stricken mother can still Malaria stricken mother can still

breastfeedbreastfeed Chloroquine ca be given to a pregnant Chloroquine ca be given to a pregnant

womanwoman If there is drug resistance, give quinine If there is drug resistance, give quinine

SO4SO4 BT in anemiaBT in anemia Dialysis in renal failureDialysis in renal failure Decreased fluids in cerebral edemaDecreased fluids in cerebral edema No meds to destroy sporozoitesNo meds to destroy sporozoites

Category of provincesCategory of provinces

Category ACategory A – no significant improvement – no significant improvement in malaria for the past 10 years. >1000in malaria for the past 10 years. >1000

- Mindoro, isabela, Rizal, Zamboanga, - Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao, kalingaCagayan, Apayao, kalinga

Category BCategory B - <1000/year - <1000/year

- Ifugao, abra, mt. province, ilocos, nueva - Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan, zambales, bataan, lagunaecija, bulacan, zambales, bataan, laguna

Category CCategory C – significant reduction – significant reduction

-pampanga, la union, batangas, cavite, albay-pampanga, la union, batangas, cavite, albay

Filariasis, Elephantiasis Filariasis, Elephantiasis Lymphatic FilariasisLymphatic Filariasis

Extremely debilitating and stigmatizing Extremely debilitating and stigmatizing disease caused by PARASITIC wormdisease caused by PARASITIC worm

Affect men, women and childrenAffect men, women and children Causes extensive disability, gross Causes extensive disability, gross

disfigurement.disfigurement. CAUSATIVE AGENTCAUSATIVE AGENT: Wuchereria bancrofti : Wuchereria bancrofti

( african eye worm)( african eye worm) Only live in lymphatic systemOnly live in lymphatic system

MOTMOT : person to person by mosquito : person to person by mosquito bitebite

FILARIASISFILARIASIS

FILARIASISFILARIASIS Parasitic disease caused by an african eye Parasitic disease caused by an african eye

worm ( microscopic thread like worm)worm ( microscopic thread like worm) Wuchereria bancrofti & Brugia malayiWuchereria bancrofti & Brugia malayi Wuchereria :Camarines norte/sur , albay , Wuchereria :Camarines norte/sur , albay ,

sorsogon , quezon , masbate , mindoro , sorsogon , quezon , masbate , mindoro , romblon , marinduque , bohol , samar , leyte , romblon , marinduque , bohol , samar , leyte , palawan , sulu , tawi-tawi and basilan.palawan , sulu , tawi-tawi and basilan.

Malayi : Palawan , eastern samar , Malayi : Palawan , eastern samar , agusan ,suluagusan ,sulu

Vector: Culex, Mansonia, Anopheles, Aedes

Filariasis ( elephantiasis )

Mosquito bitesAedes poiculus , culex

faligans and anopheles flavirostris

Bites a person with lymphatic filariasis& infect the mosquito

Microscopic worms pass from mosquitoThrough the human skin, travel to LN , grow as adult

Adult worm lives for 7 yrs in lymph vesselsMate release into blood stream- microfilaria

Person infected – bitten by mosquitoTransmitted to another person

Larvae migrate to LN, reachSexual maturity & cycle is

completed

Note: a person needs Many mosquito bite

Over several months- years to getFilariasis

Note: a person needs Many mosquito bite

Over several months- years to getFilariasis

Organs affected : kidney & lymph Organs affected : kidney & lymph systemsystem Fluid collects and causes swelling in the Fluid collects and causes swelling in the

arms, breast, legs and for men arms, breast, legs and for men genitalia genitalia Swelling decrease function of lymph Swelling decrease function of lymph

systemsystem Susceptible to bacterial infectionSusceptible to bacterial infection

Skin harden and thicken Skin harden and thicken ELEPHANTIASISELEPHANTIASIS

Conjuctival filariasis Conjuctival filariasis worm migrate eye worm migrate eye cause blindness if untreated known as cause blindness if untreated known as Onchoceriasis.Onchoceriasis.

Assessment Assessment : : s/sxs/sx Chills, headache and fever between 3 months Chills, headache and fever between 3 months

and 1 year after the insect biteand 1 year after the insect bite Swelling redness and pain in arms ,legs or Swelling redness and pain in arms ,legs or

scrotumscrotum Areas of abscesses may appear as result of Areas of abscesses may appear as result of

drying worm or secondary bacterial infectiondrying worm or secondary bacterial infection Lymphadenitis. Oophoritis, orchitisLymphadenitis. Oophoritis, orchitis

DiagnosticsDiagnostics : :Nocturnal Blood smearNocturnal Blood smear Demonstration of microfiliaria in Demonstration of microfiliaria in fresh blood obtained between fresh blood obtained between 10:00 to 2:00 am10:00 to 2:00 am

Patient ‘s history must be taken Patient ‘s history must be taken and pattern of inflammation and and pattern of inflammation and signs of lymphatic obstruction signs of lymphatic obstruction must be observedmust be observed..

Blood /vector-borne

Treatment :Treatment : Drugs Drugs Ivermectin , albendazole and Ivermectin , albendazole and

DIETHYLCARBAMAZINE (DEC)- DIETHYLCARBAMAZINE (DEC)- 6mg/KBW in divided doses for 12 6mg/KBW in divided doses for 12 consecutive daysconsecutive days

Eliminate the larvaeEliminate the larvae Impairing the adult worm’s Impairing the adult worm’s

ability to reproduceability to reproduce Kill the adult worm Kill the adult worm

Surgery – excision of subcutaneous Surgery – excision of subcutaneous nodulenodule

Elephantiasis of the legs – elevate and Elephantiasis of the legs – elevate and provide elastic bandagesprovide elastic bandages

Management GuidelinesManagement Guidelines

Supportive TherapySupportive Therapy ParacetamolParacetamol Antihistamine for allergic reaction due to Antihistamine for allergic reaction due to

DECDEC Vitamin B complexVitamin B complex Elevation of infected limb, elastic stockingElevation of infected limb, elastic stocking

PREVENTIVE MEASUREPREVENTIVE MEASURE Health teachingsHealth teachings Environmental SanitationEnvironmental Sanitation

MgmtMgmt: : Environmental sanitationEnvironmental sanitation Personal HygienePersonal Hygiene Provide mosquito netsProvide mosquito nets Long sleeves, long pants & socksLong sleeves, long pants & socks Mosquito repellantMosquito repellant Take yearly dose of medicine that kills Take yearly dose of medicine that kills

worms circulating in the bloodworms circulating in the blood Screening of housesScreening of houses

Leptospirosis (Weil’s Leptospirosis (Weil’s disease)disease) Weil’s disease, Mud fever, Trench fever, Weil’s disease, Mud fever, Trench fever,

Flood fever, Spirochetal jaundice, Flood fever, Spirochetal jaundice, Japanese 7 Days fever, Leptospiral Japanese 7 Days fever, Leptospiral jaundice, Hemorrhagic jaundice, Swine jaundice, Hemorrhagic jaundice, Swine Herds disease, Canicola feverHerds disease, Canicola fever

a zoonotic systemic infection caused by a zoonotic systemic infection caused by Leptospires, that penetrate intact and Leptospires, that penetrate intact and abraded skin through exposure to water, wet abraded skin through exposure to water, wet soil contaminated with urine of infected soil contaminated with urine of infected animals.animals.

Species: Species: L. Manilae, L. Canicula, L. PyrogensL. Manilae, L. Canicula, L. Pyrogens Incubation Period: 6-15 days Incubation Period: 6-15 days

Spirochete, Leptospira Spirochete, Leptospira interrogans, gram (-)interrogans, gram (-)

Weil’s syndrome Weil’s syndrome – severe form– severe form

MOTMOT:: Contact of skin or open wound from Contact of skin or open wound from

soil water contaminated with urine soil water contaminated with urine or feces of or feces of infectedinfected ratsrats (main host) (main host)

INGESTION OF CONTAMINATED INGESTION OF CONTAMINATED FOOD/H2OFOOD/H2O

S/SX:S/SX:

Anicteric Type (without jaundice)Anicteric Type (without jaundice) manifested by fever, conjunctival infectionmanifested by fever, conjunctival infection signs of meningeal irritationsigns of meningeal irritation

Icteric Type (Weil Syndrome)Icteric Type (Weil Syndrome) Hepatic and renal manifestationHepatic and renal manifestation Jaundice, hepatomegallyJaundice, hepatomegally Oliguria, anuria which progress to renal Oliguria, anuria which progress to renal

failurefailure Shock, coma, CHFShock, coma, CHF Convalescent PeriodConvalescent Period

DiagnosisDiagnosis

Clinical history and manifestationClinical history and manifestation CultureCulture

Blood: during the 1st weekBlood: during the 1st week CSF: from the 5th to the 12th dayCSF: from the 5th to the 12th day Urine: after the 1st week until convalescent Urine: after the 1st week until convalescent

periodperiod LAAT (Leptospira Agglutination Test)LAAT (Leptospira Agglutination Test) other laboratoryother laboratory BUN,CREA, liver enzymesBUN,CREA, liver enzymes

TreatmentTreatment

SpecificSpecific Penicillin 50000 units/kg/dayPenicillin 50000 units/kg/day Tetracycline 20-40mg/kg/dayTetracycline 20-40mg/kg/day

Non-specificNon-specific Supportive and symptomaticSupportive and symptomatic Administration of fluids & Administration of fluids &

electrolyteselectrolytes Peritoneal dialysis for renal failurePeritoneal dialysis for renal failure

LEPTOSPIROSISLEPTOSPIROSIS

JAUNDICE IS A BAD PROGNOSTIC JAUNDICE IS A BAD PROGNOSTIC SIGNSIGN

CASE FATALITY RATE : 40% CASE FATALITY RATE : 40%

Blood /vector-borne

Prevention Control & Prevention Control & Nursing Considerations:Nursing Considerations:

Avoidance of exposure to urine & tissues Avoidance of exposure to urine & tissues from infected animals ( flood)from infected animals ( flood)

Rodent ControlRodent Control Hygienic control in slaughterhouses, Hygienic control in slaughterhouses,

farmyard buildings & bathing pools farmyard buildings & bathing pools Use of protective clothing & bootsUse of protective clothing & boots Primarily a disease of domesticated & wild Primarily a disease of domesticated & wild

animals transmitted via direct or indirect animals transmitted via direct or indirect contact. It enters the skin, mucus contact. It enters the skin, mucus membrane, conjunctiva, inhalationmembrane, conjunctiva, inhalation

Disease is usually short lived & mild but Disease is usually short lived & mild but severe infection can damage kidneys & liversevere infection can damage kidneys & liver

HEPATO-ENTERIC HEPATO-ENTERIC DISEASES DISEASES

GITGIT

Typhoid FeverTyphoid Fever Salmonella typhosaSalmonella typhosa, gram (-), gram (-) Carried only by humansCarried only by humansBacterial infection transmitted by Bacterial infection transmitted by

contaminated water, milk, shellfish ( oyster ) contaminated water, milk, shellfish ( oyster ) & other foods& other foods

Infection of the GIT affecting the lymphoid Infection of the GIT affecting the lymphoid tissue ( payer’s patches) of the small intestine tissue ( payer’s patches) of the small intestine

Most severe form of salmonellosis caused by Most severe form of salmonellosis caused by salmonella typhisalmonella typhi

MOTMOT: oral fecal route: oral fecal route5 F’s : Fingers, Fomites, Flies, Feces, Food & 5 F’s : Fingers, Fomites, Flies, Feces, Food &

FluidsFluids

PathophysiologyPathophysiology

Oral ingestionOral ingestion

BloodstreamBloodstream

Reticuloendothelial system (lymph node, spleen, Reticuloendothelial system (lymph node, spleen, liver)liver)

BloodstreamBloodstream

GallbladderGallbladder

Peyer’s patches of SI necrosis and Peyer’s patches of SI necrosis and ulcerationulceration

Typhoid FeverUlceration of the Peyer's Patches

Typhoid FeverTyphoid FeverClinical Manifestations:Clinical Manifestations:

Incubation Period: 1-2 weeksIncubation Period: 1-2 weeks

1. 1. ProdromalProdromal – 1 – 1stst week: Step ladder fever week: Step ladder fever 40-41 deg, headache, abdominal pain, 40-41 deg, headache, abdominal pain, GI manifestationsGI manifestations

3 cardinal signs of pyrexial stage:3 cardinal signs of pyrexial stage:

1.1.ROSEROSE SPOTSSPOTS ( irregular rashes found ( irregular rashes found on the chest, abdomen, backon the chest, abdomen, back

2. Remittent fever ( ladder like)2. Remittent fever ( ladder like)

3. Spleenomegaly3. Spleenomegaly

Typhoid FeverRose Spots

2. 2. FastidialFastidial = 2 = 2ndnd week ( Typhoid) week ( Typhoid) a. High fever, typhoid psychosis w/ a. High fever, typhoid psychosis w/

hallucination, confusion, deliriumhallucination, confusion, delirium Drug of choice: AntibioticsDrug of choice: Antibiotics

1. 1. ChloramphenicolChloramphenicol 2. Ampicillin2. Ampicillin 3. Cotrimoxazole3. Cotrimoxazole

b. Severe abdominal painb. Severe abdominal pain c Sordes typhoid statec Sordes typhoid state

1st week step ladder fever (BLOOD)1st week step ladder fever (BLOOD)

2nd week 2nd week rose spotrose spot and fastidial and fastidial typhoid psychosis (URINE & STOOL)typhoid psychosis (URINE & STOOL)

3rd week (complications) intestinal 3rd week (complications) intestinal bleeding, perforation, peritonitis, bleeding, perforation, peritonitis, encephalitis, encephalitis,

4th week (lysis) decreasing S/SX4th week (lysis) decreasing S/SX

5th week (convalescence)5th week (convalescence)

DxDx: Blood culture (: Blood culture (typhi dottyphi dot) 1st week ) 1st week

Stool and urine culture 2nd week Stool and urine culture 2nd week

Widal test Widal test

MgmtMgmt: : ChloramphenicolChloramphenicol, Amoxicillin, , Amoxicillin, Sulfonamides, Ciprofloxacin, Sulfonamides, Ciprofloxacin, CeftriaxoneCeftriaxone

** Observe standard precaution until 3 ** Observe standard precaution until 3 negative stool culture**negative stool culture**

Nursing InterventionsNursing Interventions Environmental Environmental

SanitationSanitation Food handlers Food handlers

sanitation permit sanitation permit Supportive therapySupportive therapy Assessment of Assessment of

complications (occuring complications (occuring on the 2on the 2ndnd to 3 to 3rdrd week of week of infection )infection )

- typhoid psychosis, - typhoid psychosis, typhoid meningitistyphoid meningitis

- typhoid ileitis- typhoid ileitis

Schistosomias/Snail Schistosomias/Snail Fever/Bilharziasis/KatayamaFever/Bilharziasis/Katayama

Causative agent Causative agent : : Oriental Blood Oriental Blood FlukeFluke

Schistosoma japonicum (affects Schistosoma japonicum (affects intestinal tract)intestinal tract)

S. hematobium ( affects urinary S. hematobium ( affects urinary tract) tract)

S. mansoni ( affects intestinal tract)S. mansoni ( affects intestinal tract) IPIP: 2 months : 2 months SourceSource: feces of infected persons: feces of infected persons

Dogs, pigs, cows, carabaos, monkeys, wild ratsDogs, pigs, cows, carabaos, monkeys, wild rats

serve as HOSTSserve as HOSTS

Pathogenesis- Snail fever

Larvae ( cercaria)

Penetrate skin

Work their way toLiver venous portal circulation

In portal vessel , they mature in 1-3 months

Mature worms live in copula in the portal vesselsMigrate to some part of the body

Female cercaria lays egg in the blood vesselsLarge intestine or bladder

Ulceration in the mucosaEggs able to escape in the lumenOf intestine, excreted in the feces

Some eggs carried by portalCirculation, filtered in the Liver , formed granulomas

Granulomas are resolved& replaced by fibrous tissues

Scar formation occur

Diseases progressesLiver enlarges due

To increasing fibrosis

Blood flow interruptedResult to portal hypertension

Schistosomias/Snail Schistosomias/Snail Fever/Bilharziasis/KatayamaFever/Bilharziasis/Katayama

Causative agent Causative agent : : Oriental Blood FlukeOriental Blood Fluke Schistosoma japonicum (affects Schistosoma japonicum (affects

intestinal tract)intestinal tract) S. hematobium ( affects urinary tract) S. hematobium ( affects urinary tract) S. mansoni ( affects intestinal tract)S. mansoni ( affects intestinal tract) IP: 2 months IP: 2 months

Cycle: Egg - larvae (miracidium) - intermediary Cycle: Egg - larvae (miracidium) - intermediary host (oncomelania quadrasi/tiny amphibious host (oncomelania quadrasi/tiny amphibious snail) – cercaria ( infective stage)snail) – cercaria ( infective stage)

intermediary intermediary host host (oncomelania (oncomelania quadrasi/tiny quadrasi/tiny amphibious amphibious snailsnail))

Egg - Egg - larvae larvae (miracidi(miracidiumum

Schistosomias/Snail FeverSchistosomias/Snail Fever

MOT: MOT: penetration of penetration of cercaria to the skin cercaria to the skin >parasites live in the >parasites live in the blood vessels of blood vessels of intestines>cercaria intestines>cercaria migrates to the liver migrates to the liver for maturation> gets for maturation> gets out of the liver & goes out of the liver & goes against blood flow> against blood flow> obstruction of hepatic obstruction of hepatic portal vessels> inc portal vessels> inc pressure>portal pressure>portal hpn>leads to hpn>leads to esophageal & gastric esophageal & gastric varices, varices, ascitesascites & & hepatomegalyhepatomegaly

Assessment :Assessment : Swimmer’s itch or cercarial dermattitis Swimmer’s itch or cercarial dermattitis –– itching within 24hrs after penetration itching within 24hrs after penetration of the skin by cercaria lastof the skin by cercaria last 2-3 days 2-3 days

Migratory phaseMigratory phase : sensitized individual : sensitized individual develop systemic reaction of FEVER, develop systemic reaction of FEVER, CHILLS , SWEATING , DIARRHEA , CHILLS , SWEATING , DIARRHEA , COUGH and EOSINOPHILIACOUGH and EOSINOPHILIA

Acute Phase :Acute Phase : (+) fever , generalized (+) fever , generalized lympagenopathy, hepatomegaly and lympagenopathy, hepatomegaly and splenomegaly ( KATAYAMA FEVER) 2-splenomegaly ( KATAYAMA FEVER) 2-3 weeks after initial infection and last 3 weeks after initial infection and last for 1-2 monthsfor 1-2 months

Diagnostics: Diagnostics: Fecalysis or direct stool examFecalysis or direct stool exam Kato katz technique Kato katz technique Liver and rectal biopsyLiver and rectal biopsy ELISA ( enzyme link ELISA ( enzyme link Immunosorbent Assay)Immunosorbent Assay)

COPT ( circum-oval precipitin COPT ( circum-oval precipitin test) confirmatory diagnostic testtest) confirmatory diagnostic test

Prevention :Prevention : proper disposal of feces proper disposal of feces ; snail control; snail control

Treatment:Treatment: Praziquantel for 6 Praziquantel for 6 mos POmos PO

FuadinFuadin

Prevention & Nursing Prevention & Nursing ConsiderationsConsiderations::

Wear knee rubber bootsWear knee rubber boots Avoid washing clothes or bathing in Avoid washing clothes or bathing in

streamsstreams Use potable water supplyUse potable water supply Proper & sanitary disposal of human Proper & sanitary disposal of human

fecesfeces Snail control may be undertaken by Snail control may be undertaken by

chemicals ( Niclosemide)- Molluscideschemicals ( Niclosemide)- Molluscides Annual stool exam in endemic placesAnnual stool exam in endemic places Educate people about transmissionEducate people about transmission Proper maintenance of LatrineProper maintenance of Latrine

Viral hepatitis

VIRAL HEPATITISVIRAL HEPATITIS

A diffuse inflammation of the cells of the liver A diffuse inflammation of the cells of the liver that produces liver enlargement and jaundicethat produces liver enlargement and jaundice

Hepatitis A (HAV) – fecal-oral routeHepatitis A (HAV) – fecal-oral route Hepatitis B ( HBV) – contact with body Hepatitis B ( HBV) – contact with body fluidsfluids

Hepatitis C (HCV) – percutaneous exposure Hepatitis C (HCV) – percutaneous exposure to blood ( non A non B)to blood ( non A non B)

Hepatitis D (HDV)- contact with body fluidsHepatitis D (HDV)- contact with body fluids Hepatitis E (HEV) – water , fecal-oral routeHepatitis E (HEV) – water , fecal-oral route

VIRAL HEPATITISVIRAL HEPATITISHAVHAV HBVHBV HCVHCV HDVHDV HEVHEV

IPIP 15-50d15-50d 45-180d45-180d 14-182d14-182d 14-70d14-70d 15-64d15-64d

MOTMOT Fecal Fecal oraloral

ParenteralParenteral

PercutaneoPercutaneousus

placentalplacental

Blood Blood transfusitransfusionon

Same w/ Same w/ BB

Fecal Fecal oraloral

commcommunicabunicabilityility

Till 1 Till 1 wk after wk after onset of onset of jaundicjaundicee

During IPDuring IP

Entire Entire clinical clinical coursecourse

Years if Years if carriercarrier

As As carrier- carrier- indefinite indefinite

1 wk 1 wk before before clinical clinical onset onset

ThroughThroughout out clinical clinical diseasedisease

UnknowUnknown n

Virus infect liver-interlobular infiltration

Necrosis and hyperplasia of kuffer cells

Failure of the bile to reach intestine in normalamount

Obstructed jaundice s/sx: dark urine, pale feces, itchness

Liver cell damageNecrosis and autolytic type destroy

parenchyma

VIRAL HEPATITISVIRAL HEPATITIS AssessmentAssessment : : s/sxs/sx

Prodromal / PreictericProdromal / Preicteric SS – symptoms of URTI – symptoms of URTI WW – weight loss – weight loss AA – anorexia , chills , fever – anorexia , chills , fever RR – right upper quadrant pain – right upper quadrant pain MM – malaise – malaise

IctericIcteric JJ – jaundice – jaundice AA – acholic tool – acholic tool BB – bile colored urine ( tea – bile colored urine ( tea colored)colored)

Laboratory :Laboratory : Liver function testLiver function test SGPT/SGOTSGPT/SGOT Specific : the presence of IgM antibody Specific : the presence of IgM antibody

Hepatitis A Hepatitis A IgM HAV IgM HAV Hepatitis B Hepatitis B HbsAgHbsAg – acute or chronic – acute or chronic

infectedinfected Anti-HBsAnti-HBs – resolved or immunity – resolved or immunity HbeAg HbeAg – infected risk of – infected risk of

transmittingtransmitting Anti-HBeAnti-HBe – lower risk of – lower risk of

transmittingtransmitting Anti-HBcAnti-HBc – acute resolved or – acute resolved or

chronic chronic HBV infection HBV infection IgM anti-HBcIgM anti-HBc – acute with – acute with

recent HBV infection “ window phase “ recent HBV infection “ window phase “ Enteric fever

VIRAL HEPATITISVIRAL HEPATITIS

Analysis Analysis Knowledge deficit related to unfamiliarity Knowledge deficit related to unfamiliarity

with the disease course and treatment with the disease course and treatment Activity intolerance related to decreased Activity intolerance related to decreased

metabolism of nutrient / increased basal metabolism of nutrient / increased basal metabolic rate caused by viral infectionmetabolic rate caused by viral infection

High risk for Diversional activity deficit High risk for Diversional activity deficit secondary to isolation / lack of energysecondary to isolation / lack of energy

High risk for altered body nutrition : less High risk for altered body nutrition : less than body requirement secondary to than body requirement secondary to anorexiaanorexia

VIRAL HEPATITISVIRAL HEPATITIS

Treatment Treatment No specific treatmentNo specific treatment Bed rest essentialBed rest essential Diet : high carbohydrate , low fat , low Diet : high carbohydrate , low fat , low

proteinprotein Vitamin supplement ( B complex)Vitamin supplement ( B complex)

VIRAL HEPATITISVIRAL HEPATITIS

Nursing MgtNursing Mgt Isolation of patient ( enteric isolation)Isolation of patient ( enteric isolation) Standard precautionStandard precaution Patient should be encouraged to rest during Patient should be encouraged to rest during

acute or symptomatic phaseacute or symptomatic phase Improved nutritional statusImproved nutritional status Utilize appropriate measures to minimize Utilize appropriate measures to minimize

spread of the diseasespread of the disease

VIRAL HEPATITISVIRAL HEPATITIS Nursing MgtNursing Mgt

Observe patient for Melena and check stool for the Observe patient for Melena and check stool for the presence of bloodpresence of blood

Provide optimum i and oral careProvide optimum i and oral care Increase in ability to carry out activitiesIncrease in ability to carry out activities

Encourage the patient to limit activity when fatiguedEncourage the patient to limit activity when fatigued Assist the client in planning period of rest and activityAssist the client in planning period of rest and activity Encourage gradual resumption of activities and mild exercise during Encourage gradual resumption of activities and mild exercise during

recoveryrecovery

PREVENTION AND CONTROLPREVENTION AND CONTROL Handwashing every after use of toiletHandwashing every after use of toilet Travelers should avoid water and ice if unsure of their Travelers should avoid water and ice if unsure of their

puritypurity Educate on the mode of transmission of the disease.Educate on the mode of transmission of the disease.

ERUPTIVE FEVERERUPTIVE FEVER

MEASLESMEASLES

Extremely contagiousExtremely contagious Breastfed babies of mothers have 3 Breastfed babies of mothers have 3

months immunity for measlesmonths immunity for measles The most common complication is The most common complication is

otitis mediaotitis media The most serious complications are The most serious complications are

pneumonia and encephalitis pneumonia and encephalitis

Measles, Rubeola, Morbili, Measles, Rubeola, Morbili, 7 Day Fever, Hard Red 7 Day Fever, Hard Red

Measles, Measles, RNA, ParamyxoviridaeRNA, Paramyxoviridae Measles virus is rapidly inactivated by heat, Measles virus is rapidly inactivated by heat,

UV light, & extreme degrees of acidity & UV light, & extreme degrees of acidity & alkalinityalkalinity

Active immunity (MMR and Measles vaccine) Active immunity (MMR and Measles vaccine) Passive immunity (Measles immune globulin)Passive immunity (Measles immune globulin) Lifetime ImmunityLifetime Immunity

IP: 8-12 daysIP: 8-12 days

MOT: Direct ( droplets, airborne); Indirect MOT: Direct ( droplets, airborne); Indirect ( fomites)( fomites)

*Contagious 1-2 days before rash and 4 days *Contagious 1-2 days before rash and 4 days after the appearance of rashafter the appearance of rash

Sources of InfectionSources of Infection:: Patient’s bloodPatient’s blood Secretions from the eyes, nose & Secretions from the eyes, nose &

throatthroat

Diagnostics:Diagnostics: Nose & throat swabNose & throat swab UrinalysisUrinalysis Blood exams ( CBC, leukopenia, Blood exams ( CBC, leukopenia,

leukocytosis)leukocytosis)

Rashes:Rashes: maculopapaular,maculopapaular, cephalocaudalcephalocaudal (hairline and behind (hairline and behind the ears to trunk and the ears to trunk and limbs), confluent, limbs), confluent, desquamation, desquamation, pruritus)pruritus)

Clinical manifestationsClinical manifestations::

1. 1. Pre-eruptive stage:Pre-eruptive stage: (2-4 days) - malaise, cough, (2-4 days) - malaise, cough,

conjunctivitis, , fever,conjunctivitis, , fever, kopliks kopliks spotsspots ( ( PATHOGNOMONIC SIGNPATHOGNOMONIC SIGN)) (1-2 mm (1-2 mm blue white spots on red background blue white spots on red background along 2along 2ndnd molars), stimsons ( puffiness molars), stimsons ( puffiness of eyelid) photophobia of eyelid) photophobia

2. 2. Eruptive stage:Eruptive stage:Rash is usually seen late on the 4Rash is usually seen late on the 4thth day dayMaculo-papular rash Maculo-papular rash 3. 3. Stage of convalescenceStage of convalescence::Rashes fade away, desquamation Rashes fade away, desquamation

begins,fever subsidesbegins,fever subsidesCx: pneumonia, meningitis, Cx: pneumonia, meningitis,

MEASLESMEASLES

Fever persist Fever persist means (+) means (+) complication complication Bronchopneumonia- most commonBronchopneumonia- most commonOtitis media, reactivation of Otitis media, reactivation of previous TBprevious TB

Bronchitis, laryngitis, Bronchitis, laryngitis, exacerbation malnutritionexacerbation malnutrition

EncephalitisEncephalitis

MEASLESMEASLES

Diagnostic procedureDiagnostic procedure Physical examinationPhysical examination Nose and throat swabNose and throat swab UrinalysisUrinalysis CBC ( leukopenia & leukocytosis)CBC ( leukopenia & leukocytosis) Complement fixation or hemogglutinin testComplement fixation or hemogglutinin test

Eruptive fever

MANAGEMENTMANAGEMENT1.1. SupportiveSupportive2.2. HydrationHydration3.3. Proper nutritionProper nutrition4.4. Vitamin AVitamin A5.5. Antibiotics – if w/ Antibiotics – if w/

secondary secondary bacterial infectionbacterial infection

6.6. Vaccine- measles Vaccine- measles vaccine @ 9 mos vaccine @ 9 mos and MMR @ 15 and MMR @ 15 mosmos

7.7. Anti viral drugs Anti viral drugs ( Isoprenosine)( Isoprenosine)

Observe respiratory Isolation

Nursing CareNursing Care Isolation of the patient if necessaryIsolation of the patient if necessary TSB for feverTSB for fever Skin care is of utmost importance. The pt. Skin care is of utmost importance. The pt.

should have a daily cleansing bed bath. should have a daily cleansing bed bath. Oral & nasal hygiene is a very important Oral & nasal hygiene is a very important

aspect of nursing care of patients with aspect of nursing care of patients with measlesmeasles

Restrict to quiet environmentRestrict to quiet environment Dim light if photophobia is present; care Dim light if photophobia is present; care

of the eyes is necessaryof the eyes is necessary Administer antipyreticAdminister antipyretic Use cool mist vaporizer for coughUse cool mist vaporizer for cough

German Measles, Rubella, German Measles, Rubella, Rotheln Disease, 3 Day Rotheln Disease, 3 Day

MeaslesMeasles = contagious viral disease characterized by = contagious viral disease characterized by

fever, URTI, arthralgia, fever, URTI, arthralgia, DIFFUSEDDIFFUSED fine red fine red maculopapular rash)maculopapular rash)

CA - RNA, rubella virus ( Togaviridae)CA - RNA, rubella virus ( Togaviridae) Immunity: Active natural ( permanent or Immunity: Active natural ( permanent or

lifetime)lifetime) Active immunity - rubella vaccine and MMRActive immunity - rubella vaccine and MMR Passive immunity - gammaglobulinPassive immunity - gammaglobulin Period of communicability – contagious 7 Period of communicability – contagious 7

days before & 7 days after appearance of days before & 7 days after appearance of rash & probably during the catarrhal stagerash & probably during the catarrhal stage

German Measles, Rubella, German Measles, Rubella, Rotheln Disease, 3 Day MeaslesRotheln Disease, 3 Day Measles

IP: 14-21 daysIP: 14-21 days

MOT: Direct contact: droplets spread MOT: Direct contact: droplets spread through the nasopharynxthrough the nasopharynx

Indirect contact: transplacentalIndirect contact: transplacental

** Highly communicable infant may shed virus for months after birth**

RashesRashes: : Maculopapular, Maculopapular, Diffuse/not Diffuse/not confluent, confluent, No No desquamation,desquamation, spreads from the spreads from the face downwardsface downwards

Clinical ManifestationsClinical Manifestations::> > FORSCHEIMER’S SPOTSFORSCHEIMER’S SPOTS (petecchial (petecchial lesion on buccal cavity or soft palate)lesion on buccal cavity or soft palate)> oval, rose red papule about the size of > oval, rose red papule about the size of pin headpin head> cervical lymphadenopathy,> cervical lymphadenopathy,> low grade fever> low grade fever

Dx:Dx: clinical clinicalCXCX: rare; pneumonia, meningoencephalitis: rare; pneumonia, meningoencephalitisCX to pregnant womenCX to pregnant women:: 1st tri-congenital anomalies 1st tri-congenital anomalies

( microcephaly, heart defects, cataracts, ( microcephaly, heart defects, cataracts, deafnessdeafness

2nd tri-abortion or bleeding2nd tri-abortion or bleeding 3rd tri-pre mature delivery3rd tri-pre mature delivery

Nursing Considerations:Nursing Considerations: MMR immunization MMR immunization Use of immunoglobulins ( IG’s)- Use of immunoglobulins ( IG’s)-

ppost exposure prophylaxis – 72 hrs ppost exposure prophylaxis – 72 hrs after exxposureafter exxposure

Prevention of congenital measlesPrevention of congenital measles Avoid exposureAvoid exposure

Roseola Infantum, Roseola Infantum, Exanthem Subitum, Sixth diseaseExanthem Subitum, Sixth disease Human herpes virus 6Human herpes virus 6 3mos-4 yo, peak 6-24 mos3mos-4 yo, peak 6-24 mos

MOT: probably respiratory secretionsMOT: probably respiratory secretions

S/sx: Spiking fever w/c subsides 2-3 days, S/sx: Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear after fever Face and trunk rashes appear after fever subsides, Mild pharyngitis and lymph subsides, Mild pharyngitis and lymph node enlargementnode enlargement

Mgmt: symptomaticMgmt: symptomatic

Most highly contagious childhood Most highly contagious childhood diseasedisease

Affects adults more severely than Affects adults more severely than childrenchildren

Virus may become dormantVirus may become dormant

Chicken Pox, VaricellaChicken Pox, Varicella Acute & highly contagious disease of viral Acute & highly contagious disease of viral

etiologyetiology Childhood disease & adolescents (adults – Childhood disease & adolescents (adults –

more severe) Not common in infancymore severe) Not common in infancy Locally called “ Bulutong”Locally called “ Bulutong” Human beings are the only source of Human beings are the only source of

infectioninfection CACA = Varicella Zoster virus, Herpes virus = Varicella Zoster virus, Herpes virus IPIP – 10-21 days – 10-21 days MOTMOT: droplet spread: droplet spread

> nose & throat secretions> nose & throat secretions > Vesicles ( contagious in early > Vesicles ( contagious in early

stage of eruptionstage of eruption > Airborne> Airborne

Prodromal periodProdromal period: : headache , vomiting, headache , vomiting, feverfever

Papulovesicular rashes appear on Papulovesicular rashes appear on trunk trunk spreading to face and spreading to face and extremties ( centrifugal)extremties ( centrifugal)

MaculesMacules papules papules vesicles with vesicles with clear fluid insideclear fluid inside crusting and scar crusting and scar formationformation

The disease is communicable until the The disease is communicable until the last crust disappear ( D1 before D6 last crust disappear ( D1 before D6 after appearance of rashes)after appearance of rashes)

Rashes:Rashes: MaculopapulovesiMaculopapulovesicular (covered cular (covered areas), areas), Centrifugal Centrifugal rash distributionrash distribution, , starts on face and starts on face and trunk and spreads trunk and spreads to entire bodyto entire body

Leaves a pitted Leaves a pitted scar (scar (pockmarkpockmark))

Period of Communicability – 5 days before rashes & 5 days after rashes – crusting - dry

CXCX = secondary bacterial infection, = secondary bacterial infection, furunculosis, pneumonia, furunculosis, pneumonia, meningoencephalitis ( rare)meningoencephalitis ( rare)

Dormant: remain at the dorsal root Dormant: remain at the dorsal root ganglion and may recur as shingles ganglion and may recur as shingles (VZV)(VZV)

Curative & Nursing Curative & Nursing Considerations:Considerations:

If it feels itchy, give oral antihistamine If it feels itchy, give oral antihistamine or local antihistamineor local antihistamine

Avoid rupture of lesionsAvoid rupture of lesions Cut nails shortCut nails short Pay attention to nasopharyngeal Pay attention to nasopharyngeal

secretions/ dischargessecretions/ discharges Disinfection of linen ( sunlight or Disinfection of linen ( sunlight or

boiling)boiling) Prophylactic antibioticsProphylactic antibiotics

Tepid water and wet compresses for Tepid water and wet compresses for prurituspruritus

Soothing Baths, cool bathsSoothing Baths, cool baths

Treatment: Treatment: a. oral acyclovir a. oral acyclovir

b. Tepid water and wet compresses b. Tepid water and wet compresses for pruritusfor pruritus

c. Potassium Permanganate (ABO)c. Potassium Permanganate (ABO)

a. Astringent effecta. Astringent effect

b. Bactericidal effectb. Bactericidal effect

c. Oxidizing effect (deodorize the c. Oxidizing effect (deodorize the rash)rash)

Exclusion from school for 1 week Exclusion from school for 1 week after eruption appearsafter eruption appears

An attack gives lifetime immunity. An attack gives lifetime immunity. Second attack is rareSecond attack is rare

Immunoglobulins can be given ( 12 Immunoglobulins can be given ( 12 mos)mos)

Drug of choice: Acyclovir ( Zovirax ) Drug of choice: Acyclovir ( Zovirax ) – topical cream applied to crusts– topical cream applied to crusts

Preventive measuresPreventive measures Active immunization with Active immunization with LIVE LIVE

ATTENUATED VARICELLA VACCINEATTENUATED VARICELLA VACCINE Start at 1 yr old ( 1 dose )Start at 1 yr old ( 1 dose ) booster – 4-12ybooster – 4-12y If >13 yrs = 2 dosesIf >13 yrs = 2 doses Given SCGiven SC

Avoid exposure as much as possible Avoid exposure as much as possible to infected personto infected person

Small Pox, VariolaSmall Pox, Variola DNA, Pox virusDNA, Pox virus Last case 1977Last case 1977 spreads from man-to-spreads from man-to-

man onlyman only Active: Vaccinia pox virus Active: Vaccinia pox virus

IP: 1-3 weeksIP: 1-3 weeks

S/sx:S/sx:

Rashes:Rashes:

MaculopapulovesiculopustMaculopapulovesiculopustularular

Centripetal rash distributionCentripetal rash distribution contagious until all crusts contagious until all crusts

disappeareddisappeared

SMALL POXSMALL POX Complications:Complications:

ScarringScarring PneumoniaPneumonia BlepharitisBlepharitis Corneal ulcerationCorneal ulceration

Mortality rate : 30%Mortality rate : 30% Diagnostic : clinical evaluationDiagnostic : clinical evaluation Treatment : analgesic ( pain) Treatment : analgesic ( pain)

antibiotic for secondary infectionantibiotic for secondary infection

SMALL POXSMALL POX

Nursing mgtNursing mgt Strict respiratory and contact isolation Strict respiratory and contact isolation SupportiveSupportive Adequate hydrationAdequate hydration Mandatory reportingMandatory reporting

PREVENTIONPREVENTION Pre-exposure vaccinationPre-exposure vaccination Strict isolation of identified casesStrict isolation of identified cases

Respiratory DiseasesRespiratory Diseases

MeningococcemiaMeningococcemia

CA : CA : Neisseria meningitidesNeisseria meningitides ( bacteria) gram (-)diplococci( bacteria) gram (-)diplococci

May also be caused by H. Influenzae May also be caused by H. Influenzae and S. Pneumoniae and S. Pneumoniae

MOT: Droplets (urti) to blood stream to MOT: Droplets (urti) to blood stream to CNSCNS

IP: 1-2 days ( even faster)IP: 1-2 days ( even faster) High risk: immunocompromisedHigh risk: immunocompromised

S/sx: S/sx: 1.1. Meningococcemia – usually starts as Meningococcemia – usually starts as

nasopharyngitisnasopharyngitis, followed by sudden onset of , followed by sudden onset of spiking fever, chills, arthralgiaspiking fever, chills, arthralgia. Bacteria is . Bacteria is carried by circulation & when it reaches the carried by circulation & when it reaches the meninges of the brain, meninges of the brain, BLEEDINGBLEEDING occurs into occurs into the medulla which extends to the cortex & the medulla which extends to the cortex & petechial, purpuric or ecchymotic hemorrhage petechial, purpuric or ecchymotic hemorrhage is scattered in the entire body surface appear. is scattered in the entire body surface appear.

2.2. Fulminant Meningococcemia (Waterhouse Fulminant Meningococcemia (Waterhouse Friedrichsen) – septic shock; hypotension, Friedrichsen) – septic shock; hypotension, tachycardia, enlarging petecchial rash, tachycardia, enlarging petecchial rash, adrenal insufficiencyadrenal insufficiency

Clinical ManifestationClinical Manifestation sudden onset of high grade fever, rash sudden onset of high grade fever, rash

and rapid deterioration of clinical and rapid deterioration of clinical condition within 24 hourscondition within 24 hours

Meningococcal SepticemiaWaterhouse-friedrichsen Syndrome

Treatment:Treatment: antimicrobial antimicrobial

Benzyl Penicillin 250-400000 u/kg/day Benzyl Penicillin 250-400000 u/kg/day ( drug of choice)( drug of choice)

Chloramphenicol 100mg/kg/dayChloramphenicol 100mg/kg/day

Symptomatic and supportiveSymptomatic and supportive feverfever seizuresseizures hydrationhydration respiratory functionrespiratory function

ChemoprophylaxisChemoprophylaxis Rifampicin 300-600mg q 12hrs x 4 dosesRifampicin 300-600mg q 12hrs x 4 doses Ofloxacin 400mg single doseOfloxacin 400mg single dose Ceftriaxone 125-250mg IM single dose Ceftriaxone 125-250mg IM single dose

( Ciprobay)( Ciprobay)

Nursing InterventionNursing Intervention1. To prevent the occurrence of further 1. To prevent the occurrence of further

complicationscomplications -maintain strict surgical aseptic technique -maintain strict surgical aseptic technique

when doing dressings or lumbar puncture in when doing dressings or lumbar puncture in order to prevent the spread of order to prevent the spread of microorganismmicroorganism

-administer O2 inhalation to prevent -administer O2 inhalation to prevent respiratory distress and to maintain a clear respiratory distress and to maintain a clear open airwayopen airway

-TSB for fever to prevent convulsions-TSB for fever to prevent convulsions -observe signs and symptoms of increase -observe signs and symptoms of increase

intracranial pressureintracranial pressure -change positions at least every 2 hours to -change positions at least every 2 hours to

prevent pressure soreprevent pressure sore -protect the eyes from bright lights and noise-protect the eyes from bright lights and noise

2. Maintain normal amount of fluid and 2. Maintain normal amount of fluid and electrolyte balanceelectrolyte balance

3. Prevent spread of the disease, 3. Prevent spread of the disease, prophylaxis for close contacts prophylaxis for close contacts ( Rifampicin )( Rifampicin )

4. Ensure the patients full comfort, 4. Ensure the patients full comfort, prevent stress provoking factors that prevent stress provoking factors that may retard convalescence and to may retard convalescence and to prevent from injuryprevent from injury

5. Prevent the spread of infection, 5. Prevent the spread of infection, microorganisms and contamination microorganisms and contamination some precautions should be carried outsome precautions should be carried out

6. Maintain personal hygiene and 6. Maintain personal hygiene and cleanliness and avoid cleanliness and avoid microorganisms to harbor in the microorganisms to harbor in the patients bodypatients body

7. Maintain proper elimination of 7. Maintain proper elimination of waste product of metabolismwaste product of metabolism

8. Nutritional intake8. Nutritional intake

DiphtheriaDiphtheria CA:CA: Corynebacterium diphtheriae, gram (+)Corynebacterium diphtheriae, gram (+)

( Klebs Loeffler’s Bacillus)( Klebs Loeffler’s Bacillus) IP:IP: 2-5 days2-5 days Period of CommunicabilityPeriod of Communicability: 2-4 wks if untreated, : 2-4 wks if untreated,

1-2 days if treated1-2 days if treated Active (DPT) and Active (DPT) and

Passive Immunization Passive Immunization (Diphtheria antitoxin)(Diphtheria antitoxin)

Source:Source: Discharges of the nose, pharynx, eyes, or Discharges of the nose, pharynx, eyes, or lesion of other parts of the body infectedlesion of other parts of the body infected

More severe in unimmunized and partially More severe in unimmunized and partially immunizedimmunized

MOTMOT: Direct/indirect contact = Airborne/droplet, : Direct/indirect contact = Airborne/droplet, fomites fomites

Toxin – producing organism = Toxin – producing organism = EXOTOXINEXOTOXIN1. Nasal – invades nose by extension from 1. Nasal – invades nose by extension from

pharynxpharynx2. Tonsillar – low fatality rate2. Tonsillar – low fatality rate3. NasoPharygeal- more severe type3. NasoPharygeal- more severe type - sore throat causing dysphagia- sore throat causing dysphagia - - PseudomembranePseudomembrane in uvula, tonsils, soft in uvula, tonsils, soft

palate – gray exudatepalate – gray exudate - - BullneckBullneck – inflammation of cervical LN; – inflammation of cervical LN;

neck tissues are edematousneck tissues are edematous - increasing hoarseness until aphonia- increasing hoarseness until aphonia - wheezing on expiration- wheezing on expiration - dyspnea- dyspnea

4. Cutaneous diphtheria affect 4. Cutaneous diphtheria affect mucous membrane & any break on mucous membrane & any break on the skinthe skin

S/sx: sore throat, S/sx: sore throat, fever, “fever, “Bull-neck Bull-neck appearanceappearance”( CHA”( CHARACTERISTIC RACTERISTIC SIGN) SIGN) ,Pseudome,Pseudomembrane-mbrane-( PATHOGNOMON( PATHOGNOMONIC SIGN) gray IC SIGN) gray exudate, foul exudate, foul breath, massive breath, massive swelling of tonsils swelling of tonsils and uvula, thick and uvula, thick speech, cervical speech, cervical lymphadenopathy, lymphadenopathy, swelling of swelling of submandibular and submandibular and anterior neck), anterior neck), obstruction of obstruction of respiratory tractrespiratory tract

Dx: Dx: 1.Schick test 1.Schick test -- susceptibility to susceptibility to diphtheria toxindiphtheria toxin

2. Moloney2. Moloney - - sensitivity to sensitivity to diphtheria toxoiddiphtheria toxoid

3. Throat swab3. Throat swab (K tellurite and (K tellurite and Loeffler’s Loeffler’s coagulated blood coagulated blood serumserum

TreatmentTreatment

Neutralize the toxins – antidiptheria serumNeutralize the toxins – antidiptheria serum Kill the microorganism – penicillin, Kill the microorganism – penicillin,

erythromycin, rifampicin, clindamycinerythromycin, rifampicin, clindamycin Considered cured after 3 negative throat Considered cured after 3 negative throat

culturescultures Prevent respiratory obstruction – Prevent respiratory obstruction –

tracheostomy, intubationtracheostomy, intubation CBR up to 2 weeks to prevent myocarditisCBR up to 2 weeks to prevent myocarditis Strict isolationStrict isolation

Nursing interventionNursing intervention Strict isolation of the hospitalized childStrict isolation of the hospitalized child Administer anti-toxinAdminister anti-toxin Supportive Supportive

Maintenance of adequate nutritionMaintenance of adequate nutrition Encouraged drinks rich in vitamin CEncouraged drinks rich in vitamin C

Maintenance of adequate fluid and electrolytesMaintenance of adequate fluid and electrolytes Bed rest – for at least 2 weeksBed rest – for at least 2 weeks

Avoid exertionAvoid exertion Ice collar must be applied to the neckIce collar must be applied to the neck Nose and throat must be taken care of Nose and throat must be taken care of Administer antibiotics as prescribedAdminister antibiotics as prescribed

Penicillin – effective for respiratory diphtheriaPenicillin – effective for respiratory diphtheria

DPT- 0.5 ml IMDPT- 0.5 ml IM

1 - 1 ½ months old1 - 1 ½ months old2 - after 4 weeks2 - after 4 weeks3 - after 4 weeks3 - after 4 weeks

11stst booster – 18 mos booster – 18 mos

22ndnd booster – 4-6 yo booster – 4-6 yo

subsequent booster – every 10 yrs thereaftersubsequent booster – every 10 yrs thereafter Household contacts Household contacts

(+) primary immunization and (-) culture - (+) primary immunization and (-) culture - booster dosebooster dose

(+) culture and (-) immunization – treated as a (+) culture and (-) immunization – treated as a case of Diptheriacase of Diptheria

Pre exposure prophylaxis for Pre exposure prophylaxis for Diphtheria, Pertussis, TetanusDiphtheria, Pertussis, Tetanus

ComplicationsComplications

MyocarditisMyocarditis – most common ( caused – most common ( caused by diphtheria toxin on the heart by diphtheria toxin on the heart muscles)muscles)

PolyneuritisPolyneuritis – paralysis of the soft – paralysis of the soft palate, paralysis of the ciliary palate, paralysis of the ciliary muscle of the eye, pharyns, larynx, muscle of the eye, pharyns, larynx, or extremitiesor extremities

Airway obstruction can lead to death Airway obstruction can lead to death through asphyxiationthrough asphyxiation

Pertussis/ Whooping CoughPertussis/ Whooping Cough Bordetella pertussisBordetella pertussis, B. parapertussis, , B. parapertussis,

B. bronchiseptica, gram (-)B. bronchiseptica, gram (-) Pertussis toxin, tracheal cytotoxin, Pertussis toxin, tracheal cytotoxin,

“ “ Bordet Gengou BacillusBordet Gengou Bacillus”” Common in Infants and young Common in Infants and young

children & fatal to toddlerschildren & fatal to toddlers

IP: 5-21 daysIP: 5-21 days

MOT: airborne/droplet; direct contact MOT: airborne/droplet; direct contact ( nose & throat secretions); indirect ( nose & throat secretions); indirect contact ( articles)contact ( articles)

S/sx: S/sx: 1.1. Catarrhal stageCatarrhal stage (1-2 wks; highly contagious) – sneezing, (1-2 wks; highly contagious) – sneezing,

runny nose,tearing lacrimation, mild cough, low grade runny nose,tearing lacrimation, mild cough, low grade feverfever

2.2. Paroxysmal stageParoxysmal stage (2-4 wks) - Clusters of cough that ends (2-4 wks) - Clusters of cough that ends with a with a whoopwhoop, vomiting, exhaustion, vomiting, exhaustion

3.3. Convalescent stageConvalescent stage (2-3 wks) – less frequent cough (2-3 wks) – less frequent cough

Dx: WHO - >21 days cough + close contact w/ pertussis px + Dx: WHO - >21 days cough + close contact w/ pertussis px + (+) culture OR rise in Ab to FHA or pertussis toxin(+) culture OR rise in Ab to FHA or pertussis toxin

* throat culture w/ Bordet gengou agar* throat culture w/ Bordet gengou agar

Cx: bronchopneumonia, pneumoniaCx: bronchopneumonia, pneumoniaManagement:Management: liquefy thick secretions with liquefy thick secretions with

Ferrous iodideFerrous iodide CBRCBR Warm fresh air is better than Warm fresh air is better than

cold air w/c induces vomiting cold air w/c induces vomiting ( NO AIRCON)( NO AIRCON)

Hydration and nutritionHydration and nutrition Vit C to inc body resistanceVit C to inc body resistance Oxygen ( 1-2L/min)- to lessen the Oxygen ( 1-2L/min)- to lessen the

occurrence of paroxysmoccurrence of paroxysm Erythromycin or AmpicillinErythromycin or Ampicillin Isolation = 4 wks after coughing Isolation = 4 wks after coughing

begins & continued for 7 days begins & continued for 7 days after the onset of antiobiotic after the onset of antiobiotic therapytherapy

DPT- 0.5 ml IMDPT- 0.5 ml IM 1 - 1 ½ months old1 - 1 ½ months old

2 - after 4 weeks2 - after 4 weeks3 - after 4 weeks3 - after 4 weeks

11stst booster – 18 mos booster – 18 mos 22ndnd booster – 4-6 yo booster – 4-6 yo subsequent booster – every 10 yrs subsequent booster – every 10 yrs

thereafterthereafter Household contacts Household contacts

(+) primary immunization and (-) culture - (+) primary immunization and (-) culture - booster dosebooster dose(+) culture and (-) immunization – treated (+) culture and (-) immunization – treated as a case of Diphtheriaas a case of Diphtheria

Pre exposure prophylaxis for Pre exposure prophylaxis for Diphtheria, Pertussis, TetanusDiphtheria, Pertussis, Tetanus

Pulmonary Pulmonary Tuberculosis( Koch’s Tuberculosis( Koch’s

Disease/Pthisis/Consumption Disease/Pthisis/Consumption disease)disease) CACA: Mycobacterium tuberculosis : Mycobacterium tuberculosis

( bacteria), acid fast bacilli( bacteria), acid fast bacilli The organism multiplies slowly & is The organism multiplies slowly & is

characterized as acid fast aerobic characterized as acid fast aerobic organism which can be killed by organism which can be killed by heat, heat, sunshine, drying & ultraviolet light.sunshine, drying & ultraviolet light.

Sputum of persons with TB is the most Sputum of persons with TB is the most common source of the organism spread common source of the organism spread through droplet ( airborne)through droplet ( airborne)

Pott’s disease – thoracolumbarPott’s disease – thoracolumbar Milliary TB – kidney, liver, lungsMilliary TB – kidney, liver, lungs

- Is a chronic, or subacute or acute Is a chronic, or subacute or acute respiratory disease commonly affecting respiratory disease commonly affecting the lungs characterized by formation of the lungs characterized by formation of tubercles in the tissues which tend to tubercles in the tissues which tend to undergo caseation, necrosis and undergo caseation, necrosis and calcificationcalcification. .

IP: IP: 2 – 10 weeks2 – 10 weeks

Mode of TransmissionMode of Transmission:: Direct: droplet ( sneezing, coughing)Direct: droplet ( sneezing, coughing) Indirect: continuous exposure to Indirect: continuous exposure to

infected persons within the familyinfected persons within the family

Source of Infection:Source of Infection:sputum, blood from sputum, blood from hemoptysis, nasal discharges and salivahemoptysis, nasal discharges and saliva

Classification :Classification : Minimal – slight lesionMinimal – slight lesion Moderately advanced – one or both Moderately advanced – one or both

lung may be involvedlung may be involved Far advanced- more extensiveFar advanced- more extensive

Clinical classificationClinical classification:: 1. inactive TB1. inactive TB

Symptoms absentSymptoms absent Sputum negativeSputum negative CXR – no evidence of cavityCXR – no evidence of cavity

2. Active2. Active Tuberculin test positiveTuberculin test positive CXR – progressiveCXR – progressive (+) of symptoms(+) of symptoms Sputum (+)Sputum (+)

3. Activity not determined3. Activity not determined

Clinical manifestationClinical manifestation:: Afternoon rise of temperature for 1 Afternoon rise of temperature for 1

mo. or moremo. or more Night sweatingNight sweating Body malaise, weight lossBody malaise, weight loss Cough, dry to productiveCough, dry to productive Dyspnea, horseness of voiceDyspnea, horseness of voice Hemoptysis – pathognomonicHemoptysis – pathognomonic Occasional chest painOccasional chest pain (+) sputum for AFB(+) sputum for AFB

PD 996 – Compulsory Immunization PD 996 – Compulsory Immunization below 8 yearsbelow 8 years

( 0 -7 yrs)( 0 -7 yrs)Proclamation # 6 WHO – Universal Child Proclamation # 6 WHO – Universal Child

ImmunizationImmunization

Etiologic Factors that contribute Etiologic Factors that contribute heavily to the high Incidence & high heavily to the high Incidence & high mortality rate of TB:mortality rate of TB:

Poverty / Overcrowded homesPoverty / Overcrowded homes Protein undernutritionProtein undernutrition Deficiencies in Vit A,D,CDeficiencies in Vit A,D,C Children below 5 years old – prone Children below 5 years old – prone

to infection due to inadequate levels to infection due to inadequate levels of immunityof immunity

PathophysiologyPathophysiology InhalationInhalation

Local infiltration of neutrophils and macrophageLocal infiltration of neutrophils and macrophage

Multiply and survive in macrophageMultiply and survive in macrophage

Destroy bacteria Destroy bacteria

present it to T helper cells in LNpresent it to T helper cells in LN

Sensitized T cells searches bacteria and release lymphokinesSensitized T cells searches bacteria and release lymphokines

Attract macrophages w/c attack bacteria caseous Attract macrophages w/c attack bacteria caseous necrosisnecrosis

bacteria bacteria dormantdormant

If reactivated, If reactivated, Secondary TBSecondary TB

Heal w/ fibrosis, calcification and granuloma; Primary TB

DXDX

1. Case Finding1. Case Finding::A. A. Sputum MicroscopySputum Microscopy ( cheapest & ( cheapest &

confirmatory )confirmatory ) Results take about 3 weeks to confirmResults take about 3 weeks to confirm Sputum sample shld be taken 1Sputum sample shld be taken 1stst thing thing

in the morning upon arisingin the morning upon arising3 specimens:3 specimens: 11stst – on the spot = HC – on the spot = HC 22ndnd- upon arising = Home- upon arising = Home 33rdrd – on the spot = HC – on the spot = HC

2. Sputum Culture & Sensitivity2. Sputum Culture & Sensitivity 3. Chest X-ray – cavitary lesion3. Chest X-ray – cavitary lesion 4. Tuberculin Test4. Tuberculin Test

1. PPD – Purified Protein Derivative1. PPD – Purified Protein Derivative 2. Mantoux Test- (more reliable) = ID 2. Mantoux Test- (more reliable) = ID

injection of tuberculin extract into the injection of tuberculin extract into the inner aspect of forearm to detect inner aspect of forearm to detect infection/exposure to CA.infection/exposure to CA.

Localized reaction- detected in 48 to 72 Localized reaction- detected in 48 to 72 hourshours

(+) induration of 10 mm or above (+) induration of 10 mm or above

Tuberculin test. Erythema and induration at site of intradermal injection of 5 tuberculin units in a child with primary tuberculosis. This is an unusually severe reaction. Mantoux method.

Classification of PTBClassification of PTB

0 = No exposure; No infection0 = No exposure; No infection

1 = (+) exposure but not infected = INH 1 = (+) exposure but not infected = INH for 1 mo especially below 5yofor 1 mo especially below 5yo

2 = (+) with infection but w/o disease2 = (+) with infection but w/o disease

(+) skin test; No S/S; CXR(-) -INH 1 (+) skin test; No S/S; CXR(-) -INH 1 yryr

( -) sputum exam( -) sputum exam

3 = infected & w/ the disease = anti TB 3 = infected & w/ the disease = anti TB drug Tx drug Tx

CATEGORIES OF TBCATEGORIES OF TB category I (new PTB) - (+) sputum(+) chest category I (new PTB) - (+) sputum(+) chest

xrayxray

category II (PTB relapse not less than 6 mos)category II (PTB relapse not less than 6 mos)

category III (active PTB case) - (-) sputum category III (active PTB case) - (-) sputum chest x-ray, regression of infiltrateschest x-ray, regression of infiltrates

Category 1V – partially treated; poor Category 1V – partially treated; poor compliance to DOTScompliance to DOTS

Category V – PTB suspect ( (+) skin test; (+) Category V – PTB suspect ( (+) skin test; (+) family member with PTBfamily member with PTB

Management:Management: short course – 6-9 months short course – 6-9 months long course – 9-12 monthslong course – 9-12 months DOTS- directly observe treatment short DOTS- directly observe treatment short

coursecourse

* 2 wks after medications – non * 2 wks after medications – non communicablecommunicable

3 successive (-) sputum - non 3 successive (-) sputum - non communicablecommunicable

rifampicin or INH- prophylacticrifampicin or INH- prophylactic

TREATMENT:TREATMENT:

CATEGORY 1CATEGORY 1 - NEW PTB, (+) SPUTUM - NEW PTB, (+) SPUTUMGIVE GIVE RIPE 2 MONTHSRIPE 2 MONTHS, MAINTENANCE OF , MAINTENANCE OF RI 4 RI 4 MONTHSMONTHS

CATEGORY 2CATEGORY 2 - PREVIOUSLY TREATED WITH - PREVIOUSLY TREATED WITH RELAPSESRELAPSESGIVE GIVE RIPES 1ST 2 MONTHS, REPS 1 MONTH, RIPES 1ST 2 MONTHS, REPS 1 MONTH, MAINTENANCE RIE 5 MONTHSMAINTENANCE RIE 5 MONTHS

CATEGORY 3CATEGORY 3 - NEW PTB (-) SPUTUM FOR 3X - NEW PTB (-) SPUTUM FOR 3XGIVE GIVE RIP 2 MONTHS, MAINTENACE RI 2RIP 2 MONTHS, MAINTENACE RI 2 MONTHS MONTHS

* IF RESISTANT TO DRUGS GIVE ADDITIONAL * IF RESISTANT TO DRUGS GIVE ADDITIONAL MONTH/S AS PRESCRIBEDMONTH/S AS PRESCRIBED

Primary Anti TB DrugsPrimary Anti TB Drugs

1. Rifampicin = 1. Rifampicin = SE = orange colored urine, GI SE = orange colored urine, GI

upset, Jaundice, Renal failure, upset, Jaundice, Renal failure, thrombocytopeniathrombocytopenia

Primary Anti TB DrugsPrimary Anti TB Drugs

2. Isoniazid (INH)2. Isoniazid (INH) = = ( Bacteriostatic) inhibits( Bacteriostatic) inhibits

( Bactericidal ) kills( Bactericidal ) kills Used prophylactically to patients (+) Used prophylactically to patients (+)

of PPDof PPD SE = Rashes (give anti-histamine); SE = Rashes (give anti-histamine);

Peripheral neuritis ( Give Vit B6- Peripheral neuritis ( Give Vit B6- Pyridoxine)50 mg; Jaundice; Pyridoxine)50 mg; Jaundice; PsychosisPsychosis

3. Pyrazinamide ( PZA)3. Pyrazinamide ( PZA) SE = Hyperuricemia ( inc uric acid)SE = Hyperuricemia ( inc uric acid) Mx: Inc fluid intakeMx: Inc fluid intake

4. Ethambutol =4. Ethambutol = 15-20mg/day 15-20mg/day SE = Optic neuritis ( dec visual SE = Optic neuritis ( dec visual

acuity)acuity) Give Vit. B6(Pyrdoxine)Give Vit. B6(Pyrdoxine)

5. Streptomycin5. Streptomycin SE = Ototoxicity, 8SE = Ototoxicity, 8thth cranial nerve cranial nerve

damagedamage ( Tinnitus, dizziness, N&V)( Tinnitus, dizziness, N&V)

MDT side effectsMDT side effects r-orange uriner-orange urine i-neuritis and hepatitisi-neuritis and hepatitis p-hyperuricemiap-hyperuricemia e-impairment of visione-impairment of vision s-8th cranial nerve damages-8th cranial nerve damage

PTB- NURSING PTB- NURSING MANAGEMENTMANAGEMENT

1.1. MAINTAIN REPIRATORY ISOLATIONMAINTAIN REPIRATORY ISOLATION

2.2. Administer medicine as orderedAdminister medicine as ordered

3.3. Always check sputum for blood or purulent Always check sputum for blood or purulent expectorationexpectoration

4.4. Encourage questions and conversation so that Encourage questions and conversation so that the patient can air his or her feelingsthe patient can air his or her feelings

5.5. Teach or educate the patient all about PTBTeach or educate the patient all about PTB

6.6. Encourage patient to stop smokingEncourage patient to stop smoking

7.7. Teach how to dispose secretion properlyTeach how to dispose secretion properly

8.8. Advised to have plenty of rest and eat balanced Advised to have plenty of rest and eat balanced dietdiet

9.9. Be alert of drug reactionBe alert of drug reaction

10.10. Emphasize the importance of follow-upEmphasize the importance of follow-up

PULMONARY TUBERCULOSISPULMONARY TUBERCULOSIS( Koch’s Disease/Phthisis/ ( Koch’s Disease/Phthisis/

consumption Disease)consumption Disease)PREVENTION:PREVENTION:

1.1. Submit all babies for BCG Submit all babies for BCG immunizationimmunization

2.2. Avoid overcrowdingAvoid overcrowding

3.3. Improve nutritional and health statusImprove nutritional and health status

4.4. Advise persons who have been exposed Advise persons who have been exposed to infected persons to receive to infected persons to receive tuberculin test if necessary CXR and tuberculin test if necessary CXR and prophylactic isoniazid.prophylactic isoniazid.

Mumps ( Epidemic Parotitis); Mumps ( Epidemic Parotitis); Infectious ParotitisInfectious Parotitis

-Acute contagious VIRAL disease. -Acute contagious VIRAL disease. Characteristic feature is swelling of one or Characteristic feature is swelling of one or both of the parotid glandsboth of the parotid glands

RNA, Mumps virus ; paromyxovirus of the RNA, Mumps virus ; paromyxovirus of the Varicella family( found in the saliva)Varicella family( found in the saliva)

Mumps vaccine - > 1yoMumps vaccine - > 1yo MMR – 15 mosMMR – 15 mos Lifetime ImmunityLifetime ImmunityIP: 14-25 days, usually 18 daysIP: 14-25 days, usually 18 daysIncidence: 5-15 y/o, cold weather, common Incidence: 5-15 y/o, cold weather, common

in men. Adults less likely to be attacked in men. Adults less likely to be attacked ( If so, causes sterility)( If so, causes sterility)

MOT: droplet, fomites, salivaMOT: droplet, fomites, saliva

S/sx: S/sx: Pain at the angle of the jawPain at the angle of the jaw (Unilateral or bilateral) (Unilateral or bilateral) PATHOGNOMONIC SIGNPATHOGNOMONIC SIGN

parotitis, Orchitis - sterility if bilateral, parotitis, Orchitis - sterility if bilateral,

Period of communicabilityPeriod of communicability: 6 days before : 6 days before swelling ; until 9 days after swelling swelling ; until 9 days after swelling subsides ( 7subsides ( 7thth – 9 – 9thth day) day)

** highest communicability – 48 hrs ** highest communicability – 48 hrs after onset of swellingafter onset of swelling

Dx:Dx: serologic testing, ELISA serologic testing, ELISA

Mgmt:Mgmt: supportive supportive

Supporter for orchitisSupporter for orchitis

Analgesics Antipyretic, cold compress, Analgesics Antipyretic, cold compress, steroidssteroids

Diet : soft. Don’t give sour foodsDiet : soft. Don’t give sour foods

Promotive:Promotive: Proper disposal of nasal & throat Proper disposal of nasal & throat

secretionssecretions Bed restBed rest

Preventive: MMR vaccine ( 15 mos.)Preventive: MMR vaccine ( 15 mos.)

= LIFETIME IMMUNITY= LIFETIME IMMUNITY

Diarrheal

Diseases

Cholera / El TorCholera / El Tor Causative agent: Vibrio coma (inaba, Causative agent: Vibrio coma (inaba,

ogawa, hikojima), vibrio cholerae, ogawa, hikojima), vibrio cholerae, vibrio el tor; gram (-)vibrio el tor; gram (-)

Curved rod or coma shaped Curved rod or coma shaped organism; motileorganism; motile

Habitat: small intestineHabitat: small intestine Can survive longer in refrigerated Can survive longer in refrigerated

foodsfoods

IP: few hours to 5 daysIP: few hours to 5 days

MOT: oral fecal route ( by MOT: oral fecal route ( by contaminated food, water, shellfish)contaminated food, water, shellfish)

S/sx:S/sx: Severe vomiting, abdominal Severe vomiting, abdominal cramps, massive diarrhea of watery cramps, massive diarrhea of watery voluminous whitish grayish greenish voluminous whitish grayish greenish slightly mucoid stools (slightly mucoid stools (Rice watery Rice watery stoolstool with flecks of mucus & fishy with flecks of mucus & fishy odor), s/sx of severe dehydration ie odor), s/sx of severe dehydration ie Washerwoman’s handsWasherwoman’s hands,, sunken eyeball sunken eyeball & fontannel, thirst, poor skin turgor& fontannel, thirst, poor skin turgor

Period of communicabilityPeriod of communicability: 1: 1stst day – 10 day – 10thth day ( as long as CA is seen in feces)day ( as long as CA is seen in feces)

Dx:Dx: stool culture (+) vibrio cholerae stool culture (+) vibrio choleraeMgmt:Mgmt: IV fluids, Tetracycline, IV fluids, Tetracycline,

Doxycycline, Erythromycin, Doxycycline, Erythromycin, Quinolones, Furazolidone and Quinolones, Furazolidone and Sulfonamides (children)Sulfonamides (children)

CholeraSigmoidoscopic view of colonic mucosa

Fatal case of infection

Rice Watery Stool in Cholera

Cholera Cot and Bucket

Nursing Mx:Nursing Mx: Replacement of lost F & EReplacement of lost F & E

Administer D5LR ( more in Na) DLR ( Administer D5LR ( more in Na) DLR ( more in K)more in K)

Enteric IsolationEnteric Isolation All patients should be isolated until All patients should be isolated until

rectal swab shows (-) resultrectal swab shows (-) result All water & milk should be boiled for All water & milk should be boiled for

15 minutes 15 minutes Food must be protected from fliesFood must be protected from flies Prepare food properlyPrepare food properly Proper disposal of excretaProper disposal of excreta Good environmental sanitationGood environmental sanitation

Bacillary DysenteryBacillary DysenteryShigellosisShigellosis

Shiga bacillus: dysenteriae (fatal), Shiga bacillus: dysenteriae (fatal), flexneri (Philippines), boydii, sonnei; flexneri (Philippines), boydii, sonnei; gram (-)gram (-)

Shiga toxin destroys intestinal mucosaShiga toxin destroys intestinal mucosa Humans are the only hostsHumans are the only hostsIP: 1-7 daysIP: 1-7 daysMOT : oral fecal route ( contamination MOT : oral fecal route ( contamination of fingers, toilet seats, glass & tableof fingers, toilet seats, glass & tableWareWare

PathophysiologyPathophysiology

Shigella >>> releases Shigella >>> releases toxins>>headache toxins>>headache >>>>vomiting>>.LBM>>>stool >>>>vomiting>>.LBM>>>stool ( bloody, mucoid with pus( bloody, mucoid with pus

S/sx: S/sx: feverfever,colicky abdominal pain, ,colicky abdominal pain, diarrhea is watery to diarrhea is watery to bloody with bloody with pus, tenesmuspus, tenesmus( pain on defecation)( pain on defecation)

Dx: stool cultureDx: stool culture

Mgmt: Oresol, Ampicillin, Mgmt: Oresol, Ampicillin, Trimethoprim-Sulfamethoxazole, Trimethoprim-Sulfamethoxazole, Chloramphenicol, Tetracycline, Chloramphenicol, Tetracycline, CiprofloxacinCiprofloxacin

Nursing Mx:Nursing Mx:

Replacement of F & EReplacement of F & E Good environmental sanitationGood environmental sanitation Sanitary disposal of human fecesSanitary disposal of human feces Clean processing, preparation, Clean processing, preparation,

serving of foodserving of food Fly controlFly control

SALMONELLA INFECTIONSALMONELLA INFECTION( Salmonellosis)( Salmonellosis)

Source : contaminated food, drinks ;meat Source : contaminated food, drinks ;meat and poultry product.and poultry product.

MOT : fecal oral-routeMOT : fecal oral-route Period of communicability : throughout Period of communicability : throughout

duration of fecal excretionduration of fecal excretion IP : 6-72H ( < 24H)IP : 6-72H ( < 24H) S/SX : abrupt onset nausea, vomiting, S/SX : abrupt onset nausea, vomiting,

abdominal cramps, chills, LBM with abdominal cramps, chills, LBM with bloody mucoid stool occassionallybloody mucoid stool occassionally

SALMONELLA INFECTIONSALMONELLA INFECTION( Salmonellosis( Salmonellosis))

Physical findings: hyperactive peristalsis, Physical findings: hyperactive peristalsis, abdominal tenderness and signs of abdominal tenderness and signs of dehydration.dehydration.

Diagnosis:Diagnosis: Stool cultureStool culture Stool examinationStool examination

Treatment Treatment Non-specificNon-specific

Correction of fluid and electrolytesCorrection of fluid and electrolytes DietaryDietary

Antimicrobial not indicated unless patient is Antimicrobial not indicated unless patient is septicseptic

Resistant to antibiotics likes : ampicllin, Resistant to antibiotics likes : ampicllin, chloramphenicol and cotrimoxazole chloramphenicol and cotrimoxazole

Paralytic shellfish PoisoningParalytic shellfish PoisoningRed Tide PoisoningRed Tide Poisoning

Pyromidium Bahamense ( Algae), Dinoflagellates Pyromidium Bahamense ( Algae), Dinoflagellates PlanktonPlankton

Ingestion of Saxitoxin in contaminated bi-valve Ingestion of Saxitoxin in contaminated bi-valve shellfishshellfish

Saxitoxin binds w/ Na channels leading to loss of Saxitoxin binds w/ Na channels leading to loss of skeletal muscle excitabilityskeletal muscle excitability

IP 15 min- 12 hrsIP 15 min- 12 hrsS/sx: Circumoral and extremity numbness, nausea S/sx: Circumoral and extremity numbness, nausea

and vomiting, headache ( bec of the and vomiting, headache ( bec of the toxins),dizziness, muscle and respiratory toxins),dizziness, muscle and respiratory paralysis, rapid pulse, difficulty of speech ( ataxia)paralysis, rapid pulse, difficulty of speech ( ataxia)

Dx: historyDx: historyMgmt: emesis/gastric lavage + activated charcoal, Mgmt: emesis/gastric lavage + activated charcoal,

supportivesupportive

Paralytic shellfish PoisoningParalytic shellfish PoisoningRed Tide PoisoningRed Tide Poisoning

Dx: historyDx: historyMgmt: Mgmt: 1.1. Induce vomiting (gastric lavage + activated Induce vomiting (gastric lavage + activated

charcoal)charcoal)2.2. Drink pure coconut milk ( weakens toxins)Drink pure coconut milk ( weakens toxins)3.3. Give NaHCO3(25 mgs) in ½ glass of waterGive NaHCO3(25 mgs) in ½ glass of water4.4. Avoid using vinegar in cooking shellfish Avoid using vinegar in cooking shellfish

affected by red tide ( 15x increase when affected by red tide ( 15x increase when mixed with acid)mixed with acid)

5.5. Toxin of red tide is not totally destroyed in Toxin of red tide is not totally destroyed in cookingcooking

6.6. Avoid eating tahong , halaan, Kabiya, abaniko Avoid eating tahong , halaan, Kabiya, abaniko during red tideduring red tide

7.7. No specific medicinesNo specific medicines

BotulismBotulism

Fatal form of food poisoning caused Fatal form of food poisoning caused by an endotoxinby an endotoxin

CA = Clostridium BotulinumCA = Clostridium Botulinum MOT = Food borne or contaminated MOT = Food borne or contaminated

woundwound IP = 12-36 hrs after eating IP = 12-36 hrs after eating

improperly canned foods improperly canned foods

S/SXS/SX

1.1. Severe intoxicationSevere intoxication

2.2. Visual difficulty, Dysphagia, dry Visual difficulty, Dysphagia, dry mouthmouth

3.3. Descending, symmetrical flaccid Descending, symmetrical flaccid paralysis ( weak, soft)paralysis ( weak, soft)

4.4. Vomiting, constipation, DiarrheaVomiting, constipation, Diarrhea

5.5. Double vision, difficulty focusing eyes Double vision, difficulty focusing eyes

DxDx Culture of stool & stomach contentsCulture of stool & stomach contents Serum positive of Botulinum toxinsSerum positive of Botulinum toxins

Nursing & Medical ManagementNursing & Medical Management:: 1. IV & IM trivalent Botulinum 1. IV & IM trivalent Botulinum

antitoxinantitoxin 2. IV fluids & Electrolytes2. IV fluids & Electrolytes 3. Intensive care to manage respiratory 3. Intensive care to manage respiratory

failurefailure 4. No questionable canned food should 4. No questionable canned food should

be testedbe tested

Intestinal Intestinal

ParasitismParasitism

INTESTINAL INTESTINAL PARASITISMPARASITISM

are parasites that populate the are parasites that populate the gastro-intestinal tract. gastro-intestinal tract.

MOT : they are often spread by poor MOT : they are often spread by poor hygiene related to feceshygiene related to feces contact with animals, or poorly cooked contact with animals, or poorly cooked

food containing parasites.food containing parasites.

Two main types of intestinal Two main types of intestinal parasites:parasites: A. Helminths A. Helminths

Tapeworms, pinworms, and roundworms Tapeworms, pinworms, and roundworms are among the most common helminthsare among the most common helminths

B. Protozoa.B. Protozoa.

Cause of intestinal Cause of intestinal ParasitismParasitism

high risk for getting intestinal high risk for getting intestinal parasites: parasites: Living in or visiting an area known to have Living in or visiting an area known to have

parasites parasites Poor sanitation (for both food and water) Poor sanitation (for both food and water) Poor hygiene Poor hygiene Age -- children are more likely to get Age -- children are more likely to get

infected infected Exposure to child and institutional care Exposure to child and institutional care

centers centers

INTESTINAL INTESTINAL PARASITISMPARASITISM

Some asymptomatic Some asymptomatic S/SX: S/SX:

Diarrhea Diarrhea Nausea or vomiting Nausea or vomiting Gas or bloating Gas or bloating Dysentery (loose stools containing blood and mucus) Dysentery (loose stools containing blood and mucus) Rash or itching around the rectum or vulva Rash or itching around the rectum or vulva Stomach pain or tenderness Stomach pain or tenderness Feeling tired Feeling tired Weight loss Weight loss Passing a worm in your stool Passing a worm in your stool AnemiaAnemia

Fecal testing (stool exam) can Fecal testing (stool exam) can identify both helminths and identify both helminths and protozoa.. protozoa..

The "Scotch tape" test identifies The "Scotch tape" test identifies pinworm by touching tape to the pinworm by touching tape to the anus. Then the tape is examine anus. Then the tape is examine under a microscope for eggs under a microscope for eggs

Ascariasis (Roundworm)Ascariasis (Roundworm)CA:CA: Ascaris LumbricoidesAscaris Lumbricoides

IP:IP: weeks to months weeks to months

MOTMOT: transmitted through contaminated : transmitted through contaminated fingers into the mouth; ingestion of fingers into the mouth; ingestion of food and drinks contaminated by food and drinks contaminated by embryonated eggsembryonated eggs

Affects 4-12 years oldAffects 4-12 years old

Dx:Dx: stool for ova stool for ova

Mgmt:Mgmt: Mebendazole,/ Albendazole/ Mebendazole,/ Albendazole/ Pyrantel PamoatePyrantel Pamoate

MOT:MOT: ingestion of food ingestion of food contaminated by ascaris contaminated by ascaris eggs larvae in large eggs larvae in large intestine penetrate wall intestine penetrate wall lung where larvae grow lung where larvae grow and coughed up and coughed up intestine intestine larvae mature and larvae mature and passed out in fecespassed out in feces

Ascariasis ( roundworm Ascariasis ( roundworm infection)infection)

Nursing InterventionNursing Intervention:: Isolation is not neededIsolation is not needed Preventive measures in each home and in Preventive measures in each home and in

the community should be enforcedthe community should be enforced Wash hands before handling foodWash hands before handling food Wash all fruits and vegetable thoroughlyWash all fruits and vegetable thoroughly Availability of toilet facilities must be Availability of toilet facilities must be

ensuredensured Importance of personal hygiene should be Importance of personal hygiene should be

explainedexplained Proper waste disposal.Proper waste disposal.

Ascariasis ( roundworm Ascariasis ( roundworm infection)infection)

Prevention:Prevention: Improved sanitation and hygienic Improved sanitation and hygienic

practicespractices Improved nutritionImproved nutrition Deworming may be advisedDeworming may be advised

ComplicationsComplications

Migration of the worm to different Migration of the worm to different parts of the body Ex. Ears, parts of the body Ex. Ears, mouth,nosemouth,nose

Loefflers PneumoniaLoefflers Pneumonia

Tapeworm (FlatwormsTapeworm (Flatworms))

CA:CA: Taenia Saginata (cattle), Taenia Taenia Saginata (cattle), Taenia Solium (pigs)Solium (pigs)

MOT:MOT: fecal oral route fecal oral route(ingestion of uncooked, infected meat )(ingestion of uncooked, infected meat )

IP: 2-3 mos - yearsIP: 2-3 mos - years

Dx: Stool ExamDx: Stool Exam

Mgmt: Praziquantel, NiclosamideMgmt: Praziquantel, Niclosamide

ISOLATION OF HOSPITALIZEDISOLATION OF HOSPITALIZED

PATIENTS. STANDARS PRECAUTIONSPATIENTS. STANDARS PRECAUTIONS

RECOMMENDEDRECOMMENDED

PinwormPinworm Enterobius VermicularisEnterobius Vermicularis

MOT: fecal oral routeMOT: fecal oral route

S/sx: Itchiness at the anal area d/t S/sx: Itchiness at the anal area d/t eggs of the agenteggs of the agent

Dx: Dx: tape test at night timetape test at night time (agents release their eggs during (agents release their eggs during night time)night time)

Mgmt: Pyrantel Pamoate, Mgmt: Pyrantel Pamoate, Mebendazole Mebendazole

Enterobius vermicularis Enterobius vermicularis (PIN WORM)(PIN WORM)

The pinworm lives in the lower part of the small intestine and the upper part of the colonHuman the only natural hostIP : 1-2 months or longerMOT : indirectly by contaminated fomites-shared toys, toilet seat and bath

Isolation is not needed

Nursing InterventionNursing Intervention

Promote hygienePromote hygiene Environmental SanitationEnvironmental Sanitation Proper waste and sewage disposalProper waste and sewage disposal Antihelmintic medications repeated Antihelmintic medications repeated

after 2 weeks (entire family)after 2 weeks (entire family)

Hookworm (RoundwormHookworm (Roundworm)) CA:CA: Necator Americanus, Necator Americanus,

Ancylostoma Duodenale Ancylostoma Duodenale IPIP - few weeks to months to years - few weeks to months to years

S/sx:S/sx: Ground itch or dew itch at Ground itch or dew itch at site of entry of filariform larvae site of entry of filariform larvae involving the feet/legs, abd’l involving the feet/legs, abd’l cramps, diarrhea, abd’l cramps, diarrhea, abd’l distention, anemia, perforation to distention, anemia, perforation to peritonitis to septicemiaperitonitis to septicemia

** Isolation is not necessary **** Isolation is not necessary **

DxDx: : microscopic exam (stool microscopic exam (stool exam)exam)

Mgmt:Mgmt: Pyrantel Pamoate and Pyrantel Pamoate and MebendazoleMebendazole

don’t give drug without (+) don’t give drug without (+) stool examstool exam

members of the family must members of the family must be examined and treated be examined and treated alsoalso

Nsg. Intervention:Nsg. Intervention:

1.1. Proper disposal of excretaProper disposal of excreta

2.2. Avoid walking or playing Avoid walking or playing barefootedbarefooted

3.3. Periodic deworming of Periodic deworming of school age groupschool age group

Amoebiasis ( Amoebic Dysentery)Amoebiasis ( Amoebic Dysentery)

Protozoal infection of human beings Protozoal infection of human beings initially involving the colon, but may spread initially involving the colon, but may spread to soft tissues, most commonly to the liver to soft tissues, most commonly to the liver or lungs.or lungs.

CA:CA: Entamoeba HystoliticaEntamoeba Hystolitica, protozoa, protozoa Prevalent in unsanitary areasPrevalent in unsanitary areas Common in warm climateCommon in warm climate Acquired by swallowingAcquired by swallowing Cyst survives a few days after outside of the bodyCyst survives a few days after outside of the body Cyst passes to the large intestine & hatch into Cyst passes to the large intestine & hatch into

TROPHOZOITES.TROPHOZOITES. It passes into the mesenteric It passes into the mesenteric veins, to the portal vein, to the liver thereby veins, to the portal vein, to the liver thereby forming forming AMOEBIC LIVER ABSCESS.AMOEBIC LIVER ABSCESS.

Entomoeba histolytica Entomoeba histolytica has two has two developmental stages:developmental stages:

1.1. Trophozoites Trophozoites/vegetative form/vegetative form Trophozoites are facultative parasites that Trophozoites are facultative parasites that

may invade the tissues or may be found in may invade the tissues or may be found in the parasites tissues and liquid colonic the parasites tissues and liquid colonic contents.contents.

2. 2. CystCyst

a. Cyst is passed out with formed or semi-a. Cyst is passed out with formed or semi-formed stools and are resistant to formed stools and are resistant to environmental conditions.environmental conditions.

b. This is considered as the b. This is considered as the infective stageinfective stage in in the life cycle of the life cycle of E. histolyticaE. histolytica

PathologyPathology

When the cyst is swallowed, it passes through When the cyst is swallowed, it passes through the stomach unharmed and shows no activity the stomach unharmed and shows no activity while in an acidic environment. When it reaches while in an acidic environment. When it reaches the alkaline medium of the intestine, the the alkaline medium of the intestine, the metacystmetacyst begins to move within the cyst wall, begins to move within the cyst wall, which rapidly weakens and tears. The which rapidly weakens and tears. The quadrinucleate amoeba emerges and divides quadrinucleate amoeba emerges and divides into into amebulasamebulas that are swept down into the that are swept down into the cecum. This is the first opportunity of the cecum. This is the first opportunity of the organism to colonize, and its success depends organism to colonize, and its success depends on one or more metacystic trophozoites making on one or more metacystic trophozoites making contact with the mucosa.contact with the mucosa.

Mature cyst in the large intestines Mature cyst in the large intestines leaves the host in great numbers (the leaves the host in great numbers (the host remains asymptomatic). The cyst host remains asymptomatic). The cyst can remain viable and infective in can remain viable and infective in moist and cool environment for at moist and cool environment for at least 12 days, and in water for 30 least 12 days, and in water for 30 days. The cysts are resistant to levels days. The cysts are resistant to levels of chlorine normally used for water of chlorine normally used for water purification. They are rapidly killed by purification. They are rapidly killed by desiccation, and temperatures below desiccation, and temperatures below 5 and above 40 degrees.5 and above 40 degrees.

MOTMOT: Ingestion of cysts from fecally : Ingestion of cysts from fecally contaminated sources (Oral fecal contaminated sources (Oral fecal route) route) oral and anal sexual practicesoral and anal sexual practices

Extraintestinal amoebiasis- genitalia, Extraintestinal amoebiasis- genitalia, spleen, liver, anal, lungs and spleen, liver, anal, lungs and meningesmeninges

lifecyclelifecycle

s/sx: Blood streaked, watery mucoid s/sx: Blood streaked, watery mucoid diarrhea, abdominal cramps diarrhea, abdominal cramps

Dx: microscopic stool exam - trophozoitesDx: microscopic stool exam - trophozoites Pd of Communicability: the Pd of Communicability: the

microorganism is communicable for the microorganism is communicable for the entire duration of the illnessentire duration of the illness

Mgmt:Mgmt: Tetracycline 250 mg every 6 hoursTetracycline 250 mg every 6 hours Ampicillin, Quinolones, sulfadiazineAmpicillin, Quinolones, sulfadiazine Metronidazole (Flagyl) 800 mg TID x 5 Metronidazole (Flagyl) 800 mg TID x 5

daysdays Strptomycin SO4, ChloramphenicolStrptomycin SO4, Chloramphenicol F&E balanceF&E balance

Nsg. MxNsg. Mx

Observe isolation & enteric precautionObserve isolation & enteric precaution Provide health education & instruct patient Provide health education & instruct patient

to:to: Boil water for drinking or use purified waterBoil water for drinking or use purified water Avoid washing food from open drum or pailAvoid washing food from open drum or pail Cover leftover foodCover leftover food Wash hands after defecation or before eatingWash hands after defecation or before eating Avoid ground vegetables ( lettuce, carrots, etc)Avoid ground vegetables ( lettuce, carrots, etc)

Prevention:Prevention:

Health educationHealth education Sanitary disposal of fecesSanitary disposal of feces Protect, chlorinate & purify drinking Protect, chlorinate & purify drinking

waterwater Observe scrupulous cleanliness in food Observe scrupulous cleanliness in food

preparation & food handlingpreparation & food handling Detection & tx of carriersDetection & tx of carriers Fly control ( they can serve as vectors)Fly control ( they can serve as vectors)

CNSCNS InfectionsInfections

MENINGITISMENINGITIS( Cerebrospinal fever)( Cerebrospinal fever)

Is the inflammation of the meninges Is the inflammation of the meninges of the brain and spinal cord as a of the brain and spinal cord as a result of viral or bacterial infection.result of viral or bacterial infection.

IP : varies from 1-10 daysIP : varies from 1-10 days MOT : respiratory dropletMOT : respiratory droplet

direct invasion through otitis direct invasion through otitis mediamedia

may result after skull fructuremay result after skull fructure

Caused by bacterial pathogen, Caused by bacterial pathogen, N. menigitidis, H. Influenza, N. menigitidis, H. Influenza, Strep. Pneumoniae, Strep. Pneumoniae, Mycobacterium TuberculosisMycobacterium Tuberculosis

Clinical manifestationsClinical manifestations

headacheheadache irritabilityirritability feverfever neck stiffnessneck stiffness pathologic reflexes: kernig’s, pathologic reflexes: kernig’s,

Babinski, BrudzinskiBabinski, Brudzinski

Diagnostics:Diagnostics: Lumbar punctureLumbar puncture Gram stainingGram staining Smear and blood cultureSmear and blood culture Urine cultureUrine culture

Supportive/Symptomatic:Supportive/Symptomatic:

a. Antipyretica. Antipyretic b. treat signs of increased ICPb. treat signs of increased ICP c. Control of seizuresc. Control of seizures d. adequate nutritiond. adequate nutrition

Poliomyelitis/Infantile Poliomyelitis/Infantile Paralysis/ Heine Medin Paralysis/ Heine Medin

DiseaseDisease - acute infectious disease characterized by - acute infectious disease characterized by

changes in the CNS which may result in changes in the CNS which may result in pathologic reflexes, muscle spasm and pathologic reflexes, muscle spasm and paralysisparalysis

- it is a disease of the lower neurons, and - it is a disease of the lower neurons, and there is anterior horn involvement there is anterior horn involvement

CACA: Filterable Virus ( : Filterable Virus ( Legio DebilitansLegio Debilitans)) 3 Strains:3 Strains:

Legio BrumhildeLegio Brumhilde Legio LansingLegio Lansing Legio Leon ( rare)Legio Leon ( rare)

MOTMOT: The virus is transmitted from person to : The virus is transmitted from person to person by:person by:

1. indirectly through contaminated 1. indirectly through contaminated articles and flies, contaminated water, food articles and flies, contaminated water, food & utensils& utensils

2. Intimate contact w/ infected person2. Intimate contact w/ infected person

3. Direct contact thru nasopharyngeal 3. Direct contact thru nasopharyngeal secretionssecretions

DxDx: 1.: 1.Pandy’s testPandy’s test – culture of CSF (increased – culture of CSF (increased CHON)CHON)

2. Stool culture throughout the disease2. Stool culture throughout the disease 3. Isolation of the virus from throat washings 3. Isolation of the virus from throat washings

or swab early in the diseaseor swab early in the disease

IP: 7-21 days IP: 7-21 days Period of CommunicabilityPeriod of Communicability: first : first

three days after onset of S/SX until three days after onset of S/SX until three months of illnessthree months of illness

The disease is most contagious The disease is most contagious during the first few days of active during the first few days of active disease, and possibly from 3-4 days disease, and possibly from 3-4 days before thatbefore that

Types of PolioTypes of Polio::

1. Abortive or inapparent type –does not invade the CNS ( fever, malaise, sore throat, headache, N&V) pt. usually recovers within 72 hours

2. Non-paralytic – all the above signs; marked w/ meningeal irritation; pain in the neck, back, arms legs & abdomen; inability to place the head in between the knees; (+) pandy’s test; more severe than abortive type (

3. Paralytic polio – s/sx listed above are present; flaccid asymmetrical ascending paralysis (Landry’s sign),

(+) Hoyne’s sign (head drop), Poker’s sign (opisthotonus), (+) Kernig and

Brudzinski sign4. Bulbar ( Brain stem) –develops rapidly & is

the more serious type; motor neuron in the brainstem is attacked & affects the medulla. It weakens the muscles supplied by the cranial nerves especially the 9th ( glossopharyngeal) & 10th ( vagus); facial, pharyngeal & ocular muscles are paralyzed; respiratory failure & cardiac irregularities

Predisposing causesPredisposing causes Age – about 60% of patients are under 10 Age – about 60% of patients are under 10

yrs of ageyrs of age Sex – males are more prone to the Sex – males are more prone to the

disease than females with a ratio of 3:2disease than females with a ratio of 3:2 Heredity – poliomyelitis is Heredity – poliomyelitis is notnot hereditary hereditary Environment & hygienic condition. The Environment & hygienic condition. The

rich are more often spared than the poor. rich are more often spared than the poor. Excessive work, strain, marked Excessive work, strain, marked overexertion are also factors causing the overexertion are also factors causing the disease.disease.

PathologyPathology

The organism enters the body through The organism enters the body through the alimentary tract, multiplies in the the alimentary tract, multiplies in the oropharynx & lower intestinal tract.oropharynx & lower intestinal tract.

Then the organisms are spread to the Then the organisms are spread to the regional lymph nodes & the bloodregional lymph nodes & the blood

There seems to be subsequent There seems to be subsequent congestion, edema & necrosis in the congestion, edema & necrosis in the areaarea

ComplicationsComplications

Respiratory failureRespiratory failure Circulatory collapseCirculatory collapse Electrolyte imbalanceElectrolyte imbalance Bacterial infectionBacterial infection Urinary problems r/t retention or Urinary problems r/t retention or

paralysis of the urinary bladderparalysis of the urinary bladder

MGMT:MGMT: Analgesics for pain. Morphine is Analgesics for pain. Morphine is

contraindicated because of the danger of contraindicated because of the danger of additional respiratory suppression.additional respiratory suppression.

CBRCBR Moist heat application may reduce spasm & Moist heat application may reduce spasm &

painpain Paralytic polio requires rehabilitation using Paralytic polio requires rehabilitation using

physical therapy , braces, corrective shoes & physical therapy , braces, corrective shoes & in some cases, orthopedic surgeryin some cases, orthopedic surgery

Prevention:Prevention: Active – OPV (Sabin) and IPV (Salk)Active – OPV (Sabin) and IPV (Salk)

Nursing ManagementNursing Management:: Carry out enteric isolationCarry out enteric isolation Observe the patient carefully for paralysis & Observe the patient carefully for paralysis &

other neurologic damageother neurologic damage Perform neurologic assessment 1x a dayPerform neurologic assessment 1x a day Check BP regularly especially in bulbar polioCheck BP regularly especially in bulbar polio Maintain good personal hygiene, particularly Maintain good personal hygiene, particularly

oral care & skin careoral care & skin care Provide emotional support both to patient & Provide emotional support both to patient &

familyfamily Dispose excreta & vomitus properlyDispose excreta & vomitus properly Apply hot packs to affected limb to relieve Apply hot packs to affected limb to relieve

pain & muscle shorteningpain & muscle shortening

Tetanus/Lockjaw/TrismusTetanus/Lockjaw/Trismus

CA:CA: Clostridium tetani (gram (+), Clostridium tetani (gram (+), spore spore

formingforming, , anaerobicanaerobic ( survives w/o air) ( survives w/o air) non-motile,non-motile, vegetativevegetative( ability to grow) ( ability to grow)

Produces potent exotoxinProduces potent exotoxin Tetanus spores are introduced into the Tetanus spores are introduced into the

wound contaminated with soilwound contaminated with soil IP: 4-21 daysIP: 4-21 days Tetanus neonatorum - umbilical cordTetanus neonatorum - umbilical cord

Clostridium tetani in puncture woundClostridium tetani in puncture wound

Release of Neurotoxin (Tetanospasmin) Release of Neurotoxin (Tetanospasmin) Hemolysin ( tetanolysinHemolysin ( tetanolysin

attack PNS and CNSattack PNS and CNS

GABA and Glycine inhibitedGABA and Glycine inhibited

Tetanic spasmTetanic spasm

PathophysiologyPathophysiology

Clinical manifestationsClinical manifestations

Difficulty of opening the mouth Difficulty of opening the mouth (trismus or lockjaw) (trismus or lockjaw)

Risus sardonicus ( sneering grin) – Risus sardonicus ( sneering grin) – “ngiting aso”“ngiting aso”

DysphagiaDysphagia Generalized muscle rigidityGeneralized muscle rigidity Opisthotonus ( severe arching of the Opisthotonus ( severe arching of the

back)back) Localized or generalized muscle spasmLocalized or generalized muscle spasm Respiratory paralysis to deathRespiratory paralysis to death

S/Sx:S/Sx:Neonatal tetanusNeonatal tetanus - - Poor sucking, Poor sucking, irritability, excessive crying, irritability, excessive crying, grimaces, intense rigidity, and grimaces, intense rigidity, and opisthotonus opisthotonus

CriteriaCriteria Stage IStage I Stage IIStage II Stage IIIStage III

Incubation PeriodIncubation Period > 11 days> 11 days 8-10 days8-10 days <7days<7days

TrismusTrismus mildmild moderatemoderate SevereSevere

Muscle rigidityMuscle rigidity mildmild PronouncedPronounced Severe, boardlikeSevere, boardlike

SpasmSpasm absentabsent Mild, shortMild, short Frequent, Frequent, prolongedprolonged

Dyspnea, Dyspnea, cyanosiscyanosis

absentabsent absentabsent PresentPresent

Dx: Dx: history, leukocytosis, serum history, leukocytosis, serum antitoxin levelsantitoxin levels

Mgmt:Mgmt:Anticonvulsant, muscle relaxants, Anticonvulsant, muscle relaxants,

antibiotics, wound cleansing and antibiotics, wound cleansing and debridementdebridement

Active-DPT and tetanus toxoidActive-DPT and tetanus toxoidPassive-TIG and TAT, placental immunityPassive-TIG and TAT, placental immunity

TetanusTreatment:

1. Specific :-within 72 hours after punctured

wound received ATS,TAT or TIG espicially if no previous immunization

- Pen G to control infection - muscle relaxant to decrease muscle

rigidity. 2. Non-specific

- oxygen inhalation

Treatment:Treatment:anti-toxinanti-toxin Tetanus Anti-Toxin (TAT)Tetanus Anti-Toxin (TAT) Adult,children,infant 40,000 IU ½ IM,1/2 IVAdult,children,infant 40,000 IU ½ IM,1/2 IV Neonatal TetanusNeonatal Tetanus 20000 IU, 1/2IM, ½ IV 20000 IU, 1/2IM, ½ IV TIGTIG Neonates 1000 IU, IV drip or IMNeonates 1000 IU, IV drip or IM Adult, infant, childrenAdult, infant, children 3000 IU, IV drip or IM 3000 IU, IV drip or IM

DPT- 0.5 ml IMDPT- 0.5 ml IM

1 - 1 ½ months old1 - 1 ½ months old2 - after 4 weeks2 - after 4 weeks3 - after 4 weeks3 - after 4 weeks

11stst booster – 18 mos booster – 18 mos

22ndnd booster – 4-6 yo booster – 4-6 yo

subsequent booster – every 10 yrs thereaftersubsequent booster – every 10 yrs thereafter TT – 0.5 ml IMTT – 0.5 ml IM

TT1 6 months within pregTT1 6 months within pregTT2 one month after TT1TT2 one month after TT1TT3 to TT5 every succeeding preg or every TT3 to TT5 every succeeding preg or every year year

Pre exposure prophylaxisPre exposure prophylaxis

Antimicrobial TherapyAntimicrobial Therapy

Penicillin !-3 mil units q 4hoursPenicillin !-3 mil units q 4hours

Pedia 500000 – 2mil units q 4 Pedia 500000 – 2mil units q 4 hrshrs

Neonatal 200000 units IVP q Neonatal 200000 units IVP q 12hrs or q8hrs12hrs or q8hrs

3 types of patients w/ skin 3 types of patients w/ skin woundswounds

post exposure prophylaxispost exposure prophylaxis

1.1. (+) immunization as a child w/ (+) immunization as a child w/ boosters but last shot > 10 yrs – boosters but last shot > 10 yrs – give TT + TIG/TATgive TT + TIG/TAT

2. (-) immunization - TT + TIG/TAT2. (-) immunization - TT + TIG/TAT

3. (+) tetanus – TIG/TAT + TT + Abx + 3. (+) tetanus – TIG/TAT + TT + Abx + wound cleansing + supportive wound cleansing + supportive therapytherapy

Control of spasmsControl of spasms diazepamdiazepam chlorpromazinechlorpromazine

Preventive MeasuresPreventive Measures Treatment of woundsTreatment of wounds Tetanus toxoid (0,1,6,1,1)Tetanus toxoid (0,1,6,1,1)

RabiesRabies

CACA: : Genus Lyssavirus, Genus Lyssavirus, Family Rhabdoviridae Family Rhabdoviridae ( RNA virus)( RNA virus)

Bite/wound setting Bite/wound setting

acute viral encephalomyelitisacute viral encephalomyelitis incubation period is 4 days up to 19 incubation period is 4 days up to 19

yearsyears risk of developing rabies, face bite risk of developing rabies, face bite

60%, upper extremities 15-40%, 60%, upper extremities 15-40%, lower extremities 10%lower extremities 10%

100% fatal 100% fatal

PathophysiologyPathophysiology

Bite/woundBite/wound

Local wound replicationLocal wound replication

CNS encephalitisCNS encephalitis

ANSANS

Salivary glands, adrenal medulla, kidney, Salivary glands, adrenal medulla, kidney, lungs, skeletal muscles, skin, heartlungs, skeletal muscles, skin, heart

Rabies VirusThe rabies virus is usually transmitted to humans by a bite from an

infected dog, but the bite of any animal (wild or domestic) is suspect in an area where rabies is present. Symptoms of the disease appear after

an incubation period of ten days to one year and include fever, breathing difficulties, and muscle spasms in the throat that make

drinking painful. Death almost invariably occurs within three days to three weeks of the onset of symptoms. For this reason, the emphasis of

treatment is on prevention. In the United States, veterinarians recommend regular vaccination of domestic dogs.

Clinical ManifestationClinical Manifestation pain or numbness at the site of bitepain or numbness at the site of bite fear of waterfear of water fear of airfear of air

4 STAGES4 STAGES 1. prodrome - fever, headache, 1. prodrome - fever, headache,

paresthesia, paresthesia, 2. encephalitic – excessive motor 2. encephalitic – excessive motor

activity, activity, hypersensitivity to bright light, hypersensitivity to bright light, loud noise, loud noise,

hypersalivation, dilated pupilshypersalivation, dilated pupils 3. brainstem dysfunction – dysphagia, 3. brainstem dysfunction – dysphagia,

hydrophobia, apnea hydrophobia, apnea 4. death4. death

Dx:Dx: history history

virus isolation from saliva and CSF virus isolation from saliva and CSF

serial serum Ab sampleserial serum Ab sample

Staining of brain tissue (dog) - Staining of brain tissue (dog) - Negri bodiesNegri bodies

Postexposure prophylaxisPostexposure prophylaxisCategory ICategory ILicking of intact skinLicking of intact skin

Observe the dog for 14 daysObserve the dog for 14 days

Category IICategory IIAbrasion, laceration, punctured Abrasion, laceration, punctured wound on the lower extremitieswound on the lower extremities

1.1.Active vaccineActive vaccine2.2.Observe dog for 14 daysObserve dog for 14 days

Category IIICategory IIIAbrasion, laceration on upper Abrasion, laceration on upper extremities, head and neckextremities, head and neckDog is killed, lost, diedDog is killed, lost, died

1.1.ActiveActive2.2.PassivePassive

Category of bitesCategory of bites

I – intact skin (lick or scratch)I – intact skin (lick or scratch) II – mucosal, non bleeding wounds, II – mucosal, non bleeding wounds,

abrasionsabrasions III – bleeding bites and above neck, III – bleeding bites and above neck,

stray dogs, laceration, multiple bitesstray dogs, laceration, multiple bites

Mgmt: - wound cleansing - tetanus prophylaxis - Observe and quarantine dog for maniacal s/sx

- Active- antirabies vaccine (human diploid cell vaccine)

- 7-10 days to induce an active immune response, with immunity x 2 years- Passive – human rabies immunoglobulin

ManagementManagement No treatment for clinical rabiesNo treatment for clinical rabies ProphylaxisProphylaxis

Active vaccine (PDEV,PCEC,PVRV)Active vaccine (PDEV,PCEC,PVRV) Intradermal (0,3,7,30,90)Intradermal (0,3,7,30,90) Intramuscular (0,3,7,14,28)Intramuscular (0,3,7,14,28) (0,7,21)(0,7,21)

Antirabies vaccine Antirabies vaccine 1 ml IM1 ml IMday 0, 3, 7, 14, 28day 0, 3, 7, 14, 28

OROR 0.1 ml ID0.1 ml ID day 0 (8 sites), 7 (4 sites), 28, 91 (1 site)day 0 (8 sites), 7 (4 sites), 28, 91 (1 site) OROR 0.1 ml ID0.1 ml ID day 0, 3, 7 (2 sites), 30, 90 (1 site)day 0, 3, 7 (2 sites), 30, 90 (1 site)

Rabies immunoglobulin (HRIG/equine antiserum)Rabies immunoglobulin (HRIG/equine antiserum) 20/40 units/kg IM 20/40 units/kg IM

single shotsingle shotwound 40%, deltoid 60%wound 40%, deltoid 60%

Post exposure prophylaxisPost exposure prophylaxis

Passive VaccinePassive Vaccine a. ERIG wt in kg x .2 = cc to be a. ERIG wt in kg x .2 = cc to be

injected im (ANST)injected im (ANST) b. HRIG wt in Kg x .1333b. HRIG wt in Kg x .1333

Pre-exposure ProphylaxisPre-exposure Prophylaxis Intradermal/Intramuscular (0,7,21)Intradermal/Intramuscular (0,7,21)

Infection controlInfection control Patient is isolated to prevent exposure Patient is isolated to prevent exposure

of hospital personnel, watchers and of hospital personnel, watchers and visitorsvisitors

PPEPPE

Preventive MeasuresPreventive Measures EducationEducation Post-exposure and Pre-exposure Post-exposure and Pre-exposure

ProphylaxisProphylaxis

SNAKEBITESNAKEBITE

NeurotoxicNeurotoxic Slow swelling Slow swelling then necrosisthen necrosis

Ptosis, Ptosis, respiratory respiratory paralysis, paralysis, cardiac cardiac problemsproblems

CobraCobra

MyotoxicMyotoxic NoneNone Myalgia on Myalgia on movingmovingparesisparesis

Sea snakeSea snake

VasculotoxicVasculotoxic Rapid swellingRapid swelling Bleeding Bleeding abnormalitiesabnormalities

VipersVipers

ManagementManagement

Lie the victim flatLie the victim flat ice compress and constrictive ice compress and constrictive

materials are contraindicatedmaterials are contraindicated Transport the patient to the nearest Transport the patient to the nearest

hospitalhospital Antivenim administration in patient’s Antivenim administration in patient’s

with signs of envenomationwith signs of envenomation It is never too late to give anti-venimIt is never too late to give anti-venim

Antivenim is given thru intravenous Antivenim is given thru intravenous infusion, which is the safest and most infusion, which is the safest and most effective route. 2-5 ampules plus effective route. 2-5 ampules plus D5W to run over 1-2 hours every 2 D5W to run over 1-2 hours every 2 hourshours

Antimicrobial therapyAntimicrobial therapy sulbactam/Ampicillin or co-amoxiclav sulbactam/Ampicillin or co-amoxiclav SubstituteSubstitute Prostigmine IVinfusion, Prostigmine IVinfusion,

50-100ug/kg/dose q 8hrs50-100ug/kg/dose q 8hrs AtropineAtropine

SkinSkin TransmissionTransmission DiseasesDiseases

Leprosy/Hansen’s diseaseLeprosy/Hansen’s disease Chronic communicable disease of the skin Chronic communicable disease of the skin

& the peripheral nerves& the peripheral nerves Causative Agent: Mycobacterium Leprae, Causative Agent: Mycobacterium Leprae,

acid fast bacilliacid fast bacilli MOT: may be due to prolonged MOT: may be due to prolonged

skin-skin contact or dropletsskin-skin contact or droplets IP - years to decadesIP - years to decades

Active immunization (BCG)Active immunization (BCG)

Types of Leprosy:Types of Leprosy:

1. Lepromatous or Nodular or Gravis 1. Lepromatous or Nodular or Gravis ( most severe) Early s/sx: many ( most severe) Early s/sx: many lesions or patcheslesions or patches

2. Tuberculoid – high resistant, less 2. Tuberculoid – high resistant, less severesevere

3. Mixed type or Borderline or 3. Mixed type or Borderline or DimorphousDimorphous

4. Indeterminate4. Indeterminate

TYPES:TYPES:PAUCIBACILLARYPAUCIBACILLARY1.1. Early/Indeterminate Early/Indeterminate – hypopigmented / – hypopigmented /

hyperpigmented anesthetic macules/plaqueshyperpigmented anesthetic macules/plaques2.2. TuberculoidTuberculoid – solitary hypopigmened hypoesthetic – solitary hypopigmened hypoesthetic

macule, neuritic pain, contractures of hand and macule, neuritic pain, contractures of hand and foot, ulcers, eye involvement ie keratitisfoot, ulcers, eye involvement ie keratitis

MULTIBACILLARYMULTIBACILLARY1.1. Lepromatous Lepromatous – inability to close eyelids – inability to close eyelids

“unblinking eyes” ( lagophthalmos) multiple “unblinking eyes” ( lagophthalmos) multiple lesions, Loss of lateral portion of eyebrows lesions, Loss of lateral portion of eyebrows (madarosis), corugated skin (leonine facies), (madarosis), corugated skin (leonine facies), septal collapse (saddlenose) clawing of fingers & septal collapse (saddlenose) clawing of fingers & toes, loss of digits, enlargement of male breasts toes, loss of digits, enlargement of male breasts ( gynecomastia)( gynecomastia)

2.2. BorderlineBorderline – between lepromatous and – between lepromatous and tuberculoidtuberculoid

Mgt:Mgt: Domiciliary home treatment ( RA 4073)Domiciliary home treatment ( RA 4073) Multi Drug Therapy ( MDT) – use of 2 or Multi Drug Therapy ( MDT) – use of 2 or

more drugs for the tx of leprosy. Proven more drugs for the tx of leprosy. Proven effective cure for leprosy & renders effective cure for leprosy & renders patients non-infectious a week after patients non-infectious a week after starting treatment. starting treatment.

Paucibacillary- Rifampicin and DapsonePaucibacillary- Rifampicin and Dapsone Multibacillary-Rifam,Dapsone,ClofazimineMultibacillary-Rifam,Dapsone,Clofazimine Diaminodiphenylsulfone DDS( Dapsone)Diaminodiphenylsulfone DDS( Dapsone) RifampicinRifampicin Clofazimine (lamprene)Clofazimine (lamprene) Treatment is from 9 mos to 18 mos(2 Treatment is from 9 mos to 18 mos(2

years )years )

PediculosisPediculosis Blood sucking lice/Pediculus humanusBlood sucking lice/Pediculus humanus

p. capitis-scalpp. capitis-scalpp. palpebrarum-eyelids and eyelashesp. palpebrarum-eyelids and eyelashesp. pubis-pubic hairp. pubis-pubic hairp. corporis-bodyp. corporis-body

MOT: skin contact, sharing of grooming implementsMOT: skin contact, sharing of grooming implementss/sx: nits in hair/clothing, irritating maculopapular s/sx: nits in hair/clothing, irritating maculopapular

or urticarial rashor urticarial rashMgmt: disinfect implements, Lindane (Kwell) Mgmt: disinfect implements, Lindane (Kwell)

topicaltopicalPermethrin (Nix) topicalPermethrin (Nix) topical

CX: impetigo to AGN, RHDCX: impetigo to AGN, RHD

ScabiesScabies Sarcoptes scabieiSarcoptes scabiei Pruritus (excreta of mites)Pruritus (excreta of mites) Mites come-out from burrows Mites come-out from burrows

to mate at nightto mate at night

MOT: skin contactMOT: skin contact

s/sx: itching worse at night and s/sx: itching worse at night and after hot shower; rash; after hot shower; rash; burrows (dark wavy lines that burrows (dark wavy lines that end in a bleb w/ female mite) end in a bleb w/ female mite) in between fingers, volar in between fingers, volar wrists, elbow, penis; papules wrists, elbow, penis; papules and vesicles in navel, axillae, and vesicles in navel, axillae, belt line, buttocks, upper belt line, buttocks, upper thighs and scrotumthighs and scrotum

Dx: biopsies/scrapings of lesionsDx: biopsies/scrapings of lesions

Mgmt: Permethrin (Nix) cream, Mgmt: Permethrin (Nix) cream, crotamiton cream, Sulfur soap, crotamiton cream, Sulfur soap, antihistamines and calamine for antihistamines and calamine for pruritus, wash linens with hot water, pruritus, wash linens with hot water, single dose of Ivermectin, treat close single dose of Ivermectin, treat close contactscontacts

EmergingEmerging DiseasesDiseases

Severe Acute Respiratory Severe Acute Respiratory Syndrome (SARS)Syndrome (SARS)

is a respiratory disease in humans is a respiratory disease in humans which is caused by the SARS which is caused by the SARS Coronavirus .Coronavirus . SARS appears to have started in SARS appears to have started in

Guangdong Province, China in November Guangdong Province, China in November 2002. 2002. Pandemic Pandemic

MOT : direct Mucous membrane/ MOT : direct Mucous membrane/ droplet / exposure to fomites.droplet / exposure to fomites. Virus is stable in urine/feces for 1-2 days ; Virus is stable in urine/feces for 1-2 days ;

for patient with diarrhea up to 4 days.for patient with diarrhea up to 4 days. IP: 2-7 days ( max 10d)IP: 2-7 days ( max 10d) Mortality rate – 5% onlyMortality rate – 5% only

Heat at 56 c rapidly kills the virusHeat at 56 c rapidly kills the virus

Severe Acute Respiratory Severe Acute Respiratory SyndromeSyndrome (SARS) (SARS)

Clinical criteria :Clinical criteria : 1. Asymptomatic or mild respiratory illness , 1. Asymptomatic or mild respiratory illness ,

fever >38c ( >100.4 F )fever >38c ( >100.4 F ) 2.One or more clinical finding of respiratory 2.One or more clinical finding of respiratory

illnessillness cough / shortness of breath / DOB /hypoxiacough / shortness of breath / DOB /hypoxia

Epidemiologic Criteria:Epidemiologic Criteria: Contact (sexual or casual) with someone with a Contact (sexual or casual) with someone with a

diagnosis of SARS within the last 10 days diagnosis of SARS within the last 10 days OROR Travel to any of the regions identified by the WHO as Travel to any of the regions identified by the WHO as

areas with recent local transmission of SARS (affected areas with recent local transmission of SARS (affected regions as of 10 May 2003 were parts of China, Hong regions as of 10 May 2003 were parts of China, Hong Kong, Singapore and the province of Ontario, Canada).Kong, Singapore and the province of Ontario, Canada).

SARSSARS TreatmentTreatment

Antibiotics are ineffective as SARS is a viral disease. Antibiotics are ineffective as SARS is a viral disease. supportive with antipyretics, supplemental oxygen supportive with antipyretics, supplemental oxygen

and ventilatory support as needed.and ventilatory support as needed. Preventive measures ( HEALTH TEACHING)Preventive measures ( HEALTH TEACHING)

Consult doctor promptly – early treatment is the KEYConsult doctor promptly – early treatment is the KEY Build up good body immunityBuild up good body immunity Maintain good personal hygieneMaintain good personal hygiene Wear mask if develop runny nose, coughWear mask if develop runny nose, cough Wear protective mask in public areasWear protective mask in public areas Wash hand properly and keep them cleanWash hand properly and keep them clean Droplet & contact PRECAUTION Droplet & contact PRECAUTION

BIRDS FLUBIRDS FLU is an AVIAN FLU , a type of influenza is an AVIAN FLU , a type of influenza

known to exist worldwide.known to exist worldwide. Etiologic agent : avian influenza H5N1 Etiologic agent : avian influenza H5N1

strain strain MOT : spread in air and manure.MOT : spread in air and manure.

Transmitted through contaminated feeds, Transmitted through contaminated feeds, water, equipment, and clothingwater, equipment, and clothing

No evidence that virus can survive in well No evidence that virus can survive in well cooked meatcooked meat

Spread rapidly among birds not infect Spread rapidly among birds not infect human easilyhuman easily

No confirmed human-human transmissionNo confirmed human-human transmission

Bird FluBird Flu

Human cases of influenza A Human cases of influenza A (H5N1) infection have been (H5N1) infection have been reported in :reported in :

Cambodia Cambodia ChinaChina IndonesiaIndonesia ThailandThailand Vietnam. Vietnam.

BIRDS FLUBIRDS FLU Incubation period : 3-5 daysIncubation period : 3-5 days S/sx : S/sx :

Symptoms in animal vary -Symptoms in animal vary - can cause death can cause death within few dayswithin few days

In human – same as in human influenza In human – same as in human influenza Fever/ sorethroat/ cough/ severe cases Pneumonia.Fever/ sorethroat/ cough/ severe cases Pneumonia.

The The highly pathogenichighly pathogenic form spreads more form spreads more rapidly through flocks of poultry. This rapidly through flocks of poultry. This form may cause disease that affects form may cause disease that affects multiple internal organs and has a multiple internal organs and has a mortality rate that can reach 90-100% mortality rate that can reach 90-100% often within 48 hours. often within 48 hours.

BIRDSFLUBIRDSFLU

Prevention & treatment Prevention & treatment Avian influenza in human can be detected Avian influenza in human can be detected

with : STANDARD INFLUENZA TESTwith : STANDARD INFLUENZA TEST Antiviral drugs – clinically effective in both Antiviral drugs – clinically effective in both

preventing and treating the disease.preventing and treating the disease. oseltamavir oseltamavir and and zanamavirzanamavir

Vaccines Vaccines take at least 4 months to take at least 4 months to produce and must be prepared for each produce and must be prepared for each sub-typesub-type

Nursing Intervention :Nursing Intervention :Health Teaching Health Teaching

Wash hands with soap and warm water for at least 20 Wash hands with soap and warm water for at least 20 seconds before and after handling raw poultry and eggs.seconds before and after handling raw poultry and eggs.

Clean cutting boards and other utensils with soap and hot Clean cutting boards and other utensils with soap and hot water to keep raw poultry from contaminating other foods.water to keep raw poultry from contaminating other foods.

Use a food thermometer to make sure you cook poultry to Use a food thermometer to make sure you cook poultry to a temperature of at least 165 degrees Fahrenheit a temperature of at least 165 degrees Fahrenheit Consumers may wish to cook poultry to a higher Consumers may wish to cook poultry to a higher temperature for personal preference.temperature for personal preference.

Cook eggs until whites and yolks are firm. Cook eggs until whites and yolks are firm.

FYIFYI

There are only three known A There are only three known A subtypes of influenza viruses (H1N1, subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently H1N2, and H3N2) currently circulating among humans.circulating among humans.

Influenza A viruses are constantly Influenza A viruses are constantly changing, and they might adapt over changing, and they might adapt over time to infect and spread among time to infect and spread among humans. humans.

ENDEND

Thank You!Thank You!

Communicable Communicable DiseaseDisease

– – is an illness due to an infectious agent is an illness due to an infectious agent or its toxic products which is easily or its toxic products which is easily transmitted or communicated directly or transmitted or communicated directly or indirectly from one person or animal to indirectly from one person or animal to anotheranother

** Both infectious and contagious diseases ** Both infectious and contagious diseases are communicable**are communicable**

****All contagious diseases are communicable All contagious diseases are communicable but not all communicable diseases are but not all communicable diseases are contagious**contagious**

The Infectious ProcessThe Infectious Process

Causative Agent:Causative Agent: Type of bacterium , virus, fungus, Type of bacterium , virus, fungus,

parasite, rickettsia, chlamydia etc.parasite, rickettsia, chlamydia etc.

ReservoirReservoir – the environment in which – the environment in which the agent is foundthe agent is found Human – Human – man is the reservoir of man is the reservoir of

diseases that is more dangerous to diseases that is more dangerous to humans than to other specieshumans than to other species

Animal – Animal – responsible for infestations responsible for infestations with trophozoites, worms etcwith trophozoites, worms etc

Nonanimal – Nonanimal – street dust, garden soil, lint street dust, garden soil, lint from bleedingfrom bleeding

Mode of escape from reservoir:Mode of escape from reservoir:

Respiratory TractRespiratory Tract Gastrointestinal TractGastrointestinal Tract Genito-urinary tractGenito-urinary tract Open lesionsOpen lesions Mechanical escape ( include bite of Mechanical escape ( include bite of

insects)insects) BloodBlood

Mode of TransmissionMode of Transmission: :

1. 1. by contact transmissionby contact transmission:: Direct contactDirect contact – immediate direct transfer of – immediate direct transfer of

microorganism from person to person)microorganism from person to person) Touching, biting, kissing, sexual intercourseTouching, biting, kissing, sexual intercourse

Droplet contactDroplet contact – – occurs within 3 ft from occurs within 3 ft from sourcesource

( from coughing, sneezing or talking to an ( from coughing, sneezing or talking to an infective person)infective person)

2. 2. Indirect transmissionIndirect transmission by vehicle route by vehicle route ( through contaminated ( through contaminated

items)items) Serves as an intermediate means to Serves as an intermediate means to

transport & introduce an infectious agent transport & introduce an infectious agent into susceptible host through susceptible into susceptible host through susceptible port of entryport of entry

Fomites Fomites Inanimate objects ( handkerchief, toys, Inanimate objects ( handkerchief, toys,

soiled clothes, eating utensils ,surgical soiled clothes, eating utensils ,surgical instruments, or dressing, IV needle, instruments, or dressing, IV needle, water, food, milk, serum, plasmawater, food, milk, serum, plasma

By vector routeBy vector route Is an animal or flyingIs an animal or flying or crawling insect or crawling insect

which serves as an intermediate means which serves as an intermediate means of transporting an infectious agent. of transporting an infectious agent. Ex. Mosquitoes, snails , flies, ticks and Ex. Mosquitoes, snails , flies, ticks and

othersothers

3. 3. Airborne TransmissionAirborne Transmission:: Droplet necleiDroplet neclei ( residue of evaporated ( residue of evaporated

droplets that remain suspended in droplets that remain suspended in air)air)

Dust particles in the air containing the Dust particles in the air containing the infectious agentinfectious agent

Organisms shed into the environment Organisms shed into the environment from skin, hair, wounds or perineal from skin, hair, wounds or perineal area area

Mode of Entry of Organisms into Mode of Entry of Organisms into the Human Body:the Human Body:

Respiratory tractRespiratory tract Gastrointestinal tractGastrointestinal tract Genito-urinary tractGenito-urinary tract Direct infections of mucous Direct infections of mucous

membranes / skinmembranes / skin

Host Factors :Host Factors :

Age, sex, geneticsAge, sex, genetics Nutritional status, fitness, environmental Nutritional status, fitness, environmental

factorsfactors General physical, mental & emotional healthGeneral physical, mental & emotional health Absent or abnormal immunoglobulinsAbsent or abnormal immunoglobulins Status of hematopoietic systemStatus of hematopoietic system Presence of underlying disease ( DM, Presence of underlying disease ( DM,

lymphoma, leukemialymphoma, leukemia Pt. treated w/ certain antimicrobials, Pt. treated w/ certain antimicrobials,

corticosteroids, irradiation, corticosteroids, irradiation, immunosuppresive agentsimmunosuppresive agents