HANDOUTS IN COMMUNICABLE DISEASES DR. ROBERTO M. SALVADOR JR.

RN INFECTIOUS AND TROPICAL DISEASES SPECIALIST VECTOR BORNE INFECTIONS CLINICAL SUMMARY: DENGUE FEVER a. Caused by Flaviviridae virus and transmitted through the bite of female Aedes egypti mosquito. b. Common signs are body malaise, saddleback fever, joint pains, abdominal pain, epistaxis, gum bleeding and positive tourniquet test. c. Laboratory test are platelet count (thrombocytopenia), hematocrit (hemoconcentration) and prolonged bleeding time (PTT,PT) d. Management is only symptomatic and supportive therapy. e. Watch for signs of complications like bleeding and signs of shock CLINICAL SUMMARY: MALARIA a. Malaria is caused by a parasite called plasmodium with four species, P. Falciparum, P. Vivax, P.malaria and P. Ovale. b. Transmitted through the bite of female Anopheles mosquitoes. c. Common manifestations are divided into three predictable stages, the cold stage, the hot stage and wet stage. d. Watch for signs of cerebral malaria that is caused by the dreaded specie of malaria the P. Falciparum. Signs are headache, vomiting, changes in sensorium and seizure. e. Diagnostics is based on clinical history of travel to endemic areas, history of manifestations and malarial blood smear. f. Treatment is based on the species of malaria. g. First line anti malarial drugs is Chloroquine, Sulafadoxine Pyrimethamine and Primaquine. h. Second line of drug is Artemeter lumefranthine. i. Prophylactic drugs are Chloroquine, Doxycycline and Primaquine CLINICAL SUMMARY: FILARIASIS a. Caused by the parasite Wuchereria bancrofti and Brugia malayi which are transmitted through the bite of Aedes, anopheles and mansonia mosquito. b. Patient is usually asymptomatic on the early stage of illness. c. Common late manifestations are lymphangitis, lymphadenitis, elephantiasis and hydrocelle. d. Diagnosis is based on history of travel to endemic areas and nocturnal blood examination (NBE) or immuno-chromatographic test (ICT) and increased eosinophils

e. The drug of choice is Diethylcarbamazine or hetrazan for 12 days and surgery for chronic cases CNS INFECTIONS CLINICAL SUMMARY: MENINGITIS a. Meningitis is inflammation of the meninges that can be caused by different microorganisms like Neisseria meningitides, H. Influenza, Mycobacterium tuberculosis and Streptococcus pneumonia. b. Common manifestations of meningitis are related to increased intracranial pressure like seizure, headache, vomiting and change in sensorium. c. Pathognomonic signs of meningeal irritations are brudzinski sign, babinski sign and kernigs sign. d. Diagnostic test is lumbar puncture to get CSF fluid of the patient for evaluating the cause of the meningitis. e. Treatment is based on the etiologic agent. Mainstay of treatment of meningitis is Mannitol therapy to decrease ICP. f. Patient should be monitored for signs of sudden increase intracranial pressure. CLINICAL SUMMARY: MENINGOCOCCEMIA a. Caused by Neisseria meningitides transmitted through droplet. b. A very rapid contagious disease causing appearance of violaceous and petechial rashes and within 24 hours, if not treated properly will deteriorate and die. c. Diagnosed clinically with its pathognomonic rashes and grams stain of the skin lesion d. Drug of choice is penicillin e. Prophylactic drugs are Rifampicin 300mg 1 tab bid x 2 days, Ofloxacin 400mg 1 tab single dose or Ceftriaxone 125 mg IM single dose CLINICAL SUMMARY: RABIES a. Acute encephalitis that is cause by the bite of an infected rabid animal. The risk of development of rabies depends on the site of the bite and the nature of the bite. b. Incubation period is 4 days to 19 years. c. Common manifestation during consultation is hydrophobia, aerophobia and changes in sensorium. d. Patient should be categorized first 1. Category 1 - licking of intact skin, no abrasion 2. Category 2 lower extremity bite and biting animal should be observed for 2 weeks. 3. Category 3 upper extremity bite, head and neck bite or any site of bite and the dog cant be observed for 2 weeks. e. Treatment is based on the category of bite: 1. Category 1- observe the dog for 2 weeks

2. Category 2 give active vaccine and observe dog for 2 weeks 3. Category 3 give passive and active vaccine f. Pre-exposure prophylaxis, intradermal or intramuscular (day 0,7,28) g. Post exposure prophylaxis, intradermal (day 0,3,7,30,90), intramuscular (day 0,3,7,14,28) or (day 0,7,21) CLINICAL SUMMARY: TETANUS a. Caused by clostridium tetani, an anaerobic gram positive rod bacteria. b. Severity of tetanus infection depends on the incubation period and the source of tetanus infection. The shorter the incubation period (<7 days) the worst is the infection. c. Common manifestations are trismus, risus sardonicus, rigid abdomen and local or generalized muscle spasms. d. Goal of treatment is to maintain airway patency, neutralized the toxin and kill the microorganisms. e. Drug of choice is Penicillin f. Increase the coverage of tetanus Toxoid injection to women in childbearing age to protect the mother from tetanus and prevent neonatal tetanus. g. Tetanus Toxoid prophylaxis (0-1-6-1-1) RESPIRATORY INFECTIONS CLINICAL SUMMARY: PULMONARY TUBERCULOSIS y Caused by mycobacterium tuberculosis, a highly aerobic microorganism that is transmitted through respiratory route. Common manifestations are afternoon fever, weight loss, non productive to productive cough, cervicolymphadenopathy, hemoptysis and pleural effusion. Susceptibility is highest in children below 3 years old causing Primary Complex Infection (PKI). The source of PKI infection in children is usually adult. It is important to screen the family members to identify and treat the source of infection. Diagnosis is based on clinical manifestation, history of exposure, chest x ray, sputum exam and PPD test. Duration of treatment is based on the severity and categorization of Tb infection. Standard treatment of Tb is 6 month. 2 months intensive phase and 4 months maintenance phase using RIPES.

b. The common etiologic causes are Streptococcal pneumoniae, Haemophilus influenza, staphylococcus aureus. c. Risk factors are immunocompromised state like elderly patient, >65 years old, young patients < 5 years old, patients with AIDS, diabetes and cancer and hospitalized patient. d. Common manifestations are fever, body malaise, productive cough with yellowish to greenish sputum, rales or crackles, difficulty of breathing that can progress to respiratory failure and death once treatment fails. e. The most common cause of pneumonia in immunocompromised patient is Pneumocystis Carinii. CLINICAL SUMMARY: HISTOPLASMOSIS a. Histoplasmosis is caused by the etiologic agent histoplasma capsulatum which is transmitted trough contact with birds, bats droppings in caves or old buildings. b. Symptom develops within 14 days after exposure and this includes high grade fever, non productive cough, and dull non-pleuritic chest pain. c. Diagnosis is based on history of exposure to contaminated soil, positive histoplasmin skin test. Tissue biopsy and culture and Silver stain test, a faster diagnosis that could rule out tuberculosis infections. d. In symptomatic and chronic cases, antifungal treatments of itraconazole, fluconazole or amphotericin B are given. e. Chronic cavitary histoplasmosis is common in males over age 50 years who have COPD. Clinical findings are increasing productive cough, hemoptysis, weight loss and night sweats and chest x-ray findings are indistinguishable from cavitary tuberculosis CLINICAL SUMMARY: DIPTHERIA a. Caused by Corynebacterium diphtheria, a gram positive rod that usually infects the respiratory tract, primarily the tonsils, nasopharynx and larynx. b. Transmission is from fomites and respiratory route and the incubation period is 2-5 days. c. Pathognomonic signs are Pseudomembrane and Bullneck d. Diagnostic test are nose and throat culture using loefflers medium, Schick test and Maloney test. e. Drug of choice is Penicillin or erythromycin in patients with allergy to penicillin. f. To prevent complications like myocarditis, neuritis, muscle paralysis, anti diphtheria serum should be given as early as possible. CLINICAL SUMMARY: PERTUSIS a. Also known as whooping cough, is an acute and highly contagious infection of the respiratory tract caused by Bordetella pertussis b. Characterized by paroxysmal cough, defined as sudden, forceful, repetitive coughing. The cough occurs in a series of successive

y y

CLINICAL SUMMARY: PNEUMONIA a. A leading cause of death in children below 5 years old here in the Philippines and worldwide.

explosive outburst in series of 10-30 rapid cough in one expiration, ending in a sudden noisy inspiration associated with a long or high pitched crowing sound or whoop. c. Diagnosis is based on nose and throat swab using a special medium, Bordet Gengou agar. d. Drug of choice is erythromycin and ampicillin in patients with allergy to erythromycin. CLINICAL SUMMARY: INFECTIOUS MONONUCLEOSIS a. Also known as kissing disease because of its mode of transmission of intimate close contact with an infected person. b. Etiologic agent is Epstein Barr virus which is a known oncogenic virus that is capable of causing cancers like Hodgkin and nonHodgkins lymphoma, burkitts lymphoma and nasopharyngeal carcinoma. c. Characterized by the clinical triad of fever, cervical lymphadenopathy and sore throat combined with hepatosplenomegally and an atypical lymphocytosis and appearance of heterophil antibodies. d. Treatment is supportive and symptomatic management e. Complication is spleen rupture causing pain on the left upper quadrant radiating to the left shoulder. CLINICAL SUMMARY: MUMPS a. Caused by the virus paramyxovirus which causes painful and enlarged parotid gland. b. Transmitted through contact with saliva of an infected person either droplets or by direct contact. The patient is infectious 6 days before the onset of parotid enlargement and 5 days after the appearance of parotitis. c. Clinical manifestations of parotitis are; 1. Preceded by a prodromal period that last for 24 hours of anorexia, myalgias, body malaise, low grade fever, sore throat and tenderness at the angle of the jaw. 2. Then parotid gland enlarged progressively over a period of 1 to 3 days accompanied by earache that is aggravated by chewing, high grade fever of 38 to 40 C and pain when chewing or drinking sour or acidic drinks. d. Complications are orchitis in males and oophoritis in females, meningitis and rarely sterility e. Treatment is supportive and symptomatic therapy CLINICAL SUMMARY: CROUP a. A severe inflammation and obstruction of the upper airway causing laryngotracheobronchitis, laryngitis and acute spasmodic laryngitis. b. Parainfluenza viruses type 1, is the most common cause of croup (laryngotracheobronchitis) in children. Other viral causes are respiratory syncytial virus (RSV), influenza and measles virus.

c. Manifestations includes inspiratory stridor, hoarse or muffled vocal sounds, signs of laryngeal obstruction and a characteristic sharp, barking seal like cough. d. Diagnosis is throat swab or nasopharyngeal washings and posterior anterior X-ray revealing narrowing of the upper airway known as steeple sign e. Treatment is supportive and symptomatic therapy. In severe cases close observation and hospitalization is needed. CARDIOVASCULAR INFECTIONS CLINICAL SUMMARY: INFECTIVE ENDOCARDITIS a. Infective endocarditis is an infection of the endocardium, heart valves or a cardiac prosthesis, resulting from a bacterial or fungal infection. b. Predisposing factors are I.V drug abusers, patients with prosthetic heart valves and those with mitral valve prolapsed. c. In intravenous drug users, Staphylococcus is the most common cause and the tricuspid valve is the most commonly affected. In non-IV users the most common cause is Streptococcus viridians and the mitral valve is commonly affected. d. Modified Dukes criteria are helpful for making the clinical diagnosis of infective endocarditis in the absence of pathologic cause. e. Treatment for sub acute infective endocarditis is penicillin and Gentamycin while patient with acute infective endocarditis vancomycin (1gm Q12H), ampicillin (2g Q4H) and Gentamycin (1mg/kg Q8H) is recommended to cover the most likely pathogen like staphylococcus aureus. f. Antibiotic prophylaxis during invasive procedures for high risk patients (patients with prosthetic heart valves) and moderate risk patients ( patients with rheumatic and other acquired valvular dysfunctions) CLINICAL SUMMARY: RHEUMATIC HEART DISEASE a. Rheumatic fever is a systemic inflammatory disease of childhood which occurs as a delayed sequel to a group A beta-hemolytic streptococcal infection. b. The disease is most common between the ages 5 and 15 years when the streptococcal infection is most frequent. c. Classic symptoms of the disease like carditis, polyarthritis, Sydenhams chorea, erythema marginatum or subcutaneous nodules d. Diagnosis is made through Jones criteria 1. Evidence of preceding group A streptococcal infection with presence of 2. Two major manifestations or one major and two minor manifestations. Major criteria a. Carditis b. Polyarthritis

c. Chorea d. Erythema marginatum e. Subcutaneous nodules Minor criteria a. Clinical findings of arthralgia and fever b. Laboratory findings - Elevated erythrocyte sedimentation rate - Elevated C-reactive proteins - Prolonged PR interval e. Effective treatment for rheumatic heart disease is eradication of the streptococcal infection. f. The drug of choice to eradicate streptococcal infection is Penicillin. Parenteral injection of the drug is preferred. Intramuscular injection of a single dose of 1.2 million units penicillin or 600,000 units or procaine penicillin for 10 days is effective. GIT INFECTIONS CLINICAL SUMMARY: CHOLERA a. Cholera is an acute diarrheal disease that can result in profound rapidly progressive dehydration and death. b. The etiologic agent is vibrio cholera that exists in two forms, classical and El tor. Vibrio is a slight curved gram negative bacillus with a single flagellum. c. Cholera toxins are usually found in areas of poor sanitation where fecal contamination of water and food are common. These organisms are capable of producing epidemics and pandemic cases. d. Diagnosis is based on the clinical signs and symptoms and characteristic of the stool. Stool examination and stool culture using thiosulfatecitrate-bile-salt-sucrose (TCBS). e. Incubation period is few hours to 48 hours after ingestion of fecal contaminated water. It begins with sudden onset of painless rice watery diarrhea that may quickly become voluminous and followed by vomiting. The characteristic appearance of the stool is slightly cloudy fluid with flecks of mucus, no blood and odor is inoffensive and sweet f. Treatment is rapid replacement of fluid and electrolytes and drug of choice is tetracycline or doxycycline in adults and Co-trimoxazole or ampicillin children. CLINICAL SUMMARY: SHIGELLOSIS a. Shigellosis is acute infectious inflammatory colitis also known as bacillary dysentery that is caused by bacteria called Shigella, a slender, nonmotile, gram negative rod. b. The most common in the Philippines is flexneri and the most fatal strain is the Shiga dysenteriae. c. The characteristic appearance of the stool is bloody to watery with pus. d. Microscopic examination of the stool would help in the diagnosis and sigmoidoscopy or proctoscopy would reveal superficial ulcerations.

e. Antibiotic of choice are ciprofloxacin, ampicilin, and co-trimoxazole in children and tetracycline in adults. CLINICAL SUMMARY: AMEBIASIS a. Amebiasis is an acute and chronic intestinal protozoan infection caused by Entamoeba histolytica. It is also known as amebic dysentery. b. It is the third cause of death from parasitic disease after schistosomiasis and malaria. c. Groups that are risk are travelers, homosexuals and institutionalized people, in whom fecal-oral contamination is more common. d. The characteristic blood streaked, watery mucoid diarrhea with tenesmus. e. Diagnosis is made through stool examination which can isolate E. histolytica cyst or trophozoites or aspirates from abscesses or ulcers confirm acute amebic dysentery. f. Metronidazole is the most common drug of choice for invasive amebiasis and amebic hepatic abscess. CLINICAL SUMMARY: CAMPYLOBACTER INFECTION

a. Campylobacteriosis is an infection caused by

the genus campylobacter. Campylobacter are motile, non spore forming, curved gram negative rods. Campylobacteriosis occurs more common in the summer and the infection is predominantly isolated from infants and young adults. Diarrhea may be bloody, accompanied by nausea and vomiting and bowel movements may increase up to 10 times or more per day. The most prominent symptom is abdominal pain which may cause pseudoappendicitis. Diagnosis is made through microscopic examination of the stool and identification of Campylobacter with Gram staining or dark field microscopy to identify the characteristic darting motility. The key treatment to all kinds of diarrhea is fluid and electrolyte replacement. , Erythromycin is the drug of choice (250mg PO QID x 5-7 days). Alternate drug in adults is ciprofloxacin (500mg PO BID x 5 to 7 days) CLINICAL SUMMARY: VIRAL DIARRHEA a. Causes of viral diarrhea 1. 2. Norwalk virus this is the most common viral cause of adult food poisoning. It is also known as the cruise ship Illness Rotavirus it is the most common cause of food poisoning in infants and children and is transmitted from person to person by fecal contamination of food and shared played areas. Enteric adenoviruses they are the second most common cause of nonbacterial gastroenteritis in infants and young children.

b.

c.

d.

e. f.

3.

4.

Astroviruses causes outbreaks of gastroenteritis in children on pediatric wards and in the elderly patients in nursing homes.

b. The most important treatment is to bring back the fluids and electrolytes that was lost through drinking or intravenous therapy CLINICAL SUMMARY: CRYPTOSPORIDIUM a. Cryptosporidiosis is a highly infectious intestinal protozoon that causes an acute, self limiting diarrheal disease. b. It is recognized to cause human diarrheal disease in patients which are immunodeficient like AIDS. c. Infections are acquired through ingestion of oocysts from contaminated sources, including hand contact with the stool of infected humans or animals d. Symptoms are acute onset of watery, non bloody diarrhea accompanied by abdominal pain, fever, and nausea or weight loss. e. Diagnosis is made through fecal examination with identification of small oocysts. Acid fast or immunofluorescence staining confirms the identification of oocysts. f. Treatment consists of supportive care with fluid and electrolytes replacement and antidiarrheal agents. CLINICAL SUMMARY: MICROSPORIDIUM a. Microsporidiosis are obligate intracellular spore forming protozoa that causes significant diarrhea only in immunocompromised host like in AIDS. b. The pathogens are opportunistic to patients with HIV and immunocompromised. c. Symptoms are profuse, non bloody watery diarrhea accompanied by abdominal pain, cramping, nausea and vomiting and weight loss. d. Diagnosis of is biopsy or corneal scrapings and Staining with Giemsa, Gram or acid fast stain can help identify microsporidia in stools and duodenal fluids. e. Treatment 1. Microsporidia with albendazole (400mg PO BID x 3 weeks) leads to clinical improvement. 2. Fumagilin (20mg TID x 2 weeks) causes clearance of spores and decreases cases of relapse. Fumagilin is toxic to the bone marrow and may cause reversible bone marrow depression. CLINICAL SUMMARY: BOTULISM a. Botulism is a life threatening paralytic disease that is caused by a potent exotoxin produced by the gram positive, anaerobic bacillus, Clostridium botulinum. b. Common manifestations are acute symmetrical cranial nerve paralysis causing ptosis, dysarthia and diplopia followed by progressive weakness or paralysis of the

muscles causing dyspnea from respiratory distress. c. Ingestion of contaminated honey is the most common cause of this disease to infants d. Respiratory support and administration of botulinum antitoxin CLINICAL SUMMARY: RED TIDE POISONING a. The infection is caused by singled celled dinoflagellates known as Pyrimodium bahamense through ingestion of contaminated shellfish. b. Common manifestation after 30 minutes of ingestion of a poisonous shellfish is peri-oral numbness that progresses to difficulty of swallowing and paralysis of the respiratory muscles. c. The immediate treatment is to induce vomiting and drink coconut milk to weaken the toxin of red tide. d. If progression of respiratory muscle paralysis occurs, support the respiratory function by intubation and mechanical ventilator. e. Do not use vinegar in cooking contaminated shellfish because it would increase the virulence or red tide to 15 percent. CLINICAL SUMMARY: TYPHOID FEVER a. The most severe form of salmonellosis that is transmitted through fecal-oral route by ingestion of contaminated water or foods like shellfish or milk. b. Common manifestations are more than 7 days stepladder fever, accompanied by abdominal pain, constipation in adults and diarrhea in children and the pathognomonic exanthems called rose spots in the abdominal area and trunk. c. Diagnosis is based on clinical history and manifestation. Laboratory test are typhi dot, blood culture and widal test. d. Common complications are typhoid ileitis, typhoid encephalitis and intestinal perforation that occur on the 2nd to 3rd week of illness. e. Drug of choice is chloramphenicol in uncomplicated patients and ceftriaxone in complicated patients. CLINICAL SUMMARY: PERITONITIS a. It is the infection of the peritoneum, the membrane that lines the abdominal cavity and covers the internal organs b. Common intra-abdominal infections that can result in peritonitis are appendicitis, ascites caused by congenital heart failure, peptic ulcer, penetrating abdominal injuries and abdominal malignancies. c. Common complain of patients are sudden, severe, diffuse and constant abdominal pain and low grade. d. Empiric antibiotic therapy with a 3rd generation cephalosporin like ceftriaxone or

cefotaxime plus metronidazole or penicillin, gentamycin plus aminoglycosides and cefoxitin plus gentamicin is given to prevent complications like sepsis, hypotension or death. e. Surgical management is indicated in patient with peritonitis secondary to organ perforation to eliminate the source of the infection. HEPATOBILIARY INFECTIONS CLINICAL SUMMARY: HEPATITIS INFECTION a. Hepatitis is viral infection involving the liver. There are six common form of hepatitis; 1. Hepatitis A epidemic or infectious hepatitis, the most common form of hepatitis in school children. 2. Hepatitis B serum hepatitis, the most common cause of liver cancer and liver cirrhosis in the world. 3. Hepatitis C post transfusion hepatitis, the most common form of hepatitis in patients who requires frequent blood transfusion and to medical personnel who handles blood products. 4. Hepatitis D dormant hepatitis, it is always combined with hepatitis B infection. 5. Hepatitis E fecal oral hepatitis that is common to travelers and fatal to pregnant women. It can also cause liver cancer and cirrhosis. 6. Hepatitis G a common hepatitis that is seen in patients after hemodialysis treatment. b. Hepatitis Markers 1. anti HAV IgG, anti HAV IgM - Hepatitis A infection 2. HbsAg - Hepatitis B infection 3. HBeAg infectious hepatitis B 4. Anti HBs titer to check protection acquired from vaccine c. Supportive and symptomatic treatment is given. d. Watch for signs of complications like hepatic encephalopathy CLINICAL SUMMARY: LIVER ABSCESS a. It is caused by spread of a bacterial infection to the liver. The most common cause is benign or malignant biliary tract obstruction or infection, intra-abdominal infections like diverticulitis, appendicitis and inflammatory bowel disease. b. The most common organisms seen are anaerobic bacteria like Actinomyces, Bacteroides, Peptostreptoococcus, Fusobacterium bacteria and aerobic gram negative organisms like streptococci. Entamoeba histolytica causes a rare amebic hepatic abscess in less than 10% of patients infected with amebiasis. c. The most common manifestation is fever with or without chills accompanied by weight loss of 10 pounds or more for less than 3 months, right upper quadrant pain described as dull and constant, diarrhea, nausea, vomiting and anemia.

d. Treatment is use of empiric antibiotic therapy and surgery 1. Combinations of antibiotics like Ampicillin and metronidazole or clindamycin are given for a course of 6 weeks 2. Open surgery to drain the abscess is indicated in patient with persistent fever lasting for more than 2 weeks after antibiotic and percutaneous drainage. URINARY TRACT INFECTION CLINICAL SUMMARY: URINARY TRACT INFECTIONS a. Urinary tract infections are the most common infection seen in the outpatient department. b. The most common microorganisms that cause urinary tract infections are Escherichia coli. c. Factors to consider in the development of urinary tract infections are gender, sexual activity, diabetes, pregnancy and catheterization. d. Patients with cystitis usually experience acute onset of dysuria which is described as pain, burning or tingling sensation in the perineal area during or just after urination e. Patients with acute pyelonephritis develop rapidly over a few hours or day which includes high grade fever >39.4 C (103 F). Chills, nausea and vomiting and costovertebral angle pain. f. Appropriate antimicrobials are the key in the treatment of urinary tract infections. 1. Trimethoprim-sulfamethoxazole, ciprofloxacin, norfloxacin and amoxicillinclavulanic acid are commonly given SEXUALLY TRANSMITTED INFECTIONS CLINICAL SUMMARY: GONORRHEA

a. b. c.

d.

e.

f.

It is the most common reported STD in developing countries It is also known as morning drop, clap jack and Gonoclap. It is an infection of the mucosal surface, transitional and columnar epithelium of the genitourinary tract caused by Neisseria Gonorrhea. Common clinical manifestations are dysuria and yellowish urethral discharge in males. In females, usually patients are asymptomatic; some may also manifest the same manifestation in males. Diagnosis is culture from the site of infection like urethra, cervix, rectum or pharynx using a Thayer-Martin medium and Gram stain of urethral or cervical discharge showing gram negative diploccoci. Recommended treatment for uncomplicated gonorrhea are; 1. a single dose of ceftriaxone 125mg intramuscular or

g.

2. a single dose of Cefixime 400mg P.O or 3. ciprofloxacin 500mg PO and ofloxacin 400mg P.O 4. Azithromycin 1gm as single dose. Complications are usually seen only in female patients like pelvic inflammatory disease, ectopic pregnancy and in infants opthalmia neonatorum. CLINICAL SUMMARY: SYPHILIS

requires isolation of the virus using scrapings of lesions with staining with Wright, Giemsa (Tzanck preparation) or Papaniculaous stain. d. Antiviral immunotherapy like acyclovir is the mainstay of therapy in primary herpes infection. CLINICAL SUMMARY: TRICHOMONIASIS a. It is an acute protozoal infection of the lower genitourinary tract caused by Trichomonas vaginalis which inhabits the lower genital tract in females and urethra and prostate in males. b. Male are usually asymptomatic. In females are usually symptomatic, manifesting signs of gray or greenish yellow, malodorous vaginal discharge, vulvar erythema, severe itching, dysuria and dyspareunia. This signs and symptoms are more pronounced during pregnancy and just after menstruation. c. In pregnant women complication of premature rupture of the membrane can occur. d. Diagnosis is direct microscopic examination of vaginal or seminal discharge revealing T. vaginalis.and clinical history and physical examination of symptomatic females showing greenish yellow, malodorous discharge and strawberry appearance of the cervix. e. Treatment is metronidazole, 2 grams oral as a single dose given to both sexual partner or metronidazole 500mg twice a day for 7 days.

a. It is one of the most common sexually transmitted disease caused by Treponema palidum. b. Incubation period is between 10 to 90 days. It has three clinical stages namely; 1. Primary stage (3-6 weeks after contact) - Primary chancre usually located on the penis in men and in the anal canal, rectum or oral in heterosexual men. - This chancre is usually accompanied by unilateral or bilateral regional lymphadenopathy called Bubo. 2. Secondary stage Rashes of secondary syphilis are described as macular, papular, pustular or nodular lesions appearing on the trunk, palms, soles, arms face and moist areas. 3. Latent stage - A positive specific treponemal antibody test for syphilis together with a normal CSF examination and the absence of clinical manifestation establishes the diagnosis of latent syphilis. 4. Late syphilis - Neurosyphilis, cardiovascular syphilis, gummas. c. Diagnosis: Venereal Disease Research Laboratory (VDRL) slide test and Rapid Plasma Reagent test (RPR) and Fluorescent treponemal antibody absorption test (FTA-abs) in tissue, secretions and exudates from lesions. d. Penicillin G is still the drug of choice for all stages of syphilis. A single dose of Penicillin cures over 95% of cases of primary syphilis. CLINICAL SUMMARY: HERPES SIMPLEX INFECTIONS a. Herpes Simplex infection is an acute inflammatory disease of the genitalia and mucous membranes and commonly manifested by vesicular skin lesions and cold sores. 1. Herpes Type 1 virus typically affects the oral mucous membrane 2. Herpes Type 2 virus affects the genital area b. Clinical manifestation depends on the type of herpes virus 1. The most common manifestation of primary type 1 infection is gingivostomatitis and pharyngitis. 2. In type 2, typical painful vesicular lesions that ulcerate and heal in 1 to 3 weeks in the genital area are seen. c. Clinical diagnosis can be made accurately with identification of the characteristic multiple vesicular painful lesions and confirmation

CLINICAL SUMMARY: HIV/AIDS a. It is caused by retrovirus type 1 and type 2. The virus is capable in replicating in the immune system that without detecting that the virus is a foreign body. b. It attacks the T cells (CD4 count cells) which is the one that fights infection. c. Diagnosis is based on; 1. HIV 2 consecutive ELIZA and a confirmatory test of Western Blot Test 2. AIDS HIV plus a CD4 count cell below 500 cu/mm plus opportunistic infections 3. Full blown AIDS HIV plus a CD$ count cell below 200 cu/mm plus opportunistic infections d. The lower the CD4 count cell the more immunecompromise the patient. Common cause of infections is Pneumocystis carinii pneumonia and cryptosporidium. e. Anti-retroviral therapy (Zidovirine) is given to prolong the life of the patient and to prevent opportunistic infections. CLINICAL SUMMARY: PELVIC INFLAMMATORY DISEASE a. Pelvic inflammatory disease (PID) is a common disease of young sexually active woman. b. The infection is caused by ascending of the microorganism in the cervix to the surrounding

c. d.

e. f. g.

pelvis structures like the endometrium (endometritis), fallopian tube (salpingitis) and ovaries (oophoritis). The most common etiologic cause of PID is Neisseria gonorrhea and Chlamydia trachomatis. Risk factors that increase the development of PID are sexually active young teenagers, multiple sexual partners, abortion, childbirth, IUD insertion and a previous history of PID. Complications are infertility, sepsis, pulmonary emboli and shock. There is no specific test in the diagnosis of PID. A clinical history of sexual activity and manifestation establishes the diagnosis. Treatment a. For OPD patients, Ofloxacin or Levifloxacin plus metronidazole for 14 days is recommended or a single dose of ceftriaxone plus 14 days doxycycline with or without metronidazole, b. For inpatient treatment, second generation cephalosporin like cefoxitin or cefotetan plus doxycycline for 24 hours until clinical improvement occurs then followed by oral doxycycline to be completed for 14 days or Clindamycin and gentamycin followed by oral clindamycin or doxycycline for 14 days. CLINICAL SUMMARY: CHLAMYDIA

f.

chancroid should also be tested for HIV antibody test. Chancroid is treated with a single dose of Azithromycin orally or intramuscular ceftriaxone 250mg.

SKIN INFECTIONS CLINICAL SUMMARY: SCABIES a. It is one of the most common causes of itching dermatoses throughout the world and is predisposed by overcrowding and poor hygiene. It is caused by Sarcoptes scabie. b. Common manifestations are intense pruritus especially at night with small papules and vesicles often accompanied by eczematous plaques, pustules or nodules that are symmetrically distributed in finger web spaces, on the elbows, penis wrist and waistline. c. A definitive diagnosis of scabies requires finding a mite, egg or scybala (barrel shaped brown fecal pellets) on a skin scrapping of a burrow. d. Treatment is application of topical lindane, crotamiton or permithrin lotion from the neck down to the extremities. CLINICAL SUMMARY: PEDICULOSIS a. It is caused by Pediculus humanus var capitis. It infests the head, P. humanus var corporis, the clothing, body and Pthirus pubis infects the hair of the pubis. b. Manifestations depends on the area affected. 1. Pediculosis capitis is more common in children with long hair and the lice are commonly seen along the back of the head and ears. 2. Pediculosis capitis is common in unwashed people and people who do not change their clothing. 3. Pediculosis cruris is common in sexually active individuals. c. Treatment is application of Permethrin or lindane on the affected areas. d. Clothing and linens used by the patient should be washed in very hot water and dried in hot dryer. CLINICAL EYE: DERMATOPHYTOSIS a. Dermatophytosis is also called ringworm or tinea. It is caused by fungus that affects the stratum corneum of the skin. b. Tinea infections are common in areas with poor environmental sanitations and overcrowding. c. Common fungal skin infections are caused by dermatophytes like Trichophyton, Epidermophyton and Microsporidium. d. Transmission is caused by direct contact with the skin lesions or indirect contact with contaminated articles of the infected patients like towels, clothes, shoes and shower scrubs. e. Diagnosis is made through common test for fungal infections like wood lights examination,

a. Chlamydial infection is the most common sexually transmitted disease in the United States and it is the leading cause of preventable blindness in third world countries. b. Most infected individuals are asymptomatic early in the course of the disease. In men, patients experience dysuria with gray white urethral discharge, urinary frequency, burning and pruritus in the urethral opening. Females are usually asymptomatic. c. The drug of choice in the treatment of chlamydial infection is oral doxycycline for 7 day or Azithromycin single dose CLINICAL SUMMARY: CHANCRE a. It is one of the most common sexually transmitted infections and causes of genital ulcer and it affects males more than females. b. It was said that here is an increase risk of HIV infection in patients having this infection. c. The etiologic agent is Haemophilus ducreyi, a gram negative bacillus. It is transmitted through sexual contact with infected individuals. Poor hygiene and uncircumcised males are common risk factors. d. Soft, painful ulcers are seen on the male penis, thigh and groin. In females, tender ulcers are seen on the labia, cervix and vulva. Pus is noted in the ulcers and it bleeds easily once touched. e. Diagnosis is made through gram stain of the ulcer edges or exudates and aspirates of the inguinal lymphadenopathy. Patients with

f.

potassium hydroxide preparation and culture of the virus. The treatment of tinea infections are topical antifungal drugs like Clotrimazole, Ketoconazole, terbinafine, Miconazole and Tolnaflate. CLINICAL SUMMARY: IMPETIGO

e. Complications are renal failure, cardiogenic shock and septic shock. f. Necrotizing fasciitis is best diagnosed with tissue biopsy. Biopsy and culture specimen is obtained during surgical debridement. g. Clindamycin is the best drug to be given in patient with necrotizing fasciitis due to Group A beta hemolytic streptococcus (GAS

a. Also known as impetigo contagiosum, is a superficial skin infection that occurs primarily on the exposed areas of the face and the extremities b. This vesiculopustular disease is caused by staphylococcus aureus and less common group A beta hemolytic streptococci. c. Impetigo is a common complication of chickenpox, eczema and other skin infections d. Typically manifest a small red macular lesion that turns into vesicles that subsequently become pustular and ruptures leaving exudates of thick yellow crust. e. Diagnosis is made through clinical manifestations of the typical vesiculopustular lesions suggesting impetigo. Gram stain of the skin lesions showing Staphylococcus aureus confirms the diagnosis. f. Penicillinase resistant penicillin like cephalosporin and erythromycin for 10 days, is the treatment of choice because S. aureus CLINICAL SUMMARY: CELLULITIS a. This is the one of the most common infection that is seen and managed in the outpatient department. b. Cellulitis is caused by different microorganisms. Common causes are staphylococcus aureus and streptococcus pyogenes. c. Common signs of Cellulitis are body malaise, fever, edema, erythema, and tenderness on the affected area accompanied by enlargement of lymphnodes near the site of infection. d. Penicillin is the treatment of choice. In patients with allergy to penicillin, erythromycin is given. I e. n staphylococcal Cellulitis, Cloxacillin is given for mild infections and in severe infections oxacillin or nafcillin are given. In severe infections, incision and drainage is made to drain the infection

CLINICAL SUMMARY: LEPROSY a. Leprosy or Hansens disease, is a chronic granulomatous, systemic infection that attacks superficial tissues especially the skin and the peripheral nerves caused by Mycobacterium leprae, an acid fast bacillus b. Cardinal manifestations Early 1. Presence of Hansens bacilli in stained smear or dried biopsy material. 2. Local area of anesthesia Late 1. Madarosis 2. Leonine Fascies 3. Saddle nose 4. Gynecomastia c. Diagnosis is skin slit smear and confirmatory test is skin biopsy. d. Treatment is based on the type of leprosy. 1. Paucibacillary (9 months ) - Combination of Dapsone and Rifampicin - 6 blister packs monthly for 9 months 2. Multibacillary (12 months) - Combination of Dapsone, Rifampicin and Clofazimine - 12 blister packs taken monthly for 18 months e. For prophylaxis and in patients with single lesion and a negative slit skin smear. Single dose of rifampicin, ofloxacin or minocycline is given. BONE INFECTION CLINICAL SUMMARY: OSTEOMYELITIS a. Osteomyelitis is an infection of the bone caused by pyogenic bacteria like Staphylococcus aureus (the most common), streptococcus pyogenes, Pseudomonas aeruginosa, Proteus vulgaris and Escherichia coli. b. Clinical manifestations are chills, fever, sudden pain, tenderness and restriction of movement of the affected bone. c. The diagnosis of osteomyelitis is usually made radiologically because of their ready availability. Standard x-rays shows bone demineralization and loss of a sharp bony margin moth eaten appearance within two to three weeks of the infection. d. The antibiotic of choice for staphylococcus aureus infections are large doses of I.V. Penicillinase-resistant penicillin like nafcillin and oxacillin, cephalosporin. EYE/EAR INFECTIONS

CLINICAL SUMMARY: NECROTIZING FASCILITIS a. Necrotizing fasciitis is a fatal progressive, rapidly spreading inflammation of the superficial fascial layers involving the abdomen, extremities or perineum. b. It is commonly caused by group A beta hemolytic streptococcus (GAS) and was previously known as streptococcal gangrene. c. The common symptom initial is unexplained pain that is out of proportion to the site of injury or wound. d. The skin lesions start with erythema those progresses to bullae and massive skin necrosis.

CLINICAL SUMMARY: CONJUNCTIVITIS a. Conjunctivitis is an inflammation of the conjunctiva causing dilatation of vessels within the membrane and causes the underlying white sclera to appear red. It may results from infections, allergy or chemical reactions. b. Common causes are bacteria like staphylococcus aureus, streptococcus pneumonia, haemophilus influenza and Moraxella catarrhalis, Chlamydia trachomatis and viral infections. c. Commonly manifest redness of hyperemia of the conjunctiva accompanied by tearing and discharges. d. Diagnosis is based on physical examination of the eyes of the patients reveals peripheral injection of the bulbar conjunctival vessels. e. The treatment of conjunctivitis depends on the cause. In bacterial conjunctivitis, topical antimicrobial agents are sufficient to treat the infection. Examples of topical eye antibiotics are gentamycin or Tobramycin for gram negative infections and polymyxin or neomycin for gram positive infections. CLINICAL SUMMARY: OTITIS EXTERNA a. This infection is also called swimmers ear or external otitis, it is an inflammation of the skin of the external ear canal and auricle. b. It is most common during summer among children and young adults resulting from water being trapped in the external auditory canal resulting in irritation and infection. c. Caused by bacterial infections like Pseudomonas aeruginosa, Proteus vulgaris, Streptococci or Staphylococcus aureus. Gram negative bacteria like Pseudomonas aeruginosa is the most common pathogen. d. Manifested by redness and swelling of the external canal. A moderate to severe ear pain that is exacerbated by manipulation of the tragus and the auricle. e. Antibiotic management like instillation of otic antibiotic like polymyxin after cleaning the ear with alcohol acetic mixture and removal of ear canal debris is effective. CLINICAL SUMMARY: OTITIS MEDIA a. Otitis media is an inflammation of the middle ear and is common in children ages 6 months to 24 months due to developmental changes in the eustachian tube. b. The common pathogens that causes otitis media are Haemophilus influenza (most common cause in children under age 6), Streptococcus pneumonia, Moraxella catarrhalis and Staphylococcus aureus (most common in children more than 6 years old). c. The hallmark of middle ear infection is pain. A sense of fullness, purulent otorrhea, hearing loss, vertigo or tinnitus, fever is common. d. In acute suppurative otitis media includes the use of antibiotics like trimethoprim-

sulfamethoxazole (Cotrimoxazole), amoxicillin or ampicillin for 10 consecutive days. CLINICAL SUMMARY: MASTOIDITIS a. It is a bacterial infection and inflammation of the air cells of the mastoid anthrum that are cause by Haemophilus influenza, Moraxella catarrhalis, and staphylococcus and gram negative bacteria. b. It is usually a complication of untreated chronic middle ear infection and is potentially fatal because the infection can spread to the temporal bone causing temporal lobe brain abscess. c. Confirmatory diagnosis can be made by conventional x-ray or CT scan showing mucosal thickening in the middle ear space and in the mastoid cavity d. Parenteral antibiotic therapy of penicillin is the drug of choice given for at least 2 weeks. PARASITIC INFECTIONS CLINICAL SUMMARY: GIARDIASIS a. It is one of the most common parasitic diseases worldwide and most common in developing countries and areas with poor sanitation and hygiene caused by Giardia lamblia, enteric flagellated protozoa. b. Common symptoms are abdominal pain, bloating, nausea and vomiting and a pale, loose, greasy, malodorous, frequent stools usually 2 to 10 bowel movement per day. c. They respond easily to a 10 day course of metronidazole (250mg TID) or a 7 day course quinacrine (100mg bid) or furazolidone (100mg QID). d. Fluid therapy is important in the management of the hydration status of the patient CLINICAL SUMMARY: ASCARIASIS a. This is the most common helminthic infection of humans in tropical regions with poor fecal sanitation and in areas where farmers use human excreta as fertilizer. b. Ascaris lumbricoides is the largest intestinal nematode parasite of humans, reaching up to 40cm in length. The parasite is transmitted through fecal-oral route through ingestion of contaminated food with human feces c. The first clue may be vomiting a worm or passing a worm in the stool. Fever is usually present and may exceed 38.5C. Eosinophilia occurs during the symptomatic stage and subsides slowly over weeks. d. Microscopic identification of eggs in the stool or observation of adult worms, which may be passed rectally or by mouth, confirms the diagnosis. Complete blood count usually shows eosinophilia. e. Drug therapy with mebendazole or albendazole plus pyrantel pamoate or piperazine is the primary treatment.

CLINICAL SUMMARY: HOOKWORM a. Two species of hookworm exist 1. the Necator americanus or New World hookworm is found primarily in the western hemisphere and 2. Ancyclostoma duodenale or Old World hookworm is found predominantly in the eastern hemisphere. b. Transmitted to humans through direct skin penetration, usually in the foot by hookworm larvae in the soil contaminated with feces that contain hookworm ova. c. Infective larvae may produce a pruritic maculopapular dermatitis called ground itch at the site of the skin penetration. d. The most common abnormalities associated with hookworm are iron deficiency anemia and protein malnutrition. e. Treatment for hookworm infection includes administering mebendazole, albendazole plus pyrantel pamoate or piperazine CLINICAL SUMMARY: STRONGYLOIDES

a. This is caused by ingestion of raw fish infected with Capillaria Philippinensis common in the Philippines and Thailand. b. The disease is caused by ingestion of infected fish from fresh and brackish water. c. It has an insidious onset with nonspecific abdominal pain and watery diarrhea. If untreated, progressive autoinfection can lead to a protein losing enteropathy and severe malabsorption, leading to death from cachexia, cardiac failure or superinfection. d. The disease is diagnosed by the identification of characteristic peanut shaped eggs on the stool. e. Severely ill patients require hospitalization, hydration, nutritional therapy and prolonged antihelminthic treatment with mebendazole 100 mg bid for 20 days or albendazole 200 mg bid for 10 days. CLINICAL SUMMARY: CLONORCHIASIS a. Chlonorchiasis is an infection of the biliary system caused by a worm. b. It is also called Oriental liver fluke or Chinese liver fluke. It is endemic in China, Taiwan, Korea, Japan and Vietnam. c. Humans become infected after ingesting metacercaria in poorly cooked, pickled or smoked fish d. Acute infections are characterized by fever, eosinophilia and hepatomegally. Light infections are usually asymptomatic. In heavy infections persons suffer vague symptoms of fever, chill, anorexia and epigastric pain related to cholelithiasis and pancreatitis. e. Ascending cholangitis is a serious complication and may progress to portal hypertension, cirrhosis and atrophy of the liver parenchyma. f. Diagnosis is made by clinical presentation and detection of the characteristic ova in the feces or bile. g. The treatment of choice is oral Praziquantrel 25mg/kg tid for 1 day after meal. Albendazole can also be used for 7 day treatment course. CLINICAL SUMMARY: PARAGONIMIASIS a. It is a chronic parasitic infection caused by the trematode, Paragonimus Westermani. b. It is common in the Far East and here in the Philippines it is endemic in Mindoro, Camarines Sur, Norte, Samar, Sorsogon, Leyte, Albay, Basilan c. Paragonimus Westermani is also known as Lung Fluke disease. It is acquired primarily by ingesting poorly or partially cooked pickled crabs or crayfish d. This disease is often misdiagnosed as pulmonary tuberculosis because of the typical signs and symptoms of the disease. Usually, the patients with paragonimiasis are given with anti tuberculosis drugs which will not improve the condition. e. The disease is treated with Praziquantrel 25 mg/kg tid for 2 days. Bithionol is also effective in the treatment but more toxic.

a. Strongyloidiasis, also called threadworm infection, is a parasitic intestinal infection caused by the helminth Strongyloides stercoralis. b. Humans acquire Strongyloidiasis through contact with soil that contains infective S. stercoralis filariform larvae. c. Recurrent urticaria involving the buttocks and wrist is the most common cutaneous manifestation. d. Migrating larvae can elicit a pathognomonic serpiginous eruption, larva currens (running larva). e. Thiabendazole is the drug of choice. The recommended dose is 25mg/kg twice a day for 2 days. CLINICAL SUMMARY: ENTEROBIASIS a. Enterobiasis is also called pinworm, seatworm or threadworm, is a benign intestinal disease caused by the nematode Enterobius vermicularis. b. It is most common in children between ages 5 and 14 because of poor hygiene and frequent hand to mouth activity. c. Perianal pruritus that often interferes with sleep is the cardinal symptom. The itching is often worse at night due to the nocturnal migration of the female worms and may lead to excoriation and bacterial superinfection. d. Application of a clear tape or scotch tape method in the morning in the perianal region or flash light method are used to note for eggs deposited in the perianal area. e. Treatment is a single dose of 100mg dose of mebendazole repeated in two weeks destroys the causative parasite CLINICAL SUMMARY: CAPILLARIASIS

CLINICAL SUMMARY: TAPEWORM a. Tapeworm is caused by ingestion of contaminated meat or fish. 1. Taenia Saginata ingestion of contaminated beef may cause intestinal parasitism and anemia. 2. Taenia solium ingestion of contaminated pork, may cause CNS problem like neurocystecercosis. 3. Diphylobothrium latum ingestion of contaminated fish, may cause anemia 4. Heminolopsis nana the only tapeworm that do not need intermediate host for transmission. 5. Echinococcus - definitive hosts are dogs that pass eggs in their feces and the intermediate hosts are sheep, cattle, humans, goats and horses. b. Treatment is Praziquantrel CLINICAL SUMMARY: TRICHINOSIS a. It is an infection that is caused by nematodes, Trichinella spiralis due to ingestion of infected pork or other carnivores containing the cysts of the Trichinella spiralis. b. The manifestation depends on the load of the worms in the tissues. Most light infections (<10 larvae gram of muscle) are asymptomatic but in persons with heavy infections (>50 larvae per gram of muscle) can be life threatening. c. Presumptive diagnosis can be based on the typical features like fever, eosinophilia, and Periorbital edema after ingestion of possible contaminated meat. d. There is no effective treatment against t. Trichinella larvae in the muscles. Thiabendazole effectively combats the parasite during the intestinal phase CLINICAL SUMMARY: SCHISTOSOMIASIS a. It is also known as bilharzias, a slowly progressive disease caused by blood flukes of the class trematode. b. There are three schistosome species, Schistosoma mansoni and S. japonicum that infects the intestinal tract and Schistosoma mansoni that infects the urinary tract. c. Schistosomiasis is acquired through bathing, swimming, wading or working in contaminated water with schistosoma larvae. Intermediate host is a snail called Oncomelania Quadrasi. d. Clinical manifestation 1. The first stage occurs at the time of penetration and is termed as swimmers itch. 2. The second stage is called katayama fever, occurs 6 to 8 weeks after skin penetration, serum sickness like syndrome with elevated peripheral eosinophilia and IgE levels are seen. 3. The third stage results from granulomatous reactions to egg deposition in the liver, intestines, and bladder and rarely in lungs and central nervous system. It can lead to

chronic diarrhea, abdominal pain and blood loss. e. Diagnosis a. e. Kato Katz stool examination( presence of eggs in the stool) b. Circum-Ova precipitin Test (COPT) f. The drug of choice is Praziquantrel an antihelmintic which is given at 60mg/kg/dose once. CLINICAL SUMMARY: ONCHOCERCIASIS a. Onchocerciasis or river blindness is caused by filarial nematode Onchocerca volvulus, which is common in Africa and Latin America. b. It is the second leading cause of infectious blindness in the world. c. The disease is transmitted through the bite of an infected blackfly. The infected larvae are deposited in the skin and develop into adults that are typically found in subcutaneous nodules. d. Onchocerciasis affects primarily the skin, eyes and lymphnodes. Pruritus is the most frequent manifestation of onchocercal dermatitis. Long term infection results in exaggerated and premature wrinkling of the skin, loss of elastic fibers and atrophy. e. Diagnosis is confirmed by detection of an adult worm in an excised nodule or microfilariae in a skin snip. f. The goal of the treatment is to prevent irreversible complications and to alleviate symptoms. The drug of choice is Ivermectin, the first line agent for the treatment of onchocerciasis. It is given orally in a single dose of 150ug/kg yearly or semiannually. VIRAL EXANTHEMS CLINICAL SUMMARY: MEASLES a. Also known as Rubeola, Morbilli, 7 day measles, Hard measles or Red measles, is an acute highly contagious febrile eruption that often affects children. b. It is caused by a paramyxovirus which is transmitted through direct contact or by contaminated respiratory airborne droplets. c. The incubation period is 8 to 14 days. During the prodromal stage, patients manifest coryza, conjunctivitis, cough and the pathognomic enanthem, Kopliks pots. d. The rashes are described as maculopapular rashes appearing on the face first and spread cephalocaudal. The rashes appear at the height of the fever and during the convalescence stage, the rashes fade in the same manner as it appeared. e. There is no specific treatment. Supportive and symptomatic therapy is given to treat the manifestation and to prevent complications. 1. Supportive therapy like hydration and antipyretic treatment. 2. Vitamin A supplement 3. Antibiotic therapy for patients with complications.

CLINICAL SUMMARY: GERMAN MEASLES a. It is an acute benign febrile exanthema caused by rubella virus. It often affects children ages 5 to 9 years old, adolescent and young adults but when it occurs in pregnant women, it may lead to serious chronic fetal infection, malformation or abortion. b. Rubella virus is transmitted through contact with nasopharyngeal secretions of infected persons through direct or indirect contact. c. Incubation period of rubella is from 14 to 21 days. d. The typical rashes of Rubella is described as maculopapular, oval, red rose rashes, about the size of a pin head and begins on the face and spreads downward to the trunk and extremities. e. A pathognomonic sign is seen in the form of Forscheimmers spots, a petechial lesion on the buccal mucosa usually on the soft palate f. Rubella is also diagnosed based on the clinical history of exposure to infected patients and physical examination of lymphadenopathy and rubella rashes. g. Supportive and symptomatic therapy for fever, pruritus, adequate fluid intake and bed rest is given to the patient. CLINICAL SUMMARY: VARICELLA a. Varicella is a common, acute and extremely contagious infection often affects children characterized by exanthematous, vesicular rashes b. Reactivation of latent varicella zoster virus causes shingles or herpes zoster characterized by dermatomal vesicular rashes that appear in cluster and associated with severe pain. c. Chickenpox is transmitted direct or indirect contact with respiratory secretions or with skin lesions. The incubation period is 14 to 17 days and it is contagious 1 day before the appearance of rashes and up to 6 days after the vesicles form d. Chickenpox and Shingles is self limiting, supportive and symptomatic treatment is given to relieve signs and symptoms and to prevent avoidable complications. CLINICAL SUMMARY: SMALLPOX a. Also known as Variola is a highly contagious disease caused by poxvirus variola which is characterized by fever, vesicular pustular eruptions and a high mortality rate. b. Smallpox is transmitted by direct contact with respiratory droplets or dried scales of lesions containing the virus or indirectly by contact with contaminated materials like linens or other objects. c. The lesions are described as maculopapulovesicular rashes that first appear as minute red spots on the tongue and palate and small macules herald spots on the face and spreads centrifugally. d. Diagnosis is based on the clinical manifestation of the rashes and a simple test called Pauls test which involves instilling a vesicular fluid

with smallpox on the cornea, if keratitis develops that is smallpox. e. Treatment requires hospitalization of infected patients, with strict isolation to prevent spread, antimicrobial therapy to treat bacterial complications, supportive and symptomatic measures like antipruritus, adequate fluid intake, proper nutrition and respiratory support is given. CLINICAL SUMMARY: ROSEOLA INFANTUM a. It is also known as Exanthem subitum, is an acute benign disease of infants 6 months to 4 years old caused by human herpes virus type 6. b. It is transmitted through direct or indirect contact to contaminated respiratory secretions. though this like c. Patient manifest high grade fever for 2 to 5 days and when fever subside, appearance of non pruritic maculopapular rashes on the infants trunk, arms, neck and face. The rashes disappears within 24 hours after onset d. Treatment is supportive and symptomatic therapy aimed to make relieve the fever and to prevent complications. CLINICAL SUMMARY: ERYTHEMA INFECTIOSUM a. It is also known as the fifth disease and is caused by parvovirus infection. It is very common in children age 4 to 12 years old and common to arise during summer. b. The pathognomonic sign of erythema infectiousum is erythema over the face described as slapped cheek and lazy red rash in the arms and legs. The characteristic rashes are described as pruritic maculopapular, morbilliform, vesicular and purpuric. c. Diagnosis is based on the typical clinical presentation of the patients rashes and use of light and electron microscopy is helpful in detecting B19 infections. ` d. Most Erythema infectiousum requires no treatment. Only symptomatic and supportive measures should be given to the patients.

EMERGING DISEASES WHO Pandemic Levels : Phase 1: A virus in animals has caused no known infections in humans. Phase 2: An animal flu virus has caused infection in humans. Phase 3: Sporadic cases or small clusters of disease occur in humans. Human-to-human transmission, if any, is insufficient to cause community-level outbreaks. Phase 4: The risk for a pandemic is greatly increased but not certain. The disease causing virus is able to cause community-level outbreaks.

Phase 5: Still not a pandemic, but spread of disease between humans is occurring in more than one country of one WHO region. Phase 6: pandemic level. Community-level outbreaks are in at least one additional country in a different WHO region from phase 5. A global pandemic is under CLINICAL SUMMARY: ANTHRAX a. Anthrax is an acute bacterial infection caused by Bacillus anthracis, a natural infection in animals, primarily herbivores b. Human become infected when spores of B. anthracis are introduced into the patients body by contact with infected animals or animal products, insect bites, inhalation or ingestion. c. Three common forms of anthrax 1. Cutaneous anthrax - characterized by a skin lesion evolving from a papule or a boil like skin lesion that eventually forms an ulcer with an ulcer with a black eschar and these are often found on exposed areas of the skin. 2. Inhalation anthrax - or wool sorters disease is caused by inhalation of the spores of B. anthracis infecting the lung and spreading to the lymphnodes in the chest. This is the most fatal and lethal form of anthrax and the incubation period is 1-7 days 3. Gastro-intestinal anthrax occurs through ingestion of contaminated meat with anthrax bacteria or spores. It is characterized by severe abdominal pain, fever, diarrhea and signs of septicemia d. A history of contact with herbivores or animal products should raise the possibility of anthrax. B. anthracis in cutaneous anthrax can be demonstrated in Grams stain, direct fluorescent antibody staining or culture e. The recommended drug of choice is parenteral penicillin G. CLINICAL SUMMARY: SEVERE ACUTE RESPIRATORY SYNDROME a. Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a corona virus, called SARS-associated corona virus (SARS-CoV). b. The incubation period of SARS is 2 to 7 days. The minimum reported incubation period is 1 day and a maximum of 14 days. The clinical criteria for the diagnosis of SARS are; 1. One or more signs or symptoms of respiratory illness including cough, shortness of breath, difficulty of breathing, hypoxia or radiographic findings of a pneumonia or acute respiratory syndrome AND 2. Fever (>38 C (100.4 F) c. Diagnosis is Polymerase chain reaction, viral culture and serologic test. d. Treatment is supportive and symptomatic therapy to prevent complications of SARS CLINICAL SUMMARY: AVIAN INFLUENZA (H5N1)

a. Influenza A (H5N1) virus is an influenza A virus subtype that occurs mainly in birds. It is highly contagious among birds and very deadly to them. b. Most of cases of avian influenza infection have resulted from people having direct or close contact with H5N1 infected poultry or surfaces contaminated with secretions/excretions from infected birds. c. Common manifestations are influenza like illness symptoms, fever, cough, sore throat and muscle aches that can lead to severe respiratory illness like pneumonia and acute respiratory distress. d. Common laboratory findings are leukopenia, mild to moderate thrombocytopenia and moderately elevated aminotransferase levels e. The H5N1 virus is resistant to amantadine and Rimantadine which are the two commonly used antiviral medications for influenza. f. Two other antiviral medications, oseltamavir and zanamavir works in the treatment of influenza caused by H5N1 virus CLINICAL SUMMARY: H1N1 INFECTION a. Caused by quadruple reassortment virus. Because of the reaasortment of four different kinds of influenza strain, the effect of this virus can be lethal if not treated properly and early. b. The symptoms of novel H1N1 influenza are similar to the symptoms of seasonal flu that includes fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fever. c. Diagnosis of novel A influenza (H1N1) is based on clinical signs and symptoms, history of recent travel to H1N1 affected areas, contact with possible H1N1 patients and confirmed by laboratory procedures like nose and throat swab. d. Presently the antiviral medication that is widely used for H1N1 is Oseltamavir. Oseltamavir is given in patients with H1N1 that belongs to the high risk group CLINICAL SUMMARY: EBOLA a. This is one of the most frightening viruses that come out of the African subcontinent. The Ebola virus first appeared between June and November of 1976. b. Ebola is transmitted by direct contact with infected fluids or to contact with skin or mucous membrane. The incubation period can range from 2 21 days. the virus can remain contagious even after the patient has died. c. Clinically, the disease is similar to Marburg virus disease. Within 3 days of initial infection, the patient usually complains of flulike signs and symptoms like headache, myalgia, fever, cough and sore throat. d. Ebola may progress to cause more serious symptoms like diarrhea, dark or bloody feces, and hematemesis and as the disease progresses, severe liver and kidney complications, dehydration and hemorrhage may develop.

e.

There is no specific treatment for Ebola infection, intensive supportive, symptomatic therapy is given and assessment of complication is used in the management of Ebola infection. Fluid administration prevents severe dehydration and blood transfusion of fresh frozen plasma is given to prevent shock.

ZOONOTIC INFECTIONS CLINICAL SUMMARY: LYME DISEASE a. It is caused by the spirochete Borrelia burgdorferi, which is transmitted by the deer tick Ixodes Scapularis b. The hallmark of Lyme disease is the erythema chronic migrans, a red macule or papule often seen at the site of a tick bite. c. The diagnosis is based on clinical manifestations of the characteristic lesions erythema chronic migrants and a history of possible tick exposure in an endemic areas combined with serologic testing d. Antibiotic therapy should be started early to minimize complications. Oral tetracycline or docycline (100mg BID) plus amoxicillin (500mg PO TID) for 28 days is the first line drug of choice. CLINICAL SUMMARY: LEPTOSPIROSIS a. A Zoonotic systemic infection caused by Leptospires, that penetrate intact and abraded skin through exposure to water b. Common manifestation of a patient with leptospirosis, are Conjuctival suffusion, . Calf muscle tenderness and Oliguria to Anuria. c. Diagnosis are base on clinical history of wading to flooded waters and manifestations. Common laboratory test are LAAT and blood culrure. d. Drug of choice is penicillin in children and alternate drug in adults is tetracycline. e. Prophylactic treatment of doxycycline is given in patients living in flooded areas where leptospirosis infection is prsent. CLINICAL SUMMMARY: ROCKY MOUNTAIN SPOTTED FEVER a. Rocky Mountain Spotted Fever is an acute febrile, rash producing illness caused by Rickettsia rickettsii b. It is transmitted to humans or small animals by a bite of an adult tick. the Dermacentor andersoni, the wood stick c. Begins with faint pink macules which fades on pressure around the wrists, ankles, forehead, palms and soles d. Tetracycline (500mg PO Q6H) or doxycycline (100mg PO or iv BID) is the treatment of choice CLINICAL SUMMARY: PLAQUE a. an acute infection caused by the gram-negative bacillus Yersinia pestis that affects humans, rodents and their ectoparasites

b. It is transmitted to humans through the bite of a flea called Xenopsylla cheopsis from an infected rodents like squirrel, rat or prairie dog. c. Bubonic plaque: enlarged and extremely painful cluster of regional lymphnodes are noted called bubo found in the groin, axillary or cervical nodes. d. Pneumonic plaque: sudden onset of fever, chills and myalgias. Within 2 to 3 days patient may present with a cough producing bloody sputum, respiratory distress and may die if proper treatment is not given. e. Confirmation of the clinical suspicion of bubonic plaque may be obtained by needle aspiration of a bubo with a direct staining of the aspirated material revealing the characteristic bipolar staining or safety pin appearance. f. The treatment of choice consist of large doses of streptomycin (15 mg/kg IM Q12H), gentamycin (5 mg/kg/day IV), and doxycycline (200mg loading dose followed by 100 mg IV Q12H) to be given for 10 to 14 days. SEPTIC SHOCK CLINICAL SUMMARY: SEPTIC SHOCK a. Sepsis or severe infection is a leading cause of shock that causes organ dysfunction. b. It is usually caused by bacterial infection that causes inadequate blood perfusion and circulatory collapse c. Common cases of sepsis are caused by gram negative bacteria like Pseudomonas, Escherichia coli, Klebsiella, Enterobacter and Bacteroides. d. Factors that predispose patients to have gram negative bacteremia include immunocompromised patients like burn patients, diabetes mellitus, liver cirrhosis and invasive procedures like catheterization. e. Clinical manifestation depends on the stage of sepsis. During the acute stage, sudden onset of fever and chills are seen and in later stage, restlessness, oliguria and deterioration of other systems are seen. f. Immediate management is to reverse shock trough volume expansion therapy. Administration of higher antibiotics is the second goal in the treatment WHEN WE WAKE UP, WE HAVE TO SIMPLE CHOICES; GO BACK TO SLEEP AND DREAM OR WAKE UP AND CHASE YOUR DREAMS.. CHASE YOUR DREAM TOP AND PASS THE JULY 2011 NURSING BOARD EXAM! GOODLUCK