Communicable Diseases

Disease Causation Specific Acquired Immunity

Cause of a dse in an event condition character of Natural

combination of these factors w/c play an impt role in
producing dse. Active: because patient developed dse. during childhood

Importance Passive: immunity acquired through mother (placenta)

1. For preventing disease =at least 6 months

2. For diagnosis
3. For application of correct treatment = IgG- most abundant in the body

CD Law = RA 3573 =IgM- primary immunoglobulin

Epidemiologic Triad =IgA- can be found among epithelium/mucosa

Host Agent - Respi tract, GIT, GUT

- Breastmilk
Environment
=IgE- allergic type I
Theory of Multiple Causation
- Hypersensitivity rXn
Dse. results from an imbalance between dse., agent, and - Immediate rXn to food previously ingested
host - Produce mast cell, histamine

Chain of Transmission for Infection =IgD- found in B cells/ serum

1. Pathogenic agent- cause Artificial

Biological= organism (bacteria, virus) Active: vaccines- provide immunization from common dse.

Non-biological= chemical (poison), physical (pt fell) - To neutralize toxin of pt

- Given gradually
2. Reservoir – to grow and multiply - 2-3 doses
Man, animal, soil Passive: presence of immunoglobulin
3. Portal of exit - Give once
Respi, GIT
- To give immediate protection to pt
4. Mode of transmission
Direct contact- transmit through direct contact,
droplet, kiss, blood
Indirect contact- needs vehicle (water, food,
serum) Exposed to bacteria tissue invasion
To be transferred to pt
-vector (mosquito, arthropods) Susceptible host infection disease
- air borne
5. Portal of entry- how the organism will enter the host *spectrum = from exposure to dev’t. s/sx- death
6. Susceptible host
4 stages
*you can break the anywhere in the chain (MOT= best)
1. Incubation
Definition a. Time interval bet the 1st exposure to the
appearance of the s/sx
Antigenic- ability to stimulate the host to produce antitoxin 2. Prodromal (very contagious)
a. Premonition of an impending attack of a dse.
Infectivity- ability of an agent to invade and adapt itself to the host b. Early signs of a developing dse.
3. Pd. Illness
a. Pt actually manifests s/sx
Pathogenecity- ability of an agent to set up either a local or general
4. Convalescent
tissue reaction
a. Road to recovery
Virulence- measures the severity of reaction

- capacity to produce dse.

Community reaction to an agent
- very infectious
Sporadic- occasional/ infrequent occurrence of a dse
Invasive- infection resulting to tissue destruction
Epidemic- excessive frequency of a particular dse.

Endemic- constantly occurring in one geographical are

Pandemic- occurs in more than 1 country/ territory

KenSanRN
  Laryngeal spasm = DOB
 Aspiration – pneumonia
3 Phases of Prevention  Respi distress
 Coma and death
 Primary
o Health promotion disseminate / health Nsg. Mgt
teaching
o Specific protection vaccination  Careful cleansing and debridement of the wound
 Secondary  Monitor the vital signs and muscle tone
o Early diagnosis and prompt tx
 Tertiary *H2o2- first to debride and remove the blood clots
o Disability limitation
o Rehabilitation
*betadine nxt
 Starts: pt seek advice, help and is
admitted
*suture and dress
 Restoring health of pt
 Bring back to optimum level of
functioning  Admin tetanus vaccine
 Antibiotic= cloxa- to stop growth of toxin

If with tetanus
SKIN
- Check airway
TETANUS - Admin vaccine
- Antibiotic via IV
Trismus- lock jaw; spasm of masseter muscles
Treatment
CA: Clostridium tetani
1. Penicillin or METRONIDAZOLE
MOT: skin penetration 2. Prepare diazepam 0.2mg/kg IM/IV for seizure

INCU: 3-21 days Prevention

Exotoxin- tenanospasmin= spastic effect rigidity pain - Proper wound care

- Immunization with DPT for infants and TT to pregnant
- Tetanilysin= lysis of blood spastic mother (5 shots)
1st preg = 3
Neurotoxin- prob in impulse- convulsion and seizure TT1= o; TT2= 3, TT3= 5, TT4=10, TT5=lifetime

Notable s/sx Vaccine

Passive immunization- given once

 Progressive muscle stiffness
 Tenderness
Tetanus immunoglobulin (human serum gamma globulin) –
 Trismus IM
 Risus sardonicus –sarcastic smile
 Dysphagia Tetanus antitoxin (equine origin horse serum) –ANST
 Opistothonus
 Clonic convulsion Active

Clinical manifestation Tetanus toxoid 0.5ml/amp- no ANSt

 Early stage Neonatal Tetanus

o Headache
o Fever * mother = no TT, Poor sanitation onset between 3 and 12
o Sore throat yo
o Loss of appetite
o Malaise Manifestation
airway can die of blockage >progressive difficulty in feeding
clean wound to lessen the toxin >jaw become so still
*ALWAYS ASK THE Hx Assess Correctly

Diagnosis RABIES
 No definitive dx studies - Acute encephalitis caused by a neutrophic filterable
 Clinical findings and correct Hx of wound confirms the Dx virys rhat lead to formation of negri bodies with in the
 Serologic test (EIA) brain cells
 Wound culture and gram staining
CA: Rhabdovirus
Render immediate intervention
MOT:
Complication
KenSanRN
  Inoculation of virus laden saliva from a bite o a rabid animal Passive= 1x
 Contamination of intact mucosa
 Contamination of broken ski

*can be treated= if nergi bodies have not yet reached the brain

INCU: 20-90 days Active immunization

Variation in length of incubation pd.  Purified Verocell Rabies Vaccine= 0.5 ml/vial (IM/ID)
 Purified Duck embryo Vaccine= 0.1 ml/vial
1. Distance of the bite to CNS
2. Severity of bite ID= day0,3,7,30,90
3. Amt. virus introduced
4. Immune status of the host IM= day 0,7,21

Vaccine: anti-rabies, anti-tetanus Day 0,3,7,28-30,90

Categories *always ask for the condition of the dog

I. Feeding/ touching d/c anytime provided that the dog is ok

a. Linking of intact skin
b. Observe dog for 14 days Rapibur- purified chick embryo cell rabies vaccine
II. Licks on broken skin/ abrasion
a. Scratches
b. Give vaccine
c. Observe dog for 10-14 days
Passive immunization
III. Licks on intact mucosa
a. Deep/multiple transdermal bites
b. Observe dog 10-14 days if dog dies Human rabies Immunoglobulin (derived from plasma of human donor)
cut the head Dx negri bodies
Equine rabies Immunoglobulin (derived from horse serum) (SKIN TEST)
Clinical manifestation

Prodromal (lasts for 10 days)- treatable

Management
 Fever, headache
 Sore throat  Monitor the mental status of the pt.
 Abd. Pain  Keep pt as comfortable as possible
 Anorexia  Proper disposal of contaminated materials/ secretions
 n/v  Proper protection (gloves, gowns, mask, goggles)
 gen malaise  Dim light
 paresthesia/pain @site of bite
RA9428= rabies control program
Acute Neurologic (lasts for 2-7days)- (encephalitis)-untreatable

 hypersalivation
 aero,photo,hydrophobic MALARIA
 disorientation
 hallucination - Periodic fever
 bizarre behaviours - Infectious dse. caused by any 1 of 4 protozoa of the
 seizure plasmodium species
 nuchal rigidity
 paralysis

Coma P. Falcifarum= Most toxic

Death- respi paralysis Common in the Phil

Diagnosis Malignant tertian malaria

 fluorescent rabies antibody (sensitive) P. Vivax= most common type of benign tertian malaria
 brain biopsy
Most common in children

Benign= P. Ovale
1st Aid
Quartan malaria= P. malaria
1. wash wound with running water and soap for at least 10 min
MOT: bite of an infective Female Anopheles
2. observe the dog for 10-14 days
Infective Stage: sporozoites – can infect/ cause
3. immunization
Incu: 10 -12 days
Active = 5x injection
*hemolysis= hemolytic type of anemia (monozoite)
KenSanRN
 Spectrum

1. Dengue fever: Mod. To high grade fever 2-7 days duration

a. +tourniquet test (rumple leede test)
b. Petechiao
c. Low platelet
Clinical manifestation d. High hematocrit
e. Intermittent
 Cold stage- chills s/sx
 Hot stage- fever, n/v, headache - Severe h.a., pain behind the eyes
 Diaphoretic stage- profuse sweating - Muscle and joint pain
 Anemia - Anorexia
 Malaise - Abdominal pain
 Spleenomegaly - n/v
- rashes: Herman’s sign (white spot between the rashes)
2. Dengue Hemorrhagic Fever
a. Skin hemorrhages:
Diagnosis i. Petechiae, purpura, ecchymoses
b. Gingival bleeding- gargle, ice chips
1. Microscopy: presence of parasite in a giense stained blood c. Nasal bleeding
film d. GI bleeding
2. Rapid diagnosis test- rapid dipstick test: detect parasite i. Hematemesis, melena, hematochezia
antigen in the human blood e. Hematuria
f. Inc. menses X= don’t eat dark colored
Complication food
4 grades of DHF
 Cerebral malaria
Grade1.
 Pulmonary edema
-fever and non specific constitutional sx
 Renal impairment
- + tourniquet test is only hemorrhagic
 Massive hemolysis
manifestation
Grade2.
3. Thin(to know the species) and thick (to know how severe)
- grade 1 manifestation + spontaneous
smear= malarial smear
bleeding
Grade3.
Cerebral type of malaria -signs of circulatory failure (rapid, weak
pulse, narrow pulse pressure, HPN, cold clammy
- Pts woth danger signs skin0
- Quinine with complications Grade4.
-profound shock (undetectable pulse
Treatment and BP)

Combination therapy 3. Dengue shock syndrome

-DHF manifestation +circulatory failure
-in confirmed uncomplicated and sever P. Falcifarum -rapid and weak pulse, narrow pulse pressure, HPN and
restlessness
-artemether-lumefantrine
Mgt.
-chloroquine, primaquine
Tx: replace fluid and electrolytes (D5LR)
In case of tx failure
To control DF: know the nature of the dse. causation
-quinine + artemether-lumefantrine or
quinine+doxycycline/tetra In case of dhf: place ibag over the forehead if there is epistaxis

Give H2 blocker to prevent ulcer

Prevention and Control Diet: low fiber, low fat, no carbonated drinks, no irritating food, no dark
colored food
1. H.E.
-IEC materials WOF: danger signs
Use of repellants- off lotion, mosquito nets and insecticide
Stream seeding bioponds  <100,000 cell/cu mm
Stream cleaning cut the vegetation  hcT rise in > 20 % ave.
2. Case finding and tx
3. Environmental sanitation Indicator for hospitalization:

DENGUE 1. inc. hct count

2. persistent headache
- Acute febriledse. Caused by 4 immunological type of 3. persistent marked abd pain and vomiting
flavivirus 4. spontaneous bleeding

MOT: Aedes Aeygypti 4s in dengue

Aedes Albopictus- provinces; rural 1. search and destroy

2. self protection
KenSanRN
 3. seek immediate tx INCU pd.: 1-2 wks
4. say no to indiscriminate fogging
Clinical Manifestation
Dengue NS1 antigen- early detection of both primary and secondary
 Anicteric
ELISA- can detect if pt has old (IgG)/ new case (IgM) o Fever
o Chills
Dengue rapid strip test o Severe headache
o Conjunctival suffusion
FILARIASIS o rashes
 severe
- wuchereria bancrofti- most common in the Phil  with jaundice
- brugia malayi  renal Dysfxn
- b. timors  hemorrhagic diathesis
 hepatomegaly
intermediate host
*targets liver and kidney leading to liver/kidney failure(most common
complication)
1. Aedes (finlaya) poecilus
a. Breeds in abacca plants (bicol, quezon, Mindoro,
Mindanao, sulu) Diagnosis

MOT: mosquito bite - culture: 1st week blood and after 1st week urine
- csf from 5th to 12th day
*lodges in lymphatic system - ELISA
- Leptspiral Antibody test
CM bilateral
Treatment
Acute Stage
Replace : Fluid and electrolytes
- Lymphadenitis
- Swollen inguinal node For mild to moderate cases= doxycycline 1000 mg PO BID
- Lymphagitis
- Epididymytis For severe cases= pen G 1.5 m units IV q 6
- Orchitis
If allergic to pen = erythromycin (on full stomach to prevent ulcer)
Chronic
Nsg. Mgt.
- Hydrocele
1. Avoid swimming
- Lymphedema
2. Use preventive boots
- Elephantiasis
o Scrotum, labia, breast maybe
affected SCABIES
o Drain and/or amputate
- Infectious dse. of the skin caused by a mite
Diagnosis
CA: Sarcoptes Scabies
Blood culture
MOT: direct contact with infected person/ indirect contact thru
Nocturnal blood exam bedding, linen, clothes

Treatment INCU: 1-4 days- 4 wks

Ivermectin 100-400 ug/kg *very contagious- ask the condition of other fam. Member

Diethylcarbamazine citrate – dec, drug of choice

Surgery: elephantiasis, hydrocele Clinical manifestation

Prevention: environmental sanitation  Intense pruritus

 Macule
 Papule and vesicles
 Eczematous plaques, pustules and nodules
 Rashes/lesion
LEPTOSPIROSIS
 Papule with scratch (burrow of mite)
CA: leptospira interrogans
Diagnosis
AKA: well’s dse.
- Biopsies/scraping of lesions
Rat – main reservoir for icterohemorrahagiae
Treatment
MOT: water/ food contaminated with leptospira
- 5% permethrin cream
- 1% lindane lotion/ cream
: mucous membrane breaks in the skin
- *herbal=akapulko

KenSanRN
Prevention: 1. Cutaneous
2. Inhalation
- Wash bedding and clothing with hot water 3. Ingestion
- Strictproper hygiene
- Take a bath daily Skin trauma – most common
- Isolate belongings

Cutaneous anthrax

 Pruritic papule
SCHISTOSOMIASIS  Papule-vesicle-necrotic ulcer
 Marked edema, lyohadenopathy, fever, headache
- Blood flukes  Full eschar leaves scar
- Bilhariasis
Inhalation
Etiology:
-hemorrhagic necrosis, edema of mediastinum, substernal pain, cough,
S. haematobium- bladder CA, Africa, eastern Countries h.a. fever, chills, DOB

S. mansoni- Africa, eastern Countries Ingestion

S. japonicum- only in Phil (leyte davao, sulu) -n/v, abd pain, bloody diarrhea, hematochezia

Oncomelania quadrasi- small snail, intermediate host Diagnosis

Cercaria- infective stage- penetrates the skin Immunoflourescence staining tech

MOT: skin penetration Gram staining

INCU: @least 2months ELISA

Endeic foci: sorsogon,samar,leyte,bohol,Mindoro, bicol davao Blood culture

Usual COD: bleeding

Treatment
Clinical manifestation
 Pen G- IM
 Itchiness/ rashes
 Fever
 Abd pain and diarrhea
 Blood in stoll Respiratory
 Anemia
 Hepatosplenomegaly PULMONARY TUBERCULOSIS

Complication CA: mycobacterium Tuberculae

 Liver fibrosis INCU: 2-10wks-3mo. After exposure

 Portal HPN
 Esophageal varices –hamatemesis-
MOT: direct airborne
Diagnosis and treatment

Rectal biopsy: + eggs

Children
Katokatz- stool exam
 No capability to expel bacilli in lungs
Circum oval precipitate test (COPT)-serum /blood  Not contagious
 Primary complex
Drug of choice Praziquantel
Adult
Prevention
 Contagious
1. Snail control: mollucides
 Apex = Increase V/P ratio= Increase 02= presence of M.
2. Health education
3. Environmental sanitation Tuberculae

ANTHRAX S/Sx

Aka: woolsorter dse  Chronic cough (2 wks or more)

 Fever
CA: Bacillus Antracis  Chest/back pain
 Significant weight loss (muscle wasting)
MOT:  Hemoptysis
KenSanRN
  Night sweats, body malaise, SOB III: 2 RIPE/ 4 RI

Diagnosis  New pulmonary sm (–) with minimal lesion

 Direct sputum smear microscopy/ AFB: sputum or gastric S/E

aspirate =rifampicin
 3 consecutive days (or 3 times)  red orange urine tears saliva sweat
o 1st sample: collected @the time of consultation o (contact lenses absorb the red color
o 2nd: first sputum produces early in the morning  Hepatotoxicity
upon waking up = isoniazid
o 3rd: the time the pt comes back for consultation  Peripheral neuritis/ peripheral neuropathy
 Upon waking up NPO o Treat with vit. B6
o Contraindication: massive hemoptysis = pyrazinamide
o Chest xray  Increase uric acid (treat with allupurinol)
o Treat hemoptysis  Avoid purine rich foods
o AFB = ethambutol
 Eyes- optic neuritis, visual problems, color blindness (green,
CXR- shows how progressive the lesions are red)
= streptomycin
Sputum culture- if pt manifests multidrug resistance  Ears- otitis, ototoxicity,
 Nephrotoxicity
Tine test  Most toxic
 Can cause congenital hearing loss
Mantoux test IV: refer to special facility, DOTS PLUS center (AFB smear)
 Chronic (still (+) for smear after supervised re tx)
 PPD 0.1ml ID  Drug resistant
 Interpreted after 48-72 hrs
 += 10 mm diameter Mgt
 Tb with AIDS= + =5mm  Maintain respi isolation until pt responds to medicine
 Admin o2 as needed
Classification  Maintain semi fowler position
 Monitor the weight daily
Class 1: TB exposure  Encourage to eat nutritious diet to promote healing and
improve the defense against infection = increase CHON=
- +exposure increase immune system

Class 2: TB infection
Prevention: BCG- prevents extrapulmonary TB

- +/- hx of exposure
DIPHTHERIA
- + mantoux
 Bullneck
 Pseudomembrane- grayish white membrane and bleeds
Class 3: TB dse.
when scraped (if throat swap is needed do it gently, don’t
scratch)
- s/sx
CA: corynebacterium diphtheria
- Highly contagious, klebs ioeffler bacillus, club shaped
Class 4: TB inactive
appearance
- INCU: 2-4 days
- -s/sx
- MOT: direct contact with exudates of nasopharynx
- +mantoux

DOTS = Direct Observe Tx Short Course Complication

 Myocarditis
 6-8 mo.  Neuritis

Elements = +sputum/ +CXR S/sx

- Nasal discharges; low grade fever, coryza
PTB Category and tx - Tonsils/pharynx; fever, malaise, anorexia, sorethroat, h.a.
o Mild cervicolymphadenopathy
I: 2 RIPE/ 4 RI - Laryngotracheal; laryngeal edema, barking cough, noisy
breathing, dyspnea, suffocation
 New pulmo sm (+) case
 New pulmo sm (–) with extensive lung lesion Dx
 Extrapulmo Schick test
- Gram stain
II: 2 RIPES/1 RIPE/6 RIE - Loeffler Slant (recognize the agent)
- Nose and throat swab
 Treatment failure RAD
 Relapse Tx / nsg. Mgt
KenSanRN
 1. Diphtheria antitoxin o P. aerigenosa
2. Erythromycin or penicillin o Strep. penumoniae
3. Isolation and bed rest
a. Disinfect article and dispose properly COD: septic shock
b. Increase fluid intake INCU: 2-3 days
c. DPT vaccine for infant
S/SX
PERTUSSIS  Tachypnea/tachycardia
- Whooping Cough on inspiration  Rhinitis/ common colds
CA: bordetella pertussis  Productive cough
INCU: 3-7 days in most environment varies bet 7-10 days  Pleuritic chest pain
 High fever/ chills
Stages and S/sx  Chest indrawing
Catarrhal (mild)  Crackling breath sounds
 After the incubation of 2 wks
 Mild cough and sneezing Dx
 Fever  CXR
 Watery eyes  Blood culture- detedt the specific classification
 Pd. Of Communicability
Paroxysmal IMCI Classification
 Lasts 4-6 wks
 Explosive cough Pink – Very Severe = refer to hosp
 Rapid exhaustion  Any danger signs/ shest indrawing/stridor
 Vomiting Yellow- Pneumonia = initiate tx
 Cyanosis  Fast breathing
 Convulsion Green – cough/colds
 Inspiratory whoop (spasm of glottis)  No sign of pneumonia/
Convalescent
 Decline attacks lasting from 4 months/ more

Complication: Pneumonia Tx
Very severe
Dx  Give 1st dose of an appropriate antibiotic
 Culture- bordet gengou medium  Refer urgently to hosp
 Polymerase chain RXn- most sensitive to Dx Pneumonia
 Give oral antibiotic for 3 days
Mgt. o Cotir, amox
 Isolation and proper disposal of secretion  Advise when to return immediately
 Suction PRN  Follow up after 2 days
 O2 administration Cough/colds
 Soothe the throat and relieve the cough with a safe remedy
Tx  Advise to return immediately
 Erythromycin=drug of choice  Follow up in 5 days if not improving
 Tetracycline
 Azithromycin Mgt.
 Hyperimmune pertussis gammaglobulin  Administer 02 if pt has inadequate gas exchange (2-3L)
 DPT vaccine for infant o Allow cough to expel bacteria
o Make sure to cover mouth
Cough = Vit C  Monitor v/s
o Double dose for short Pd. Only or may cause  Semi fowlers for resting and breathing
kidney prob.  Encourage cough and suction

PNEUMONIA LEPROSY
- Cheat indrawing - Hanse’s Dse.
o Waving ribs CA: mycobacterium lepriae
- Inflammation of the terminal airways and alveoli MOT: prolonged intimate skin to skin contact
- An inflammation of the lungs associated with exudates in : nasal secretion (most common)
the alveolar lumen _chronic mildly communicable dse. affecting the skin, peripheral
nerves, eyes and mucosa of the URT
 Bronchopneumonia
o Common type; starts from bronchial and Tuberculoid Lepromatous
bronchioles - Benign -progressive
 Lobar - Non progressive - symmetrical
o Consolidation of all/part of the lobe (opacity) - Asymmetrical – usually on right
 Others: interstitial and milliary
 Nosocomial
o Hospital acquired (48 hrs after admitted) Early stage
KenSanRN
  Conjunctivitis Conjunctivitis
 Change in skin color (shiny, hypopigmented macule) Coryza
 Nasal obs
 Absence of sweating Koplik’s spots- buccal mucosa
 Muscle weakness White spots inside buccal cavity
 .Loss of sensation
 Paralysis of extremities I Prodromal Phase
Pre eruptive stage (2-4 days)
Late  Fever
 Madarosis  Coryza
 Sinking nose bridge  Cough
 Leonine appearance (nodular and thick skin of forehead and  Conjunctivitis
face)  Koplik’s spots
 Gynecomastia  Maculopapular rash
 Clawing of fingers and toes  Pd. Of communicability
 Lagopthalmos
II Eruptive phase
RA4073- Leprosy control program  Rash starts at head
 Irritability and restlessness
Dx  Enlarged cervical glands
 Lepromin test  Red and swollen throat
 Slit skin smear screening pr AFB skin smear  Fever subside

Tx III Desquamation stage

 Multiple drug therapy  Rash fade
o To prevent resistance
*virus self limiting – supportive mgt
Classification *med- if the pt have complications eg encephalitis
 Paucibacillary (non infectious) tuberculoid/ intermediate
o Regimen W/in 6-9 mo DX
o Rifampin 600 mg  Confirmatory: culture of naso pharyngeal secretion
o Dapsone 100mg (drug of choice)  Blood culture
 Mutlibacillary (infectious) lepromatous/borderline
o Regimen w/in 12-18 mo ELISA- serologic
o Rifampin 600 mg
o Clofazimine 300mg (darkens skin) Complications
o Dapsone 100 mg  Viral pneumo
 Encephalitis
Prevention  Otitis media
 Protect from injury (+) sensory loss  Subacute sclerosing panencephalitis
 Protective footwear  Jerking convulsion
 Hygiene – skion supple
Post measles encephalitis
 Exercise
 Drowsiness > coma>severe disability>death
*no hx of measles vaccine
MGT.
 Prevention: BCG
MGT/TX
 Proper hygiene  Isolation
 Proper disposal of articles
MEASLES  Keep pt. well ventilated
 Rubeola  Oronasal hygiene
 7 day measles  Increase fluid intake
 Contagious exanthematous dse. of acute onset Passive immu:
Immune globulin .25 cc/kg to mac of 15ml with in
CA: paramyxovirus 6 days
INCU: 9-11days Active: MMR

Typically a 7-11 days illness GERMAN MEASLES

 Rubella
MOT: direct contact/ indirect with nasal secretion from  3 days measles
infected person or respiratory airborne CA: myxovirus, togaviridae Family

Fever- rashes MOT

Cephalocaudal 1. Direct contact with nasopharyngeal secretions
2. Indirect contact (fomites)
3 Cs 3. Transplacental transmission
Cough

KenSanRN
INCU: 2-3weeks Complication
 Pneumonia
Clinical Manifestation  Encephalitis
 Fever, headache  Nephritis
 Mild sore throat  Conjunctival ulcer
 Maculopapular rashes
 Forchymer spots (may be present /absent) DX:
 Lymphadenopathy- suboccipital, post auricular  Fluorescent antibodies
 Microscopic exam for inclusion bodies
Complication:
 Otitis media MGT:
 Encephalitis  Penicillin for severe crusted infection
 Congenital defect (PDA, congenital cataract)  Isolation but well ventilated
Rubella Syndrome  Use warm bath to relieve itch and use calamine
 PDA, Cataract, Microcephaly lotion
DX:  Maintain good hygiene
 Culture of nasopharyngeal secretion Artificial active immunization- varicella vaccine
 HI test Hemaglutination Inhibihtion
MGT Complication: bacterial infection
 For acquired rubella – symptomatic
Herpes Zoster
Roseola (tigdas hangin)  Shingles
 exanthema infantum  An inflame con. in w/c a virus produces a painful
 non contagious vesicular eruption along the distribution of the
 1 wk nerves from 1/ more posterior ganglia
 Acute febrile dse. of ionfants CA: varicella zoster
INCU: 10 -16 days INCU: 2-3 wks
Clinical manifestation MOT: direct contact, air borne, indirect through fomites
 Fever
 Mild anorexia *antiviral and analgesic> pain> mefenamic>with food
 Irritability
 Fine maculopapular rash begins in trunk and Clinical Manifestation
spread upward  Prodromal period
 1-3 days o Malaise
o Fever
MGT  Eruptive
 Supportive- TSB  Papules-vesicles-scabs in 5-10 days
 Anti pyretic  Unilateral lesions along the thoracis spinal 5th and
7th CN
Varicella Zoster  Eruption with painful sensation
 Chicken pox Complication:
 Herpes  Keratitis
Chicken pox  Iritis
 Varicella  Peripheral paralysis
 Highly contagious dse. usually occurring in small  Ramsay hunt syndrome
children with gen vesicular eruption o Otalgia
CA: varicella zoster o Loss of taste @ anterior 2/3 of the
INCU: 2-3 wks tongue
mOT: direct contact with droplet form respiratory passage o Facial paralysis
DX
Clinical Manifestation:  Tzanck smear: scraping the lesion
 Mild type  PCR
o Slight fever  Fluorescent antibody test with ELISA
o Malaise
o Anorexia TX
o Exterme pruritus  Antiviral
o Papules the vesicle lesions o Acyclovir (Drug of choice) 200 mg QID
 Severe o Vidarabine 10-15 mg/kg/day q 12
o High fever for 3-4 days o Valacyclovir
o Initial lesion red papule  Analgesic
o Become pus filed with in 4 day  Varicella zoster immune globulin- used to prevent
o Vesicular lesion w/c are very pruritic illness in immunocompromised patient exposed to
*pustules scars> cut nail > mittens varicella

Chicken pox- macule, vesicle, papule MUMPS

Small pox- macule only/ vescicle only or papule only  20-50% sterility for males
 Infectious parotitis
KenSanRN
  Acute viral dse char by tenderness and swelling of INCU: 1-10 days usually less than 4 days
1 or both parotid glands
CA: myxovirus parotidis MGT:
MOT; direct contact with saliva/ by droplet infection
PD of Communicability: 1-6 days before parotid swelling to 9 - Isolation
- Start giving penicillin
days afterwards
- Nurse should take prophylaxis
INCU: 2-3 wks (ave 18 days) o Rifampicin= 2 days BID
o Ciprofloxacin= single dose > delays cartilage of
Clinical manifestation: children> cephaloxone
 Headache
 Fever Clinical Manifestation
 Malaise
 Anorexia  Fever
 Swelling of salivary glands  Drop of BP
 + kernig sign (flex legs-extend knee= pain on neck) or
 Temporary hearing loss brudzinski (flex head=ankle elevates)
 Dysphagia  Nuchal rigidity
 Sorethroat  Altered consciousness
*soft diet/ liquid> mefenamic  Purpura in the extremities
*do not give mangoes> Increases saliva>more pain  Non blanching rashes
*RULE OUT POST EXTRACTIVE TOOTH FIRST  Focal inxn:
o Arthritis
o Pleuritis
Complications o Pneumonia
 Epididymo-orchitis (sterility post puberty male 20- o Pericarditis
50%)
 Oophoritis Meningococcal polysaccharide vaccine
 Encephalitis
 Permanent nerve deafness - 2 dose
 Pancreatitis - Immunization: work in places with outbreak
 CNS involvement 15 % of clinical case
Clinical manifestation
*refrain from lifting
DX:
 Fever,chills, prostration, rash
 Elisa  Rash macular- maculopapular- petechial-purpura
 Compliment fixation test  Delirium stupor

MGt: WATERHOUSE FRIDERICHSEN SYNDROME

 Active immunity: MMR
 Respi isolation Fulminant cases with purpura > DIC > Shock > Coma > Death
 Bedrest until swelling subsides
 Give fluid and soft bland food *purpura fulminous gangrene
 Provide cold packs for relief of discomfort
DX:
 P 48 hours warm compress
TX:  Ct scan
 Supportive therapy (antipyretic and analgesic)  Cbc
 Blood cs
MENINGITIS  CSF-LP

Bacterial meningitis CSF Cell Glucose

Protein
 Neonates
o E. coli (oral-fecal route)
Bac. Meningitis WBC
 Neonates – 3 mo (n.meningitides)
o Sero Grp B strp agalactiae
 Children 6mo- 5 yrs Fungal( cryptococcal) Lymphocytes
o Haemophilus influenziae
 Infants – 5 yrs and young adult Viral(hepes simplex) N
o Neisseria minigitidis (skin prob purpura)
 All age group Highest incidence in elderly
o Streptococcus pneumonia
Presentation
Meningococcemia
CA: Neisseria minigitidis Meningitis: CNS problem
-Rate for infxn for sporadic cases is common in young
children : contaminated if exposed to blood

Sero group A- epidemic Meningo: Skin prob

: more contagious (respi)

MOT: direct contact with respiratory droplets of infected person
Infection control:

KenSanRN
  Respi isolation Lysis 4th wk
 Wear mask
 Use of RPE prophylaxis TX for exposed individual DX:
o Rifampin
o Ceftriaxone
 Widal test
o Ciprofloxacin
o 2nd/3rd wk
TX: o Commonly used before
o Blood
Antibiotic: Pen G 24m unit/day (drug of choice)  Culture (BUS)
o 1st wk blood
Ceftriaxone 4 gm/day o 2nd wk urine
o 3rd wk stool
Ceftazidine 6gm/ day
Complications
Diuretic: mannitol >decompress swelling
 Intestinal hemorrhage
 Intestinal perforation
 Peritonitis
DISEASE ACQUIRED THROUGH GI
MGT:
TYPHOID FEVER
 maintain f and e balance
 record i/o
 Enteric fever
 proper hand washing
 Bacterial infection of GI
 screen foods against flies
CA: salmonella Typhi  carriers must not handle food consumption

MOT: ingestion of contaminated water and food TX:

INCU: 1-3 wks  chloramphenicol

o drug of choice
PD of communicability: 1 wk from the convalescence o 100 mg/kg/day in 4 dose
 X to pregnant > gray baby syndrome
Target: Lymph nodes of Peyer’s patches in ileum  Cause aplastic anemia

: gall bladder -ciprofloxacin

Carrier: asymptomatic -ampicillin

Complication: peritonitis 4F’s

Clinical manifestation Food/ finger/ fomites flies

 Rose spot (pathognomonic sign)

o Pinkish macule on abdomen
SHIGELLOSIS
Prodromal Phase (invasive)
 Bacterial dse involving the distal small and large intestine
 1st wk  Bacillary dysentery
 Stepladder fever
 Headache CA: shigella bacilli
 Malaise
 Anorexia 1. S. dysenteria
 Rose spot 2. S. flexneri – common in phil
 Abd pain 3. S. boydi
 Diarrhea 4. S. sonnei

MOT: direct fecal oral transmission or indirect through flies, fomites ,

Fastigial ingestion of contaminated food/water

 2nd wk INCU: usually 1-2 days

 high grade fever
*diarrhea with high grade fever
 sever abd pain
 coma vigil (stare on blank space)
*hematochezia
 carphologia
 sordes (bacterial lesion on lips and gums)
Clinical manifestation
rd
Defervesnce 3 wk
KenSanRN
  High grade fever 2. Serology –IH test
 Headache
 N/V Complication:
 Abd pain and cramping
 Bloody watery diarrhea  Liver abscess- most common; tx with metro or operation
 Tenesmus- anal spasm (pain during diarrhea  Brain abscess
 Pulmo abscess
DX:  Intestinal perforation
 Intestinal hemorrhage
 Stool culture  Peritonitis

MGT: MGT:

 Isolate pt  Monitor i/o

 Maintain adequate f/e  Rehydrate parenterally/ orally
 Monitor signs of DHN = oresol  Educate to avoid spicy, fatty, fried food (diarrhea)
 Good hygiene and proper disposal of articles  BRAT diet
 TSB and antipyretic
TX:

 metronidazole 500 mg tid; for symptomatic (7-14 day)

 Iodoquinol 600 mg TID; for asymptomatic (cyst passing)

TX: *don’t give anti motility (loperamide)= defacation lessen the organism

1. Antibiotics *weakness d/t hypokalemia

a. Cotrimoxazole (old)
b. Ciproflozacin(drug of choice NOW) Banana- saba uncooked
2. Ampicillin
3. Ceftriaxone

AMOEBIASIS Amoebic Bacillary

 Protozoa Gradual onset acute onset

 Amoebic dysentery
 Parasite of the large intestine -fever +Fever
 Can recur
-Vomiting +vomiting
CA: entamoeba Histolytica
Bloody mucoid stool bloody watery
MOT: Direct transmission by fecal-oral route/ indirect thru fomite
Offensive odor odorless
INCU: few days to several months (usu 2-4 wks)
Acidic alkaline
 No fever
 Foul smelling stool Few pus cells many pus cells

Clinical Manifestation

 Mild ROTAVIRUS
o Nausea
 Most common type that leads to diarrhea> DHN
o Abd cramps
 Most common cause of severe gastroenteritis
o Flatulence
 Reoviridae family
o Diarrhea
MOT: Fecal –Oral route; fomites
 Severe
INCU: 2-4 days
o Colic pain
DX:
o Foul smelling stool
1. ELISA
o Diarrhea
2. PCR(polymerase chain rxn)
o Tenesmus
3. Culture
o Flatulence

Clinical manifestation
 Vomiting
Dx:  Fever
 Abd pain
1. Microscopic exam/culture  Diarrhea
a. Trophozoites/ cyst
Eggs common result MGT:
KenSanRN
  ORS- increase fluid intake INCU: 7-14 day for paralytic cases
 Hydrite/glucorite/pedialite  3rd stage = nerve damage = atrophy
 Gatorade for mild  Post residual poliomyelitis = atrophy
Prevention:  1st stage= no atrophy
 Breastfeeding-has glucose and contains antibody, IgA
 Proper hygiene No specific treatment == vaccine only
 Handwashing
 Rotasix- human derived monovalent live attenuated vaccine 4 Stages
 Rotate-2nd rotavirus vaccine 1. Abortive poliomyelitis
o oral a. Fever
b. Headache
CHOLERA c. n/v, sore throat, constipation
 enteric dse of the proximal small intestine causing watery 2. non paralytic poliomyelitis
diarrhea a. septic meningitis (aka)
CA: Vibrio el tor b. s/s above + stiffness, back and neck pain
: vibrio cholera 3. paralytic poliomyelitis
INCU: Few hours to 5 days; usu 2-3 days a. flaccid paralysis D/t lower motor neuron damage
MOT: direct Fecal-oral 4. progressive poliomyelitis
*will not manifest blood in stool a. muscle atrophy (rare)
*RICE WATERY STOOL > diarrhea >DHN b. muscle wasting
PD of communicability: during the stage of +stool c. loss of neuromuscular function
Few days after recovery
Clinical manifestation SABIN-oral
 n/v *foot drop – usual sign of pt with polio
 abd cramp
 profuse diarrhea DX:
 rice watery stool  stool culture
 washer woman’s hand  nasopharyngeal culture
 rapid DHN  CSF
 *no fever fever is caused by DHN MGT:
 Supportive mgt
DX:  Analgesic
 Stool culture (takes 5-6 days)  Maintain f/e
 Rectal swab – wear goggles, gloves, mask  Provide adeq. Rest
 Passive exercise
TX; Prevention
 Cotrimoxazole –old drug of choice  Vaccine (SABIN)
 Tetracycline- drug of choice o 3 dose = 2 drops
 Erythromycin-drug of choice o Immunize stomach and intestine
o Better than salk
MGT:  Formalized vaccine (SALK) –IM
 Replacement of F/E o Prevents paralysis
o Oresol
o IVF  Avoid breakfast 30 mins before and after vaccine
 WOF signs of DHN
 If vomits, wait and give vaccine

DHN
Mild Moderate Severe HEPATITIS
Thirsty eagerly thirsty
lethargic  A& E > fecal –oral route
-H2O deficiency irritable, restlessness  B> sex, body secretions, saliva, body fluids, BT, placenta
unconscious (2nd worse)
-primary dry lips.mucosa very  D> most fulminant, pt must have heap B before
sunken
Sunken eyeballs
very dry
Fontanels Hepatitis A
Abdomen goes back
goes very slowly  Acute infections
slowly  Does not lead to liver problem
 Aka: acute viral heap
o Epidemic heap
POLIOMYELITIS o Infectious heap
 Polioviral fever, infantile paralysis
 Contagious disease affecting the anterior horn cells of the
spinal cord, medulla, cerebellum and midbrain MOT; oral –fecal route
CA: polio virus / Legio debilitans
KenSanRN
Fulminant: rare MOT: serum, blood, semen, saliva, parenteral and mucosal inoculations

Chronic: never Fulminant: rare

Oncogenic: no Chronic: often

INCU: 15-45 DAYS Oncogenic: yes (hepatocellular carcinoma)

Pd.of communicability: latter half of the incubation period and during

the first week of symptoms
Concentration Of Hepa B Virus
Clinical Manifestation
High Moderate Low/undetected
 Fever, headache
 N/V Blood semen urine
 Anorexia, malaise
Serum vaginal fluid feces
Acute icteric Period
Wound saliva sweat
 Jaundice, icterus (icteric sclera)
 RUQ pain, tea= urine, clay= stool Exudates tears

DX:

 Increase in SGOT  Immediately after delivery to a positive mother give Hepa B

 Present infection = IgM anti Hav: acute disappear after vaccine active and passive
infection
 Past infection= IgG anti Hav: past infection, lifetime immunity Clinical Manifestation
agaist recurrent HAV
 Prodromal
SGOT>AST o Transient fever
o Headache
SGPT>ALT o n/v
o anorexia
+ IgG anti HAV: immune against Hepa A= immunization o fatigue
 icteric Phase
MGT: o may last up to 2 months
o jaundice
 Bedrest o pruritus
 Adeq. Nutrition (high calorie, carbo low fat)  other
 Proper isolation and proper disposal o urticaria
 Supplemental vitamins o maculopaular rash
 No specific meds o arthritis

*avoid fatty foods to prevent fatty liver INCU: 40-150 days

Prevention Complications

 Personal hygiene  liver cirrhosis –portal HPN, ascitis in cirrhosis

 Tx of water supply  liver failure
 Proper preparation of foods and monitor establishments  liver cancer
 Environmental sanitation

Vaccine – hepatitis A immune globulin

 carrier: remains infective throughout lifetime
HAV inactivated vaccine: IM
DX:
-1ml for adult
 HBsAG > acute HBV infection
-0.5 for child >booster after 6 months  HBeAG> highly infectious
 Anti HBcAG IgM> new infection
Hepatitis B  Anti HBc AG IgG> old infection
 HBeAb> low infectious
 Can be treated if mild  Anti HBsAG> immune against HBV
 Cant if carrier/ severe
 Aka homologous serum jaundice Ascitis > Drain
parenteral hepatitis
 Monitor abdominal girth

KenSanRN
  Monitor weight Red tide Dinoflagellat 30 Numbness Coconut
 Monitor BP> risk to develop HPN> stop drain> can cause es min – dizziness milk
hypovolemic shock severa palpitation
Plankton l dysphagia NPO
MGT: pollution hours paralysis
N/V NGT
 If exposed to HBV percutaneously/ contaminated mucosa
o Give immediately HBIG and HBsAG vaccine IV

TX: *charcoal – depress toxin

 Interferon Bacillus cereus (fried rice)

 Lamivudine
 Telbivudine HELMINTHS
 adefovirDiprivoxil
Helminths MOT Manifestation TX
Prevention:
Ascariasis Ingested egg Obstruction Mebendazole
 Hepa B vaccine and HB immunoglobulin (round worm)
o Infant @birth> 1-2 mo > 6-18 months
o Adult initial – 1months – 6 months Enterobiasis Ingested egg Anal pruritus Mebendazole
 Booster 5-10 years (pin worm)
 Proper blood screening Inhalation of
 Adeq. Sterile needle and syringes / proper disposal ova

Trichuriasis Ingested egg Rectal mebendazole

(whip worm) (bipolar prolapsed
Hepatitis C plugged ova)
Diarrhea
 Aka post transfusion non A non B hepatitis,
o parenterally non A non B hepatitis Hook worm Skin Ground itch, Mebendazoleq
penetration IDA
MOT: parenteral transfusion
Strongyloides Skin Steatorrhea Mebendazole
Fulminant: rare (dwarf+worm) penetration gastritis

Chronic: often Capillariasis Ingested raw Chronic watery Mebendazole

fish diarrhea
Oncogenic: yes
Paragonimus Ingested raw Hemoptysis Praziquantel
crab

FOOD POISONING

Causative INCU Manifestatio MGT Ascariasis

agent n
CA: a. lumbricoides
Staphylococc Staph 2-6 Dizziness Pen
us Gastro Enterotoxin hrs n/v Clinical manifestation:
enteritis adb pain Fluid
(Food rich in diarrhea replaceme  cough
carbs nt
 colicpain
Salmonella Salmonella 6- Dizziness Ampicillin
Gastroenteriti Enteritidis/ 48hrs n/v  N/V
s typhinurium adb pain TMP_SMX
diarrhea  Fever
(protein) Fluid
replaceme Pathology:
nt
 Loffler’s syndrome
Botulism Clostridium 18-24 Diplopia MV
Botulinum hrs dysphagia  Malnutrition
(targets muscle Supportive
lungs) (canned weakness  Intestinal obstruction
honey) respi
paralysis DX:

KenSanRN
  Stool exam MOT: skin penetration

Nx MGT: Pathology:

 Restore F/e balance  Ground itch

TX:  Respi prob

 Deworm  Hook worm anemia in chronic

 Mebendazole o Infetive stage

 Pyrantel pamoate  Suck blood

*defacation, vomiting > common DX:

* eyes, nose, ears > rare cases  Fecalysis

 Harada mori fecal culture

Enterobiasis Clinical Manifestation

CA: E. verniularis  Itching sensation

Pathology:  Erythematous papular rash vesicle

 Nocturnal and pruritus in children  N/V

Clinical manifestation  Abd pain

 Itchiness in anus  Diarrhea

 Vaginitis  Low grade fever

 Restlessness  Weakness, malaise

DX:  Cough, pharyngitis, laryngitis

 Scotch tape swab – deposit eggs on the skin of perianal area

TX; Strongyloides (dwarf threadworm)

 Pyrantel amoate CA: strongyloides stercordis

 Mebendazole MOT: skin penetration of filariform larva

DX Stage: Rhabditiform larva

Trichusis Infective Stage: Filariform Larva

CA: T. Trichuria

Pathology: Rectal prolapse; hypochromic anemia DX:

DX:  Fecalysis

 Fecalysis  Harada mori culture

 Proctoscopy Clinical Manifestation

 Pruritus

Hookworm  Larva currens (creeping eruption lesions)

 2 most common to man  Diffuse abd pain

o Ancylostoma duodenata  Diarrhea

o Necator americanus Pathology

KenSanRN
  Malabsorption and steratorrhea DX: Sputum exam

 Gastritis  Stool exam

TX: TX:

 Thiabendazole  pranziquantel

COMMUNICABLE DISEASES (GUT)

AIDS

Capillaria (Pudocworm) Etiologic agent: HIV

CA: capillaria philippinensis Family: retrovirus

MOT: ingestion of infective larva in undercooked fish Subfamily: lentivirus

Clinical manifestation:
HIV is an RNA Virus whose hallmark is the reverse transcription of its
 Diarrhea enomic RNA to DNA by the enzyme reverse transcriptase

 Wt loss Types:

 Weakness HIV

 Abd distention  CD4 + t lymphocytes

o Main target cells w/c place a key role in man’s
DX: immune system

 Stool exam Most common MOT: Sexual transmission

Pathology: Other MOT:

 Intestinal gurgling  blood and blood product

 injection drug use or paraphernalia
 Protein losing enteropathy
 needle prick injuries
 perinatal
 Chronic watery diarrhea
Clinical manifestation
TX:

 Mebendazole  fever (on and off)

 wt loss (N/V, diarrhea)
 Night sweats

Paragonimus (oriental lung fluke) Common opportunistic infection:

 Protozoa
CA: paragonimus westermani o Toxoplasma gondii
 Toxoplasmosis
MOT: ingestion of raw crab or cray fish  Contaminated food (feces of cats)
 Fungi
Infective stage: metocercaria o Pneumonocystic carinii- atypical pneumonia
o Candida albicans- skin lesion, mouth ulcer
Clinical manifestation  Candida vaginitis- cheesy vaginal
discharge, pruritus
 Cough/ hemoptysis o Cryptococcus neoforms- inhalation of pigeon
droplets from manure- cryptococcal meningitis
 Chest pain  Bacteria
o M. tuberculae
 Night sweats  Virus
o CMV(cytomegalovirus)
 Mod. Rigidity o Herpes simplex virus – vesical ulceration
 Type 1 droplet
 Fever/ epilepsy  Type 2 sexual
 Unusual neoplasm
Pathology:
o Kaposi sarcoma
o Oncogenic
 Infantile paralysis, cerebral hemorrhage
KenSanRN
  Male and female
Most common worldwide: Pneumocystic carinii> P. jiroveci o Yellow creamy pus
CD4- <200 cells/mcl o Dysuria
DX: o Burning sensation
 ELISA- screening test o Itching
o Repeat after 6 months  Neonate
 Western blot- confirmatory o Conjunctivitis thru passage in birth canal (cs
section)
Nucleosid Reverse Transcriptase Inhibitor Complication:
 Zidovudine aka AZT –azido thymidine (most common)  Sterility
 Didanosine  Epididymitis
 Zalatabine  Arthritis
 Stavudine  Endocarditis
 Lamivudine  Conjunctivitis
 Abacavir  Meningitis
 Delavirdine
Protease Inhibitor Gonococcal conjunctivitis
 Saquarnavir Bartholin’s abscess
 Ritonavir
 Indinavir DX:
 Nelfinavir  Culture from the blood/ joint fluids
 Thayer martin medium (pus, mucus)= definitive
 3 drug combi are recommended
TX:
 RA 8504- AIDS prevention prog  PEN-G
o Advocate right to protection d human dignity  Ceftriaxone IM +doxycycline PO (if uncomplicated genital)
o Sex abstinence  Erythromycin (if pregnant)
o Mutual faithful sexual relation
o Infected: do not donate blood/ and don’t get GARDNERELLA
pregnant  Poor hygiene
- Refer to san lazaro CA: Gardnerella vaginalis
 Isolated from normal GUT
CHLAMYDIA  Non specific vaginitis
- Sexual contact
MOT: unknown
Clinical manifestation Associated with premature rupture of membrane and preterm labor

 Men : nongonococcal urethritis Clinical manifestation:

Epididymitis  Yellowish/grayish vaginal discharge “fishy odor”
S/Sx: discharge, itchy, burning sensation, dysuria  Burning sensation
 Women: urethritis, cervicitis, PID  Pruritus of the labia
S/Sx: vaginal discharge, itchy dyspareunia  Dysuria
@ risk for ectopic pregnancy DX:
 Infant: conjunctivitis  Clue cells (wet smear)
TX:
DX:  Mebendazole
 Culture o Oral
 Direct smear fluorescent antibody test o Suppository

Complication: HERPES SIMPLEX VIRUS

 Salpingitis INCU:
 Infertility  HSV I= 3-5 days = above waistline
 Ectopic pregnancy: common site= amupulla  HSV II 2-12 daYS= below waistline
 Neonatal infection (conjunctivitis and otitis media)
 Common site that ruptures during e.p.: isthmus Common MOT:
 HSV I= direct contact with infected saliva or respi droplet
TX:  HSV II= sexual intercourse
 Tetracycline
 Doxycycline CF:
 Erythromycin-for pregnant  Type I
o Oropharyngeal dse. = fever
GONNORHEA o Keratoconjunctivitis = blurring of vision > blindness
 Clap, morning drop  Type II
 Sexual intercourse o Vesicle ulceration with discharges
 Neonatal herpes
CA: neisseria gonorrhea (can cause septic arthritis) DX:
Clinical Manifestation:  PCR- polymerase chain reaction
KenSanRN
TX:
 Acyclovir Clinical Manifestation
 Vidarabine  Thin purulent frothy and malodorous discharge
 Can cause vulvar erythema and edema
SYPHILIS  Cervix can be erythematous and may have punctuate
Aka: bad blood, pox hemorrhage
CA: triponema pallidum DX:
Spirochete that can be acute and chronic infectious dse.  Culture
INCU: 10 days – 3 months  Microscopic exam
MOT; sexual intercourse , BT, Thru placental transfer TX;
 Metronidazole
Primary stage:
 2-4 weeks
 Painless chancre(firm ulcerated painless lesion) STD Management
Secondary stage: 1. Explain transmission of STD and prevention
 2 months 2. Encourage the women to have a routine pap smear
 Bacterial stage 3. While treating both partners stress the need for sexual
 Rash palm/soles abstinence or use of condoms
 Condyloma latum- mucocutaneous changes in secondary 4. Make sure the pregnant women are tested and treated for
syphilis STDs
 Sore throat
 Headache/fever
 Arthralgia Cervical CA
 Gen. LADP  Human papilloma virus
 Strain
Latent Stage
 4 yrs Gardasil- 4 strains
 25% relapse Cevarix- 2 strains
 Asymptomatic
Tertiary Prevention
 Months to several yrs  Health and sex education
 CVD, AA  Condom use
 Neurosyphilis  Proper hygiene
o Unequal size of pupil (archill robinson pupil)  Give eye prophylaxis
 Refrain from sexual intercourse during her tx
CONGENITAL SYPHILIS  Notify also sexual partners
 Early congenital syphilis: within 2 yrs  Screen infants
o Widespread rash and condyloma latum  Wear gloves
o Runny nose
o Enlarged lymph node, liver, spleen in the X-Ray UTI
and osteritis  Women
 Late congenital syphilis o Shorter urethra
o Neurosyphilis like in adult with deafness  Men
o Periosteal inflammation, saddle nose and saber o Obstruction like BPH, strictures
shin  Children – congenital obstruction, vesicoureteral reflux,
o Hutchinson’s teeth and mulberry molars urinary stasis
 Wide space with curve on incisors
o Corneal inflammation Most common org: E. Coli
Liver prob.= distilled water
DX: culture/ sensitivity
 VDRL Clinical Manifestation
 RPR  Suprapubic pain
 FTA- ABS  Dysuria
TX:  Frequency
 Penicillin  Hematuroa
 Erythromycin  Fever
 Doxycycline po
 Tetracycli po DX:
 Urinalysis
TRICHOMONIASIS  Urine culture- E. Coli
T. vaginitis TX:
 Co trimoxazole
Largest pathogen – may cause non specific urethritis  Ofloxacin
MOT; sexual contact  Nitrofurantoin
Fomites Upper UTI – KIDNEY> fever chills
INCU: 4- 20 days Lower UTI- BLADDER> cystitis
*strawberry cervix Urine= pH= acidic
KenSanRN
 Alkaline urine> take ascorbic acid to acidify the urine AVIAN INFLUENZA

MGT.  Spreads more rapidly: birds and fowls

1. Increase fluid intake  A h5N1
2. Encourage to empty the bladder  Re emerging infection
3. Avoid irritant: tea, alcohol, cola, coffee  Infectious dse in chicken, ducks etc
4. Wipe from front to back after using the restroom
MOT: close contact through infected aerosol, discharges, surface
Infection control
PPE- Personal protective equipment INCU: 3 days (2-8days)

Mask *Asian countries impose increase risk bec of migratory birds

Gown
Protective eyewear
Gloves
Single use cap Clinical manifestation
Shoe covers
PRODROMAL LOWER RESPI
Handwashing- still essential to prevent transmission of infection RECOVERY

0-1 day 1-7 day

50%
EMERGING DISEASE
High grade fever DOB
Influenza A H1N1 most cases

Avian Flu Cough and SOB inspiratory crackles

die after 10
SARS (Severe Acute Respiratory Syndrome)
Pleuritic pain ARDS
days

SARS Watery diarrhea

Feb. 2003- Guandong, China Abd pain

 Newly recognized form of atypical pneumonia Sore eyes/throat

CA: coronavirus family w/c are resp. for common colds

MOT: droplet (appox. 3 ft) *Chicken not laying eggs, edematous feet, feathers not arranged with
colds, died unknown
INCU: 2-10 days
DX:
 No specific vaccine and treatment
 PCR
Clinical manifestation
TX:
 Fever
 Headache  Rimanitidine bec of resistance - use oseltamivir 1cap
 Chills BID
 Cough
 Body malaise Amantidine prophylaxis: 1 cap od x 7
 DOB days
 SOB
 Supportive
DX:  Ventilation

 PCR
 Immuno-fluorescent antibody
 ELISA INFLUENZA A H1N1

TX:  Outbreak in US and mexico

 Potential for pandemic
 Supportive  Secretion of pigs
 Provide ventilator assistance
 Empirical tx – based of exp of other pt *rna enveloped
 Use n95 mask
KenSanRN
-viral family (orthomyxoviridae)

-size: 80-200nm/.08-.12um in diameter

Surface antigens

H- haemaglutinin

N- neuraminidase

= makes virus mutate, grow and spread (h1n1)

MOT: contact

Clinical manifestation

 Fever * FLU in human > animals(mutates) >

Human
 Diarrhea
 Headache
 Runny nose
 Muscle aches

Dx: Respi swab

TX:

 osaltamivir Tamiflu (oral)

 Zanamivir (relenza (inhaled))

Prevention

 Cover nose and mouth

 Handwash
 Alcohol (rub it)
 Avoid close contact

KenSanRN