Communicablediseases 110227001506 Phpapp02 PDF

Community Health Nursing
Communicable Disease Lecture Notes

Prepared by: Mark Fredderick R. Abejo RN,, MAN
COMMUNITY HEALTH NURSING

Communicable Disease
Lecturer: Mark Fredderick R. Abejo RN, MAN
EPI TARGET DISEASES
Disease
Tuberculosis
Primary Complex is
less than 3 years old
- any child who does
not return to normal
health after measles or
whooping cough.
Most hazardous
period: first 6-12
months after
infection
Highest in risk of
developing: under 3
years old
Causative Agent
Mode of
Transmission
Clinical Manifestation
Reservoir
Diagnostic Exam
Treatment
Mycobacterium
Droplet Infection
Man
( inhalation of bacilli
from patient who
coughs and sneeze)
Sputum Exam
3 sample are taken
with 24 hrs:
DOTS
Tuberculosis
General weakness
Loss of weight, cough and
wheeze which does not
respond to antibiotic
therapy.
Fever and night sweat
Abdominal swelling with a
hard painless mass and free
fluid
Hemoptysis and chest pain
Painful firm or soft
swelling in a group of
superficial lymph nodes.
Note:
Degree of
Communicability
Depends upon:
- num.of bacilli
- virulence of bacilli
- environmental
In young children the only

sign of pulmonary TB may be
stunted growth or failure to
And
Diseased Cattle
- spot sample (1st

visit)
(Bovine TB)
- early morning
specimen
- spot sample
- patient is required
to take the Ant-Tb
drugs in the
presence of a health
care provider to
ensure compliance
to treatment
regimen
(2nd visit)
Note: at least 2
sample are
positive
Nursing Implication
Pointers for teaching

on Anti-TB drugs:
Rifampicin: taken
befor meals, causes red
urine urine
Isoniazide: causes
peripheral neuritis,
given with Vit.B6
Pyrazinamide: cause
hyperurucemia
Anti-TB drugs:
Ethambutol: causes

conditions
thrive
(RIPES)
Chest Xray
Mantoux Test
- .1 cc injection of
PDD and 48-72
hours reading
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
optic neuritis/ blurring

of vision
Streptomycin: cause
tinnitus, loss of
hearing balance,
damage to 8th cranial
nerve
* 10 mm +
5 mm + (HIV pt.)
Note: After 2-4 weeks
of treatment, patient is
no longer contagious

The National Tuberculosis Control Program
Increase and sustain support and financing for TB control activities
Vision: A country where Tb is no longer a public health problem

Mission: Ensure that TB DOTS services are available, accessible and
affordable to the communities in collaboration with the LGUs
and other partners
Goal: To reduce prevalence and mortality from TB by half the year
2015 ( Millennium Development Goal )
Strategies:
Targets:
1. Cure at least 85% of the sputum smear- positive TB patient discovered.
2. Detect at least 70% of the estimated new sputum smear-positive TB cases.
Objective D:
Facilitate implementation of TB-DOTS Center certification and accreditation

Build TB coalitions among different sectors
Advocate for counterpart input from local government units
Mobilize/extend other resources to address program limitations
Strengthen management (technical and operational) of TB control services at

all levels
NTP Objectives and Strategies

Objective A:
Improve access to and quality of services provided to TB patients, TB symptomatics and
communities by health care institutions and providers
Strategies:
Enhance quality of TB diagnosis.
Ensure TN patients treatment compliance.
Ensure public and private health care providers adherence to the implementation of national
standards of care for TB patients.
Improve access to services through innovative service delivery mechanisms for patients living in
challenging areas.
Strategies:
Enhance managerial capability of all NTP program managers at all levels
Establish an efficient data management system for both public and private sectors.
Implement a standardized recording and reporting system.
Conduct regular monitoring and evaluation at all levels.
Advocate for political support through effective local governance
KEY POLICIES
Case Finding
1.
DSSM ( Direct Sputum Smear Microscopy ) shall be the primary diagnostic

tool in NTP case finding.
Note: No TB diagnosis shall be made based on Xray result alone likewise result
of PDD skin test (Mantoux Test)
2.
All TB symptomatic identified shall undergo DSSM for diagnosis before start of
treatment
Note: Only contraindication for sputum collection is hemoptysis
3.
After three sputum specimen yielding negative result X-ray and culture are
necessary
Note: Diagnosis based on Xray shall be made by the TB DiagnosticCommittee.
4.
Only trained medical technologist or microscopist shall perform DSSM.
Objective B:
Enhance the health-seeking behavior on TB by communities, especially the TB
symptomatics
Strategies:
Develop effective, appropriate and culturally-responsive IEC/communication materials.
Organize barangay advocacy groups
Objective C:

Patients with the following conditions shall be recommended for hospitalization:

massive hemoptysis
pleural effusion
military TB ( TB of the Spine Pots Disease)
TB meningitis
TB pneumonia
and those requiring surgical intervention
RECOMMENDED CATEGORY OF TREATMENT REGIMEN
Category
Type of TB Patient
Treatment
Regimen
Intensive
Phase
Continuation
Phase
Total
Period
2 RIPE
4 RI
6 mos.
5 RIE
8 mos.
4 RI
Anti-TB drugs:
(RIPES)
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
Two Formulation of Anti-TB Drugs

1.
2.
Fixed-Dose Combination ( FDCs) two or more first line anti-TB drugs are combined in
one tablet. There are 2,3, or 4 drug fixed dose combinations.
Single Drug Formulation (SDF) each drug is prepared individually. Isoniazid,
Pyrazinamide and Ethambuto are in tablet form while Rifampicin is in capsule form and
streptomycin is injectable.
II
III
IV
New smear positive

PTB
New smear positive
PTB with extensive
parenchymal lesion
EPTB and Severe
concomitant HIV
disease
Treatment Failure
Relapse
Return after default
New smearnegative PTB

With minimal
parenchymal
lession
Chronic ( still
smear-positive after
supervised retreatment )
2 RIPES /1
RIPE
2 RIP
mos.
Refer to
Specialized
facility
or DOTS
Plus Center
refer
Provincial
NTP
to City
Coordinator

Categories II : 2 RIPES / RIPE / 4RIE (FDC)

DOSAGE PER CATEGORY OF TRATMENT REGIMEN
A. Fixed-Dose Combination Formulation
Body
Weight
Intensive
Phase
Continuation
Phase
FDC-B
( RI )
400 mg
The number of tablets of FDCs per patient will depend on the body weight.
First Two (2)
Months
3rd Month
Categories I and III : 2 RIPE / 4 RI ( FDC)

FDC-A
Streptomycin
(RIPE)
Body Weight (kg)
FDC-A
(RIPE)
No.of tablets per day
No. of tablets per day
Intensive Phase
Continuation Phase
( 2 months )
( 4 months )
FDC-A ( RIPE)
FDC-B (RI)
30 - 37
38 54
55 70
B. Single Dose Formulation ( SDF )
More than 70
Simply add 1 tablet of Isoniazid ( 100mg) , Pyrazinamide (500mg) and

Ethambutol ( 400mg) each for the patient weighing more than 50kg before treatment
initiation. Modify drug dosage within acceptable limits according to patients body weight,
particularly those weighing less than 30 kg at the time of diagnosis.
30 37
0.75 g
38 54
0.75 g
55 70
0.75 g
More
than 70
0.75 g

Categories I and III: 2 RIPE / 4 RI (SDF)

Anti-TB Drugs
Intensive Phase
Continuation Phase
( 2 months )
( 4 months )
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Anti-TB Drugs
Dose per Kg Body Weight and Maximum Dose
Rifampicin
5 ( 4 6 ) mg/kg and not to exceed 400 mg daily
Isoniazid
Pyrazinamide
Ethambutol
15 ( 15 20 ) mg/kg and not to exceed 1.2 g daily
Streptomycin
15 ( 12 18 ) mg/kg and not to exceed 1 g daily
Categories II: 2 RIPES / 1 RIPE / 5 RIE
Anti-TB Drugs
No. of Tablets /
Intensive
Vial per day

Phase
No.of Tablets per day
( 5 months )
First 2 months
3rd months
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
2
1 vial
Note: 56 vials of Streptomycin for two months
per day
D.O.T.S ( Directly-Observed Treatment Shortcourse ) TuTok Gamutan
Continuation Phase
(3months )
Streptomycin
Drug Dosage per Kg. Body Weight
5 Elements of D.O.T.S
Sustained political commitment
Access to quality-assured sputum microscopy
Standardized short-course chemotherapy for all cases of TB
Uninterrupted supply of essential drugs
Recording and reporting system enabling outcome assessment of all patients and
assessment of overall program performance.

MANAGEMENT OF CHILDREN WITH TB
Management
Prevention
For children with exposure to TB
BCG vaccination shall be given to all infants.

BCG vaccine is moderately effective. It has a protective efficacy of:
50 % against any TB disease
64 % against TB meningitis
Should undergo physical examination and PDD testing (Mantoux Test)

A child with productive cough shall be referred for DSSM, if found positive, treatment
shall be started immediately. PDD testing shall no longer needed.
Children without sign/symptoms of TB but with positive Mantoux Test and those with
symptoms of TB but negative Mantoux Test shall referred for chest x-ray examination.
74 % against death from TB

For children with signs and symptoms of TB
Case Finding
Cases of TB in children are reported and identified in two instances:
- The patient sought consultation.
- The patient was reported to have been exposed to an adult with TB
All TB symptomatic children 0-9 years old, except sputum positive child shall subject to PDD
testing
- Only trained nurse and midwife shall do the PDD test and recording
- Testing and reading shall be conducted once a week either on Monday or
Tuesday.
Note: 10 children shall be gathered for testing to avoid wastage.
A child shall be suspected as having TB and considered symptomatic if with any three (3) of the
following sign and symptoms:
cough and wheezing for 2 weeks or more
unexplained fever for 2 weeks or more
loss of appetite, loss of weight, failure to gain weight
failure to respond to a 2 weeks of appropriate antibiotic therapy
failure to regain state of health 2 weeks after a viral infection or after having measles.
A child shall be clinically diagnosed or confirmed of having TB if he has any three (3) of the
following condition:
positive history of exposure to an adult/ adolescent TB case
presence of sign and symptoms suggestive of TB
positive Mantoux Test
abnormal chest radiograph suggestive of TB
A child to have signs and symptoms of TB with either known or unknown exposure
shall be referred for Mantoux test.
For children with known contact but with negative Mantoux and those unknown contact
but with positive Mantoux shall be referred for chest x-ray examination.
For a negative x-ray report, Mantoux test shall be repeated after 3 months.
Chemoprophylaxis of Isoniazid for 3 months shall be given to children less than 5 years
old with negative chest x-ray after which Mantoux test shall be repeated
Treatment
D.O.T.S will still be followed just like in adult
Short course regimen:
- at least 3 anti-TB drugs for 2 months ( intensive phase )
- 2 anti-TB drugs for 4 months ( continuation phase )
* For Extra Pulmonary TB Cases:
- 4 anti-TB drugs for 2 months ( intensive phase )
- 2 anti-TB drugs for 10 months ( continuation phase )
Domiciliary treatment shall be the preferred mode of care
No treatment shall be initiated unless the patient and health worker has agreed upon a
caseholding mechanism for treatment compliance.

Treatment Regimen
Continuation Phase
A. Pulmonary TB
Drugs
Rifampicin
Isoniazid
Daily Dose (mg/kg per body weight )
Duration
10-15 mg/kg body weight
2 months
10 months
Intensive Phase
Rifampicin
Isoniazid
Pyrazinamide
Public Health Nurse Responsibilities ( Childhood TB )

Continuation Phase
Rifampicin
Isoniazid
4 months
1.
2.
3.
4.
5.
6.
B. Extra Pulmonary TB
Drugs
Daily Dose (mg/kg per body weight )
Duration
Intensive Phase
Rifampicin
Isoniazid
Pyrazinamide

Plus
Ethambutol
OR
Streptomycin
2 months
Interview and open treatment cards for identified TB children.

Perform Mantoux testing and reading to eligible children
Maintain NTP records
Manage requisition and distribution of drugs
Assist the physician in supervising the other health workers of the RHU in the
proper implementation of the policies and guidelines on TB in children.
Assist in the training of other health workers on Mantoux testing and reading.
Community Health Nursin

EPI TARGET DISEASES

Disease
Causative Agent
Mode of
Transmission
Clinical Manifestation
Reservoir
Diagnostic
Treatment
Nursing Implication
Exam
Diphteria it is an
acute pharyngitis, acute
nasopharyngitis
Corynebacterium
Respiratory
Droplets
diphtheriae
Nasal
Man
- test for the

susceptibility to
Diptheria
dryness of the upper

lip
serosanguinous
secretion in the nose
or acute laryngitis with

Pseudo membrane
grayish white in color
with leathery
consistency in the
throat and on the tonsil
Schicks Test
Pharyngeal
Antibiotics
Pen G Potassium
Erythromycin
Moloney Test
Bullneck
appearance because of
the enlarge cervical
lymph nodes.
- for hypersensitivity to
Diptheria toxin
Isolate patient until

2-3 cultures taken at
least 24hrs apart are
negative
Small frequent
feeding
Promote absolute
rest
Use ice collar to
relieve pain of sore
throat
May put on soft diet
Laryngeal
Pertussis
- 100 days cough
- Whooping cough
- tuspirina
Bordetella Pertussis
Airborne droplet
Primarily by direct
contact with he
discharge from
respiratory mucous
membranes of
infected person
sore throat
hoarseness
brassy metallic cough
At first, the infected
child may have a
common cold with
runny nose, sneezing
and mild cough
Intermittent episode
of paroxysmal cough
followed by a whoop
ending vomiting
Bordet-Gengou
Agar Plate
Erythromycin
Ampicillin
- used for culture

medium
- is given 5-7 days
Man
Place the patient on

NPO during
paroxysmal stage to
prevent aspiration
Position prone for
infants and upright
for older

Neonatal Tetanus
Clostridium Tetani
- which produces the

exotoxins:
Tetanolysin
Tetanospasmin
Unhygienic cutting
of umbilical cord
Improper handling
of cord stump esp.
when treated with
contaminated
substance
Assess the NEWBORN

for a history of all 3 of
the following:
Blood Culture
CSF analysis
Normal suck and cry

for the first 2 days of
life
Onset of illness
between 3 and 28
days
Inability to suck
followed by stiffness
of the body and
convulsion
In OLDER CHILDREN,
the following may be
observed:
Trismus lockjaw
Opisthotonus
arching of the neck
and back
Ridus Sardonicus
sardonic smile
Penicillin
Erythromycin
Tetracycline
- administered within
4 hours of injury
Soil
Intestinal
canal of
animal
Man
Prevention
Aseptic handling of
the neonatal
umbilical cord
Tetanus Toxiod
immunization for
mothers
Active immunization
of DPT

Poliomyelitis
Infantile Paralysis
3 Types of Polio Virus

Type I Brunhilde
Type II Lansing
Type III Leon
Fecal-oral route
Oral route through

pharyngeal
secretion
Abortive - did not

progress to systemic
infection
Throat swab
Man
Stool exam
Non-paralytic slight
involvement of the CNS
Lumbar exam
Contact with
infected person
Strict Isolation
Hot moist compress
to relieve spasm
Poker spine or
stiffness of the spinal
column
Use protective
devices:
- handroll to prevent
claw hand
Pandys test
- for CSF analysis
Spasms of the
hamstring
With paresis
- trochanter roll, to
prevent outer rotation
of femur
- footboard
Paralytic severe
involvement of CNS
Hoynes Sign head

falls back when he is
in supine with
shoulder elevated
Paralysis
Head log/drop
Tripod position
extend his arm behind
for support when he
sits up
Kernigs sign
Brudzinski sign

Hepatitis B
- it is liver infection
caused by the B type of
hep.virus.
Prodromal/pre-icteric
Hepa B Virus
3 Ps
Person to person
It attacks livers the

liver often resulting in
inflammation
Liver Function
Test
Man
Paramyxo Virus
Droplet
Increase CHO
Moderate fat
Low CHON
Observed universal
precaution
Parenteral
Placental
Measles
Symptoms of URTI
Weight loss
Anorexia
RUQ pain
Malaise
Icteric
Jaundice
Acholic stool
bile-colored urine
3 Cs
Conjunctivitis
Coryza
Cough
Kopliks spot bluish
gray spot on the buccal
mucosa.
Generalized blotch rash
Man
Observe respiratory
isolation
Should kept out of
school for at least 4
days after rash
appear
For Photophobic,
darkened room,
sunglasses

DISEASES TRANSMITTED THROUGH FOOD AND WATER
Disease
Causative Agent
Mode of Transmission
Vibrio cholera
Vibrio coma
Ogawa and Inaba
bacteria
Fecal-oral route
5 Fs
Amoebic
Dysentery
Entamoeba histolytica
Protozoan (slippershaped
body)
Fecal-oral route
Shigellosis
Shigella bacillus
Sh-dysenterae most
infectious
Sh-flesneri common
in
the Philippines
Sh-connei
Sh-boydii
Fecal-oral route
Salmonella typhosa
(plural, typhi)
Fecal-oral route
5 Fs
Cholera
Other names:
El tor
Other names:
Bacillary
dysentery
Typhoid fever
Incubation Period:
Few hours to 5 days;
Usually 3 days
5 Fs: Finger, Foods,

Feces, Flies,
Fomites
Pathognomonic Sign
Management and Treatment
Prevention
Diagnostic Test:
Stool culture
Treatment:
Oral rehydration solution (ORESOL)
IVF
Drug-of-Choice: tetracycline (use straw; can
cause staining of teeth).
Oral tetracycline should be
administered with meals or after milk.
Abdominal
cramping
Bloody mucoid stool
Tenesmus - feeling
of
incomplete defecation
Metronidazole (Flagyl)
* Avoid alcohol because of its Antabuse effect
can cause vomiting
Proper handwashing
Proper food and water
sanitation
Abdominal
cramping
Bloody mucoid stool
Tenesmus - feeling
of incomplete
defecation
Drug-of-Choice: Co-trimoxazole
Diet: Low fiber, plenty of fluids, easily

digestible
foods
Proper handwashing
sanitation
Fly control
Rose Spots in the

abdomen due to
bleeding caused by
perforation of the
Peyers patches
Ladderlike fever
Diagnostic Test:
Rice watery stool

Period of
Communicability:
7-14 days after onset,
occasionally 2-3
months
Proper handwashing
sanitation
Immunization of Chole-vac
Incubation Period:
1 day, usually less
than 4 days
Incubation Period:
Usual range 1 to 3
weeks, average 2
weeks
Typhi dot confirmatory test; specimen is feces

Widals test agglutination of the patients
serum
Drug-of-Choice: Chloramphenicol
Proper handwashing
sanitation

Hepatitis A
Hepatitis A Virus
Other names:
Hepatitis /
Epidemic
Hepatitis /
Catarrhal Jaundice
Paralytic
Shellfish
Poisoning (PSP I
Red tide
poisoning)
Fecal-oral route
5 Fs
Incubation Period:
15-50 days,
depending on dose,
average 20-30 days
Dinoflagellates
Phytoplankton
Ingestion of raw of
inadequately cooked
seafood usually
bivalve mollusks
during red tide
season
Incubation Period:
30 minutes to
several hours after
ingestion
Fever
Anorexia (early sign)
Headache
Jaundice (late sign)
Clay-colored stool
Lymphadenopathy
Prophylaxis: IM injection of gamma globulin

Hepatitis A vaccine
Hepatitis immunoglobulin
Avoid alcohol
Complete bed rest to reduce the breakdown of
fats for metabolic needs of liver
Low-fat diet; increase carbohydrates (high in
sugar)
In convalescent period, patient may have
difficulty with maintaining a sense of well-being.
Numbness of face
especially around the
mouth
Vomiting and
dizziness
Headache
Tingling
sensation/paresthesia
and
eventful paralysis of
hands
Floating sensation
and
weakness
Rapid pulse
Dysphonia
Dysphagia
Total muscle
paralysis
leading to respiratory
arrest and death
Treatment:
Avoid eating shellfish

such as tahong, talaba,
halaan, kabiya, abaniko
during red tide season
Dont mix vinegar to

shellfish it will increase
toxic effect 15 times
greater
1. No definite treatment
2. Induce vomiting
3. Drink pure coconut milk weakens the
toxic effect
4. Sodium bicarbonate solution (25 grams in
glass of water)
Advised only in the early stage of illness
because paralysis can lead to aspiration
NOTE: Persons who survived the first 12 hours
after
ingestion have a greater chance of survival.
Proper handwashing
sanitation
Proper disposal of urine
and feces
Separate and proper
cleaning of articles used by
patient

DISEASES CAUSED BY VIRUS

Disease
Chickenpox
Other names:
Varicella
Causative Agent
Human (alpha) herpes
virus 3 (varicella-zoster
virus), a member of the
Herpesvirus group
Period of
Communicability:
From as early as 1 to 2
days before the rashes
appear until the lesions
have crusted.
Droplet spread
Direct contact
Indirect through articles
freshly soiled by
discharges of infected
persons
Incubation Period:
2-3 weeks, commonly
13 to 17 days
Pathognomonic Sign
Vesiculo-pustular
rashes
Centrifugal
appearance of
rashes rashes which
begin on the trunk and
spread peripherally
and more abundant on
covered
body parts
Pruritus

No specific diagnostic exam
Treatment is supportive.
Drug-of-choice:
Acyclovir / Zovirax (orally to reduce the
number of lesions; topically to lessen the
pruritus)
NEVER give ASPIRIN. Aspirin when given to
children with viral infection may lead to
development of REYES SYNDROME.
Prevention
Nursing Diagnoses:
Disturbance in body image
Impairment of skin integrity
German
Measles
Other Names:
Rubella
Three-day
Measles
Herpes Zoster
Other names:
Shingles
Cold sores
Rubella virus or
RNAcontaining
Togavirus
(Pseudoparamyxovirus)
Droplet
Incubation Period:
Three (3) days
German measles is
teratogenic infection,
can cause congenital
heart disease and
congenital
cataract.
Herpes zoster virus
(dormant varicella
zoster
virus)
Droplet
Direct contact from
secretion
Forscheimer spots
red pinpoint patches
on the oral cavity
Maculopapular rashes
Headache
Low-grade fever
Sore throat
Enlargement of
posterior cervical and
postauricular
Diagnostic Test:
Rubella Titer (Normal value is 1:10); below 1:10
indicates susceptibility to Rubella.
Painful vesiculopustular
lesions on limited
portion of the body
(trunk and
shoulder)
Low-grade fever
Treatment is supportive and symptomatic

Acyclovir to lessen the pain
Instruct the mother to avoid pregnancy for three

months after receiving MMR vaccine.
MMR is given at 15 months of age and is given
intramuscularly.
Case over 15 years of age

should be investigated to
eliminate possibility of
smallpox.
Report to local authority
Isolation
Concurrent disinfection of
throat and nose discharges
Exclusion from school for
1 week after eruption first
appears
Avoid contact with
susceptibles
MMR vaccine (live

attenuated virus)
- Derived from chick
embryo
Contraindication:
- Allergy to eggs
- If necessary, given in
divided or fractionated
doses and epinephrine
should be at the bedside.
Avoidance of mode of
transmission

Mumps
Other name:
Epidemic Parotitis
Mumps virus, a
member
of family
Paramyxoviridae
Direct contact
Source of infection:
Secretions of mouth and
nose
Incubation Period:
12 to 26 days, usually
18 days
Painful swelling in
front of the ear, angle
of the jaws and down
the neck
Fever
Malaise
Loss of appetite
Supportive and symptomatic

Sedatives to relieve pain from orchitis
Cortisone for inflammation
MMR vaccine
Isolate mumps cases
Avoid use of common

towels, glasses, and eating
utensils
Cover mouth and nose
during cough and sneeze
Diet: Soft or liquid as tolerated

Support the scrotum to avoid orchitis, edema,
and atrophy
Dark glasses for photophobia
Swelling of one or
both testicles (orchitis)
in some boys
Influenza
Other name:
La Grippe
Influenza virus
A most common
B less severe
C rare
Period of
Communicability:
Probably limited to 3
days from clinical onset
Direct contact
wesDroplet infection or by
articles freshly soiled
with nasopharyngeal
discharges
Airborne
Incubation Period:
Short, usually 24 72
hours
Sudden onset
Fever with chills
Headache
Myalgia / arthralgia

Keep patient warm and free from drafts
TSB for fever
Boil soiled clothing for 30 minutes before
Immunization:
Flujob/Flushot effective
for 6 months to 1 year

DISEASES CAUSED BY BACTERIA

Disease
Pneumonia
Types:
a. Community
Acquired
Pneumonia (CAP)
b. Hospital /
Nosocomial
c. Atypical
Causative Agent
Bacteria:
Pneumococcus,
streptococcus
pneumoniae,
staphylococcus aureus,
Klebsiella pneumonia
(Friedlanders bacilli)
Droplet
Incubation Period:
2 3 days
Virus:
Haemophilus
influenzae
Fungi: Pneumonocystis
carinii pneumonia
Streptococcal
sore throat
Group A beta hemolytic

streptococcus
Other name:
Pharyngitis
Tonsillitis
Other diseases:
Scarlet fever
St. Anthony fire
Puerperal sepsis
Imoetigo
Acute
glomerulonephritis
Rheumatic Heart
Disease
Droplet
Complication:
Rheumatic Heart
Disease
Pathognomonic Sign
Rusty sputum
Fever and chills
Chest pain
Chest indrawing
Rhinitis/common cold
Productive cough
Fast respiration
Vomiting at times
Convulsions may occur
Flushed face
Dilated pupils
Highly colored urine
with reduced chlorides
and increased urates
Diagnosis:
Based on signs and symptoms
Dull percussion on affected lung
Sputum examination confirmatory
Chest x-ray
Sudden onset
High grade fever with
chills
Enlarged and tender
cervical lymph nodes
Inflamed tonsils with
mucopurulent exudates
Headache
Dysphagia
Diagnosis:
Throat swab and culture
Prevention
Avoid mode of
transmission
Build resistance
Turn to sides
Proper care of influenza
cases
Management:
Bedrest
Adequate salt, fluid, calorie, and vitamin intake
Tepid sponge bath for fever
Frequent turning from side to side
Antibiotics based on CARI of the DOH
Oxygen inhalation
Suctioning
Expectorants / mucolytics
Bronchodilators
Oral/IV fluids
CPT
Treatment: erythromycin
Care:
Bed rest
Oral hygiene with oral antiseptic or with saline
gargle (1 glass of warm water + 1 tsp rock salt)
Ice collar
Avoid mode of
transmission

Meningitis
Other name:
Cerebrospinal
fever
Meningococcus
Neisseria meningitides
Direct (Droplet)
Incubation Period:
2 - 10 days
A. Sudden Onset
- high fever
accompanied
by chills
- sore throat, headache,
prostration (collapse)
Diagnostic Test:
Lumbar puncture or Lumbar tap - reveals CSF
WBC and protein, low glucose; contraindicated
for increased ICP for danger of cranial
herniation
Hemoculture to rule out meningococcemia
B. entrance into the

bloodstream leading to
septicemia
(meningococcemia)
a. rash, petchiae,
purpura
Treatment:
Osmotic diuretic (Mannitol) to reduce ICP and
relieve cerebral edema; Alert: fastdrip to prevent
crystallization
Anti-inflammatory (Dexamethasone) to
relieve
cerebral edema
Antimicrobial (Penicillin)
Anticonvulsany (Diazepam / Valium)
C. Symptoms of
menigeal
irritation
- nuchal rigidity (stiff
neck) earliest sign
- Kernigs sign when
knees are flexed, it
cannot
be extended
- Brudzinski signs
pain on neck flexion
withautomatoc flexion
of the knees
- convulsion
- poker soine (poker
face /
flat affect)
- Increased ICP
(Cushings triad:
hypertension,
bradycardia,
bradypnea)
and widening pulse
pressure
Complications:
Hydrocephalus
Deafness (Refer the child for audiology testing)
and mutism
Blindness
Respiratory Isolation

VECTOR-BORNE DISEASES
Disease
Malaria
Causative Agent
Plasmodium Parasites:
Vivax
Falciparum (most fatal;
most common in the
Philippines)
Ovale
Malariae
Bite of infected
anopheles mosquito
Night time biting
High-flying
Rural areas
Clear running water
Pathognomonic Sign
Cold Stage: severe,
recurrent chills (30
minutes to 2 hours)
Hot Stage: fever (4-6
hours)
Wet Stage: Profuse
sweating
Episodes of chills,
fevers, and profuse
sweating are
associated with rupture
of the red blood cells.
- intermittent chills
and
sweating
- anemia / pallor
- tea-colored urine
- malaise
- hepatomegaly
- splenomegaly
- abdominal pain and
enlargement
- easy fatigability

Early diagnosis identification of a patient
with malaria as soon as he is seen through
clinical and/or microscopic method
Clinical method based on signs and
symptoms of the patient and the history of his
having visited a malaria-endemic area
Microscopic method based on the
examination of the blood smear of patient
through microscope
(done by the medical technologist)
QBC/quantitative Buffy Coat fastest
Malarial Smear best time to get the
specimen is at height of fever because the
microorganisms are very active and easily
identified
Chemoprophylaxis
Only chloroquine should be given (taken at
weekly intervals starting from 1-2 weeks before
entering the endemic area). In pregnant women,
it is given throughout the duration of
pregnancy.
Treatment:
Blood Schizonticides - drugs acting on sexual
blood stages of the parasites which are
responsible
for clinical manifestations
1. QUININE oldest drug used to treat
malaria; from the bark of Cinchona tree;
ALERT: Cinchonism quinine toxicity
2. CHLOROQUINE
3. PRIMAQUINE sometimes can also be
given as chemoprophylaxis
4. FANSIDAR combination of
pyrimethamine and sulfadoxine
Prevention
*CLEAN Technique
*Insecticide treatment of
mosquito net
*House Spraying (night
time fumigation)
*On Stream Seeding
construction of bio-ponds
for fish propagation (2-4
fishes/m2 for immediate
impact; 200-400/ha. for a
delayed effect)
*On Stream Clearing
cutting of vegetation
overhanging along stream
banks
*Avoid outdoor night
activities (9pm 3am)
*Wearing of clothing that
covers arms and legs in the
evening
*Use mosquito repellents
*Zooprophylaxis typing
of domestic animals like
the carabao, cow, etc near
human dwellings to
deviate mosquito bites
from man to these animals
Intensive IEC campaign
NURSING CARE:
1. TSB (Hot Stage)
2. Keep patent warm
(Cold Stage)
3. Change wet clothing
(Wet Stage)
4. Encourage fluid intake
5. Avoid drafts

Filariasis
Other names:
Elephantiasis
Endemic in 45 out
of 78 provinces
Highest
prevalence rates:
Regions 5, 8, 11
and CARAGA
Shistosomiasis
Other Names:
Snail Fever
Bilharziasis
Endemic in 10
regions and 24
provinces
High prevalence:
Regions 5, 8, 11
Dengue
Hemorrhagic
Fever
Other names:
H-fever
Wuchereria bancrofti
Brugia malayi
Brugia timori
nematode parasites
Bite of Aedes poecillus

(primarily)
Aedes flavivostris
(secondary)
Incubation period:
8 16 months
Asymptomatic Stage:
Presence of
microfilariae
in the blood but no
clinical signs and
symptoms of disease
Acute Stage:
Lymphadenitis
Lymphangitis
Affectation of male
Genitalia.
Schistosoma mansoni
S. haematobium
S. japonicum (endemic
in the Philippines)
Contact with the

infected freshwater with
cercaria and penetrates
the skin
Vector: Oncomelania
Quadrasi
Dengue virus 1, 2, 3,
and 4 and Chikungunya
virus
Types 1 and 2 are
common in the
Philippines
Bite of infected
mosquito (Aedes
Aegypti) - characterized
by black and white
stripes
Daytime biting
Low flying
Stagnant clear water
Urban
Diagnosis
Physical examination, history taking,
observation of major and minor signs and
symptoms
CLEAN Technique
Use of mosquito repellents
Anytime fumigation
Wear a long sleeves, pants
and socks
Laboratory examinations
Nocturnal Blood Examination (NBE) blood
are taken from the patient at his residence or in
hospital after 8:00 pm
Immunochromatographic Test (ICT) rapid
assessment method; an antigen test that can be
done at daytime
Chronic Stage: (10-15

years from onset of
first
attack)
Hydrocele
Lymphedema
Elephantiasis
Treatment:
Drug-of-Choice: Diethylcarbamazine Citrate
(DEC) or Hetrazan
Diarrhea
Bloody stools (on and
off dysentery)
Enlargement of
abdomen
Splenomegaly
Hepatomegaly
Anemia / pallor
weakness
Diagnostic Test:
COPT or cercum ova precipitin test (stool
exam)
Classification (WHO):
Diagnostic Test:
Torniquet test (Rumpel Leads Test / capillary
fragility test) PRESUMPTIVE; positive when
20 or more oetechiae per 2.5 cm square or 1
inch square are observed
Platelet count CONFIRMATORY; (Normal
is
150 - 400 x 103 / mL)
Grade I:
a. flu-like symptoms
b. Hermans sign
c. (+) tourniquet sign
Treatment:
Drug-of-Choice: PRAZIQUANTEL
(Biltracide)
Oxamniquine for S. mansoni
Metrifonate for S. haematobium
*Death is often due to hepatic complication
Dispose the feces properly

not reaching body of water
Use molluscides
Prevent exposure to
contaminated water (e.g.
use rubber boots)
Apply 70% alcohol
immediately to skin to kill
surface cercariae
Allow water to stand 48-72
hours before use
4 oclock habit
Chemically treated
mosquito net
Larva eating fish
Environmental sanitation
Antimosquito soap
Neem tree (eucalyptus)

Period of
communicability:
Unknown. Presumed to
be on the 1st week of
illness up to when the
virus is still present in
the
blood
Occurrence is sporadic
throughout the year
Epidemic usually occur
during the rainy seasons
(June to November)
Peak months:
September
and October
Incubation Period:
Uncertain. Probably 6
days to 1 week
Manifestations:
First 4 days:
Febrile/Invasive Stage
- starts abruptly as fever
- abdominal pain
- headache
- vomiting
- conjunctival infection
-epistaxis
4th 7th days:
Toxic/Hemorrhagic
Stage
- decrease in
temperature
- severe abdominal pain
- GIT bleeding
- unstable BP (narrowed
pulse pressure)
- shock
- death may occur
7th 10th days:
Recovery/Convalescent
Stage
- appetite regained
- BP stable
Grade II:
a. manifestations of
Grade
I plus spontaneous
bleeding
b. e.g. petechiae,
ecchymosis purpura,
gum
bleeding,
hematemesis,
melena
Grade III:
Grade
II plus beginning of
circulatory failure
b. hypotension,
tachycardia, tachypnea
Grade IV:
Grade
III plus shock (Dengue
Shock Syndome)
Treatment:
Paracetamol for fever
Analgesic for pain
Rapid replacement of body fluids most
important
treatment
ORESOL
Blood tansfusion
Diet: low-fat, low-fiber, non-irritating,
noncarbonated.
Noodle soup may be given. ADCF
(Avoid Dark-Colored Foods)
ALERT! No Aspirin
Eliminate vector
Avoid too many hanging
clothes inside the house
Residual spraying with
insecticide
Daytime fumigation
Use of mosquito repellants
Wear long sleeves, pants,
and socks
For the control of H-fever,
knowledge of the natural
history of the disease is
important.
Environmental control is
the most appropriate
primary prevention
approach and control of
Hfever.

DISEASES TRANSMITTED BY ANIMALS

Disease
Leptospirosis
Other Names:
- Weils Disease
- Mud Fever
- Trench Fever
- Flood Fever
- Spirochetal
Jaundice
- Japanese
Seven Days
fever
Rabies
Other Names:
Lyssa
Hydrophobia
Le Rage
Causative Agent
Leptospira interrogans
bacterial spirochete
RAT is the main host.
Although pig, cattle,
rabbits, hare, skunk,
and other wild animals
can also serve as
reservoir
Through contact of the
skin, especially open
wounds with water,
moist soil or vegetation
infected with urine of
the infected host
Incubation Period:
7-19 days, average of
10 days
Occupational disease
affecting veterinarians,
miners, farmers, sewer
workers, abattoir
workers,
etc
Pathognomonic Sign
Leptospiremic Phase
- leptospires are present
in blood and CSF
- onset of symptoms is
abrupt
- fever
- headache
- myalgia
- nausea
- vomiting
- cough
- chest pain

Diagnosis
Clinical manifestations
Culture of organism
Examination of blood and CSF during the first
week of illness and urine after the 10th day
Leptospira agglutination test
Treatment:
Penicillins and other related B-lactam antibiotics
Tetracycline (Doxycycline)
Erythromycin
Most common complication: kidney failure
Immune Phase
- correlates with the
appearance of circulating
IgM
Rhabdovirus of the
genus
lyssavirus
Degeneration and
necrosis
of brain formation of
negri bodies
Bite or scratch (very

rare) of rabid animal
Non-bite means:
leaking, scratch, organ
transplant (cornea),
inhalation/airborne
(bats)
Two kinds of Rabies:

a. Urban or canine
transmitted by dogs
b. Sylvatic disease of
wild animals and bats
which sometimes
spread
to dogs, cats, and
livestock
Source of infection:
saliva of infected
animal or human
Incubation period:
2 8 weeks, can be
years depending on
severity of wounds, site
of wound as distance
from brain, amount of
virus introduced, and
protection provided by
clothing
Sense of apprehension
Headache
Fever
Sensory change near site
of animal bite
Spasms of muscles of
deglutition on attempts to
swallow
Fear of
water/hydrophobia
Paralysis
Delirium
Convulsions
FATAL once signs and
symptoms appear
Diagnosis:
history of bite of animal
culture of brain of rabid animal
demonstration of negri bodies
Management:
*Wash wound with soap immediately.
Antiseptics
e.g. povidone iodine or alcohol may be applied
*Antibiotics and anti-tetanus immunization
*Post exposure treatment: local wound
treatment, active immunization (vaccination) and
passive immunization (administration of rabies
immunoglobulin)
*Consult a veterinarian or trained personnel to
observe the pet for 14 days
*Without medical intervention, the rabies victim
would usually last only for 2 to 6 days. Death is
often due to respiratory paralysis.
Prevention
Protective clothing,
boots and gloves
Eradication of rats
Segregation of domestic
animals
Awareness and early
diagnosis
Improved education of
people
Avoid wading or
swimming in water
contaminated with urine
of infected animals.
Concurrent disinfection
of articles soiled with
urine.
Have pet immunized at 3

months of age and every
year thereafter
Never allow pets to roam
the streets
Take care of your pet
National Rabies
Prevention and Control
Program
Goal: Human rabies is
liminated in the
Philippines and the
country is declared
rabiesfree

DISEASES OF THE SKIN
Disease
Leprosy
Other names:
Hansenosis
Hansens disease
-an ancient
disease and is a
leading cause of
permanent
physical disability
among the
communicable
diseases
Causative Agent
Mycobacterium leprae
Airborne-droplet
Prolonged skin-toskin
contact
Pathognomonic Sign
Early signs:
Change in skin color
either
reddish or white
Loss of sensation on
the skin
lesion
Loss of sweating and
hair growth
Thickened and painful
nerves
Muscle weakness or
paralysis or
extremities
Pin and redness of the
eyes
Nasal obstruction or
bleeding
Ulcers that do not heal
Late Signs:
Madarosis
Loss of eyebrows
Inability to close
eyelids
(lagophthalmos)
Clawing of fingers and
toes
Contractures
Chronic ulcers
Sinking of the
nosebridge
Enlargement of the
breast
(gynecomastia)

Diagnostic Test:
Slit Skin Smear - determines the presence of M.
leprae; optional and done only if clinical
diagnosis
is doubtful to prevent misclassification and
wrong
treatment
Lepromin Test determines susceptibility to
leprosy
Prevention
Avoid prolonged skin-to skin
contact
BCG vaccination
practical and effective
preventive measure
against leprosy
Good personal hygiene
Adequate nutrition
Health education
Major activity of leprosy
control program:
casefinding and treatment
with effective drugs
Prevent deformities by
self-care, exercise, and
physical therapy.
Treatment:
Ambulatory chemotherapy through use of MDT
Domiciliary treatment as embodied in RA 4073
which advocates home treatment
PAUCIBACILLARY (tuberculoid and

indeterminate); noninfectious type
Duration of treatment: 6 to 9 months
Procedure:
Supervised: Rifampicin and Dapsone once a
month on the health center supervised by the
rural health midwife
Self-administered: Dapsone (side effect:
itchiness of the skin) everyday at the clients
house
MDT Facts:
It reduces communicability period
of leprosy in 4-6 weeks time.
It prevents development of
resistance to drugs.
It shortens the duration of
treatment.
MULTIBACILLARY (lepromatous and

borderline); infectious type
Duration of treatment: 24-30 months
Procedure:
Supervised: Rifampicin, Dapsone, and Lamprene
Clofazimine; side effect: dryness or flaking of
the skin) once a month on the health center
supervised by the rural health midwife
Self-administered: Dapsone and Lamprene
everyday at the clients house

Anthrax
Bacillus anthracis
Other names:
Malignant pustule
Malignant edema
Woolsorter
disease
Ragpicker disease
Charbon
Incubation period:
few hours to 7 days
most cases occur within
48 hours of exposure
3. Scabies
Sarcoptes scabiei
- An itch mite
parasite
Contact with
a. tissues of animals
(cattle, sheep, goats,
horses, pigs, etc.)
dying of the disease
b. biting flies that
had partially fed on such
animals
c. contaminated hair,
wool, hides or products
made from them e.g.
drums and brushes
d. soil associated
with infected animals or
contaminated bone
meal used in
gardening
Direct contact with

infected individuals
Incubation
Period:
24 hours
Cutaneous form most

common
- itchiness on exposed
part
- papule on inoculation
site
- papule to vesicle to
eschar
- painless lesion
Treatment: Penicillin
Proper handwahing
Immunize with cell-free
vaccine prepared from
culture filtrate containing
the protection antigen
Control dust and proper
ventilation
Pulmonary form
contracted from
inhalation of B.
anthracis spores
- at onset, resembles
common URTI
- after 3-5 days,
symptoms become
acute, with fever,
shock,
and death
Gastrointestinal
anthrax
contracted from
ingestion of meat from
infected animal
- violent gastroenteritis
- vomiting
- bloody stools
Itching
When secondarily
infected:
Skin feels hot and
burning
When large and
severe: fever,
headache, and malaise
Diagnosis:
Appearance of the lesion
Intense itching
Finding of causative mite
Treatment: (limited entirely to the skin)
Examine the whole family before undertaking
treatment
Benzyl benzoate emulsion (Burroughs,
Welcome)
cleaner to use and has more rapid effect
Kwell ointment
Personal hygiene
Avoid playing with dogs
Laundry all clothes and
iron
Maintain the house clean
Environmental sanitation
Eat the right kind of food
Regular changing of clean
clothing, beddings and
towels

SEXUALLY TRANSMITTED DISEASES
Disease
Syphilis
Other names:
Sy
Bad Blood
The pox
Lues venereal
Morbus gallicus
Gonorrhea
Other names:
GC, Clap, Drip,
Stain, Gleet,
Flores Blancas
Causative Agent
Treponema pallidum
(a spirochete)
Incubation Period:
10 to 90 days (3
months);
average of 21 days
Neiserria gonorrheae
Direct contact
Transplacental (after
16th week AOG)
Through blood
transfusion
Indirect contact with
Contaminated articles
Direct contact
genitals, anus,
mouth
Incubation Period:
2 10 days
Pathognomonic Sign
Primary stage (4-6
weeks): painless
chancre at site of entry
of germ
with serous exudates
Tertiary stage (one to
35 years) : Gumma,
syphilitic endocarditis
and meningitis
Primary and secondary
sores will go even
without treatment but
the germs continue
to spread throughout
the body.
Latent syphilis may
continue 5 to 20+
years with NO
symptoms, but the
person is NO longer
infectious to other
people.
A pregnant
mother can transmit
the disease to her
unborn child
(congenital syphilis).
Thick purulent
yellowish discharge
Burning sensation
upon
urination / dysuria

Diagnostic test:
Dark field illumination test
Fluorescent treponemal antibody absorption
test, most reliable and sensitive diagnostic test
for Syphilis; serologic test for syphilis which
involves antibody detection by microscopic
flocculation of the antigen suspension
VDRL slide test, CSF analysis, Kalm test,
Wasseman test
Prevention
Abstinence
Be faithful
Condom
Treatment:
Drug of Choice: Penicillin (Tetracycline if
resistant
to Penicillin)
Diagnostic test:
Culture of urethral and cervical smear
Gram staining
Treatment:
Drug of Choice: Penicillin
Abstinence, Be faithful
Condom
Prevention of gonococcal
ophthalmia is done through
the prophylactic use of
ophthalmic preparations
with erythromycin or
tetracycline

Trichomoniasis
Trichomonas vaginalis
Other names:
Vaginitis
Trich
Direct contact
Incubation Period:
4 20 days; average
of 7 days
Females:
white or greenishyellow odorous
discharge vaginal
itching and soreness
painful urination
Diagnostic Test:
Culture
Treatment:
Drug of Choice: Metronidazole (Flagyl)
Abstinence
Be faithful
Condom
Personal Hygiene
Males:
Slight itching of penis
Painful urination
Clear discharge from
penis
Chlamydia
Chlamydia trachomatis
(a rickettsia)
Direct contact
Incubation Period:
2 to 3 weeks for
males; usually no
symptoms for
females
Candidiasis
Other names:
Moniliasis
Candidosis
Candida albicans
Direct contact
Females:
Asymptomatic
Dyspareunia
Fishy vaginal
discharge
Diagnostic Test:
Culture
Abstinence
Be faithful
Condom
Treatment:
Drug of Choice: Tetracycline
Males:
Burning sensation
during
urination
Burning and itching of
urethral opening
(urethritis)
White, cheese-like
vaginal
discharges
Curd like secretions
Diagnostic Test:
Culture
Gram staining
Treatment:
Nystatin for oral thrush
Cotrimazole, fluconazole for mucous
membrane and vaginal infection
Fluconazole or amphotericin for systemic
infection
Abstinence
Be faithful
Condom

Acquired
immune
deficiency
syndrome (AIDS)
Retrovirus
(Human T-cell
lymphotrophic virus 3
or HTLV 3)
Attacks the T4 cells:
Thelper
cells; Tlymphocytes,
and CD4
lymphocytes
The major route of HIV
transmission to
adolescent
is SEXUAL
TRANSMISSION.
French kissing brings
low
risk of HIV
transmission.
Blood and body

fluids
Transplacental
Incubation period:
3-6 months to 8-10
years
Variable. Although
the time from
infection to the
development of
detectable antibodies
is generally 1-3
months, the time
from HIV infection
to diagnosis of
AIDS has an
observed range of
less than 1 year to 15
years or longer.
(PHN Book)
Window Phase
a. initial infection
b. lasts 4 weeks to 6
months
c. not observed by
present
laboratory test (test
should
be repeated after 6
months)
Acute Primary HIV
Infection
a. short, symptomatic
period
b. flu-like symptoms
c. ideal time to
undergo
screening test (ELISA)
Asymptomatic HIV
Infection
a. with antibodies
against HIV but not
protective
b. lasts for 1-20 years
depending upon
factors
ARC (AIDS Related
Complex)
a. a group of
symptoms indicating
the disease is likely to
progress to AIDS
b. fever of unknown
origin
c. night sweats
d. chronic intermittent
diarrhea
e. lymphadenopathy
f. 10% body weight
loss
Enzyme-Linked Immuno-Sorbent Assay

(ELISA)
- presumptive test
Western Blot confirmatory
Treatment:
1. Treatment of opportunistic infection
2. Nutritional rehabilitation
3. AZT (Zidovudine) retards the replication
of retrovirus; must be taken exactly as
ordered
4. PK 1614 mutagen
Major signs of Pediatric AIDS:
Chronic diarrhea > 1 month
Prolonged fever > 1 month
Weight loss or abnormally slow growth
Breastmilk is important in preventing
intercurrent infection in HIV infected infants and
children.
The care of HIV patients is similar to the routine
care given to cases of other diseases.
Not everybody is in danger of becoming infected
with HIV through sex.
Never give live attenuated (weakened) vaccines
e.g. oral polio vaccine.
HIV positive pregnant women and their partner
must be informed of the potential risk to the
fetus.
Abstinence
Be faithful
Condom
Sterilize needles, syringes,
and instruments used for
cutting operations
Proper screening of blood
donors
Rigid examination of blood
and other blood products
Avoid oral, anal contact
and swallowing of semen
Avoid promiscuous sexual
contact
Avoid sharing of
toothbrushes.
HIV/AIDS Prevention
and Control Program:
Goal: Contain the
transmission of HIV /AIDS
and other reproductive tract
infections and mitigate
their impact
LECTURE DISCUSSION
best method to use in
teaching about safe sex
Priority intervention when
caring for AIDS patient:
Use disposable gloves
when in contact with non intact
skin.

AIDS
a. manifestation of
severe
immunosuppression
b. CD4 Count:
<200/dL
c. presence of variety
of
infections at one time:
oral candidiasis
leukoplakia
AIDS dementia
complex
Acute encephalopathy
Diarrhea, hepatitis
Anorectal disease
Cytomegalovirus
Pneumonocystis
carinii
pneumonia (fungal)
TB
Kaposis sarcoma
(skin
cancer; bilateral
purplish
patches)
Herpes simplex
Pseudomonas
infection
Blindness
Deafness

DISEASES OF THE NEW MILLENIUM

Disease
Causative Agent
Meningococcemia
Neisseria meningitides
Direct contact with
respiratory droplet from
nose and throat of
infected individuals
Incubation Period:
2 10 days
Severe Acute
Respiratory
Syndrome / SARS
Coronavirus
Earliest case:
Guangdong
Province,
China in November
2002
Close contact with

respiratory droplet
secretion from patient
Incubation Period:
2 10 days
Prevention
High grade fever in the

first 24 hours
Hemorrhagic rash
petechiae
nuchal rigidity
Kernigs sign
Brudzinski sign
Shock
Death
Respiratory isolation within 24 hours
Prodromal Phase:
Fever (>38 0C)
Chills
Malaise
Myalgia
Headache
Infectivity is none to
low
No specific treatment
PREVENTIVE MEASURES and CONTROL
1. Establishment of triage
2. Identification of patient
3. Isolation of suspected probable case
4. Tracing and monitoring of close contact
5. Barrier nursing technique for suspected
and probable case
Utilize personal protective

equipment (N95 mask)
Handwashing
Universal Precaution
The patient wears mask
Isolation
Control in birds:
1. Rapid destruction (culling or stamping out of
all infected or exposed birds) proper disposal of
carcasses and quarantining and rigorous
disinfection of farms
2. Restriction of movement of live poultry
In humans:
1. Influenza vaccination
2. Avoid contact with poultry animals or
migratory
birds
Isolation technique
Vaccination
Proper cooking of poultry
Drug-of-Choice: Penicillin
Universal precaution
Chemoprophylaxis with
Rifampicin to protect
exposed individual from
developing the infection
Proper hand washing
Respiratory Phase:
Within 2-7 days, dry
nonproductive cough
progressing to
respiratory
distress
Global outbreak:
March 12, 2003
First case in the
Philippines:
April 11, 2003
Bird Flu
Other Name:
Avian Flu
Pathognomonic Sign
Influenza Virus H5N1
Contact with infected

birds
Incubation Period:
3 days, ranges from 2
4 days
Fever
Body weakness and
body
malaise
Cough
Sore throat
Dyspnea
Sore eyes

Influenza A
(H1N1)
Other Name:
Swine Flu
May 21, 2009
first confirmed
case in the
Philippines
June 11, 2009
The WHO raises
its Pandemic Alert
Level to Phase 6,
citing significant
transmission of the
virus.
Influenza Virus A
H1N1
This new virus was
first detected in people
in April 2009 in the
United States.
Influenza A (H1N1) is
fatal to humans
Exposure to droplets
from the cough and
sneeze of the infected
person
Influenza A (H1N1) is
not transmitted by
eating thoroughly
cooked pork.
The virus is killed by
cooking temperatures of
160 F/70 C.
Incubation Period:
7 to 10 days
- similar to the
symptoms
of regular flu such as
Fever
Headache
Fatigue
Lack of appetite
Runny nose
Sore throat
Cough
- Vomiting or nausea
- Diarrhea
Diagnostic:
Nasopharyngeal (throat) swab
Immunofluorescent antibody testing to
distinguish influenza A and B
Treatment:
Antiviral medications may reduce the severity
and
duration of symptoms in some cases:
Oseltamivir (Tamiflu)
or zanamivir
Cover your nose and

mouth when coughing and
sneezing
Always wash hands with
soap and water
Use alcohol- based hand
sanitizers
Avoid close contact with
sick people
Increase your body's
resistance
Have at least 8 hours of
sleep
Be physically active
Manage your stress
Drink plenty of fluids
Eat nutritious food

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Community Health Nursing

Communicable Disease Lecture Notes

COMMUNITY HEALTH NURSING

EPI TARGET DISEASES

In young children the only

- spot sample (1st

Pointers for teaching

Community Health Nursing

optic neuritis/ blurring

Community Health Nursing

The National Tuberculosis Control Program

Increase and sustain support and financing for TB control activities

Vision: A country where Tb is no longer a public health problem

Facilitate implementation of TB-DOTS Center certification and accreditation

Strengthen management (technical and operational) of TB control services at

NTP Objectives and Strategies

DSSM ( Direct Sputum Smear Microscopy ) shall be the primary diagnostic

Only trained medical technologist or microscopist shall perform DSSM.

Community Health Nursing

Patients with the following conditions shall be recommended for hospitalization:

RECOMMENDED CATEGORY OF TREATMENT REGIMEN

Two Formulation of Anti-TB Drugs

New smear positive

New smearnegative PTB

Community Health Nursing

Categories II : 2 RIPES / RIPE / 4RIE (FDC)

Categories I and III : 2 RIPE / 4 RI ( FDC)

No.of tablets per day

No. of tablets per day

B. Single Dose Formulation ( SDF )

Simply add 1 tablet of Isoniazid ( 100mg) , Pyrazinamide (500mg) and

Community Health Nursing

Categories I and III: 2 RIPE / 4 RI (SDF)

No. of tablets per day

No. of tablets per day

Dose per Kg Body Weight and Maximum Dose

5 ( 4 6 ) mg/kg and not to exceed 400 mg daily

10 ( 8 12 ) mg/kg and not to exceed 600 mg daily

25 ( 20 30 ) mg/kg and not to exceed 2 mg daily

15 ( 15 20 ) mg/kg and not to exceed 1.2 g daily

15 ( 12 18 ) mg/kg and not to exceed 1 g daily

Categories II: 2 RIPES / 1 RIPE / 5 RIE

Vial per day

No.of Tablets per day

Note: 56 vials of Streptomycin for two months

D.O.T.S ( Directly-Observed Treatment Shortcourse ) TuTok Gamutan

Drug Dosage per Kg. Body Weight

Community Health Nursing

MANAGEMENT OF CHILDREN WITH TB

For children with exposure to TB

BCG vaccination shall be given to all infants.

Should undergo physical examination and PDD testing (Mantoux Test)

74 % against death from TB

Community Health Nursing

10-15 mg/kg body weight

10-15 mg/kg body weight

10-15 mg/kg body weight

10-15 mg/kg body weight

Public Health Nurse Responsibilities ( Childhood TB )

20-30 mg/kg body weight

10-15 mg/kg body weight

10-15 mg/kg body weight