CHN 5

Malaria  March Fever

 Etiologic Agent
1.Plasmodium falciparum most common in the  Pathophysiology
Philippines, around 70% of cases Oncomelania quadrasi (tiny snail)
2.Plasmodium vivax
3.Plasmodium malariae
4.Plasmodium ovale not found in the Phils Miracidum (lives inside snail)

 Vector : Anopheles mosquito (primary vector; Cercaria (evolved miracidium)

breeds in clear, slow flowing streams)
Skin penetration
 Signs & Symptoms
1.Recurrent chills
2.Fever
3.Profuse sweating  Signs and
4.Anemia Symptoms
5.Malaise 1.swimmer’s itch  pruritic rash on site of entry
6.Hepatomegaly 2.fever
7.Splenomegaly 3.abd. Discomfort  hepatomegaly, splenomegaly
& lymphadenopathy
 Treatment 4.bloody mucoid stool
 Mg’t And Prevention 5.icteric & jaundice
1.Meds
a.Chloroquine phosphate  Collaborative Mg’t
b.Quinine hydrochloride 1.prevention
c.Tetracycline Hcl a.reduce snail density
d.Quinidine sulfate 1)expose nail to sunshine  clears vegetation
e.Sulfadoxine 2)construct drainage to dryland surface 
2.Insecticide-treated nets where nail strives
3.Indoor residual spraying b.diminish infection rate
4.Larviciding and Biological control 1)proper waste disposal
5.Environmental management (clearing of stream) 2)prevent people from bathing the streams
6.Personal protection measures 2.meds  praziquantel

I. Parasitic Infections B. Filariases/ Elephantiasis

A. Schistosomiasis/ Bilharziasis/ Snail Fever
 Cause 
 Cause Wuchereria bancrofti
1. schistosoma japonicum  oriental  Incubation Period
Schistosomiasis  8 – 16mos.
2. schistosoma mansoni  Mode of
3. schistosoma haematobium Transmission  transferred from person to
person by mosquito byte
 Incubation Period  Diagnostics
 at least 2 mos. 1.circulating filarial antigen (CFA) finger-prick
blood droplet
 Mode of 2.larvae found in blood
Transmission
1.ingestion of contaminated water  Signs and
2.skin pores Symptoms
3.Oncomelania quadrasi  tiny snail 1.swelling & pain in arms, legs or scrotum
2.abscess  due to dying worms
 Diagnostics
1. fecalysis  Collaborative Mg’t
2.ELISA 1.prevention
3.Cercum Ova Precipetin Test (COPT)  a.sleep under mosquito net
definitive b.use mosquito repellamt

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c.take yearly dose of medicine w/c kills worms in 3.pleuritic pain

the blood
2.meds  ivermectin, albendazole  Collaborative Mg’t praziquantel
diethylcarbamazene (DEC)  PREVENTION
3.elephantiasis of legs  eased up by elevating 1.Treatment of infected person
legs 2.Proper waste disposal
4.surgery 3.Antimollusk campaigns
C. Paralytic Shellfish Poisoning/ Red Tide  4.Education of the population
microscopic phytoplanktons, specifically 5.Avoid eating infected foods
dinoflagellates 6.Avoid bathing in infected water
E. Helminthiases
 Cause
1.Gonyaulax  Cause
2.Protogonyaulax 1.Hookworm infestation Ancylostoma duodenale
3.Gessnerium 2.Roundworm infestation Ascaris lumbricoides
 Seafoods affected  spec. shellfish  Incubation Period
a.Soft shell clamps  4- 8 weeks
b.Oysters  Mode of
c.Mussels Transmission
d.scallops 1.Direct contact through skin of foot
o Lobster, crabs, shrimps & fishes  not 2.Fecal-oral
affected
 Signs and
 Factors w/c are favorable for growth: Symptoms
a.warm surface temp. 1.Hookworm infestation
b.high nutrient content a.Irritation, pruritus, and edema at the site of
c.low salinity/ calm seas entry with pustule formation
d.rainy days followed by sunny weather b.nausea,
c.weight loss,
 Signs and d. melena,
Symptoms e.uncontrolled diarrhea
1.tingling lip & tongue f. anemia,
2.headaches & dizzness 2.Roundworm infestation
3.resp. arrest a.Vague stomach discomfort (mild), stomach
pain (severe), vomiting, restlessness,
 Collaborative Mg’t b.disturbed sleep,
1.prevention c.intestinal obstruction (extreme cases)
a.all shellfish area should have a monitoring test d. pneumonitis (due to migration of larvae to the
for water lungs)
b.if accidental ingestion of toxic shellfish is
suspected, seek medical attention immediately  Collaborative Mg’t
2.induce patient to vomit 1.Pyrantel Pamoate (Quantrel)
3.charcoal hemoperfusion  pumps arterial bl;ood 2.Diet
through an activated charcoal filter 3.Personal hygiene
4.artificial respiration as necessary 4.Proper disposal of excreta
5.Avoid going barefoot
D. Paragonimiasis 6.Use purified or boiled water for drinking
 Cause  7.Vegetables should not be eaten raw
Paragonimus westermani
F. Pinworm An intestinal infection due to small
 Mode of intestinal worm
Transmission  ingestion of raw or uncooked  Etiologic Agent Enterobius vermicularis
crabs w/ metacercaria (infective stage of larvae)
 Incubation Period 1-2 weeks
 Signs and
Symptoms similar to PTB  Period of communicability As long as the
1.cough w/ sputum  orange-brown person harbors the organism
2.hemoptysis
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 Mode of Transmission Direct and indirect H. Scabies infestation of sarcopets scabei

contact (mites)
 Incubation period Within 24 hours
 Signs and Symptoms  Period of communicability For the entire
1.Intense itching around the anus period the host is infected
2.Difficulty sleeping  Mode of transmission
3.Irritability 1.Direct contact
4.Vaginal irritation 2.Indirect contact
5.Loss of appetite
6.(+) scotch tape test  Signs & Symptoms
1.intense itching especially at night
2.burrows bet. Fingers, wrists & axillary folds
3.redness, swelling & vesicular formation
 Collaborative Mg’t
1.Piperazine hexahydrate  Collaborative Mg’t permethrin 5% cream
2.Family treatment (elimite) -- applied to skin from head to soles of
3.Toilet seats must be washed foot & left for 8 – 14 hrs & washed off
4.Sleep alone
5.Handwashing II. Sexually Transmitted Disease
6.Slippers and shoes A. AIDS/HIV  condition resulting from a severe
impairment of immune system’s ability to respond
to invading pathogens & affects all body system
G. Trichinosis  CD4+ T helper cells  regulating cells of immune
 Causative Agent Trichinella spiralis system & used to monitor the stages of virus
 Site of Entry Gastrointestinal tract (normal is atleast 800cells/ml)
 Mode of transmission  Ingestion of
contaminated meat esp. pork  Causative Agent Human Immunodeficiency
Virus
 Signs & Symptoms  Incubation Period 3-6 months to 8-10 years
1.Invasion 1 wk after ingestion
a.Anorexia,  Mode of transmission
b.N/V, 1.blood transfusion
c.diarrhea, a.sharing of needles or accidental needle pricks
d.abdominal pain from infected person
e.cramps b.exposure of client’s infected blood via open
wound
2.Dissemination 7-10 days after ingestion 2.sexual transmission any sexual activity that
a.Periorbital edema, involves direct contact w/ vaginal secretions &
b.muscle pain, semen may transmit HIV
c.pruritus, 3.perinatal transmission exposure can occur
d.sweating, during pregnancy, vaginal delivery or during
e.respi infection, postpartum period through breast milk
f. palpitation,  caesarian delivery  decrease risk of
g.lethargy transmission
 prophylactic antiviral meds  during
3.Encystment:occurs during convalescence pregnancy reduce rate of infection
 Natural Occurrence of HIV
 Collaborative Mg’t HIV infection
1.Thiabendazole  (3 -8 weeks)
2.Corticosteroids Acute illness
3.Analgesics (fever, rash, joint and muscle pain, sorethroat)
4.Treat infected individual  (mos. To yrs.)
5.Health education on personal, environmental, Chronic Illness
and food hygiene (opportunistic infections, weight loss, diarrhea, lymphadenopathy)
6.Proper food preparation 
7.Avoid raw meat AIDS
(Kaposi;s sarcoma, pneumocystis carinii, cryptococcal meningitis)
 Diagnostics
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1.ELISA  high sensitivity but low specificity 1.male  can also be asymptomatic & become
2.Western Blot analysis  low sensitivity but chronic carrier
high specificity (confirmatory) a.urethritis
b.dysuria
 FOUR C’s IN THE MANAGEMENT OF AIDS c.purulent discharge
1.Compliance d.epididymitis
2.Counseling/education
3.Contact tracing 2.female
4.Condoms a.urethritis
b.cervicitis
c.vaginal discharge
d.dysuria
e.if untreated  PID
3.neonate  opthalmia neonatorum
 Collaborative Mg’t  Diagnostics
1.Prevention 1.gram stain  gram negative intracellular and
a.Maintain monogamous relationship extracellular cocci
b.Avoid promiscuous sexual contact 2.c/s
c.Sterilize needles, syringes and instruments
used for cutting operations  Collaborative Mg’t
d.Proper screening of blood donors 1.neonate (opthalmia neonatorum) 
e.Rigid examination of blood and other products erythromycin or silver nitrate
for transfusion 2.antibiotics
f. Avoid oral, anal contact and swallowing of a.ceftriaxone 1 gram single dose IM
semen b.cefixime  single dose
g.Use condom and other protective devices c.doxycycline  for 7 -10 days to treat existing
Chlamydial infection
2. meds  highly active antiretroviral therapy 3.abstinence  until culture are negative
(HAART) 4.treat sexual partner
a.nonnucleoside reverse transcriptase
inhibitors  bind to enzyme & prevent  Complications
conversion of RNA to DNA 1.Male
1)nevirapine a.prostatitis
2)delavirdine b.urethral strictures
3)efavirenz c.urethritis
b.nucleoside analogue reverse transcriptase d.sterility
inhibitors  incorporate into the viral DNA & 2.Female
cause destruction a.PID
1)didanosine b.Infertility
2)zidovudine c.Ectopic pregnancy
3)lamivudine d.Bartholin’s abscess
c.protease inhibitors  prevent production &
assembly of new virus C. Syphilis
1)saquinavir  Causative agent  Treponema pallidum
2)ritonavir (spirochete)
3)indinavir  Incubation Period  10 – 90 days

 Stages
B. Gonorrhea  may affect genitourinary tract, 1.Primary Stage  highly infectious stage
rectum, pharynx, & eyes a.chancre  small, hard painless lesion found in
penis, vulva, lips, vagina or rectum
 Causative Agent  Neisseria gonorrhoeae b.heals w/in 2 -3 weeks with or without
 Incubation Period  3 – 4 days treatment
 Mode of transmission  direct contact via c.regional lymphadenopathy
sexual contact or passage through the birth canal
(contagious as long as bacteria is present)

 Signs & Symptoms

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 Signs & Symptoms  males & females are

frequently asymptomatic
1.Male
2.Secondary Stage  client may be 2.Female
asymptomatic & occurs 2wks – 6mos. After a.cervicitis (reservoir of Chlamydia)
healed b.salpingitis  inflammation of fallopian tube
a.maculopapular rash on palms of hands & c.mucopurulent discharge
soles of foot d.vaginitis

 Diagnostics  tissue or culture of discharge

 Collaborative Mg’t
1.doxycycline  teratogenic
b.sore throat & headache
2.azithromycin  drug of choice (long term
c.lymphadenopathy  gray mucuous patches in
antibiotic therapy may be done)
the mouth
3.treatment of partner may be needed
d.condylomata lata  flat lesions that may
appear in moist areas (most infectious of
syphilitic lesion)
E. Trichomoniasis
e.symptoms disappears 2 -6 weeks
 Causative Agent  trichomonas vaginalis
(protozoa)
3.Latent Age  absence of clinical symptoms
a. results of serological tests  remains  Signs & Symptoms
positive 1.may be asymptomatic
b. transmission can occur  blood contact 2.frothy, green-yellow malodorous vaginal
c. majority remains in this stage w/out discharge
symptoms 3.strawberry spot on cervix
4.itching, burning & dyspareunia
 Diagnostics
1.Venereal Dse. Research lab. (VDRL)
2.Fluorescent treponemal antibody

 Collaborative Mg’t
1.penicillin (IM)  single dose w/ probenicid
 After therapy, the woman may experience a  Mode of transmission  sexually transmitted
sudden episode of hypotension, fever,  Treatment
tachycardia, and muscle aches. 1.Metronizadole The drug of choice is
 Jarisch-Herxheimer reaction due to the metronidazole which may be teratogenic.
sudden destruction of spirochetes. It lasts for 2.Clotrimazole  is used for trichomoniasis
24 hours and then fades. 3.avoid usage of tight-fitting undergarments for
long periods
2.tetracycline or doxycycline  if allergic w/ 4.use condoms
penicillin

 Complications  systemic involvement of F. Hepa B àLiver disease caused by viruses, bacteria,

cardiovascular & central nervous sytems protozoa, toxic chemicals, drugs, and alcohol

 Cause  Hepatitis B virus

D. Chlamydia
 Mode of Transmission
 Cause  chlamydia trachomatis (non-gonococcal 1.Blood & blood products
urethritis) – usually a person who has gonorrhea 2.Skin or mucous membrane break (needle sticks,
may be infected w/ Chlamydia as well cuts, ear piercing)
3.Sexual contact
 Mode of transmission  sexually transmitted 4.Infected mother to her baby

 incubation period  2 – 35 days

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 Incubation Period 6wks- 6mos.  contagious as c.Smoking Cessation

long as antigen appears d.Modification of risk factors
2. CAD
 High Risks a.Regular activity and exercise- inc HDL
1.Household contacts b.Proper nutrition- limit fats: inc in LDL
2.Sexual contacts c.Ideal BW
3.Dental, lab. & medical personnel d.Smoking cessation
4.Multiple BT recipients e.Early dx and prompt tx
5.IV drug users 3. CVA
a.Tx and control HTN
b.Smoking cessation
c.Smoke free environment
d.Prevent thrombus formation
e.Limit alcohol
f. Avoid IV drug abuse and cocaine
g.Prevent atherosclerosis

II. CANCER Abnormal proliferation of malignant

 Signs & Symptoms cells causing destruction of surrounding tissues
Anicteric Phase Icteric Phase Post-icteric Phase
(jaundice) (after jaundice) 1.Carcinomas epithelial cells
2.Leukemias  blood-forming organs
Lasts for 1 week Reaches its 6wks- 4 mos. 3.Lymphomas lymph node organs
intensity in 2 wks &
last from 4-6wks 4.Sarcomasconnective tissues
 Anorexia,  Dark urine  Malaise
nausea   bilirubin  Easily  9 WARNING SIGNS OF CANCER
 URQ  Pruritus fatigued  Change in bowel or bladder
discomfort  Stool   Hepatome
 Malaise, galy remains for
habits
clay color
headache  Liver several weeks  A sore that does not heal
 Low-grade remains enlarged  Unusual bleeding or
fever & tender discharge
 hepatome
galy
 Thickening or lump in breasts
or elsewhere
 Indigestion or difficulty in
 Diagnostics - Hepa B  presence of HBsAg in
swallowing
serum
 Obvious change in wart or
A. ELISA  initial screening ( high sensitivity but
mole
low specificity)
 Nagging cough or hoarseness
B. Recombinant Immunoblot Assay (RIBA) 
confirmatory
 Unexplained anemia
 Sudden unexplained weight
loss
NON-COMMUNICABLE DISEASES
I. CARDIOVASCULAR DISEASES
 MANAGEMENT
A. Congenital Heart Diseases Maternal
1.AIM of Mgt: Maintain the integrity and
Infections, Drug Intake, Maternal Diseases,
dignity of cancer patients.
Genetics
B. Rheumatic fever/ Rheumatic Heart Disease
2.Priority for health supervision
Frequent Streptococal Sore Throat
a.Newly diagnosed cases
C. Hypertension Heredity, Age, Sex, Diet
b.Post-op or discharged cases
D. Ischemic Heart Diseases Smoking, Obesity,
c.Indigent cases needing continuity
HTN, Stress, Hyperlipidemia, DM, sedentary
d.Terminal cases
lifestyle
 KEY AREAS OF PREVENTION PREVENTION
 KEY AREAS FOR THE PREVENTION OF
AND CONTROL
CANCER
1. HTN
1.Smoking cessation
a.Proper Nutrition
2.Proper nutrition
b.Ideal Body Weight
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3.Alcohol in moderation 5.Nephrolithiasis

4.Proper Nutrition and exercise 6.Nephrotic Syndrome
5.Screening 7.UTI
8.Renal Tubular defects
III. DIABETES MELLITUS Error in glucose 9.Urinary Tract Obstruction
metabolism
 RENAL DISEASE CONTROL PROGRAM
 Types:  OBJECTIVE Reduce the occurrence of
1.Type 1- IDDM Kidney Diseases and End Stage Renal
2.Type 2- NIDDM Disease to 3000 cases a year by enhancing
3.Gestational DM public awareness through health education
about healthy lifestyle and interaccess to basic
 Sx: 3 P’s and weight loss health services

 KEY AREAS IN THE PREVENTION AND  PREVENTION

CONTROL OF DM 1.Good nutrition
1.Maintain Ideal BW- waist circumference 2.Clean environment
2.Proper nutrition- high fiber 3.Early detection
3.Regular activity and exercise 4.Urinary screening of asymptomatic children
4.Smoking cessation 5.Increase casefinding and treatment for
Chronic Glomerulonephritis
6.Good glycemic control
7.Optimum BP control
IV. OSTEOPOROSIS A disease that weakens the
bones, making it more fragile and likely to break  MANAGEMENT
 “Silent disease” 1.Dialysis
 Considered a major health and economic 2.Renal Transplant
problem
 Not an inevitable part of aging 3.Health Education on Prevention
 Risk of fracture: female, increase is seen after a.Adequate water intake
menopause while male, increase is seen after b.Balanced diet
age 70 c.Good personal hygiene
d.Regular exercise
 RISK FACTORS FOR OSTEOPOROSIS e.Regular BP check up
(SAIMA) f. Complete immunization for infants and
1.Smoking children
2.Alcoholism g.Proper mgt of throat and skin infections
3.Immobilization h.Yearly urinalysis
4.Menopause
5.Asian or Caucasian race 4.Health education on Signs and
Symptoms
 DIAGNOSIS  Measurement of bone density a.Edema
by the Dual Energy X-ray Absorptionmetry b.High BP
(DEXA) machine
5.Routine screening for UTI, DM, and
 PREVENTION Kidney Diseases
1.Exercise as walking, cycling, tennis, aerobics,
jogging and badminton
2.Regular intake of calcium rich foods and
supplements
3.Regular medical check-up

V. KIDNEY DISEASES
 Most Common Kidney Diseases
1.Chronic glomerulonephritis
2.Acute Renal Failure
3.Chronic Renal Failure
4.Acute Nephritis

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