Communicable Diseases

Epidemiology  Anti-genecity—ability of the

organism to stimulate an
 Patterns of Disease Occurrence: antibody response
o Sporadic o Environment—2 roles: provides
 Occasional or intermittent medium for culture of the causative
occurrence of a disease organism & provides means of
 Ex. Meningococcemia transmitting organism to others.
o Endemic o Host
 Continuous constant  Intrinsic-traits innate in us
occurrence therefore we have no control
 Ex. Malaria, Dengue (e.g. age, gender,
o Epidemic  Extrinsic-traits we have control
 Sudden increase in number of of (e.g. lifestyle, immune
cases in a short period of time system)

Chain of Transmission/Infectious Cycle

 Ex. Food poisoning,
Dengue (now), Cholera,
o Pandemic
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 SARs, HIV

 Communicable Disease—disease caused by an

infectious agent acquired from an infected
individual and can be transmitted to a
susceptible host either by direct or indirect
contact or through direct inoculation into
broken skin.
o Infectious-not transmittable to one
person or another, transfer is via direct
inoculation only (e.g. Malaria, Tetanus,
Dengue, Filiariasis)
o Contagious-transmittable from one
person to another. Easier way: direct
contact (e.g. TB, gonorrhea) either by
direct, indirect, or droplet contact. Agent-Itself

 Toxic product
 Epidemiologic/Ecologic Triad o Endotoxin (inside; dead)e.g. Toxin by
o Agent—possible causative agents: salmonella typhosa responsible for
bacteria, virus, fungi typhoid fever, chloramphenicol (toxin
 Infectivity—ability of organism will be absorbed in general circ. and
to enter a body brain)
 Infective dose—number of o Exotoxin (outside, alive)  e.g. toxin
organism sufficient to cause a by clostridium tetani
disease
 Pathogenecity—ability of Reservoir
organism to cause disease
 Virulence—potency that will  Environment, area, body where pathogenic
influence the course of disease organism is found, dependent for survival,
multiplies
 o Humans
 Frank cases—the ones infected
already Susceptible Host
 Sub-clinically infected—with
Weakest link in the chain of transmission
vague, mild symptoms, person
still functional
 Carrier—harboring organism
but is not manifesting any signs Immunity—power to resist a specific disease
and symptoms
o Animals  Natural—inherent; inborn
o Plants o Active—developed through exposure
o Soil and experience of disease (e.g. chicken
o Fomites pox)
o Passive—placental transmission, breast
Portal of Exit feeding,

 Respiratory tract (exhalation, coughing, etc.)  Acquired--developed

 GIT (vomiting, defecation) o Active—antigens are introduced;
 GU (voiding, sexual intercourse) immunization (e.g. tetanus toxoid to
 Wounds (boil, scabies, etc) mother) live attenuated
 Mechanical escape (I&D, needle aspiration, Killed-- vaccine with killed organism
bites/stings) (pertussis of DPT); you have a fraction
of causative organism (e.g. hepa B
Mode of Transmission virus HBsAg (hepa B surface
antigen) component of hepa B
CONTACT
vaccine)
 Direct fraction
 Indirect o Passive—antibodies are pre-formed.
 Droplet (within three feet) More than five (e.g. immunoglobulins human rabies
microns (e.g. pneumonia) IG, tetano IG, human rabies IG; from
animals: anti-serum/anti-toxin, not IG,
AIRBORNE (more than three feet) less than five which is from humansanti-tetano
microns, can be brought by direct current (e.g. measles, serum, anti-rabies serum, anti-
chickenpox, TB) diphtheria serum)
 *animal serum needs skin
VEHICLES OF TRANSMISSION—matters that serve as testing first
intermediary means of organism transmission (e.g.  Ig-equine rabies IG [ERIG](for
water, food, milk, blood, semen, feces, stool, urine) rabies); came from horses (anti-
rabies serum)
VECTORS—(e.g. insects, rodents)

FOMITES—(e.g. inanimate objects)

Active Immunization slow to come, slow to go (e.g.
Verorab) duration: 3 years
Portal of Entry
Passive Immunization quick to come, quick to go (e.g.
 Respiratory –inhalation anti-rabies serum) duration is two weeks to three
 GIT-ingestion weeks, most is one months.
 GU-sex
 Skin—needle prick, body piercing
 Blood—blood transfusion, sharing in the works Stages of a Disease
 Placental entry
 1. Incubation—time interval from the first
exposure to the disease to the appearance of
the first signs and symptoms (e.g. tetanus: QUARANTINE
nasugat namaga sugat)
 Limitation of freedom of movement
2. Prodromal—time interval from the appearance
 Of exposed individuals, animals, contacts
of first signs and symptoms to appearance of
 Based on the longest incubation period of the
characteristic symptoms of disease (appearance
disease
of non-specific to specific symptoms)
[inflammationlock jaw] ISOLATION
3. Illness—full blown disease (characteristic
symptoms can be observed) [ lock jaw, spasm]  Separation
4. Convalescence—signs and symptoms gradually  Of the infected person
disappear  Based on the longest period of communicability
of the disease

Isolation Technique
General Nursing Care for those with Communicable
Disease  Strict
 Reverse/protective
I. Prevention
 Respiratory
a. Primary—applied to general population
 Enteric
i. Health Education
 Wound
ii. Specific protection
 Blood and body fluids precaution (Universal
iii. Environmental sanitation
Precaution/Standard Precaution)
(environmental code PD 866;
PD 825—anti-littering law) Disinfestation
Monitoring of sex workers included (every four to six  Fogging/fumigation
weeks for syphilis, every two weeks for gonorrhea  Spraying
(incubation period: 5-7 days)  Delousing

b. Secondary—applied to those who are

early sick, exposed, came in contact Disinfection
with infected individual
i. Case finding; screening Methods:
ii. Early diagnosis
iii. Prompt treatment; prophylaxis  Mechanical
c. Tertiary—applied to the sick,  Chemical
recovering o Antiseptics
i. Limitation of disability o Disinfectants
ii. Rehabilitation  Techniques:
o Concurrent
o Terminal

CONTROL Asepsis

 Report  Surgical-“Sterile Techniques” (purpose: to

 Epidemiological investigation (headed by the render an area free of pathogenic organisms)
doctor)  Medical-“Clean Techniques” (principle: reduce
 Case finding; early diagnosis; prompt treatment number and prevent transfer of
 Quarantine, isolation microorganisms)
 Disinfestations, disinfection
Medical Asepsis
 Asepsis
  Handwashing spots on reddish spots
 Concurrent disinfection buccal cavity) seen in the soft
 Personal protective equipments (PPEs) palate)
 Barrier cards/placarding Exanthem Maculo- Maculo-papular
papular (may or may not
(reddish and be itchy; pinkish
very itchy; in color, skin is
Respirators with HEPA filter for patient who hot and dry cold and moist
underwent organ transplant or biological warfare to touch) to touch)
Direction of spread Cephalo- Cephalo-caudal
of rashes caudal
CDs affecting the Integumentary System:

Virus: Measles
 Virus:
 Symptoms:
o Measles  all four are eruptive fevers
o Pre-eruptive—fever, Stimson’s sign
o German measles
(Measles’ eye sign; has puffiness,
o Chicken pox photophobia, mucopurulent discharge),
o Herpes zoster catarrhal (dry cough), Koplik’s,
o Exanthem stomatitis (singaw solved by
o Koplik spots of mycostatin (Nystatin) oral antifungal
measles drug); 1 teaspoon three times a day
 Macule—small, flat reddish swish and swallow; others: gentian
spot in the skin (parang violet, tawas)
pimples) o Eruptive—rashes + previous symptoms
 Papule—elevated spot in the o Desquamation—drying  brownish
skin (parang bungang araw) staining  peeling off  normal
 Vesicle—blisters; fluid-filled  Dx: no specific exam
lesions  Tx: symptomatic and supportive; give vit. A
 Pustule—pus-filled supplement (to maintain respiratory and GI
 Scab—crust, langib (e.g pock tract to prevent complications like pneumonia
mark in measles) and diarrhea)
 Bacteria:  Nx:1. Strict isolation
o Anthrax o Cooling measures
o Eye care
o Ear care (to prevent otitis media)
Measles German Measles o Oral care: Mycostatin, etc.
Synonym Rubeola Rubella (Tigdas o Skin care: Calamine lotion; “Kolantro”,
(Tigdas) Hangin) etc.
Causative Agent Paramyxo Toga virus  Prevention: MMR, AMV (attenuated measles
virus vaccine 0.5 cc SQ)
MOT Airborne Droplet;
placental
Age of Childhood Childhood
Susceptibility German Measles
Period of 4 days Entire course
 Sx: with post-auricular, post-cervical, sub-
Communicability before/5 days
occipital lymph nodes enlargement
after rashes
o Will have Teratogenic effect on the
appear
fetus if acquired by a pregnant mother
Enanthem Koplik’s spots Forscheimer’s
(microcephaly, cataract, congenital
(bluish white spots (petechial,
 deafnessmutism, PDA, abortion,  Post herpetic neuralgia complication that
stillbirth) may occur after herpes zoster; on and off pain
o Blue-berry muffin skin lesion and discomfort that is felt at the site involved
 Dx: rubella titer test (if pregnant) test to during the infection
determine the titer of level of AB present:  Tx: corticosteroid, analgesic
value: 1 (antigen): 8-10 (antibodies); less than  Nx: same as chicken pox
1:8 = susceptible, higher = resistant, there is  Prevention: Avoid MOT
presence of antibodies, exposed mommy given
gamma globulin
 Tx: symptomatic/supportive
 Nx: symptomatic/supportive Anthrax
 Prevention: Rubella vaccine (1-3 months of
abstinence before getting pregnant; to give  Causative Agent: Bacillus anthracis—disease of
time to produce antibodies); MMR herbivorous animals occupational disease in
farmers and in workers in the wool and hide
Chicken Pox Herpes Zoster industries
Synonym Varicella Shingles  “Woolsorter’s disease”, “Ragpicker’s disease”
Causative Agent Varicella Dormant VZV  Pathophysiology:
zoster virus or HZV
MOT Airborne Droplet macule --> papule --> pustule
Age of Childhood 35 years old (resembles a boil) --> eschar
susceptibility and above Cutaneous Anthrax (malignanat -->septicemia
pustule or eschar)
Period of Until all lesions Until all lesions
Communicability have crusted have crusted (Woolsorter's Disease) dangerous form of
Enanthem None None penumonia --> septicemia --> death
Pulomonary Antrhrax
Exanthem Vesiculo- Vesiculo-
pustular-crust pustular-crust GI symptoms
Direction of Spread Centrifugal Follows Intestinal/GI
of Rashes peripheral
nerve pathway;
unilateral,
limited
distribution

 Dx: culture
 Tx: Chloramphenicol, Penicillin, Erythromycin,
Chicken Pox Tetracycline, Ciprofloxacin (“Cipro”)
Sx: Low grade fever, cold-like symptoms, vesiculo-  Nx: Symptomatic
pustular lesions  Prevention: vaccines, sterilizing potentially
Dx: no specific infected articles manufactured form animals,
o *most contagious during the catarrhal wearing PPEs
stage
Tx: symptomatic; acyclovir (Zoviraxhastens and Scabies
lessens healing of lesions)
Nx: Skin care  Causative Agent: Sarcoptes scabiei (female itch
Prevention: Avoid MOT, immunization (Varivax, mite)
“Oka” varicella vaccine)  MOT: close body contact; contaminated stuff
 Found in warm moist pits of the skin
 Symptoms: linear burrows (on warm, moist area
of body)
Herpes Zoster o Pruritus at night  weeping itch
 Sx: painful vesiculo-pustular lesions; fever (oozing with sero-sanguinous
secretions)
 Dx: no specific
  Dx: Clinical manifestations  Prevention
 Tx: Eurax (Crotamiton) safer than Kwell, Kwell o Search and destroy
(gamma benzene hexa-chloride) o Self-protection measures
 Nx: Hygiene, cleansing of the wound o Seek early consultation
o Stop indiscriminate fogging

Pediculosis/Lousiness
 Causative Agent: P. capitis (scalp hair), P. Malaria
humanus (body hair), P. pubis (pubic louse)
 Also known as “Ague”
 Causative Agent: Plasmodium
 MOT: Mosquito bite (Anopheles mosquito)
Circulatory System  Plasmodium  bloodstream  RBC, Liver 
RBC
Viral: Dengue fever  Most common cause: vivax and falciparum
(most virulent; capable of multiplying rapidly =
Protzoan: Malaria more RBC destroyed) 2 complication in
falciparum: black water fever (after a bout of
Helminth: Filariasis
fever, urine will have a dark color due to RBC
hemolysis) and cerebral malaria (clots form in
vessels towards the brain =  blood flow to brain
= tissue hypoxia = cerebral malaria; convulsion)
Dengue Fever  Incubation period: 12-30 days
 Anopheles: dust-dawn biter; breeds in clear,
 Causative Agent: Arbovirus (Dengue virus I, II, slow flowing water, common in rural areas,
III, IV) night-biter
 MOT: mosquito bites  Sx: cold stage  chill (30 minutes, 2 hours);
 Vector: Aedes aegypti (day biting, from 6 am to hot-stage  fever (4-6 hours); wet stage
6 pm, breeds in clear, stagnant, urban, diaphoresis
crowded)  Sx of anemia
 Incubation period: uncertain; 6 days – 1 week  Dx:
 Sx: Grade I: fever, abdominal pain, Herman sign, o Clinical findings
positive Tourniquet test, rash o History of travel/residency in a malaria-
o Grade II: grade I + bleeding
endemic area
o Grade III: grade II + beginning o Laboratory exam
symptoms of circulatory failure  Malarial smear (specimen
o Grade IV: grade III + shock should be taken at height of
 Dx: Tourniquet test (presumptive, Rumpel- fever)
Leede Test/Capillary Fragility Test)  QBC (quantitative buffy coat;
o Platelet count (confirmatory, 150 K-400 only detects falciparum strain)
K)  Tx:
o Dengue blot test (Dengue IgM Test) o Quinine
o Hematocrit count o Chloroquine (Aralen)
o Prothrombin time o Fansidar
o CTBT  (Pyrimethamine + sulfadoxine)
 Tx: symptomatic and supportive o Primaquine (usually given at the end of
 Nx: management of bleeding episode)
 Prevention: Chemically-treated mosquito net o First three drugs attract the organisms
o Larvae-eating fish inside red blood cells, primaquine for
o Environmental sanitation those in liver.
o Anti-mosquito soap  Nx: symptomatic and supportive
  Prevention: “CLEAN”  Similar to:
o Influenza
o Streptococcal sore throat
o Drug rash
Filariasis o Hepatitis
 Common among military personnel and college
 Causative Agent: Wuchereria bancrofti, Brugia
students
malayi/timori
 Sx:
 MOT: mosquito bites
o Peri-orbital edema, H/A
 Vectors:
o Sore throat
o Aedes poecillus
o Cervical lymphadenopathy  neck pain
o Aedes albopictus
o Petechiae  palate
o Culex quiquefasciatus
o Rashes  skin
o Anopheles flavirostris
o Splenomegaly
o Mansonna mosquitos
 Dx: EBV specific antibody test
 Tx: analgesic
o Corticosteroid
 Incubation period: 8-16 months  Health Teaching:
 Signs and Symptoms: fever, chills, and body o Observe for upper quadrant pain
malaise radiating to shoulder (ruptured spleen)
o Lymphangitis (limbs and scrotum)  o Avoid strenuous activities
edema  elephantiasis; hydrocoele
o Skin of affected area thickens, rough,
coarse
 Dx: Nocturnal Blood Exam (NBE)  10 pm – 2-4 Kawasaki Disease/MCLS/Muco-
am (helminth is believed to be active during this cutaneous Lymph Node Syndrome
time)
o Immunochromatographic Test (ICT)  Causative Agent: unknown
daytime specimen is enough  Similar to the following diseases:
 Tx: o Staphylococcal and streptococcal
o Chemical infections
 Hetrazan/DEC o Leptospirosis, measles, rickettsial
(diethylcarbamazine citrate) infection, Steven-Johnson syndrome,
 Ivermectin drug reactions, juvenile rheumatoid
o Surgical arthritis
 Lympho-venous anastomosis:  Most common cause of acquired heart disease
stripping; ligation) among children five years old and below
 Nx: *with elephantiasis:  Symptoms:
o Elevate affected part o Fever for 5 days (38.5 and above,
o Wash skin with plain soap and water cannot be relieved by antipyretics,
and dry. antibiotics)
o Inspect for “entry wounds”; treat with o Bilateral, non-purulent conjunctivitis
anti-bacterial o Cervical lymphadenopathy
o Changes in the lips and mouth:
 Dry, cracked lips
 “strawberry” tongue
Infectious Mononucleosis/Mono/Kissing
o Changes in the hands (palmar
Disease erythema), feet and inguinal area:
erythema  edema  desquamation
 Causative Agent: Epstein-Barr virus, herpes virus
o Truncal rash
 Incubation period: 4-7 weeks
 Dx: based on clinical findings
 MOT: contact with saliva
 Tx: aspirin, IgS
  Health Teaching: importance of follow up check o Board-like
up rigidity of
o 2D echogram (every 2 to 3 months to abdomen
monitor for possibility of complications) o Extension of
 Cx: lower
o Endo/myocarditis extremities
o Coronary arteritis o Diaphoresis
o Thrombocytosis o Low-grade
fever (if more
than 37.8, may
have
Tetanus/Lockjaw complication;
pneumonia)
 C.A: clostridium tetani  Respiratory difficulty
o Anaerobic  Dx: clinical manifestations (Lockjaw)
o Non-motile  History of wound
o Pastureland, decaying, organic  Tx:
materials, trash (paper, cartons, plastic,  ATS/TAT (anti-tetano
soil with manure of herbivorous serum/tetano antitoxin) (IM/IV,
animals) ANST)
o Spore-forming  TIG (IM, no ST) tetano
o Soil, gut  herbivorous Ig
o 2 forms  IVF
 Spore-form  Penicillin G Sodium (kill positive
 Vegetative (tetano lysine organism) or Metronidazole as
causes RBC lysis, tetano alternative for penicillin
spasmin  causes tonic type of  Diazepam (side drip/IV push
spasm, muscles are PRN) to alleviate spasms, after
continuously contracting) improvement, oral muscle
 Board like rigidity of the relaxant (KVO rate: 10-15
abdomen, trying to grasp drops)
abdomen makes you unable to  Supportive:
do so.  Oxygen inhalation
 MOT: thru break in the skin and mucous  Tracheostomy
membranes (thru the umbilical cord)  Suction secretions
 Incubation period: 3-14 days  Nx
 Sx:  Dark, quiet room (types of
 Neonate: stimuli: )
 Difficulty in sucking  Exteroceptive—noise,
 Excessive crying bright light
 Stiffness of jaw  Propioceptive—applied
 Adult stimulus
 Risus sardonicus (with  Interoceptive—stimulus
one raised eyebrow);; coming from patient
 Trismus (lockjaw) himself
 Opisthotonus  Minimal handling
 Tonic spasm  Lockjaw management
 Muscular spasm  NPO
o Flexion of  Strict aspiration
upper precaution
extremities  Management of spasm
 Do not restrain
  Side rails up  Ulcerations
 Observe for:  Dx:
o Duration o Slit skin smear (check slit skin smear)
o Frequency o Lepromin test (determine resistance to
o Muscles leprosy)
involved  Patient Classification
 Prevention: o Paucibacillary few bacilli are found,
 Proper wound care less than five lesion present
 Immunization (DPT, tetanus  Indeterminate
toxoid, passive, ATS (anti-  Tuberculoid
tetanus serum) o Multibacillary many bacilli are found,
more than five lesions present
 Borderline
 Lepromatous
Leprosy/Hansenosis/Hansen’s  Tx:
Disease o Mono-therapy
 Dapsone
 Slow advancing disease o Multi-drug therapy (MDT)
 Initially affecting the skin, mucous membrane  Advantages:
and peripheral nerves (cold areas; e.g.  Reduces degree of
extremity) infectiousness in a
o That may lead to deformity/disability short period of time
o Social isolation (after four to six intake,
 Causative Agent: Mycobacterium leprae degree of
 MOT: skin to skin contact, droplet, armadillos infectiousness already
second reservoir of this organism reduced)
 Incubation Period: 3-5 years  Shortens duration of
 Sx: treatment
o Early  Prevents resistance
 Reddish or whitish change in  Treats Dapsone-
skin color resistant infections
 Loss of sensation at site of  Home treatment is
discolored skin possible
 Enlargement of peripheral o Paucibacillary (PB6 6 months)
nerves  Rifampicin 600 mg + Dapsone
 Positive slit Skin smear 100 mg  drunk once a month,
 Loss of sweat (anhydrosis) health center, supervised
 Loss of hair growth  Dapsone 100 mg  daily, self-
 Redness/painful eyes administered, house
 Epistaxis/nasal obstruction
 Skin lesion that does not heal
o Late o Multibacillary (MB12-18)
 Madarosis (losing the  Rifampicin 600 mg + Dapsone
eyebrows) 100 mg +Clofazimine
 Lagopthalmos (eyelid doesn’t (Lamprene) 300 mg = once a
close) month, health center,
 Sinking of the bridge of the supervised.
nose  Dapsone 100 mg + Lamprene 50
 Leonine face mg = daily, self-administered,
 Gynecomastia house
 Clawing/ contracture of
fingers/toes Single-lesion paucibacillary (SLPB)
  Increase ICP (beginning: H/A,
Single dose of three drugs (ROM): projectile vomiting; later:
 Rifampicin 600 mg restlessness, papilledema)
 Ofloxacin 400 mg  (+) Brudzinski, Kernig’s sign *B:
 Minocycline 100 mg Batok: Ask patient to bend his
 Nx: head, normally, there is not
reaction in the legs; it does not
o Correct misconceptions move, pathologic: involuntary
o Provide psychological and drawing up of lower extremities
emotional support with head flexion. *K: Knee:
o Eye care Patient cannot extend legs with
o Hand and feet care thigh flexion; usually
o Hygienic measures accompanied by pain.
 Convulsive seizurescommon
in young children
Meningitis  III, VIII cranial involvement (3:
oculomotor nystagmus &
 Causative Agent: diplopia; 8: vestibulocochlear
o Bacteria  initially, tinnitus, then
 *Haemophilus influenzae-most patient cannot hear + vertigo)
common cause meningitis  A LOC
among young children  Opisthotonus
 HIB vaccine  Decortication; Decerebration
(Haemophilus influenza
*Rifampicin taken BID for 3 to 5 days, now, ciprofloxacin
type B vaccine)
given to meningococcemia
 Neiserria meningitidis
o Virus (Aseptic) **Doctor needs cipro before checking patient, next the
 enterovirus; echovirus, mumps relatives, third, the staff nurses
virus, HSV
o Fungi  Dx:
 Cryptococcus neoformans o Hemoculture
(dove shit) o Lumbar puncture/LP/Spinal tap
 MOT: droplet (L3L4/L4L5)
 Incubation: 2 – 10 days
Pre-op informed signed consent
*viral type of meningitis—prognosis is better than
bacterial meningitis DuringAsk patient to void first, position:
lateral recumbent position/side-lying knee
 Sx: chest/fetal position (not knee chest position)
o Implantation into the nasopharynx
o Systemic invasion  Post-op FOB for 6-8 hours
 Septicemia  bacteremia  *contraindication to lumbar puncture:
meningococcemia rash  increased ICP
petechiae  purpura 
ecchymoses *30 degrees position for meningitis after LP
o Symptoms of meningeal irritation
 Nuchal  Tx:
rigiditypathognomonic *How o Anti-microbial
to test for this: Doctor poses a o Anti-inflammatory (corticosteroids like
finger in front of child, child dexamethasone; prednisone cannot
cannot follow due to stiffness of cross the BBB)
the neck. Child is unable to
bend his head.
 o Osmotic diuretic (for  ICP like 20%  Excitement
mannitol, if hypotensive, do not give  Hyperirritability
the drug)  Disorientation
o Anti-convulsant (Dilantin-Phenytoin;  Manic
before giving, it may cause gingival  Hydrophobia
hyperplasia, check oral care)  Aerophobia
o CNS stimulant ( Pyritinol, Pyrazetam)  Paralytic
o Symptomatic/Supportive
 Nx:  Tx:
o Symptomatic/supportive o “Preventable but not curable”
o If with  ICP, o For dog bite:
 Elevate head at 30 degree angle  Wash with soap and water
 No suctioning via the nose  Seek consultation
 No sharp turning of the head to  SOB  site of the bite
the sides “the nearer the bite to
 Maintain head and body the brain, the shorter
alignment the incubation period.”
 Maintain regular bowel Esp. from the neck up.
movement  NOB  nature of the
bite
 COD condition of dog
after bite
Encephalitis  WOD where is the
dog? Is it wild or
 Primary (arthropod-borne) encephalitis—e.g. St. domestic?
Louis, Equine; Australian X
 DOB date of bite
o Causative organism directly attacks the  Tetanus prophylaxis
brain 1. Cleansing, suturing
 Secondary (post-infectious) encephalitis—e.g. 2. ATS, IM, ANST, gluteus
mumps, influenza post-vaccination, measles, 3. Tetanus toxoid, IM, deltoid
etc. 4. Amoxicillin, oral
 Toxic encephalitis—e.g. lead, mercury poisoning  Rabies prophylaxis (UP TO 3
years of protection)
1. Active –
Rabies a. Verorab (PVRV) 
IM, ANST, deltoid
 Hydrophobia; Lyssa; Le Rage b. Rabipur (PCEC) 
 Causative agent: Rhabdovirus ID, no ST, deltoid
 Source of infection: saliva area
 MOT: bite, non-bite (licking; scratch; organ 2. Passive-
transplant; inhalation) a. ARS ( Hyperab;
 Incubation period: 10-14 days Favirab)  IM,
 Sx: ANST, gluteus
o Dog: b. HRIG (Imogam;
 Dumb or paralytic Rabuman)  IM,
 Furious no ST, gluteus
o Man:  Nx:
 Prodromal o Standard precaution
 Flu-like symptoms o Avoid sight and sound of water
 Unusual salivation & o Provide food and water, if requested
perspiration o Restrain
 Tingling, numbness at
site
 o Emotional and psychological support for -Anterior horn cells of the spinal cord  causes
family asymmetric paralysis (either or both arm or/and legs)
 Prevention
o Immunization Bulbo-spinal
o Be a responsible pet owner -Landry’s
 Dx: Brain Biopsy
-Ascending paralysis, thus mistaken as Guillaine-Barre

-Quadriplegia

 Dx:
o Blood and throat culture
o Stool examination (virus is presented
Poliomyelitis throughout the course of the disease)
o Lumbar tap-Pandy’s test
 Infantile paralysis/Heine-Medin Disease
o EMG-electromyography
 Causative agent: Legio debilitans
 Tx:
o Type I-Brunhilde
o Symptomatic and supportive
o Type II- Lansing
 Nx:
o Type III-Leon
 Isolation
 MOT: fecal-oral
 Bed rest
 Incubation period: 7-21 days
 Hot moist compress (15 to 30 minutes)
 Sx:
 Protective devices (e.g. hand roll to prevent
o Types:
claw hand of paralyzed patient, trochanter
 Abortive
roll—to prevent outward rotation of the
 Flu-like symptoms
femur, etc)
 Non-Paralytic
 Rehabilitation
 2 hump (bi-phasic)
 Prevention:
temperature curve
o OPV immunization (2-3 drops) 6, 10,
 Poker spine
14 weeks
 Tightness and spasm of
the hamstring
 Hypersensitiveness of
the skin (easily causes
pain)
Respiratory Infections
 (+) Babinski A. Bacteria
 Paresis (weakness) a. Diphtheria
 Paralytic—Hoyne’s Sign (head b. PTB
drop) c. Pertussis
 Indicates severe d. Pneumonia
involvement of the CNS B. Viral
 Types: a. Influenza
o Bulbar b. Avian Flu
o Cranial nerves

-Ptosis-drooping of eyelids

-Nasal Twang (similar to “ngo-ngo”)

Diphtheria
 An acute contagious disease characterized by:
-Medulla oblongata (expect respiratory difficulty)
o GENERALIZED TOXEMIA leading to
Spinal PSEUDO-MEMBRANE pathognomonic
of diphtheria (grayish white membrane
with leathery consistency
 *removing of pseudo-membrane facilitates *check apical pulse, if below 60, may be sign of
bleeding at site and regeneration impending cardiac arrest
 Causative agent: Corynebacterium diphtheria/
Klebs-Loeffler bacilli
 MOT: droplet; direct and indirect contact
 Source of infection: naso-pharyngeal PTB/Koch’s/Phthisis/Consumption
secretions, sneezing, coughing
 Chronic inflammatory disease of the lungs that
 Incubation:2-5 days
lead to tubercle formation
 Sx:
 Tubercle—circumscribed amorphous mass of
o Nasal
lung tissue; initial lesion formed in TB infection
 Dryness and excoriation of
upper lip with serosanguinous Hard Tubercle = fibrosis  calcification  scar
secretions
 Pseudo-membrane in nasal Soft tubercle = caseation (cheese-like) inflammatory
turbinate reaction  liquefaction  spills out to trachea-
o Pharyngeal/Faucial bronchial tree  phlegm & empty sac  cavity
 Pseudomembrane in oro-
pharynx Four means for tubercle spread:
 “Bullneck” appearance
 Direct extension
(enlargement of cervical lymph
 Via blood or
glands)
 lymphatic fluid (Miliary TB)
o Laryngeal
*Scrofula, TB lymphadenitis –TB spreads to neck
 Sore throat  hoarseness
 Bronchogenic extension--Aspiration to
aphonia (transient)
uninfected side of the lung
 Laryngeal stridor (harsh sound
 Causative agent: Mycobacterium tuberculosis
heard upon inspiration)
o Strain Hominis (75%)
 Respiratory difficulty
o Strain Bovis (contracted from non-
o Cutaneous/extra pulmonary diphtheria
pasteurized milk)
 Can be mistaken for anthrax
o Strain Avis
 Dx:
1. Nose and throat culture (diagnostic)  MOT: Airborne
2. Schick’s test (test of susceptibility or  Incubation Period: 4-8 weeks
resistance to diphtheria)  Sx:
3. Moloney test--Test of hypersensitivity to o Fever
diphtheria toxin o Night sweats
 Tx: o Easily fatigability
o Anti-diphtheria serum o Persistent cough
o Erythromycin; ampicillin o Blood-streaked sputum
o Supportive (suctioning of secretions) o Hemoptysis (pathognomonic of TB) 
 Nx: can also be seen in bronchiectasis and
o Strict isolation lung cancer
o CBR (due to the toxins)  Primary TB (non-contagious)
o Diet (liquid to soft diet, observe strict  Adult TB (cough with hemoptysis)
aspiration precaution,  OFI)  Miliary TB
o Concurrent disinfection
*gibbus deformity following TB of the spine d/t Pott’s
 Prevention: DPT (vastus, @ 6, 10, 14 weeks, Z- Disease
track, deep IM; expect fever w/n 24 hours;
encourage antipyretic drugs)  Lab exam:
o Sputum for AFB (3-5 cc)
*common complication: myocarditis; requires strict
o Chest X-ray
isolation
o Lesion
Other complications: peripheral neuritis,  Minimalsmall
  Moderately advanced size of Duration 6 mos 8 mos 6 mos
lesion less than 4 cm
 Advanced more than 4 cm
and with cavitation *multiple drug resistant TB: I & R
o Tuberculin Test (PPD Test)
 Tx:
 Mantoux Test-method of
o Tranexamic acid (hemostan) for
administering PPD test
hemoptysis
 Most reliable skin test
o Vit. K
 0.1 cc PPD
 Nx:
 Volar aspect of arm
o Oxygen, ice cap to chest
 48-72 hours; best time:
o Anti-hemorrhagic agent
72 hours, because
immune response is o Refer to physician
delayed. o Bronchial-tapping contraindicated
 Size of wheal/bleb o Cover nose/mouth; if not, use mask
o Less or equal to o Proper disposal of sputum
4 mm (-), 5-9 o Separate children from TB-infected
(0), greater adult
than 10 mm (+) o Hygiene
 Tx:  Prevention:
o DOTS (five elements: treatment o Avoid MOT
partner, records, anti-TB drugs, o BCG
microscope, support)
 Rifampicin—orange urine,
nephro and hepatotoxic, flu-like
symptoms, thrombocytopenia Pneumonia
 Isoniazid—peripheral neuritis,
 Old term for pneumonia: pneumonitis
given together with B6,
 Pathophysiology: inflammation  consolidation
 Pyrazinamide-- causes
(due to inflammatory exudates; e.g. phlegm) 
hyperurecemia, encourage 
solidification  filling up  alveolar sacs
OFI, contraindicated to
o Stages of inflammation:
pregnant women
 Ethambutol—optic neuritis  1. Engorgement—highly
 Streptomycin SO4 (IM)— inflammation; therefore heavy,
contraindicated to pregnant dark and full; will pit upon
women, causes nephrotoxicity, pressure
causes vertigo and problems  2. Red hepatization—resembles
with hearing the liver in appearance; blood
rushes to area to solve infection
Category Category II Category  3. Gray hepatization—the
III inflamed lung resembles a gray
Criteria -sputum -relapses -sputum granite
(+) -failures (-)  4. Resolution
-newly dx -etc. -newly dx.  Types:
-with But with o Community-acquired
severe TB mild TB  The common type
disease o Hospital-acquired
Intensive RIPE (2 RIPES (2 RIP/RIPE (2 o Atypical
phase MOS) MOS) MOS)  Example: SARS
RIPE (1
MO)
Maintenance RI (4 mos) RIE (5 mos) RI (4 mos)  Causative Agent:
Phase
 o Infectious: bacteria, virus (coronavirus  An acute contagious disease
of SARS), fungi (pneumocystic carina of  Intermittent episodes of paroxysmal cough 
PCP) inspiratory “whoop”  vomiting
o Non-infectious: hypostatic pneumonia,  Causative Agent: Bordetella pertussis
aspiration pneumonia, inhalation of  MOT: droplet
toxic fumes/gases  Source of infection: broncholaryngeal
 MOT: droplet discharges
 Incubation period: 1-3 days  Incubation: 7-21 days
 Symptoms:  Age of susceptibility: highest under 7 years of
o Fever and one instance of chills age
o Chest pain  Symptoms:
o Respiratory difficulty o Catarrhal –most communicable stage
 Nasal flaring (with dry, hacking cough  frequency
 Circum-oral pallor > cyanosis at night; sneezing with watery nasal
 Sterna retraction discharges)
 Chest indrawing o Paroxsymal (cough-whoop-vomit;
 Tachypnea whooping sound due to entrance of air
o Shortness of breath: dyspnea in the partially closed glottis)
o Productive cough: o Convalescence
 Scanty sputum (atypical  One attack confers definite and prolonged
pneumonia) immunity.
 Whitish (non-infectious causes)
 “rusty” sputum (streptococcus
pneumoniae)
 Diagnostic: culture (Bordet-Gengou agar plate)
 Greenish (pseudomonas and H.
 Treatment: Erythromycin, Ampicillin, Sinecod
influenzae)
anti-tussive
 Diagnosis: sputum exam (diagnostic); chest x-
 Nursing Care:
ray (purpose: to indicate part of the lung
o Isolation
involved)
o Rest
 Treatment:
o Diet (SFFs, strict aspiration precaution)
o Antibiotic
o During attack: NPO, position, observe
o Mucolytic/expectorant
o Avoid stimuli that triggers coughing
o Inhalation treatment (oxygen,
o Use of abdominal binder (for splinting)
nebulization, steam)
o PVDs (percussion/vibration/postural o Concurrent disinfection
drainage)/chest physiotherapy  Prevention: DPT
o Deep breathing/coughing
o Suctioning
o Fluid therapy (IVF; increase oral fluid)
Influenza
o CBR
o DAT  Flu
 Prevention: for bedridden/unconscious: turn to  Causative Agent: Influenza virus (Type A-most
sides  number one intervention; done every severe, B, C-rare)
2-3 hours; pneumococcal vaccine (required: for  MOT: droplet
elderly, health workers)  Incubation: 24-72 hours
 Symptoms:
o Fever, chills
o Headache, dizziness, nausea, vomiting
Pertussis o Myalgia, arthralgia
 A.k.a. whooping cough; 100-day cough; o Abdominal pain, diarrhea/constipation
Tuspirina o Productive cough, rales
 Three forms of influenza:
 o Respiratory Candidiasis
o Intestinal
o Nervous (may lead to encephalitis and  Causative agent: Candida albicans
meningitis) o E.g. use of antibiotics, DM, pregnancy,
 Dx: based on clinical findings aging
 Nursing Care: supportive  Symptoms: whitish, thick, clumpy discharge,
 Prevention: Avoid MOT, influenza vaccine severe itchiness

Chlamydia
 Causative agent: Chlamydia trachomatis
 Symptoms: muco-purulent, whitish discharge,
Avian Flu and Swine Flu dysuria, dyspareunia
 Causative agent: H5N1 (avian flu), AH1N1 o Symptoms manifest long after infection,
(Swine flu) silent disease, observed at a later date
 Source of infection:saliva, feces
 MOT: droplet
 People at risks: poultry workers/piggery
workers
Gonorrhea
 Symptoms: same as human flu  Causative agent: Neisseria gonorrhea
 Tx: Tamiflu (Oseltamivir)  Symptoms: thick, yellowish, purulent discharge,
 Prevention: Influenza vaccine dysuria
o Forms a great scar on the reproductive
organ involved
 Newborn: ophthalmia neonatorum/gonorrheal
Sexually Transmitted Diseases conjunctivitis  Crede’s prophylaxis
 Trichomoniasis Diagnosis: Gram’s stain; swab; culture
 Candidiasis
 Chlamydia Treatment: Trichomoniasis-Metronidazole
 Gonorrhea
Candidiasis: Miconoazole, Clotrimazole,
Syphilis Nystatin vaginal suppository

Herpes Simplex Gonorrhea: Penicillin, Ciprofloxacin,

Ceftraixone, Doxycycline, Spectinomycin
 HIV
Chlamydia –same with Gonorrhea

STDs (according to vaginal discharges)

Trichomoniasis STDs (Genital ulcers)

 Causative agent: Trichomonas vaginalis
o Grows in alkaline pH (5.5-5.8) Syphilis
o E.g. oral contraceptives, pregnancy,
 Causative Agent: Treponema pallidum
frequent douching
 Adult: 1. Primary- “chancre” (painless, pimple-
 Symptoms: foul, profuse, yellow-green, frothy
like ulceration; usually found on the genitalia)
discharge with itchiness
o Secondary-“condylomata” (c. lata:
syphilisseen in ano-genital area; c.
acuminata: herpes papilloma virus)
With rashes, patchy alopecia
 o Tertiary-“gumma” (gummatous identifying marker of T-helper cells)  causes
lesions necrotic tissues on the blood irreversible damage to immune system
vessels, skin, mucous membrane, bone)
 Congenital:
o Abortion
o Stillbirth
o Lung: pneumonia alba (syphilitic
infection of fetus’ lungs during
pregnancy)
o NB:
 Early: snuffles; condylomata at
palms and soles of the feet
 Late: interstitial keratitis; saddle
nose; cleft lip/palate;
Hutchinson’s teeth (saw-like
teeth)
o Saber shin—abnormality of the tibia

HPV: Venereal Warts

Herpes Simplex
 2 types:
o HSV-1 Labialis (Cold sores/Fever
blisters)-thru kissing (usually found
from waist up)
o HSV-2 Genitalis-thru sex
 Multiple, painful vesicular lesions
Dx: Syphilis: Darkfield illunation test
Serologic exams (VDRL, FTA-Abs more
accurate)
Herpes simplex-Tzanck’s test
Tx: Syphilis: Penicillin, Doxycycline, Tetra, and
Erythromycin
Herpes Simplex: Acyclovir

HIV (AIDs)

 Causative agent: Human immunodeficiency

virus, also known as Retrovirus
 Source of infective: blood, semen, cervical
discharges, breastmilk, CSF
 Incubation period: 6 months to 5 years or more
(less than 1 year and more than 9 years)
 MOT: 3 P’s (person to person  sex;
percutaneous/parenteral; placental
transmission)
 HIV, the virus (Retrovirus  converts into DNA-
virus: enzyme-reverse transcriptase)  attacks
T-helper cell (surface receptor: CD 4—