Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos o Mechanical Barriers COMMUNICABLE DISEASE o Chemical Barriers

o Bodys own pop of microorganisms - microbial It is an illness caused by an infectious agent or its toxic antagonism principle products that are transmitted directly or indirectly to a well Second inflammatory response person through an agent, vector or inanimate object. o Phagocytic cells and WBC to destroy invading microorganism manifesting the cardinal signs TWO TYPES: Third immune response o Natural/Acquired Infectious Disease - Not easily transmitted by ordinary o Active/passive contact but require a direct inoculation through a break in the previously intact skin or mucous membrane RISK FACTORS Contagious Disease - easily transmitted from one person to another through direct or indirect means. Age, sex, and genes Nutritional status, fitness, environmental factors General condition, emotional and mental state Terminologies Immune system Underlying disease ( diabetes mellitus, leukemia, transplant) Disinfection destruction of pathogenic microorganism Treatment with certain antimicrobials ( prone to fungal outside the body by directly applying physical or chemical infection), steroids, immunoisuppresive drugs etc. means. Concurrent method of disinfection done CHAIN OF INFECTION immediately after the infected individual discharges infectious material/secretions. This method of disinfection is when the patient is still the source of infection Terminal applied when the patient is no longer the source of infection. Disinfectant -chemical used on non living objects Antiseptic chemical used on living things. Bactericidal kills microorganism Sterilization complete destruction of all microorganism

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General Principles Pathogens move through spaces or air current Pathogens are transferred from one surface to another whenever objects touch Hand washing removes microorganism Pathogens are released into the air on droplet nuclei when person speaks, breaths, sneezes Pathogens are transferred by virtue of gravity Pathogens move slowly on dry surface but very quickly through moisture

MODE OF TRANSMISSION Contact transmission o Direct contact - person to person o Indirect - thru contaminated object o Droplet spread - contact with respiratory secretions thru cough, sneezing, talking. Microbes can travel up to 3 feet. Airborne Transmission Vector Borne Transmission Vehicle Borne Transmission

INFECTION
invasion and multiplication of microorganisms on the tissues of the host resulting to signs and symptoms as well as immunologic response injures the patient either by: o competing with the hosts metabolism o cellular damage produced by the microbes intracellular multiplication.

EMERGING INFECTIOUS DISEASES Developing resistance to antibiotics eg: anti tb drugs, MRSA, VRE Increasing numbers of immunosuppressed patients. Use of indwelling lines and implanted foreign bodies has increased.

CLASSIFICATION ACCORDING TO INCIDENCE Sporadic - disease that occur occasionally and irregularly with no specific pattern Endemic those that are present in a population or community at times. Epidemic diseases that occur in a greater number than what is expected in a specific area over a specific time. Pandemic is an epidemic that affects several countries or continents

INFECTION CONTROL MEASURES Universal Control Measures All blood, blood products and secretions from patients are considered as infected Work Practice Control Used needles and sharps shall not be bent, broken, recapped. Used needles must not be removed from disposable syringes. Eating, drinking, smoking, applying cosmetics or handling contact lenses are prohibited in work areas. Foods and drinks shall not be stored in refrigerators, freezers where blood or other infectious materials are stored. All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, or spraying.

CAUSES OF INFECTION Some bacteria develop resistance to antibiotics Some microbes have so many strains that a single vaccine cant protect against all of them ex. Influenza Most viruses resist antiviral drugs Opportunistic organisms can cause infection in immunocompromised patients Most people have not received vaccinations . Increased air travel can cause the spread of virulent microorganism to heavily populated area in hours Use of immunosupressive drugs and invasive procedures increase the risk of infection Problems with the bodys lines of defense

THREE LINES OF DEFENSE First line of defense

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos o weight loss Masking Wear mask if needed. Patient with infectious o easy fatigability respiratory diseases should wear mask. Adult TB Handwashing Practice it with soap and water. o afternoon rise in temperature Gloving Wear gloves for all direct contact with patients. o night sweats Change gloves and wash hands every after each patient. o weight loss Gowning - Wear gown during procedures which are likely o cough dry to productive to generate splashes of blood or sprays of blood and body o Hemoptysis fluids, secretions or excretions. o sputum AFB (+) Eye protection (goggles) wear it to prevent splashes. Milliary TB - very ill, with exogenous TB like Potts disease Environmental disinfection Clean surfaces with Primary Infection disnfectant (70% alcohol,diluted bleach) o Asymptomatic o No manifestations even at CXR, Sputum AFB ISOLATION PRECAUTIONS Primary Complex o Minimal manifestation separation of patients with communicable diseases from o Lymphadenopathy others so as to reduce or prevent transmission of infectious

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agents. 7 Categories Recommended in isolation Strict isolation prevent spread of infection from patient to patient/staff.- handwashing, infectous materials must be discarded, use of single room, use of mask, gloves and gowns and (-) pressure if possible Contact isolation prevent spread by close or direct contactRespiratory isolation prevent transmission thru air. TB isolation for (+)TB or CXR suggesting active PTB. Enteric Isolation direct contact with feces Drainage/secretion precaution- prevent infection thru contact with materials or drainage from infected person. Universal Precaution for handling blood and body fluids.( bloods, pleural fluid, peritoneal fluid etc.)

Diagnosis Tuberculin testing Chest X-Ray Sputum AFB

PREVENTION Immunization introduction of specific antibody to produce immunity to certain disease. Natural passive (from placenta), active (thru immunization & recovery from diseases) Artificial passive (antitoxins), active (vaccine, toxoid)

Prevention BCG Avoid overcrowding Improve nutritional status

Treatment DOTS 6 months of RIPE Respiratory isolation, Take medicines religiously prevent resistance Stop smoking Plenty of rest Nutritious and balance meals, increase CHON, Vit. A, C

Maintain vaccine potency by preventing: Heat and sunlight Freezing Antiseptic/ disinfectants/ detergents lessen the potency of vaccine. Use water only when cleaning fridge/ref. COLD CHAIN SYSTEM maintenance of correct temperature of vaccines, starting from the manufacturer, to regional store, to district hospital, to the health center to the immunizing staff and to the client.

MENINGITIS Acute meningococcemia - with or without meningitis o Waterhouse Friederichsen Syndrome Inflammation of the meninges usually some combination of headache, fever, stiff neck, and delirium Meningococcemia: cerebrospinal fever Etiologic agent: Neisseria meningitides Incubation: 2-10 days MOT: droplet

DISEASES ACQUIRED THRU RESPIRATORY

TUBERCULOSIS Chronic respiratory disease affecting the lungs characterized by formation of tubercles in the tissues---> caseation --> necrosis ---> calcification. AKA: Phthisis, Consumption, Kochs, Immigrants dse Etiologic agent: Mycobacterium tuberculosis Incubation period: 2 10 wks. Period of communicability: all throughout the life if not treated MOT: Droplet Sources of infection sputum, blood, nasal discharge, saliva Classification 1. Inactive asymptomatic, sputum is (-), no cavity on chest X ray 2. Active (+) CXR, S/S are present, sputum (+) smear Classification 0-5 1. Minimal slight lesion confined to small part of the lung 2. Moderately advanced one or both lungs are involved, volume affected should not extend to one lobe, cavity not more than 4 cm. 3. Far advance more extensive than B

Diagnostics Lumbar tap, CSF - high WBC and CHON, low glucose

Manifestations Primary Complex (TB in children): non contagious o children swallow phlegm o fever o cough o anorexia

Manifestations Sudden onset of fever x 24h Petechiae, Purpuric rashes Meningeal irritation o Stiff neck o Opisthotonus

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos o Kernigs sign Repeated attacks of spasmodic coughing with series of o Brudzinski sign explosive expirations ending in long drawn force inspiration ALOC Etiologic agent: Bordetella pertusis or Haemiphilus S/S of Increase ICP pertussis Incubation period: 7-14 days Nursing Management Period of communicability: 7 days post exposure to 3 wks post disease onset MOT DropleT Administer prophylactic antibiotics: Rifampicin - drug of choice Aquaeous Pen Mannitol Dexamethasone Priority: AIRWAY, SAFETY Maintain seizure precaution Respiratory precaution Handwashing Suction secretions

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DIPTHERIA Acute contagious disease characterized by generalized toxemia coming from localized inflammatory process Etiologic agent: Corynebacterium Diptheria (Klebs loffer bacillus) Incubation period: 2-5 days Period of communicability: variable, ave:2-4 weeks MOT Droplet, direct or intimate contact, fomites, discharge from nose, skin, eyes

Manifestation rapid cough 5-10x in one inspiration ending a high pitched whoop. Catarrhal slight fever in PM, colds, watery nasal discharge, teary eyes, nocturnal coughing, 1-2 weeks Paroxysmal Spasmodic stage; 5-10 successive forceful coughing ending with inspiratory whoop, involuntary micturition and defecation, choking spells, cyanosis Convalescent 4th- 6th week; diminish in severity, frequency

Manifestations Pseudomembrane - grayish white, smooth, leathery and spider web like structure that bleeds when detached Types of Respiratory Diptheria o Nasal serous to serosanginous purulent discharge Pseudomebrane on septum Dryness/ excoriation on the upper lip and nares o Pharyngeal pharyngeal pseudomembrane bull neck ( cervical adenitis) Difficulty swallowing o Laryngeal Sorethroat, pseudomemb Barking, dry mettallic cough

Complications Otitis media Acute bronchopneumonia Atelectasis or emphysema Rectal prolapse, umbilical hernia Convulsions (brain damage - asphyxia, hemorrhage)

Diagnostics Elevated WBC Nasopharyngeal swab

Nursing Management Complications Due to Toxemia o Toxic endocarditis o Neuritis o Toxic nephritis Due to Intercurrent Infection o Bronchopneumonia o Respiratory failure Prevention: o DPT Parenteral fluids Erythromycin - drug of choice Prone position during attack Abdominal binder Adequate ventilation, avoid dust, smoke Isolation Gentle aspiration of secretions

Diagnostics Nose and throat swabs - culture of specimen form beneath membrane Virulence test Shicks test : test for susceptibility to diptheria Moloneys test: for hypersensitivity to diphtheria

MEASLES Sources of infection secretions from eyes, nose and throat Pathognomonic sign: o Kopliks spots

Management Penicillin, Erythromycin Diptheria Antitoxin after skin test if (+), fractional dose Supportive o O2, if laryngeal obstruction tracheostomy o CBR for 2 weeks o Increase fluids, adequate nutrition- soft food, rich in Vit C o Ice collar Isolation till 3 negative cultures

Prevention DPT Manifestations

PERTUSIS (WOOPHING COUGH)

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos Pre eruptive stage / Prodromal (10-11 days) MMR, Pregnant women should avoid exposure to rubella o Coryza, Cough, Conjunctivitis patients o Kopliks Spots, whitish spot at the inner cheek Administration of Immune serum globulin one week after o Fever, photophobia exposure to rubella. Eruptive stage o Maculopapular rashes CHICKENPOX o Rash is fully developed by 2nd day o High grade fever on and off Acute and highly contagious viral disease characterized by o Anorexia, throat is sore vesicular eruptions on the skin Convalescence (7-10 days) Infectious agent Herpes zoster virus or Varicella zoster o Desquamation of the skin Incubation period 10 -21 days Period of communicability: 1 day before eruption up to 5 Diagnostics days after the appearance of the last crop MOT: airborne, direct, indirect Nose and throat swab o Direct contact thru shedding vesicles, o Indirect thru linens or fomites Treatment Manifestations Antiviral drugs- Isoprenosine Antibiotics if with complications Pre eruptive: Mild fever and malaise Supportive O2, IVF Eruptive: rash starts from trunk Lesions - red papules then becomes milky and pus like Complications within 4 days, Pruritis Bronchopneumonia Stages of skin affectations otitis media o Macule flat o Papule elevated above the skin diameter about 3 encephalitis cm o Vesicle o Pustule Nursing Management o Crust scab , drying on the skin Preventive measles vaccine at 9 months, MMR 15 Complications months and then 11-12; defer if with fever, illness Isolation - contact/respiratory pneumonia TSB , Skin care daily cleansing wash sepsis Oral and nasal care Plenty of fluids Treatment Avoid direct glare of the sun- due to photophobia

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GERMAN MEASLES Mild viral illness caused by rubella virus. AKA: Rubella; 3-Day Measles Incubation period from exposure to rash 14 -21d Period of communicability one week before and and 4 days after onset of rashes. Worst when rash is at its peak. MOT: Droplet, nasal ceretions, transplacental in congenital

Zovirax 500mg tablet 1 tab BID X 7 days Acyclovir Oral antihistamine Calamine lotion Antipyretics

Nursing Management Strict isolation until all vesicles scabs disappear Hygiene of patient Cut finger nails short Baking soda - pruritus

Manifestations Prodromal low grade fever, headache , malaise, colds, lymph node involvement on 3rd to 5th day Eruptive Forscheimers spots: pinkish rash on soft palate, rash on face, spreading to the neck, arms and trunk o lasts1-5 days with no pigmentation or desquamation o muscle pain

Prevention Live attenuated varicella vaccine VZIG - effective if given 96h post exposure

HERPES ZOOSTER Acute inflammatory disease known to be caused by herpes virus varicellae or VZ virus Infection of the sensory nerve charac by extremely painful infection along the sensory nerve pathway Occurs as reinfection of VZ virus MOT o Direct o Indirect airborne Incubation: 1-2 weeks

Treatment symptomatic treatment

Complications Encephalitis, neuritis Rubella syndrome microcephaly, mental retardation, deaf mutism, congenital heart disease RISK for congenital malformation o 100% when maternal infection happens on first trimester of pregnancy. o 4% - second/third trimester

Nursing Management Isolation. Bed rest Room darkened photophobia Encourage fluid like measles tx

Prevention

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Clinical Manifestations Diagnostic procedure Hx of chickenpox Pain and burning sensation over lesions of vesicles along nerve pathway Smear of vesicle fluid- giant cells Viral cultures of vesicle fluid Electron microscopy Giemsa-stained scraping multinucleate giant epithelial cells sudden headache, earache , loss of appetite swelling of the parotid gland pain is related to extent of the swelling of the gland which reaches its peak in 2 days and continues for 7-10 days. fever may reach 40 C during acute stage, one gland may be affected first and 2 days later the other side is involved

Complications Orchitis testes are swollen and tender to palpation. Oophoritis- pain and tendeness of the abdomen Mastitis Deafness may happen Meningo-encephalitis possible

Signs and Symptoms Burning, itching, pain then erythematous patches followed by crops of vesicles Eruptions are unilateral Lesions may last 1-2 weeks Fever, regional lymphadenopathy Paralysis of cranial nerve, vesicles at external auditory canal Paralytic ileus, bladder paralysis, encephalitis

Diagnostics Viral Culture WBC count

Complications Opthalmia herpes blindness because of damage of gasserian ganglion Geniculate herpes deafness because of infection of 7th CN (AKA: Ramsay Hunt Syndrome)

Prevention MMR Vaccine

Treatment Modalities Antiviral drugs NSAIDS Acetaminophen

Nursing Intervention MUMPS Acute viral disease manifested by swelling of one or both of the parotid glands, with occasional involvement of other glandular structures,particularly testes in male. Etiologic agent filterable virus of paramyxovirus group usually found in saliva of infected person. AKA: Epidemic/ infectious parotitis Incubation period: 14 -25 days. Period of communicability 6d before and 9d post onset of parotid gland swelling 48 hrs immediately preceding the onset of swelling is the highest communicability. MOT: direct, indirect - droplet, airborne Compress of NSS or alluminum acetate over lesions Analgesics, sedatives weeks to mos Steroids Keep blister covered with sterile powder esp after break Prevent bacterial invasion Encourage proper disposal of secretions and usage of gown and mask

Nursing Interventions Symptomatic Application of warm/ cold compress Oral care, warm salt water gargle Diet semi solid, soft food easy to chew o Acid foods/fluids fruit juices may increase discomfort

DISEASES ACQUIRED THRU GIT

Diseases caused by Bacteria o Typhoid Fever o Cholera o Dysentery Diseases caused by Virus o Poliomyelitis o Infectious Hepatitis A Diseases caused by Parasites o Amoebiasis o Ascariasis

THYPHOID FEVER infection of the GIT affecting the lymphoid tissues(ulceration of Peyers patches) of the small intestine Etiologic Agent: Salmonella typhosa and typhi, Typhoid bacillus Incubation period: 1-2 weeks Period of communicability: as long as the patient is excreting the microorganism, MOT: fecal-oral route, contaminated water, milk or other food Sources of Infection o A person who recovered from the disease can be potential carrier.

o o

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos Ingestion of shellfish taken from waters contaminated by sewage disposal Stool and vomitus of infected person are sources of infection.

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Clinical manifestations Acute, profuse, watery diarrhea. Initial stool is brown and contains fecal material becomes rice water Nausea/ Vomiting S/s of Dehydration poor tissue trugor, eyes are sunken Pulse is low or difficult to obtain, BP is low and later unobtainable. RR rapid and deep Cyanosis later Voice becomes hoarse speaks in whisper Oliguria or anuria Conscious, later drowsy Deep shock Death may occur as short as four hours after onset. Usually first or 2nd day if not treated Principal deficits o Severe dehydration - circulatory collapse o Metabolic acidosis loss of large volume of bicarbonate rich stool. RR rapid and deep o Hypokalemia massive loss of K. abdominal distention paralytic ileus

Clinical Manifestations Ladderlike fever Nausea, vomiting and diarrhea RR is fast, skin is dry and hot, abdomen is distended Head-ache, aching all over the body Worsening of symptoms on the 4th and 5th day Rose spots

Complications Hemorrhage, Peritonitis, Pneumonia, Heart failure, Sepsis

Diagnostics WBC elevated Blood Culture (+) S. typhosa Stool Culture (+) Widal test blood serum agglutination test o antigen active typhoid o H antigen- previously infected or vaccinated o Vi antigen carrier

Diagnostics Fecal microscopy o Rectal swab o Stool exam

Treatment Chloramphenicol drug of choice Paracetamol

Nursing Management Restore FE balance Bedrest Enteric precautions Prevent falls/safety precautions WOF intestinal bleeding o Bloody stools o Sweating o Pallor NPO, BT

Treatment IVF- rapid replacement Oral rehydration Strict I and O Antibiotics Tetracycline, Cotrimoxazole.

Nursing Management Medical Asepsis Enteric precaution VS monitoring I and O Good personal hygiene Proper excreta disposal Concurrent disinfection. Environmental sanitation

CHOLERA an acute bacterial disease of the GIT characterized by profuse diarrhea, vomiting, loss of fluid. Etiologic agent: Vibrio cholerae, V. comma Pathognomonic sign: rice watery stool Incubation period: 2-3 days Period of Communicability: entire illness, 7-14d MOT: fecal oral route

Prevention protection of food and water contamination. Water should be boiled/ chlorinated. Milk should be pasteurized. Sanitary disposal of human excreta Environmental sanitation. supply from fecal

DYSENTERY Acute bacterial infection of the intestine characterized by diarrhea and fever Etiologic Agent: Shigella group Shigella flesneri - commmon in the Philippines Shigella boydii, S. connei,

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos S. dysenteria most infectious, habitat exclusively in man, they develop resistance to antibiotics Incubation period 7 hrs. to 7 days

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Period of communicability during acute infection until the feces are (-) MOT fecal-oral route, contaminated water/ milk/ food.

Clinical Manifestations Fever esp. in children Nausea, vomiting and headache Anorexia, body weakness Cramping abdominal pain (colicky) Diarrhea bloody and mucoid Tenesmus Weight loss Diagnostics Fecalysis Rectal Swab/culture Bloods WBC elevated Blood culture

Treatment Antibiotics- Ampicillin, Cotrimoxazole, Tetracycline IVF Anti diarrheal are Contraindicated

Nursing Management Maintain fluid and electrolyte balance Restrict food until nausea and vomiting subsides. Enteric precaution Excreta must be disposed properly. Prevention- food preparation, safe washing facilities, fly control

3 Types of Paralysis o Spinal Paralytic Flaccid paralysis Autonomic involvement Respiratory difficulty o Bulbar Form Rapid & serious Vagus and glossopharyngeal nerves affected Cardiac and respiratory reflexes altered Pulmo edema Hypertension, impaired temp regulation Encephalitic s/s o Bulbospinal Combination Minor Polio o Inapparent / subclinical o Abortive: recover within 72 hours; flulike; backache; vomiting Major Polio o Paralytic: asymmetrical weakness, paresthesia, urinary retention, constipation o Non paralytic: slight involvement of the CNS; stiffness and rigidity of the spine, spasms of hamstring muscles, with paresis o Tripod position: extend his arms behind him for support when upright o Hoynes sign: head falls back when he is in supine position with the shoulder elevated o Meningeal irritation: (+) Brudzinski, Kernigs sign

Diagnostics Throat swab, stool exam, LP

Nursing Interventions Supportive, Preventive Salk and Sabin Vaccine NO morphine Moist heat application for spasms Airway: tracheotomy Footboard to prevent foot drop Fluids, NTN, Bedrest Enteric and strict precautions

POLIOMYELITIS An acute infectious disease caused by any of the 3 types of poliomyelitis virus which affects mainly the anterior born cells of the spinal cord and the medulla, cerebellum and the midbrain AKA: Acute anterior poliomyelitis, heinmedin disease, infantile paralysis Etiologic Agent: Poliovirus (Legio Debilitans) 3 Types of Poliovirus o Type I - most paralytogenic, most frequent o Type II - next most frequent o Type III - least frequent associated with paralytic disease 3 Strains o Brunhilde o Laasing o Leon MOT: Fecal-Oral Incubation period: 7-14 days ave (3-21 days) Period of communicability: 7-16 days before and few days after onset of s/s

HEPATITIS A Inflammation of the liver caused by hepatitis A virus AKA: infectious hepatitis Incubation period: 2-6weeks MOT: oral-fecal/ enteric transmission Diagnostic test: liver function (SGOT/SGPT)

Sign and Symptoms Febrile episodes with varying degrees of muscle weakness Occasionally progressive Flaccid Paralysis

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos Diagnostics Stool Exam ( cyst, amoeba+++) WBC elevated

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Treatment Amoebacides Metronidazole(Flagyl) 800mg TID 7days Bismuth gylcoarsenilate combined with Chloroquine Antibiotic Ampicillin, Tetracycline, Chloramphenicol Fluid replacement IVF, oral X

Nursing Management Enteric precaution Health education- boil drinking water (20-30 mins), Use mineral water. Cover leftover food. Avoid washing food from open drum/pail. Wash hands after defecating and before eating. Observe good food preparations. Fly control

Clinical Manifestations Prodromal/ pre icteric o S/S of URTI o Weight loss o Anorexia o RUQ pain o Malaise Icteric o Jaundice o Acholic stool o Bile-colored urine

ASCARIASIS Helminthic infection of the small intestine caused by Ascaris Lumbrecoides MOT: fecal-oral Incubation period: 4-8 weeks Communicability: as long as mature fertilized female worms live in intestine

Diagnostic tests HaV Ag, Ab, SGOT, SGPT Diagnostics Microscopic identification of eggs in stool CBC Hx of passing out of worms (oral or anal), Xray,

Nursing Interventions Provide rest periods Increase CHO, mod Fat, low CHON Intake of vits/minerals Proper food preparation/handling Handwashing to prevent transmission

Signs and Symptoms Stomachache Vomiting Passing out of worms

AMOEBIASIS involves the colon in general but may involve the liver or lungs as well Etiologic agent: Entamoeba histolytica Incubation: 3-4 weeks Period of communicability: duration of illness MOT: fecal oral route o Indirect - Ingestion of food contaminated with E.Histolytica cysts, polluted water supply, exposure to flies, unhygienic food handlers. o Direct contact sexual, oral, or anal, proctogenital

Complications Energy / Protein malnutrition Anemia Intestinal obstruction

Treatment: Pyrantel Pamoate Piperazine Citrate Mebendazole, Tetramizole Dicyclomine Hcl, NSAIDS for abdominal pain For intestinal obstruction o Decompression o Fluid and electrolyte therapy o If persistent, laparotomy FF up stool exam 1-2 weeks after treatment

Nursing Intervention Isolation- not needed Enteric precaution Handwashing Proper nutrition Maintenance of hydration / fluid balance / boil of water Improve personal hygiene Proper food prep/handling Administer meds (NSAIDS, MEBENDAZOLE)

Clinical Manifestations Intermittent fever Nausea, vomiting, weakness Later : anorexia, weight loss, jaundice Diarrhea watery and foul smelling stool often containing blood streaked mucus Colic and abdominal distention Intestinal perforation bleeding

DISEASES ACQUIRED THRU THE SKIN

Diseases caused by Trauma and Inoculation o Tetanus o Rabies o Malaria o DHF o Leptospirosis

o Schistosomiasis Disease acquired thru Contact O Leprosy

TETANUS

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos During convalescence Determine vertebral injury Attend to residual pulmonary disability Physiotherapy TT Nursing Interventions

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an acute, often fatal, disease characterized by generalized rigidity and convulsive spasms of skeletal muscles caused by the endotoxin released by C. Tetani AKA: Lockjaw Etiologic Agent: Clostridium Tetani o Anerobic o Spore forming, gram positive rod Sources: o Animal and human feces o Soil and dust O Plaster, unsterile sutures, rusty scissors, nails and pins MOT: o Direct or indirect contact to wounds o Traumatic wounds and burns o Umbilical stump of the newborn o Dirty and rusty hair pins o GIT- port of entry rare o Circumcision/ ear pearcing Incubation period: 3d-3week (ave:10d)

Prevention o DPT Adverse Reactions Local reactions (erythema, induration) Fever and systemic symptoms not common Exagerated local reactions Prevention of CV and respiratory complications o Adequate airway o ICU ET- MV Provide cardiac monitoring KVO Wound care (TIG, Debridement, TT) Administer antibiotics as ordered o Penicillin Care during tetanic spasm/ convulsion o Administer Diazepam muscle rigidity/spasm o Administer neuromuscular blocking agents (metocurin iodide) relax spasms and prevent seizure Keep on seizure precaution Parenteral nutrition Avoid complications of immobility (contractures, pressure sores) WOF urinary retention, fractures

RABIES

a viral zoonotic neuroinvasive disease that causes acute encephalitis Etiologic agent: Rhabdovirus AKA: Hydrophobia, Lyssa Negri bodies in the infected neurons pathognomonic Incubation period: 4-8 weeks; 10d-1yr Period of communicability: 3-5 days before the onset of s/s until the entire course of disease MOT: contamination of a bite of infected animals

Diagnostics Signs and Symptoms persistent contraction of muscles in the same anatomic area as the injury Local tetanus Cephalic tetanus - rare form otitis media (ear infections) Generalized tetanus o trismus or lockjaw o stiffness of the neck o difficulty in swallowing o rigidity of abdominal muscles o elevated temperature o sweating o elevated blood pressure episodic rapid heart rate Neonatal tetanus - a form of generalized tetanus that occurs in newborn infants History of exposure PE/ assessment of s/s Microscopic examination of Negri bodies using Sellers MayGrunwald and Mann Strains Fluorescent Rabies Antibody technique / Direct Immunofluorescent test

Diagnostics entirely clinical CSF normal WBC- normal or slight elevated Clinical Manifestations Prodromal Phase / Stage of Invasion o Fever, anorexia, malaise, sorethroat, copious salivation, lacrimation, perspiration, irritability, hyperexcitability, restlessness, drowsiness, mental depression, marked insomia o Sensitive to light, sound, and changes in temp o Myalgia, numbness, tingling, burning or cold sensation along nerve pathway; dilation of pupils Stage of Excitement o Marked excitation, apprehension o Delirium, nuchal stiffness, involuntary twitching

Treatment Wounds should be cleaned Necrotic tissue and foreign material should be removed Tetanic spasms - supportive therapy and maintenance of an adequate airway Tetanus immune globulin (TIG) o help remove unbound tetanus toxin o cannot affect toxin bound to nerve endings o single intramuscular dose of 3,000 to 5,000 units o contains tetanus antitoxin. Oxygen NGT feeding Tracheostomy Adequate fluid, electrolyte, caloric intake

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos o Painful spasms of muscles of mouth, pharynx, and o Mosquito bite: Vector female Anopheles larynx on attempting to swallow food or water or mosquito the mere sight of them hydrophobia o Also by blood transfusion o Aerophobia o Precipitated by mild stimuli touch or noise Diagnostics o Death spasm from or from cardiac / respiratory failure Malarial smear film of blood is placed on a slide, stained Terminal Phase or Paralytic Stage and examined o Quiet and unconscious Rapid diagnostic test (RDT) done in field. 10 -15 mins o Loss of bowel and bladder control result blood test o Tachycardia, labored irregular respiration, steady rising temp o Spasm, progressively increasing paralysis o Death due to respiratory paralysis

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Treatment No cure No specific symptomatic/ supportive directed toward alleviation of spasm Employ continuing cardiac and pulmonary monitoring Assess the extent and location of the bite biting incident/ status of the animal o Severe exposure o Mild exposure Wound treatment (local care) o Cleanse thoroughly with soap and water (or ammonium compounds, betadine, or benzalkonium cl) o Anti rabies serum o Tetanus prophylaxis o Antibiotics o Suturing should be avoided Antirabies sera o Heterologous serum obtained by hyperimmunization of different animal species i.e. horses o HRIG Homologous reabies immunoglobulin human origin Rabies Vaccine Active immunization o Administered 3 years duration o Used for lower extremity bites o Lyssavac (purified protein embryo), Imovax, Antirabies vaccine Passive immunization o 3 months o Rabuman, Hyper Rab, Imogam

Clinical Manifestions Rapidly rising fever with severe headache Shaking chills Diaphoresis, muscular pain Splenomegaly, hepatomegaly Hypotension o May lasts for 12 hours daily or every 2 days. Complicated Malaria o GIT Bleeding from GUT, N/V, Diarrhea, abdominal pain, gastric, tyhoid, choleric, dysenteric o CNS or Cerebral Malaria Changes in sensorium Severe headache N/V o Hemolytic Blackwater fever - Reddish to mahogany colored urine due to hemoglobinuria Anuria death o Malarial lung disease

Nursing Interventions Isolation of patient o Provide comfort for the patient by: o Place padding of bedside or use restraints o Clean and dress wound with the use of gloves o Do not bathe the patient, wipe saliva or provide sputum jar Provide restful environment o Quiet, dark environment o Close windows, no faucets or running water should be heard o IVF should be covered o No sight of water or electric fans

Management Antimalarial drugs Chloroquine (all but P. Malarie), quinine, Sulfadoxine (resistant P falciparum) Primaquine (relapse P vivax/ovale) RBC replacement/ erythrocyte exchange transfusion

MALARIA Acute and chronic disease transmitted by mosquito bite confined mainly to tropical areas. Etiologic agent Protozoa of genus Plasmodia o Plasmodium Falciparum (malignant tertian) most serious, high parasitic densities in RBC with tendency to agglutinate and form into microemboli. Most common in the Philippines o P. Vivax - non life threatening except for the very young and old. Manifests chills every 48 hrs on the 3rd day onward if not treated o P. malarie (Quartan) less frequent, non life threatening, fever and chills occur every 72 hrs on the 4th day of onset o P. ovale - rare Incubation period: o 12days P. falciparum, 14 days P vivax and ovale, 30 days P. malariae Period of communicability o If not treated /inadequate more than 3 yrs. P malariae, 1-2 yrs. P. vivax, 1 yr- P. falciparum Mode of transmission

Nursing Management Isolation of patient Use mosquito nets Eradicate mosquitos Care of exposed persons case finding I and O BUN & creatinine dialysis could be life saving ABG TSB, ice cap on head Hot drinks during chilling, lots of fluid Monitoring of serum bilirubin Keep clothes dry, watch for signs of bleeding

Prevention Mosquito breeding places should be destroyed Insecticides, insect repellant Blood donor screening

DENGUE FEVER

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Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos Is an acute febrile disease cause by infection with one of the Observe for signs of shock VS (BP low), cold clammy skin serotypes of dengue virus which is transmitted by mosquito (Aedes aegypti). Prevention Dengue hemorrhagic fever fatal characterized by bleeding and hypovolemic shock Mosquito net Etiologic agent Arbovirus group B Eradication of breeding places of mosquito AKA: Chikungunya, O nyong nyong, west nile fever o house spraying Mode of Transmission: Bite of infected mosquito Aedes o change water of vases Aegypti o scrubbing vases once a week o cleaning the surroundings Incubation period 3-14 days o keep water containers covered Period of communicability mosquito all throughout o avoid too many hanging clothes inside the house life Sources of infection LEPTOSPIROSIS o Infected person- virus is present in the blood and will be the reservoir when sucked by mosquitoes o Stagnant water = any Infectious bacterial disease carried by animals whose urine contaminates water or food which is ingested or inoculated thru the skin. Etiologic agent: spirochete Leptospira interrogans found in river, sewerage, floods AKA: Weils disease, mud fever, Swineherds disease Incubation Period: 6 -15 days Period of Communicability found in urine between 1020 days MOT contact with skin of infected urine or feces of wild/domestic animals; ingestion, inoculation

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Diagnostics Diagnostics Torniquet test Platelet Count Hematocrit Clinical manifestations Culture

Manifestations Prodromal symptoms o malaise and anorexia up to 12 hrs. o Fever and chills, head-ache, muscle pain o N &V Febrile Phase o Fever persists (39-40 C) o Rash - more prominent on the extremities and trunk o (+) torniquet test- petechia more than 10. o Skin appears purple with blanched areas with varied sizes ( Hermans sign) o Generalized or abdominal pain o Hemorrhagic manifestations epistaxis, gum bleeding o Circulatory Phase o Fall of temp on 3rd to 5th day o Restless, cool clammy skin o Profound thrombocytopenia o Bleeding and shock o Pulse - rapid and weak o Untreated shock --- coma death o Treated recovery in 2 days

Source of Infection Rats, dogs, mice Manifestations Septic Stage o Early - Fever (40 C), tachycardia, skin flushed, warm, petechiae o Severe (Multiorgan)Conjunctival affectation, jaundice, purpura, ARF, Hemoptysis, head-ache, abdominal pain, jaundice Toxic stage with or w/o jaundice, meningeal irritation, oliguria shock, coma , CHF Convalescence recovery Management IV antibiotic o Pen G Na o Tetracycline o Doxycycline Dialysis peritoneal IVF Supportive Symptomatic

Classification Grade 1 Grade 2 Grade 3 Grade 4

Nursing Interventions Isolation of patient urine must properly disposed Care of exposed persons keep under close surveillance Control measures o Cleaning of the environment/ stagnant water o Eradicate rats o Avoid bathing or wading in contaminated pool of water o vaccination of animals (cattles,dogs,cats,pigs)

Treatment No specific antiviral therapy for dengue Analgesic not aspirin for relief of pain IV fluid BT as necessary O2 therapy

SCHISTOSOMIASIS Nursing Management Kept in mosquito free environment Keep pt. at rest VS monitoring Ice bag on the bridge of nose and forehead. Parasitic disease caused by Schistosoma japonicum, S. mansoni, S. Hematobium AKA: Bilharziasis, Snail fever Incubation period: 2-6 weeks MOT: bathing, swimming, wading in water

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Diagnostics Fecalysis o Identification of eggs Liver and rectal biosy Immunodiagnostic tests / circumoval precipitin test and cercarial envelope reactions

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos Vector: Oncomelania quadrasi Proper sanitation or disposal of feces Cercariae: most infective stage Creation of a program on snail control chemical or changing snail environment

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LEPROSY Chronic systemic infection characterized by progressive cutaneous lesions Etiologic agent: Mycobacterium leprae Acid fast bacilli that attack cutaneous tissues, peripheral nerves producing skin lesions, anesthesia, infection and deformities. Incubation period 5 1/2 mo - eight years. MOT respiratory droplet, inoculation thru break in skin and mucous membrane.

Diagnosis Identification of signs and symptoms Tissue biopsy Tissue smear Bloods inc. ESR Lepromin skin test Mitsuda reaction

Signs and Symptoms Swimmers itch o Itchiness o Redness and pustule formation at site of entry of cercariae o Diarrhea o Abdominal pain o Hepatosplenomegaly

Manifestations Corneal ulceration, photophobia blindness Lesions are multiple, symmetrical and erythematous macules and papules Later lesions enlarge and form plaques on nodules on earlobes, nose eyebrows and forehead Foot drop Raised large erythemathous plaques appear on skin with clearly defined borders. rough hairless and hypopigmented leaves an anesthetic scar. Loss of eyebrows/eyelashes Loss of function of sweat and sebaceous glands Epistaxis

Clinical Manifestations Abdominal pain Cough Diarrhea Eosinophilia - extremely high eosinophil granulocyte count. Fever Fatigue Hepatosplenomegaly - the enlargement of both the liver and the spleen. Colonic polyposis with bloody diarrhea (Schistosoma mansoni mostly) Portal hypertension with hematemesis and splenomegaly (S. mansoni, S. japonicum); Cystitis and ureteritis with hematuria bladder cancer; Pulmonary hypertension (S. mansoni, S. japonicum, more rarely S. haematobium); Glomerulonephritis; and central nervous system lesions.

Prevention multiple drug therapy sulfone rehab occupational Health isolation moral support

Complications Pulmonary hypertension Cor pulmonale Myocardial damage Portal cirrhosis

Prevention Report cases and suspects of leprosy BCG vaccine may be protective if given during the first 6 months.

Treatment Trivalent antimony o Tartar emetic administered thru vein o Stibophen (Fuadin) given per IM Praziquantel per orem Niridazole

Nursing Interventions Isolation of patient until causative agent is still present Care of exposed persons Household contact Diaminodiphenylsulfone for 2 years Observe carefully for symptoms of the disease

DISEASES ACQUIRED THRU SEXUAL CONTACT

Nursing Interventions HIV/AIDS Administer prescribed drugs as ordered Prevent contact with cercaria-laden waters in endemic areas like streams Chronic disease that depresses immune function

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Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos Charecterized by opportunistic infections when T4/CD4 Manifestations count drops <200 MOT sexual contact with infected unprotected, injection of blood/products, placental transmission Minor signs cough for one month, general pruritus, recurrent herpes zoster, oral candidiasis, generalized lymphadenopathy History Major signs loss of weight 10% BW, chronic diarrhea 1month up, prolonged fever one month up. 1959 - African man Persistent lymphadenopathy 1981- 5 homosexual men Cytopenias (low) 1982-Designated as disease by CDC PCP 1983- HIV 1 discovered Kaposis sarcoma 1987- 1.5 million HIV-infected in USA Localized candida 1994- WHO reports 8-10 mil. Worldwide & protease Bacterial infections inhibitors introduced TB 1999-First clinical trials for HIV vaccine STD Neurologic symptoms The Immune System Criteria for Diagnosis of AIDS Macrophages CD4 counts of 200 or less Humoral response Evidence of HIV infection and any of Cell-mediated response o Thrush RNA virus o Bacillary angiomatosis Retrovirus o Oral hairy leukoplakia Reverse transcriptase o Peripheral neuropathy Protease o Vulvovaginal candidiasis o Shingles o Idiopathic thrombocytopenia o Fatigue, night sweats, weight loss o Cervical dysplasia, carcinoma in situ

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Evidence of HIV infection and any one of the following: o Bronchial candidiasis o Esophageal candidiasis o CMV disease o CMV retinitis o HIV encephalopathy o Histoplasmosis o Kaposis Sarcoma o Herpes simplex ulcers, bronchitis, pneumonia

Treatment Started in CD4 counts of <200 Viral load >10,000 copies All symptomatic regardless of counts Note: CD4 reflects immune system destruction. Viral loaddegree of viral activity Nucleoside Reverse Transcriptase Inhibitors o Blocks reverse transcriptase o Acts by binding directly to the reverse transcriptase enzyme o Not used alone o Rapid development of resistance Trade AZT, ZDV, Retrovir ddI, Videx ddC,Hivid d4T, Zerit 3TC, Epivir Combivir Dose 300 mg. Bid 200 mg bid .75 mg TID 400 mg bid 150 mg bid 150/300 mg Notes Taken with food Peripheral neuropathy No antacids Peripheral neuropathy Used as resistance develops Bone marrow toxicity

Diagnostics ELISA Western Blot CD4 count Viral load testing Home test kits

Generic Zidovudine Didanosine Zalcitibine Stavudine Lamivudine Lamiduvine/ Zidovudine

HIV/AIDS Spectrum

Protease Inhibitors o Introduced in 1995 o Acts by blocking protease enzyme o Indinavir (Crixivan) o CDC Guidelines Combination of 2 NRTI + PI

Nursing Management Administer Antiviral meds as ordered Universal precaution Reverse isolation gloves, needle stick injury prevention Assist in early diagnosis and management of complications 4 Cs

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Compliance info, + drugs Counselling education Contact tracing tracing out and tx for partners Condoms safe sex

Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos o

a curable infection caused by the bacteria Neisseria gonorrhoea AKA: Clap, Drip, G. vulvovaginitis MOT: transmitted during vaginal, anal, and oral sex Incubation period: 3-10 days initial manifestations Period of communicability: considered infectious from the time of exposure until treatment is successful

Manifestations Urethritis both male and female S/S: dysuria and purulent discharge Cervicitis Upper Genital Tract females (PID), Endometritis, Salpingitis, Pelvic Abscess

syphilis rash - an infectious brown skin rash that typically occurs on the bottom of the feet and the palms of the hand o condylomata lata - flat broad whitish lesions o Fever, sore throat, swollen glands, and hair loss can also be experienced Third stage o Will manifest 1 10 years after the infection o characterised by gummas - soft, tumor-like growths o seen in the skin and mucous membranes occurs in bones o joint and bone damage o increasing blindness o numbness in the extremities, or difficulty in coordinating movements. neurosyphilis o generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes cardiovascular syphilis o aortitis, aortic aneurysm, Aneurysm of sinus of valsalva and aortic regurgitation, - death

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Complications PID Infertility Upper Genital Tract male Epididymitis, Prostatitis, Seminal Vesiculitis Disseminated Gonococcal Infection (DGI) Tenosynovitis or Polyarthritis, skin lesions and fever Anorectal Infection Pharyngeal Infection Gonococcal Conjuctivitis Opthalmia Neonatorum Meningitis, Endocarditis Diagnosis Culture & Sensitivity Blood tests for N. gonorrhoeae antibodies

Treatment Antibiotics o Penicillin o Single dose Ceftriaxone IM + doxycycline PO BID for 1 week o Prophylaxis: Silver nitrate, Tetracycline, Erythromycin

Consequences in Infants o congenital syphilis o extremely dangerous A o Deformities o Seizures o Blindness o Damage to the brain, bones, teeth, and ears.

Test and diagnosis Venereal Disease Research Laboratory (VDRL) test Flourescent treponemal antibody absorption (FTA Abs) Micro hemagglutination test (MHA - TP) CSF examination

Nursing Interventions Case finding Health teaching on importance of monogamous sexual relationship Treatment should be both partners to prevent reinfection Instruct possible complications like infertility Educate about s/s and importance of taking antibiotic for the entire therapy

Treatment Syphilis is easily treatable when early detected Penicillin & other antibiotics Prevention Abstinence Mutual monogamy Latex condoms for vaginal and anal sex

SYPHILIS a curable, bacterial infection, that left untreated will progress through four stages with increasingly serious symptoms Etiologic agent: Treponema pallidum AKA: Lues, The pox, Bad blood Type of Infection: Bacterial Modes of transmission : o Through sexual contact/ intercourse, kissing o abrasions o Can be passed from infected mother to unborn child (transplacental)

Nursing interventions Case finding Health teaching and guidance along preventive measures Utilization of community health facilities Assist in interpretation and diagnosis Reinforce ff up treatment VD control program participation Medical examination of patients contacts

Symptoms Primary syphilis (10 90 days after infection) o Chancre a firm, painless skin ulceration localized at the point of initial exposure to the bacterium appear on the genitals o can also appear on the lips, tongue, and other body parts Secondary syphilis (last 2 6 weeks)

HEPATITIS B serious disease caused by a virus that attacks the liver Etiologic agent: hepatitis B virus (HBV) Source of infections: Blood and body secretions

Risk factors

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Chinese General Hospital College of Nursing Communicable Diseases Pocholo Santos multiple sex partners or diagnosis of a sexually transmitted MOT: Airborne disease Sex contacts of infected persons Signs and Symptoms Injection-drug users Household contacts of chronically infected persons flu like: fever, myalgia, lethargy, gastrointestinal symptoms, cough, sore throat Infants born to infected mothers fever above 38 C (100.4 F) Infants/children of immigrants from areas with high rates of HBV infection Shortness of breath Health-care and public safety workerr Symptoms usually appear 210 days following exposure Hemodialysis patients require mechanical ventilation Complications

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Lifelong infection Liver cirrhosis Liver cancer Liver failure Death

Diagnostics Chest X-ray (CXR)- abnormal with patchy infiltrates WBC and PLT CT. - LOW ELISA test detects antibodies to SARS o but only 21 days after the onset of symptoms Immunofluorescence assay can detect antibodies 10 days after the onset of the disease o labour and time intensive test Polymerase chain reaction (PCR) test that can detect genetic material of the SARS virus in specimens ranging from blood, sputum, tissue samples and stools CXR - increased opacity in both lungs, indicative of pneumonia SARS may be suspected o o fever of 38 C (100.4 F) or more AND Either a history of: Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days OR Travel to any of the regions identified by the WHO as areas with recent local transmission of SARS (affected regions as of 10 May 2003 were parts of China, Hong Kong, Singapore and the province of Ontario, Canada).

Signs ans Symptoms Jaundice Pruritus Fatigue RUQ - Abdominal pain Loss of appetite Nausea, vomiting Joint pain

Prevention Hepatitis B vaccine has been available since 1982. Routine vaccination of 0-18 year olds Vaccination of risk groups of all ages Immune globulin if exposed

Medical Management Interferon alfa-2b Lamivudine Telbivudine Entecavir Adefovir dipivoxil

Nursing Interventions Blood and body secretions precautions Prevention- Hepa B vaccine Proper rest periods Prevent stress physio/psychological Proper NTN, increase in CHO, high in CHON, low fats, Vit. K rich foods and minerals Assistance to prevent injury, promote safety AAT WOF s/s bleeding, edema Health education on safe sex

probable case of SARS o above findings plus positive chest x-ray findings of atypical pneumonia or respiratory distress syndrome

Treatment supportive with antipyretics, supplemental oxygen and ventilatory support as needed. Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with full barrier nursing precautions taken for any necessary contact with these patients steroids antiviral drug SARS vaccine

SEVERE OF ACUTE RESPIRATORY SYNDROME An acute and highly contagious respiratory disease in humans Etiologic agent: SARS coronavirus November 2002 and July 2003, with 8,096 known infected cases and 774 deaths Incubation period: 2-3days

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