COMMUNICABLE & INFECTIOUS DISEASES

CHAIN OF INFECTION
EPIDEMIOLOGIC PATTERNS 1) INFECTIOUS AGENT
1) SPORADIC  Bacteria, Virus, Fungi, Protozoa
✓ Intermittent Occurrence  How to break the CHAIN?
✓ Irregular interval a) Rapid organism identification
✓ Random locations (DIAGNOSIS)
✓ Scattered cases b) Prompt treatment
✓ E.g. rabies c) Decontamination
2) ENDEMIC VIRULENCE ✓ Ability to cause a disease
✓ Continuous occurrence ✓ Overall strength to cause a
✓ Steady frequency disease
✓ Over a period of time INFECTIVITY ✓ Capacity of agent to enter
✓ Inherent in that locality and multiply in a susceptible
✓ E.g. Schistosomiasis in Leyte, host
Malaria in Palawan INVASIVENESS ✓ Ability to penetrate an intact
3) EPIDEMIC skin
✓ Outbreak PATHOGENICITY ✓ Capacity if agent to cause a
✓ Greater than usual clinical disease in the
✓ Short period of time infected host
4) PANDEMIC TOXIGENICITY ✓ Capacity of agent to produce
✓ Concurrent occurrence a toxin or poison
✓ Same disease ANTIGENICITY ✓ Ability to combine
✓ Different countries specifically with the final
products of the mention
DIFFERENCE of NOSOCOMIAL and COMMUNITY responses (i.e. antibodies
ACQUIRED INFECTION and/or cell-surface
NOSOCOMIAL/HOSPITAL COMMUNITY ACQUIRED receptors)
ACQUIRED
Infection that is Infection that is 2) RESERVOIR (any site where the pathogen
acquired after 48-72 acquired within 48-72 can multiply or merely survive until it is
hours of hospital stay hours of hospital stay transferred to a host)
 Human Reservoirs
 Animal Reservoirs
STAGES OF ILLNESS:  Environmental Reservoirs (plants, soil
1) INCUBATION PERIOD and water)
✓ When the pathogen enters, no  How to break the CHAIN?
signs and symptoms yet a) Environmental sanitation
✓ Insufficient number of pathogens b) Good health & hygiene
2) PRODROMAL PERIOD c) Decontamination/ Sterilization
✓ Appearance of initial signs and d) Dressing change
symptoms (fever, sore throat) e) Appropriate linen disposal
✓ Pathogens continues to multiply f) Proper feces and urine disposal
3) PERIOD OF ILLNESS/ACUTE STAGE 3) PORTAL OF EXIT (path by which the
✓ All signs and symptoms appears organism leaves the reservoir)
✓ Signs and symptoms are MOST  Mouth (vomit, saliva)
OBVIOUS and SEVERE  Cuts in the skin (blood)
✓ Pathognomonic signs appears  During diapering and toileting (stool)
(characteristic signs of a specific  How to break the CHAIN?
disease) a) Control of secretions
4) PERIOD OF DECLINE b) Hand hygiene
✓ Number of pathogens begins to c) Proper waste disposal
decrease d) Avoid taking, coughing or
✓ Sign and symptoms of illness begin sneezing over open
to decline wounds/sterile fields
✓ In this stage, the client is prone for e) Cover mouth and nose when
secondary infection due to their coughing/sneezing
temporary suppressed immune 4) MODE OF TRANSMISSION (means by which
system. the agent passes through from the portal of
5) CONVALESCENT/DEFERVESCENT exit of the reservoir to the host)
✓ CONVALESCENT = Recovery
✓ DEFERVESCENT = Complication/
Death
 3) Transmission-based Precaution
DIRECT CONTACT INDIRACT CONTACT 4) Isolation Technique
CONTACT VEHICLE
CDC and Prevention Isolation Guidelines
Skin to skin contact, Indirectly transmit an A. TIER ONE
sexual contact infectious agent 1) STANDARD PRECAUTIONS
✓ Designated for the care of ALL
5 F’s: hospital patients.
Feces, Food, Fluids, ✓ Hand Hygiene
Fingers, Flies, Fomites ✓ PPE (depending on the care
rendered to a patient)
NO DEVELOPMENT of ✓ Respiratory Hygiene
agent ✓ Puncture-Resistant Containers
AIRBORNE ❖ In PPE:
✓ Upon WEARING in SEQUENCE:
Suspended longer GoMEGlo
Travels more than 3 ft. VECTOR a) Gown
DROPLET b) Mask
Animals/insects that can c) Eyewear
Travels less than 3 ft. transmit the disease d) Gloves
AEROSOL ✓ Upon REMOVING in SEQUENCE
DEVELOPMENT of agent (GlEGoMa)
Tuberculosis, Measles, a) Gloves
Chickenpox e.g. Mosquitoes, Fleas, b) Eyewear
Ticks c) Gown
DROPLET OF SALIVA d) Mask
B. TIER TWO
Mumps, Rabies, 1) TRANSMISSION-BASED PRECAUTIONS
Infectious ✓ AIRBORNE-PRECAUTIONS
mononucleosis 1. Isolate
2. Negative Air Pressure Room
 How to break the CHAIN? 3. N95 Mask
a) Hand Hygiene ✓ DROPLET PRECAUTIONS
b) Isolation Precautions 1. Isolate
c) Disinfection/Sterilization 2. Mask (Not Necessarily N95)
d) Use Of PPE 3. Maintain 3 Ft Distance
e) Aseptic Technique ✓ CONTACT PRECAUTIONS
5) PORTAL OF ENTRY 1. Isolate
 Mouth, Cuts in the skin, Eyes 2. Wear PPE
 How to break the CHAIN? ✓ Protective Environment
a) Hand Hygiene 1. People underground gene
b) Aseptic Technique therapy, organ transplant
c) Wound Care 2. Administered drugs that
d) Puncture-Resistant Containers cause immunosuppression
✓ Hand hygiene
✓ PPE (depending on the care
6) SUSCEPTIBLE HOST rendered to a patient)
 How to break the CHAIN? ✓ Respiratory Hygiene
a) Recognize High-Risk Patients ✓ Puncture-Resistant Containers
b) Prompt Treatment
c) Maintain Skin Integrity CATEGORIES RECOMMENDED IN ISOLATION
d) Balanced Diet 1) STRICT ISOLATION
e) Immunization a) COVID-19
 RISK FACTORS OF A SUSCEPTIBLE HOST b) Measles
a) Children c) Chickenpox
b) Elderly 2) CONTACT ISOLATION
c) People with a weakened a) Herpes Simplex Virus
immune system b) Impetigo
d) Unimmunized people c) Parasitic Mites
d) Chickenpox/Shingles (if ruptured
INFECTION CONTROL vesicles)
1) Aseptic Technique 3) RESPIRATORY ISOLATION
2) Standard Precaution a) COVID-19
 b) Measles ISOLATION TECHNIQUE
4) TB ISOLATION SOURCE PROTECTIVE
5) ENTERIC ISOLATION ROOM - +
a) Hepatitis A PRESSURE
b) Cholera PROTECTED OTHERS PATIENT
c) Diarrheal Diseases PERSON
6) DRAINAGE/SECRETION ISOLATION MOVEMENT OF IN OUT
a) Jackson-Pratt Drainage of AIR
Patients having Brain Abscess
b) Burn Patients TRANSMISSION-BASED PRECAUTIONS
7) BLOOD & BODY FLUIDS ISOLATION AIRBORNE
a) AIDS PATIENT  Chickenpox
b) Hepatitis B  Measles
c) Malaria  TB
d) Syphilis PLACEMENT NEGATIVE PRESSURE
8) REVERSE ISOLATION/PROTECTIVE OR PRIVATE ROOM
NEUTROPENIC ISOLATION PPE  N95 (95% of air
a) Leukemia particular filter
b) Neutropenia respirator)
TRANSPORT  Limited to essential
purpose
MEDICAL ASEPSIS SURGICAL ASEPSIS  Place a surgical mask
REDUCES number of ELIMINATES ALL
pathogens pathogens DROPLET
CLEAN TECHNIQUE STERILE TECHNIQUE PATIENT  Diphtheria
USES FOR:  Meningitis
Administration of DRESSING CHANGES  Pertussis
MEDICATIONS PLACEMENT PRIVATE ROOM
ENEMAS CATHETERIZATIONS PPE  Mask
TUBE FEEDING SURGICAL PROCEDURES TRANSPORT  Limited to essential
DAILY HYGIENE Operating Room purpose
Proper Cleaning of Labor & Delivery Room  Place a surgical mask
supplies and equipment
Proper Disposal Of Special Diagnostic Areas CONTACT
Needles, Contaminated PATIENT  Decubitus ulcer
Materials And Infectious  Discharges
Wastes PLACEMENT PRIVATE ROOM
Disinfection PPE  Gloves
 Gown
BLACK  Dry TRANSPORT  Limited to essential
 Non-Infectious purpose
Waste
GREEN  Wet VECTOR-BORNE & ZOONOTIC DISEASES
 Non-Infectious A. DENGUE FEVER
Waste ➢ Acute febrile disease transmitted by a
YELLOW  Infectious mosquito
 Pathologic Waste ➢ CAUSATIVE AGENT: Aedes aegypti
 Chemical Waste ➢ It is a DAY-BITING mosquito
YELLOW WITH BLACK  Heavy Metal ➢ It breeds on STAGNANT water
BAND ➢ DF can be infected 4 times
ORANGE  Radioactive Waste ➢ 3 CLASSIFICATIONS:
RED  Sharps 1) Dengue Fever
✓ VIRUSES:
CONSIDERATIONS FOR COHORTING a) Dengue Virus 1, 2, 3, 4
 Placement and care of individuals who are b) Chikungunya Virus
infected or colonized with the same c) Arboviruses
microorganism in the same room. ✓ Pregnant women can pass DF to
1) Client’s Diagnosis their child (crosses placental
2) Presence Or Absence Of Infection barrier).
3) Infectious clients are considered DIRTY 2) Dengue Hemorrhagic Fever
4) Postoperative clients are considered • A severe form of DF that cause
CLEAN severe bleeding.
3) Dengue Shock Syndrome
 bradycardia), and
DAYS diuresis ensues.
1-3 FEBRILE  FEVER typically lasts  Hematocrit stabilizes
DAYS 2-7 days can be or may fall because
biphasic. of the dilutional
 S/Sx: effect of the
a) Severe headache reabsorbed fluid
b) Retro-orbital eye  WBC count usually
pain starts to rise
c) Muscle, joint, and  Platelet count
bone pain recovery
d) Macular or  Convalescent phase
maculopapular rash desquamates ad
rash be pruritic.
e) Minor  Hypervolaemia (only
hemorrhagic IV therapy has been
manifestations excessive and/or has
(petechial, extended into this
ecchymosis, period)
purpura,
epistaxis, DF GRADING
bleeding gums, GRADE I  Non-specific
hematuria, (+) symptoms
tourniquet test)  (+) Tourniquet test
 Dehydration: High GRADE II  Grade 1 symptoms
fever may cause  Spontaneous
neurological bleeding
disturbances and GRADE III  Grade 2 symptoms
febrile seizures in  Circulatory failure
young children. GRADE IV  Grade 3 symptoms
4-7 CIRCULATORY  CRITICAL PHASE of  Profound shock
DAYS dengue begins at
DEFERVESCENCE and WHO DEFINITION OF DHF:
typically lasts 24-48 1) Fever
hours 2) Hemorrhagic Episode
 Most patient 3) Platelet (<100,00/m3)
clinically improve 4) Increased vascular permeability
during this phase
 Can develop severe DIAGNOSIS OF DF
dengue to those 1) Tourniquet Test (Rumple Leeds Test)
having substantial a) Take the patient’s blood pressure
plasma leakage and record it
resulting a marked o e.g. 100/70 mmHg
increase in vascular b) Inflate the cuff to appoint midway
permeability between SBP and DBP and maintain
a) Shock from for 5 minutes.
plasma o (100 + 70)/2 = 85 mmHg
leakage c) Reduce and wait 2 minutes
b) Severe d) Count petechiae below antecubital
hemorrhage fossa
c) Organ e) (+) Tourniquet test: 10 or more
impairment petechiae per 1 square inch.
8-10 RECOVERY  As plasma leakage
DAYS subsides, patient MANAGEMENT OF DF
enters the 1) Hydration
convalescent phase 2) Analgesics
 Begins to reabsorb 3) Antipyretics
extravasated IV fluids 4) Administer Blood Transfusions
and pleural and 5) Environmental Control
abdominal effusions 6) Encourage Bed Rest
 Hemodynamic status 7) O2 therapy
stabilizes (may 8) On Trendelenburg Position
manifest 9) Oral Rehydration Solution (ORS)
 10) Use Sedatives

PREVENTION OF DF: MAG 4S KONTRA DENGUE

1) SEARCH & DESTROY
2) SELF-PROTECTION MEASURES
3) SEEK EARLY CONSULTATION
4) SAY NO TO INDISCRIMINATE FOGGING

B. FILARIASIS
➢ Parasitic disease which causes an extremely
debilitating and stigmatizing disease
➢ CAUSATIVE AGENTS:
a) Wuchereria bencrofti
b) Lymph vessels
c) Cules or Anopheles
 Mosquito takes a blood
meal
(L3 larvae enter skin)

HUMAN STAGES
MIGRATE TO HEAD AND •ADULTS IN
MOSQUITO'S LYMPHATICS
PROBOSCIS

ADULTS PRODUCE
SHEATHED
L3 LARVAE MICROFILLARIAE THAT
MIGRATE INTO LYMPH
AND BLOOD CHANNELS

MOSQUITO TAKES A
L1 LARVAE BLOODMEAL (INGESTS
MICROFILLARIAE

MICROFILLARIAE SHED
SHEATHES, PENETRATES
MOSQUITO'S MIDGUT,
AND MITIGATE TO
THORACIC MUSCLES
MANIFESTATIONS OF FILARIASIS a) Bite of an infected mosquito
1) ASYMPTOMATIC b) Parenterally through BT
2) ACUTE c) Shared contaminated needles
3) CHRONIC d) Transplacental transmission
➢ PATHOPHYSIOLOGY
DIAGNOSIS OF FILARIASIS ➢ SIGNS & SYMPTOMS: CHASE
1) NOCTURNAL BLOOD EXAMINATION a) CHILLS
2) IMMUNOCHROMATOGRAPHIC TEST b) HEPATOMEGALY
c) ANEMIA
MANAGEMENT OF FILARIASIS  Lysis of infected and
1) SURGERY uninfected RBCs
2) HYGIENE  Suppression of hematopoiesis
3) ON DEC or HERTRAZAN  Increased clearance of RBCs by
4) ELASTIC BANDAGE spleen
5) START ANTIBIOTICS/ANTIFUNGALS d) SWEATING (PROFUSE)
e) ELEVATED TEMPERATURE
PREVENTION OF FILARIASIS ➢ PREVENTION: CLEAN
1) DAY a) Chemoprophylaxis
a) Environmental sanitation b) Larva-eating fish
b) House spraying c) Environmental sanitation
2) NIGHT d) Anti-mosquito repellents
a) Use of mosquito net e) Neem Tree/ Oregano Tree
b) Long sleeves and pants ➢ CONTROL: Sustainable preventive and
vector control measures
C. MALARIA a) Insecticide Treatment
➢ Acute and chronic parasitic disease b) On Stream Seeding
transmitted by the bite of infected c) House Spraying
mosquitos d) On Stream Clearing
➢ CAUSATIVE AGENTS: e) Zooprophylaxis
a) Plasmodium falciparum f) Chemoprophylaxis
b) Plasmodium malariae g) Avoiding outdoor nighttime
c) Plasmodium vivax activities
d) Plasmodium ovale h) Using of mosquito repellents
➢ VECTORS: i) Planting Neem Trees
a) Breeds in clear, flowing, shaded j) Wearing Long sleeved clothes
streams
b) Brown in color D. SCHISTOSMIASIS
c) Assumes a 36 degrees position when ➢ Known also as:
it alights a) SNAIL FEVER
d) NIGHT BITING b) BILHARZIA
➢ MOT: c) KAYTMA FEVER
➢ CAUSATIVE AGENTS:
a) Schistosoma japonicum
SPOROZOITES
LIVER
MEROZOITES b) Schistosoma mansoni
ENTER AFTER c) Schistosoma haematobium
INVASION
CIRCULATION INCUBATION
d) Oncomelania quadrasi

SCHIZONTS
RBC INVASION
FORMATION
➢ MOT:

b) Avoiding bathing in infected

➢ DIAGNOSTIC TEST: streams
a) CERCUM OVA PRECIPETIN TEST c) Building foot bridges over
➢ PREVENTION: streams
1) REDUCE SNAIL DENSITY d) Providing water supply
a) Clearing vegetation 3) PREVENT EXPOSURE
b) Constructing drainage a) Using rubber boots
c) Improving farming b) Towel-drying
2) DIMINISH INFECTION RATE c) Applying alcohol
a) Disposing of urine and feces
properly E. LEPTOSPIROSIS
 ➢ Zoonotic infectious bacterial disease carried b) Pain at the original site of
by animals whose urine contaminates food bite
and water. c) Sensitivity to light, sound,
➢ CAUSATIVE AGENT: Leptospira interrogans temperature
➢ DIAGNOSIS: d) Pain and aches in different
a) Clinical body part
b) Culture & Sensitivity e) Mild difficulty swallowing
c) Serologic Test f) Numbness, tingling, burning
➢ MANAGEMENT: sensation
1) ANTIBIOTICS 2) EXCITEMENT/NEUROLOGICAL
a) PENICILLIN G (SEVERE) PHASE
b) DOXYCYCLINE (MILD) a) Marked excitation
c) CEFTRIAXONE (MILD) b) Eyes become fixed and glossy
2) BLOOD TRANSFUSION c) Skin is cold and clammy
3) CONFRONT AND CONTROL d) Severe and painful spasm of
4) DALYSIS IF NECESSARY the mouth, pharynx, and
5) ELECTROLYTES larynx
e) Profuse drooling of saliva
➢ PREVENTION f) Tonic-clonic contractions of
a) Protective clothing, boots and gloves muscles
b) Educate people at risk 3) TERMINAL/PARALYTIC PHASE
c) Rat eradication program a) Patient becomes quiet and
d) Segregate domestic animals unconscious
e) Chemoprophylaxis (DOXYCYCLINE) b) Loss of bowel and urinary
control
F. RABIES c) Spasm ceases with
➢ CAUSATIVE AGENT: Rhabdovirus progressive paralysis
➢ CARRIERS: d) DEATH:
a) Bats 1. Respiratory failure
b) Skunks 2. Circulatory collapse
c) Raccoons 3. Heart failure
d) Cats ➢ MANAGEMENT:
e) Dogs 1) Immunize household dogs and cats
➢ FACTORS AFFECTING INCUBATION PERIOD: at 3 mos. Of age
1) Distance of the bite to the brain 2) Immunize people who are expose to
2) Extensiveness of the bite animals
3) Specie of the animal 3) Carefully and thoroughly clean and
4) Richness of nerve supply flesh wounds with soap and water
5) Resistance of the host 4) Povidone iodine or alcohol may be
➢ DIAGNOSIS used
1) Virus isolation from the patient’s 5) Patients may be given antibiotics,
saliva Tetanus toxoid, or ATS
2) Fluorescent Rabies Antibody Test 6) Animals that bite are observed for
3) Presence of Negri bodies 10-14 days;
➢ PHASES: a) If SICK: should be euthanized
1) PRODROMAL/INVASION PHASE and their brains examined
a) 1ST SYMPTOM: Flu-like ➢ PREVENTION
symptoms 1) PRE-EXPOSURE VACCINE
a) IM administration in the deltoid
 b) Days 0, 7, and 21 or 28 b) Food
2) POST EXPOSURE VACCINE c) Fingers
a) Previously unimmunized d) Fomites
1. 1 mL vaccine IM on days e) Feces
0, 3, 7, 14, 28 ➢ CLINICAL MANIFESTATIONS
2. Administer HRIG a) Neurological Changes
b) Previously immunized b) Pea-Soup Diarrhea
1. 1 mL vaccine IM on days c) Rose Spots (Rash)
0 and day 3 ➢ DIAGNOSTIC: TyphiDot
2. Do not administer HRIG ✓ Presence of Salmonella typhi
➢ COMPLICATION:
 It can spread VASCULARLY
GASTROINTESTINAL DISEASES a) Meningitis
A. PARALYTIC SHELLFISH POISONING b) Waterhouse-Friderichsen
➢ Food borne marine toxin disease with both Syndrome
GI and Neurologic symptoms c) Skin lesions
Occurs within minutes or several hours d) Vascular collapse
after ingestion of poisonous shellfish e) Pulmonary insufficiency
➢ CAUSATIVE AGENT: Dinoflagellates f) Adrenal necrosis
✓ Become poisonous after a heavy ➢ PREVENTION: BREAK THE CHAIN of fecal, hand
rainfall preceded by prolonged and oral route
summer ➢ MANAGEMENT: TYPHOSA
➢ MOT: through INGESTION 1) TSB
➢ CLINICAL MANIFESTATION : 2) You have to monitor S/Sx closely
a) Tingling of lips and tongue 3) Position Changes
b) Tingling of the face, neck 4) Hydration And Food
c) Tingling of fingertips and toes 5) Oral Care
d) Dysphagia 6) Safety Is A Priority
e) Headache, Dizziness, Nausea 7) Antibiotics: Chloramphenicol
f) Muscular Paralysis
g) Respiratory Difficulty C. CHOLERA
➢ DIAGNOSTICS: ➢ Acute bacterial enteric disease
a) Clinical ➢ CAUSATIVE AGENT: Vibrio cholerae
b) Urine test ➢ MOT: FECAL-ORAL ROUTE
➢ PREVENTION: a) Flies
a) Monitoring program to test water b) Food
b) Avoid eating shellfish during red tide c) Fingers
➢ MANAGEMENT: 4 A’s d) Fomites
a) Allow/induce vomiting e) Feces
b) Alkaline fluids are given ➢ CLINICAL MANIFESTATIONS: HARD
✓ E.g. Coconut water a) Hypovolemic Shock
c) Activated charcoal b) Acidosis
d) Artificial respiration c) Rice Watery Stool
d) Diarrhea
B. TYPHOID FEVER ➢ DIAGNOSTIC:
➢ Bacterial infection of the GIT affecting the a) Culture & Sensitivity (Gold Standard)
➢ CAUSATIVE AGENT: Salmonella typhi b) Dip Stick Test
➢ MOT: FECAL-ORAL ROUTE c) Stool examination
a) Flies
➢ PREVENTION: BREAK THE CHAIN of fecal, hand a) Presence of signs and symptoms
and oral route b) History contact of People with
➢ MANAGEMENT: leprosy
1) High Calorie, Low Fiber Diet c) 1 of the 3 symptoms:
2) IV Treatment 1. Hypopigmented or reddish
3) Antibiotics (Tetracycline) patches with definite loss of
4) Monitor I&O with VS sensation
5) Oral Rehydration Therapy 2. Damaged peripheral nerves
3. Acid Fast Bacilli on Skin Slit
LEPROSY (HANSEN’S DISEASE) Smear
➢ Chronic systemic infection characterized by
progressive cutaneous lesion BACTERIAL CLASSIFICATION
➢ CAUSATIVE AGENT: Mycobacterium leprae PAUCIBACILLARY MULTIBACILLARY
➢ AFFECTED ORGANS: NON- INFECTIOUS/
a) Skin INFECTIOUS/TUBERCULOID LEPROMATOUS
b) Peripheral nerves Incubation period of 2-5 Incubation period of 8-12
c) Eyes years years
d) Testes <5 Lesions >5 Lesions
e) Mucosa of the URT Normal Cell-mediated Deficient CMI
➢ MOT: Immunity (CMI)/ Partially
a) Aerosol spread from infected nasal deficient CMI
and oral mucosa Rapid peripheral nerve Rapid peripheral nerve
b) Prolonged skin to skin contact involvement involvement
➢ CLINICAL MANIFESTATIONS (+) LEPROMIN (Skin test) (-) LEPROMIN (Skin test)
1) FINE NERVES
a) Anesthesia Few Bacilli Numerous Bacilli
b) Anhidrosis PHARMACOLOGIC MANAGEMENT
c) Dryness 1) RIFAMPICIN 1) RIFAMPICIN
2) LARGE NERVES 2) DAPSONE 2) DAPSONE
a) Pain then anesthesia 3) CLOFAZIMINE
b) Paralysis
c) Atrophy ➢ MODALITIES OF TREATMENT:
3) Changes in skin color a) MDT
4) Loss of sensation on the lesion b) Rehabilitation
5) Decrease or loss of sweating c) Sulfone Therapy
6) Thickened or painful nerves ➢ TREATMENT: MULTIDRUG THERAPY
7) Muscle weakness a) Use of two or more drugs for the
8) Pain and redness of the eyes treatment of leprosy
9) Nasal obstruction or bleeding b) Renders patients non-infectious 1 week
10) Ulcers that do not heal after initiation of therapy
11) LEONINE FACIES (Pathognomonic) 1) RIFAMPICIN
12) Madarosis (loss of eyebrows)  600 mg once a month
13) Lagopthalmos (inability to close 2) DAPSONE
eyelids)  100 mf daily
14) Clawing of fingers and toes 3) CLOFAZIMINE
15) Contractures  50 mg daily
16) Gynecomastia  S/E: skin discoloration
17) Chronic ulcers ➢ NURSING MANAGEMENT:
➢ DIAGNOSIS a) Moral support and encouragement
 b) Diet should be wholesome ✓ CAUSATIVE AGENT: Hepatitis E virus
c) Terminal disinfection ✓ MOT: Fecal-Oral Route
➢ PREVENTION AND CONTROL ✓ INCUBATIONPERIOD: 2-8 weeks
a) Reporting of all cases and suspects ✓ CLINICAL SYMPTOMS:
b) Separating newborns from leprous a) Jaundice
mothers b) Nausea
c) BCG vaccination c) Fatigue
d) Adequate nutrition
e) Health education on the MOT
✓ CHRONIC STAGE:
HEPATITIS a) Weak immune system
➢ CLASSIFICATION: b) Pregnancy
1) HEPATITIS A ✓ GREATER RISK:
✓ CAUSATIVE AGENT: Hepatitis A virus a) Fulminant liver failure
✓ May be Asymptomatic b) Cirrhosis
✓ MOT: Fecal-Oral Route ➢ RA 7846
✓ Vaccine Preventable ✓ An Act Requiring Compulsory
✓ Curable Immunization Against Hepatitis B
✓ Contagious before they feel sick For Infants And Children Below 8
2) HEPATITIS B (Serum Hepatitis) Years Old.
✓ CAUSATIVE AGENT: Hepatitis B virus ➢ MANIFESTATIONS: PHASES
✓ Usually no symptoms 1) PREICTERIC PHASE
✓ MOT: a) Flu-like symptoms:
a) Sexual Contact  Malaise
b) Contaminated Needles  Fatigue
c) Body fluids (Blood or  Fever
Semen) b) GI symptoms
✓ Vaccine preventable  Anorexia
✓ Can become CHRONIC  Nausea
✓ Treatable but no cure exists  Vomiting
3) HEPATITIS C  Diarrhea/Constipation
✓ CAUSATIVE AGENT: Hepatitis C virus c) Muscle aches
✓ Usually no symptoms d) Mild RUQ pain and
✓ MOT: Blood-blood transmission tenderness
✓ NO VACCINE 2) ICTERIC PHASE
✓ Usually become chronic a) Jaundice
✓ Curable b) Pruritus
4) HEPATITIS D (Delta Hepatitis) c) Clay-colored stool
✓ CAUSATIVE AGENT: Hepatitis D virus d) Brown or tea-colored urine
✓ MOT: e) Decrease in PREICTERIC
a) Sexual Contact PHASE symptoms
b) Contaminated Needles 3) POSTICTERIC OR RECOVERY
✓ Can only be infected if have current a) Disappearance of Jaundice
Hepatitis B b) Urine & stool color become
✓ Hepatitis D resides inside Hepatitis B NORMAL
✓ HREATER RISK of Liver failure c) Appetite improves
✓ Increased risk + Progression to liver d) GI symptoms disappears
cirrhosis
5) HEPATITIS E
 e) COMPLETE RECOVERY of 2) CAUTIOUS USE OF SHARPS BY HEALTH
liver may take up to 6 WORKERS
months 3) SCREENING OF BLOOD AND BLOOD
➢ NURSING INTERVENTIONS PRODUCTS
1) Use Standard Precautions 4) ABSTINENCE
2) Encourage planned rest periods 5) CONDOM
3) Diet:
a) Moderate Fat
b) High Caloric
c) High Carbohydrates
d) High Proteins
4) Small frequent feedings
5) Majority of caloric intake should be
scheduled in the morning
6) Avoid alcohol intake and diet drinks
7) Use warm water when bathing,
8) Use mild soap or no soap
9) Limit duration of baths and shower
10) Keep fingernails short and wear
cotton mittens

TREATMENT
HEPATITIS 1) INTERFERON ALPHA
B  Interferes with viral
replication
 Given IM or SC EPI-PREVENTABLE COMMUNICABLE AND
 S/E: flu-like symptoms INFECTIOUS DISEASES
2) LAMIVUDINE
 Reduces liver inflammation VACCINE ROUTE INJECTION SCHEDULE
HEPATITIS 1) INTERFERON ALPHA + RIBAVIRIN SITE
C  Ribavirin adverse effects: BCG ID Upper right At birth
a) Hemolytic anemia arm
b) Birth defects HepB IM Outer mid- At birth
PREVENTION AND CONTROL thigh
OPV PO Mouth 6-10-14 weeks
HEPATITIS A AND E IPV IM Outer left 14 weeks
1) HANDWASHING upper thigh
2) TRAVELERS SHOULD AVOID WATER AND PENTA IM Outer right 6-10-14 weeks
ICE IF UNSURE OF THEIR PURITY upper thigh
3) FOOD HANDLERS SHOULD BE CAREFULLY
PCV IM Outer left 6-10-14 weeks
SCREENED
upper thigh
4) SAFE FOOD PREPARATION AND HANDLING
PPV IM Upper right Adults 60 and
5) PUBLIC SHOULD BE EDUCATED ON THE
arm 65 years old
MODE OF TRANSMISSION
Rotavirus PO Mouth 6-10 weeks
PREVENTION AND CONTROL
Vaccine
HEPATITIS B, C, AND D MMR SC Upper right 9 months and
arm 12 months
1) AVOID SHARING NEEDLES
MR SC Upper right Grade 1 and 7
 arm 4) Contact with contaminated eating or
Td IM Outer left Grade 1 and 7 drinking utensils
upper arm for children. ➢ CLINICAL MANIFESTATIONS:
1) Cough for 2 weeks
Pregnant 2) tiredness
Mothers: 3) Loss Of Appetite
4) Weight Loss
Td (1): As early 5) Fever
as possible in 6) Night Sweats
pregnancy. ➢ SCREENING:
1) Intradermal PPD: MANTOUX TEST
Td (2): 4 weeks a) 0.1 mL of PPD injected ID into
after Td (1) the forearm
MANTOUX TEST POSITIVE RESULTS IMPLICATION
Td (3): 6 > 5 mm  HIV Positive
months after  Recent contact with an
Td (2) active TB patient
 Nodular or fibrotic
Td (4): 1 year changes on CXR
after Td (3)  Organ transplant
>10 mm  Recent arrivals (<5 years)
Td (5): 1 year from high-prevalence
after Td (4) countries
JE SC Upper arm 9 months  IV drug users
HPV IM Outer Female: 9-10  Resident/employee of
upper arm years old high risk congregate
Influenza IM Outer 60 years old settings
Vaccine upper arm and above  Mycobacteriology lab
annually personnel
(every year)  Comorbid conditions
PULMONARY TUBERCULOSIS (KOCH’S DISEASE)  Children <4 years old
➢ CAUSATIVE AGENTS:  Infants, children, &
1) Mycobacterium tuberculosis adolescents exposed to
2) Mycobacterium avium high risk categories
3) Mycobacterium africanum >15 mm  Persons with no known
4) Mycobacterium bovis risk factors for TB
➢ INCUBATION PERIOD: 2-10 weeks 2) CHEST X-RAY
➢ SOURCES OF INFECTION
1) Saliva
2) Sputum ➢ DIAGNOSIS:
3) Nasal Discharge 1) Direct Smear Sputum Microscopy
4) Blood from Hemoptysis ✓ Primary diagnostic tool in NTP case
➢ MOT: finding prescribed to all TB
1) Airborne (Coughing, Singing, Sneezing) symptomatic
2) Direct invasion through mucous ✓ 3/6 Symptoms: (+)
membranes or breaks in the skin a) Coughing or wheezing for 2
3) Ingestion of unpasteurized milk weeks
 b) Unexplained fever of 2 weeks or ➢ OTHER DIAGNOSTIC TESTS:
more a) VISION EXAMINATION
c) Failure to respond to 2 weeks of b) LIVER FUNCTION TESTS
antibiotic for LRTI c) AUDIOMETRIC TESTING
d) Loss of appetite/weight or ➢ PREVENTION: PROPHYLAXIS
failure to gain weight a) ISONIAZID (INH) 300 mg/day for 6-12
e) Failure to regain previous state months
of health 2 weeks after viral ➢ TREATMENT: DOTS
infection a) RIFAMPICIN (R)
f) Fatigue, reduced playfulness or ✓ Adverse effect: HEPATOTOXIC
lethargy ✓ Contact lenses should not be worn
✓ Any person with cough for 2 or more ✓ With meals
weeks with or without the following b) ISONIAZID (H)
symptoms: ✓ HEPATOTOXIC\Avoid alcohol
a) Fever ✓ Peripheral neuropathy
b) Chest and/back pains not ✓ Take with Vitamin B6 (Pyridoxine)
referable to any musculoskeletal ✓ Take on empty stomach
disorder ✓ CONTRAINDICATION: Pregnancy
c) Hemoptysis or recurrent blood- c) PYRAZINAMIDE (Z)
streaked sputum ✓ Hyperuricemia
d) Significant weight loss ✓ HEPATOTOXIC
e) Other symptoms: ✓ Avoid using alcohol
1. Sweating ✓ Administer with meals
2. Fatigue d) ETHAMBUTOL (E)
3. Body malaise ✓ Optic neuritis
4. SOB ✓ Monitor vision daily
2) Acid Fast Bacilli: RED ✓ Schedule visual examination
e) STREPTOMYCIN (S)
COMMUNITY ✓ Administered IM
SYMPTOMATIC ✓ Sites are rotated
✓ Maintain fluid intake of 2-3 L/day
✓ Monitor urine output, BUN,
DOTS FACILITY Creatinine
✓ Assess balance
CASE FINDING ✓ Reinforce safety

SIDE EFFECTS DRUG(S) WHAT TO DO

MICROSCOPY CENTER RESPONSIBLE
MAJOR SIDE EFFECTS: DISCONTINUE TAKING
MEDICINES AND REFER TO MHO/CHO/PHYSICIAN
IMMEDIATELY
Severe Skin Any kind of Discontinue and
DIAGNOSIS
Rash drug refer
(especially,
Streptomycin)
Jaundice Due Any kind of Discontinue and
➢ SPUTUM SPECIMEN To Hepatitis drug refer
a) SPOT SPECIMEN (especially,
b) SPOT/EARLY MORNING SPECIMEN
 HRZ) If symptoms ➢ Route: Intradermal (ID)
subside, resume ➢ Site: Deltoid
treatment and ➢ Vaccine type: Attenuated
monitor
Impairment Of Ethambutol Discontinue and PREVENTION AND CONTROL
Visual Acuity refer 1) Submit all babies for BCG
And Color ophthalmologist 2) Avoid overcrowding
Vision 3) Improve health status
Hearing Streptomycin Discontinue and 4) CONTRAINDICATION:
Impairment refer a) Patients who have compromised
immune system
CATEGORY 1st Sputum 2nd 3rd Sputum
Follow-up Sputum Follow-up
Exam Follow-up Exam
Exam A. MEASLES (RUBEOLA)
I Towards Towards End of 6th ➢ Acute highly communicable infection
end of 2nd end of 5th month characterized by fever, rash and respiratory
month month symptoms
II Towards Towards End of 8th ➢ CAUSATIVE AGENT: Morbilli
end of 3rd end of 5th month Paramyxoviridae; an RNA virus
month month ➢ INCUBATION PERIOD: 8-12 days
➢ MOT:
5 ELEMENTS OF DOTS a) DIRECT (DROPLETS, AIRBORNE)
1) SUSTAINED POLITICAL COMMITMENT b) INDIRECT (FOMITES)
2) ACCESS TO QUALITY-ASSURED SPUTUM ➢ PERIOD OF COMMUNICABILITY
MICROSCOPY a) CONTAGIOUS 4 days before
3) UNINTERRUPTED OR REGULAR SUPPLY OF appearance of rash
QUALITY-ASSURED DRUGS b) CONTAGIOUS 4 days after
4) STANDARDIZED RECORDING AND appearance of rash
REPORTING SYSTEM ➢ CLINICAL MANIFESTATIONS: STAGES
5) STANDARDIZED TREATMENT WITH SHORT- a) PRE-ERUPTIVE STAGE
COURSE CHEMOTHERAPY  Flu-like symptoms
 Cough
PTB - NURSING MANAGEMENT  Conjunctivitis
1) COVER NOSE WHEN COUGHING OR  Body ache
SNEEZING  KOPLIK’S SPOTS
2) HAND WASHING (Pathognomonic)
3) RESPIRATORY ISOLATION − Bluish-whitish spots on
4) ADMINSTER MEDICATION AS ORDERED soft palate or buccal
5) PATIENT EDUCATION mucosa
a) COUGH ETIQUETTE b) ERUPTIVE STAGE
b) SIGNS OF DRUG REACTION  Maculopapular Rashes (starts
form the hairline down to behind
BACILLE-CALMETTE-GUERIN (BCG) VACCINE the ears to trunk and limbs)
➢ Minimum age at 1st dose: AT BIRTH  Pruritus
➢ Dosage: 0.05 mL c) STAGE OF CONVALESCENCE
➢ Number of doses: 1 dose  Rashes desquamates (peeling)
➢ Interval between doses: None  Fever dissipates
➢ MANAGEMENT:
 a) Active Immunity (MMR & Measles
Vaccine) MEASLES – PREVENTION
b) Passive Immunity (Measles 1) ISOLATION
Immunoglobulin) 2) DISINFECTION
c) Lifetime Immunity for primary 3) VACCINATION
infection (Active Natural)
➢ OTHER FACTS OF MEASLES: MEASLES – NURSING MANAGEMENT
a) It is EXTREMELY CONTAGIOUS 1) ISOLATE PATIENT
b) Breastfed babies of mothers have 3 2) TSB FOR FEVER
month immunity for measles 3) SKIN HYGIENE
c) MOST COMMON COMPLICATION: 4) ORAL & NASAL HYGIENE
 Otitis Media 5) RESTRICT TO QUIET ENVIRONMENT
d) MOST SERIOUS COMPLICATIONS 6) DIM LIGHT
 Pneumonia 7) ANTIPYRETICS
 Encephalitis
➢ DIAGNOSTICS: MEASLES – MANAGEMENT
a) Physical Examination (CLINICAL) 1) MOUTH AND NOSE CARE
b) Nose & Throat Swab (not routinely 2) APPETITE IS CONCERN
done) 3) HYDRATION STATUS
c) U/A 4) IN HEAT/FEBRILE
d) CBC 5) YES, RASHES WILL FADE
DAY 0-1 PRODROME 6) A (VITAMINS)
COUGH
CORYZA MEASLES VACCINE
CONJUNCTIVITIS ➢ Minimum age at 1st dose: 9 MONTHS
DAY 2-3 KOPLIK SPOTS APPEAR ➢ Dosage: 0.5 mL
DAY 4-5 MORBILLIFORM RASH ➢ Number of doses: 1 dose
APPEARS ➢ Interval between doses: None
DAY 6 KOPLIK SPOTS REGRESS ➢ Route: SUBCUTANEOUS
DAY 7-8 RASH IS MOST INTENSE ➢ Site: OUTER PART OF UPPER ARM
DAY 10 RASH BEGINS TO ➢ Vaccine type: Attenuated
RESOLVE
3 C’S OF MEASLES B. GERMAN MEASLES (RUBELLA)
 FIRST SIGN: Mild-Moderate Fever ➢ POST NATAL: an infection that primarily
1) CORYZA affects the skin and lymph nodes
2) COUGH ➢ CONGENITAL: fetal infection which results
3) CONJUNCTIVITIS to congenital abnormalities
➢ Known as 3 DAY MEASLES (After 3 days,
MEASLES – MANAGEMENT: measles disappears)
1) OBSERVE RESPIRATORY ISOLATION ➢ CAUSATIVE AGENT: Rubi Togaviridae; a
2) SUPPORTIVE MANAGEMENT OF SYMPTOMS rubella virus; RNA
3) HYDRATION ➢ INCUBATION PERIOD: 14-21 days
4) PROPER NUTRITION ➢ MOT:
5) VITAMIN A a) DIRECT
6) ANTIBIOTICS (if with secondary bacterial − DROPLETS spread through
infection) the nasopharynx
7) MEASLE VACCINE at 9 MONTHS b) INDIRECT:
8) MMR VACCINE at 12-15 MONTHS − TRANSPLACENTAL
➢ CLINICAL MANIFESTATIONS:
 a) Maculopapular Rashes (diffuse/ non- a) CONTAGIOUS for 7 DAYS BEFORE
confluent, no desquamation, spreads appearance of rash
from face downwards) b) CONTAGIOUS for 7 DAYS AFTER
b) Blueberry Muffin Appearance appearance of rash
c) FORSCHEIMER’S SPOTS c) During Catarrhal Stage
(Pathognomonic) ➢ NURSING CONSIDERATIONS:
− Petechial reddish spots on a) MMR immunization
soft palate or buccal mucosa b) Use of Immunoglobulin
d) Cervical lymphadenopathy (swelling c) Prevention of congenital measles
of cervical lymph nodes) d) Avoid exposure
e) Low-grade fever compared to
measles RUBELLA – PREVENTION:
➢ DIAGNOSTICS: 1) DISINFECTION
a) CLINICAL 2) ISOLATION
b) Serologic testing 3) DROPLET PRECAUTION
➢ COMPLICATIONS:
a) Pneumonia RUBELLA – MANAGEMENT (POST NATAL)
b) Meningoencephalitis 1) BED REST
c) Congenital Rubella Syndrome: 2) STARCH BATH
1. Deafness 3) ANTIHISTAMINE
2. Cataracts
3. Heart defects C. CHICKENPOX (VARICELLA)
4. Microcephaly ➢ Acute & highly CONTAGIOUS characterized
5. Mental retardation by vesicular eruptions
6. Bone alterations ➢ Childhood disease & adolescents
7. Liver and spleen damage ➢ Human beings are the only source of
➢ COMPLICATIONS TO PREGNANT WOMEN: infection
a) Severe birth defects (acquired ➢ CAUSATIVE AGENT: Varicella Zoster Virus
German measles on 1st trimester) ➢ INCUBATION PERIOD: 10-21 days
b) Abortion (acquired German measles ➢ MOT: DROPLETS spread
on 2nd trimester) a) Nose & throat secretions
c) Premature baby (acquired German b) INDIRECT CONTACT
measles on 3rd trimester) c) Vesicles (contagious in early stage of
d) 100% = 1st trimester eruption)
e) 4% = 2nd and 3rd trimester d) Airborne
f) 90% = excretion o virus at birth ➢ CLINICAL MANIFESTATIONS:
g) 10% = contagious until 1 year a) PRODROMAL PERIOD:
➢ MANAGEMENT:  Headache
a) Active Natural Immunity  Vomiting
(PERMANENT or Lifetime after  Anorexia
primary infection)  Malaise
b) Active Immunity (MMR & Rubella  Mild Fever
Vaccine)  Papulovesicular Rashes
c) Passive Immunity (Gamma globulin) appear on trunk (spreads to
➢ PERIOD OF COMMUNICABILITY the face and extremities –
CENTRIFUGAL)
 e) Prophylactic antibiotics
MACULES PAPULES f) Exclusion from school for 1 week
after eruption appears
g) An attack gives lifetime immunity
(Active Natural)
VESICLES WITH
h) DOC: Acyclovir (topical cream
PUSTULE CLEAR FLUID applied to crusts)
INSIDE ➢ PREVENTIVE MEASURES:
a) Active Immunization with LIVE
ATTENUATED VARICELLA VACCINE
b) Avoid exposure as much as possible
SCAR
CRUSTING
FORMATION
to infected person

CHICKENPOX HERPES ZOSTER

➢ PERIOD OF COMMUNICABILITY (SHINGLES)
a) CONTAGIOUS for 5 DAYS BEFORE DISTRIBUTION GENERALIZED UNILATERAL
appearance of rash MAIN ITCHINESS BURNING PAIN
b) CONTAGIOUS for 5 DAYS AFTER CONCERN
appearance of rash (Crusting) MANAGEMENT ACYCLOVIR ACYCLOVIR
c) CONTAGIOUS a DAY BEFORE the ANTIPYRETIC ANALGESIC
eruption of first lesion ANTIPRURITIC ANTI-
➢ COMPLICATIONS: INFLAMMATORY
a) Pneumonia PREVENTION  IMMUNIZATION
b) Meningoencephalitis (rare)  AVOIDING EXPOSURE
c) Hepatitis  DISINFECTION
d) Skin lesions may develop secondary  WEARING PPE
bacterial infections
e) Reye’s Syndrome (associated with D. MUMPS (PAROTITIS)
Aspirin use) ➢ Inflammation of the parotid glands
➢ DORMANT: ➢ Human beings are the only RESERVOIR
a) Remain at the dorsal root ganglion ➢ CAUSATIVE AGENT: Paramyxovirus
and may recur as SHINGLES. ➢ MOT: DROPLETS spread
➢ MANAGEMENT: a) CONTACT
a) ANTIVIRALS b) IINDIRECT CONTACT
b) ANTIHISTAMINES ➢ PERIOD OF COMMUNICABILITY
c) ANTIPRURITIC LOTIONS a) CONTAGIOUS for 3 days before the
d) ANTIPYRETICS onset
e) Mild/bland, soft foods b) CONTAGIOUS for 4 days after the
f) Acyclovir, Antihistamines start of parotitis
g) Nasal and Oral care ➢ COMPLICATIONS:
h) Observe proper hygiene a) Meningitis
i) Keep fingernails short b) Encephalitis
➢ NURSING CONSIDERATIONS: c) Pancreatitis
a) If itchy, give antihistamines PO or d) Oophoritis
local e) Orchitis
b) Avoid rupture of lesions ➢ DIAGNOSIS : CLINICAL
c) Cut nails short ➢ PREVENTION:
d) Pay attention to nasopharyngeal 1) Isolation
secretions/discharges
 2) Disinfection
3) Distance
➢ MANAGEMENT: SADAACO
1) Soft diet
2) Aqua therapy
3) Discharges
4) Aspirin
5) Allow Bed Rest
6) Control scratching
7) Oral Antiseptics
8) Orchitis