The Nurse and the Communicable Diseases

GERARDO A. NICOLAS RN, RM, RPT, MAN

 Anthrax is a serious
infectious disease caused by gram-
positive, rod-shaped bacteria known as
Bacillus anthracis. Anthrax can be found
naturally in soil and commonly affects
domestic and wild animals around the
world.
Although it was one of the treaty
signatories, the Soviet Union continued
researching and producing biological
weapons - and in April 1979 an
accidental release of anthrax spores
from a military facility near Sverdlovsk
caused 68 known deaths.
Contact with anthrax can cause severe
illness in both humans and animals.
This can happen when people breathe
in spores, eat food or drink water that is
contaminated with spores, or get spores
in a cut or scrape in the skin. It is very
uncommon for people to get infected
with anthrax. The incubation period is 2
to 7 days.
Anthrax is most common in agricultural
regions Central and Southwestern Asia.
Anthrax is rare in the United States, but
sporadic outbreaks do occur in wild and
domestic grazing animals such as cattle
or deer. Anthrax is more common in
developing countries and countries that
do not have veterinary public health
programs that routinely vaccinate animals
against anthrax.
The types of anthrax are:

(1) Cutaneous - most common form of

anthrax infection, anthrax can occur
when workers who handle contaminated
animal products get spores entering into
a open wound, and is considered to be
the least dangerous. Infection usually
develops from 1 to 7 days after
exposure
(2) Inhalation - inhalation anthrax is
considered to be the most deadly
form of anthrax as the human
breathes the spores through the nose
and into the lungs. Infection usually
develops within a week after
exposure, but it can take up to 2
months.
The symptoms of anthrax depend on
the type of infection:
(1) Cutaneous anthrax symptoms can
include: a group of small blisters or
bumps that may itch, swelling can occur
around the sore, a painless skin sore
(ulcer) with a black center that appears
after the small blisters or bumps, most
often the sore will be on the face, neck,
arms, or hands.
(2) Inhalation anthrax symptoms can
include: fever and chills, chest
discomfort, shortness of breath,
confusion or dizziness, cough, nausea,
vomiting, or stomach pains, headache,
sweats (often drenching), extreme
tiredness and body aches.
CDC Guidance and case definitions are
available to help doctors diagnose
anthrax, take patient histories to
determine how exposure may have
occurred, and order necessary diagnostic
tests. If inhalation anthrax is suspected,
chest X-rays or CT scans can confirm if
the patient has mediastinal widening or
pleural effusion, which are X-ray findings
typically seen in patients with inhalation
anthrax.
The only ways to confirm an Anthrax
diagnosis are: (1) to measure antibodies
or toxin in blood, and (2) to test directly
for Bacillus anthracis in a sample of
blood, skin lesion swab, spinal fluid, and
respiratory secretions. Samples must be
taken before the patient begins taking
antibiotics for treatment.
Doctors have several options for treating
patients with anthrax, including
antibiotics and antitoxin, continuous fluid
drainage and help breathing through
mechanical ventilation, intravenous
antibiotics such as penicillin,
doxycycline, tetracycline, erythromycin,
chloramphenicol and ciprofloxacin.
Pediculosis
Types:
a. Pediculosis capitis – head lice
b. Pediculosis corporis – body lice
c. Phthirus pubis – pubic or crabs lice
MOT: direct contact, beddings, towel,
clothes and hairbrush
Clinical manifestations:
1. Intense pruritus, leads to
secondary excoriation
2. Eggs (nits) attached to the
hair shaft
Scabies: an infestation
of the skin by
Sarcoptes scabiei
mites
a. Intense itching
b. Superficial burrows,
especially between
fingers, the surface
of the wrist and in
axilla
c. Redness, swelling
may be noted
Treatment
A. Pediculosis
Pediculosis
1. Permethrin
Permethrin 1%
1% (Nix)
(Nix)
2. Pyrethrine
Pyrethrine compunds
compunds(Rid)
(Rid)
B. Scabies
Scabies
1. Permethrin
Permethrin 5%
5% cream
cream(Elimite)
(Elimite)
Home care:
1. All family members and close contacts
need to be treated
2. Concurrent Disinfection
a. Daily washing of recently worn
clothes, towels and bedding.
b. Areas such as shared toilet and
shared commode chair seats need to be
thoroughly wiped after each use
 Is an endemic protozoan infection that affects
the liver and GIT
 Capable of producing obstructive jaundice

and liver cirrhosis

 Bilharziasis

The etiology of schistosomiasis in humans

was first discovered in 1851 by the German
physician Theodor Bilharz.
 Schistosoma japonicum
 Schistosoma mansoni
 Schistosoma haematobium
 Adult female and male parasites
 Ova
 Miracidium – infective stage in snails
 Cercaria – infective stage in man and animals
 Snail (Oncomelania quadrasi)

 About 2-6 weeks from skin penetration by

cercaria
 Abdominal pain
 Diarrhea with

bloody stools
 Portal

hypertension and
signs of liver
cirrhosis
 Anemia
 The classic form of
presinusoidal portal
hypertension is caused by
the deposition
of Schistosoma oocytes in
presinusoidal portal venules
, with the subsequent
development of granulomata
and portal fibrosis. Schisto
somiasis is the most
common noncirrhotic cause
of variceal bleeding
worldwide
 Kato-katz – specimen is stool
 Circumoval precipitin test (COPT) – specimen

is blood
 HBT – UTZ
 Liver function tests
 Praziquantel (biltricide) – drug of choice
 Oxamniquine (vansil), metrifonate
 Travelers to endemic areas should avoid
exposure to fresh water that is likely to be
contaminated
 No accepted prophylactic regimens have been

developed and no vaccines are currently

available
 Eradication of snails
A parasite is an organism that lives on or in a
host organism and gets its food from or at the
expense of its host. There are three main
classes of parasites that can cause disease
in humans: protozoa, helminths, and
ectoparasites. Helminths are large,
multicellular organisms that are generally
visible to the naked eye in their adult stages.
MOT: INGESTION
1. Pinworm- Enterobius, Seatworm
s/s: Nocturnal itchiness
of anus (female pinworm lays
eggs on the anal sphincter)
2. Giant Roundworm (Ascariasis)
Potbelly
3. Whipworm (Trichuriasis)
4. Tapeworm
Taenia saginata- raw beef
Taenia solium- raw pork
Diphyllobotrium latum – raw fish
5. Lung fluke – Paragonimiasis
MOT: Raw mountain crab

37
II. MOT: Skin penetration
1. Hookworm (Ancyclostomiasis)
2. Threadworm (Strongyloidiasis)

38
Antihelminthic use should always be under
steroid cover that is carefully considered and
discussed with a specialist consultant. In
adults aged over 18 years albendazole
15mg/kg can be given once daily for eight
days in patients who are not pregnant or
breastfeeding, or praziquantel 50mg/kg can
be given once daily in divided doses for 15
days.
Republic Act 9482

The national government has implemented

the Anti-Rabies Act of 2007, which
mandates the creation of the National
Rabies Prevention and Control Program
(NRPCP). It is the goal of the NRPCP to
eliminate rabies in the country and declare
the Philippines rabies-free by the year
2020.
Executive Order No. 84 series of 1999
Lyssa
Hydrophobia
The origin of the word rabies from the Latin
"rabere" (to rage). The ancient Greeks called
rabies "lyssa" (violence). Today, the virus
causing rabies is classified in the genus Lyssa
Virus".
Louis Pasteur developed the earliest effective
vaccine against rabies on 6 July 1885.
Nine-year-old Joseph Meister (1876–1940),
who had been mauled by a rabid dog, was the
first human to receive this vaccine.
Rhabdo virus
◦a bullet-shaped virus with
strong affinity to CNS tissues
 Bite of an infected animal
 Licking of open wounds by a rabid

animal
 Scratch of a rabid animal
 Man to man transmission (10%)
 Saliva of infected animals or
human

 10-14 days (dogs)

 1 day – 5 yrs. (humans)
Incubation period depends on the
following factors
1. Distance of the bite to the brain
2. Extensiveness of the bite
3. Species of the animals
4. Richness of the nerve supply in the
area of the bite
5. Resistance of the host
Rabid animal
Dumb stage – quiet, stays

in corner with copious

salivation
Furious stage – easily

agitated, hydrophobia
Rabid Man
1)Prodromal / Invasion stage
◦Mental depression, headache,
sore throat, low-grade fever
◦Copious salivation
◦Quiet
2) Excitement stage
◦ Restless, irritable
◦ Hydrophobic
◦ Aerophobic
◦ Drooling of saliva

3) Paralytic
◦ Flaccid ascending symmetric paralysis
◦ Coma, death
Fluorescent rabies anti body
(FRA)- Confirmatory test
Brain biopsy of the animal

(Negri bodies)
14 days observation of the

animal
No specific treatment
Prevention is the best

treatment
Anti – rabies vaccination of

animal and exposed

individual
 Provide a dim, quiet and non-
stimulating room for the patient
 Wear gown, mask and goggles
 All noises no matter how minor should

be avoided
 Restrain the patient when needed
 Stimulation of any senses by fluids

must be avoided
 Anti – rabies vaccine
How effective is the rabies vaccine?

The rabies vaccine works remarkably well.

Studies indicate that if the vaccine is given
immediately and appropriately to someone
who was bitten by a rabid animal, it is 100
percent effective.
A vaccine can confer active
immunity against a specific harmful agent by
stimulating the immune system to attack the
agent.

A serum can confer passive immunity

(rabies immune globulin) is commonly used
after a certain type of wild animal bites an
individual.
A person who is exposed and has never been
vaccinated against rabies should get 4 doses
of rabies vaccine – one dose right away, and
additional doses on the 3rd, 7th, 21st days and
5 doses of rabies vaccine – one dose right
away, and additional doses on the 3rd, 7th,
14th and 28th days. They should also get
another shot called Rabies Immune Globulin
at the same time as the first dose.
DOSAGE:
Human Rabies Immune-globulin (HRIG)
20 IU/kg body weight
Equine Rabies Immune-globulin (ERIG)
40IU/kg body weight
Skin testing
Immunization
Keepaway from stray
animal
Black Death / Blue
Sickness / La Pest / The
Great Mortality
Definition
The term bubonic is derived from the
Greek word boubon, meaning "groin
The term "
buboes" is also used to refer to the swolle
n lymph
nodes

The plague is believed to be the cause of

the Black Death that
swept through Asia, Europe, and Africa in
the 14th century and killed an estimated 5
0 million people.
Causative agent
> Yersinia pestis
- is a Gram-negative, nonmotile, rod-

shaped coccobacillus, with no spores

-It is a facultative anaerobic organism

that can infect humans via the oriental rat

flea.
- It causes the disease plague, which

takes three main forms: pneumonic,

septicemic, and bubonic plagues.
Mode of transmission

Commonly through the bite of an infective

flea. Other important modes of transmission
include direct contact with infectious body
fluids, handling of tissues of infected animals
and inhalation of infectious respiratory
droplets.
Primary pneumonic plague is transmitted
thorough inhalation of aerosolized infective
droplets and can be spread from person to
person.
Bubonic Septicemic Pneumonic
 Most common form  fatality rate of 30-  100% death rate if
(~85% of all cases) 50% in treated cases, not treated within first
 causes swollen 50-90% in untreated 24 hrs
lymph nodes (buboes) cases  can be transmitted
 can only spread from  causes severe blood via direct inhalation of
person to person via infection throughout the the germs
direct contact with bubo body and gangrene of  least common, yet
drainage acral regions (nose and most dangerous form
 1%-15% death rate if digits) if untreated
Primary:
treated; if not treated, Primary:  occurs via inhalation
40%-60% death rate  occurs when a flea of pneumonic
 the backbone of the inserts y. pestis directly respiratory droplets
survival of y. pestis into the bloodstream
Secondary:
because it can develop Secondary:  occurs when bubonic
into both secondary  occurs as a severe or septicemic plagues
septicemic and development from spread to the lungs
pneumonic types bubonic or pneumonic
(when y pestis migrates
to bloodstream)
The plague can cause a range of symptoms
such as: fever, vomiting, bleeding, organ
failure open sores, If the disease isn’t treated
immediately, the bacteria can spread in the
bloodstream and cause sepsis, or septicemic
plague. If the bacteria infects the lungs, it can
cause pneumonia or pneumonic plague.
Without treatment, the bubonic plague can
cause death in up to 60 percent
 • Complications

• Hemorrhagic changes in
skin called “purpuric
lesions”

•Disseminated
intravascular
coagulation (DIC)

• Extremity gangrene

•It is the blackened gangrene characteristic of advanced

septicemic plague that gave the pandemic of Medieval Europe
the name “Black Death.”
Diagnostic Exams

Bacteriology (Gold Standard)

Yersinia pestis culture (a sample is taken
from a patient; this confirms the presence of
the plague)
Rapid Dipstick testing RDT (confirms
presence of Yersinia pestis antigen in
patients)
Serum Examination (this verifies presence of
infection)
Period of communicability
Fleas may remain infective for months.

Pathognomic Sign
Characterized by painful swollen lymph
nodes or 'buboes'.
Incubation Period
A person usually becomes ill with bubonic
plague 2 to 6 days after being infected.
Someone exposed to Yersinia pestis through
the air would become ill within 1 to 3 days.

Confirmation of plague requires lab

testing. The best practice is to identify
Y. pestis from a sample of pus from a
bubo, blood or sputum.
Several classes of antibiotics are effective in
treating bubonicplague . These include:
aminoglycosides such as streptomycin
and gentamicin, tetracyclines (especially
doxycycline), and the fluoroquinolone
ciprofloxacin.
People potentially infected with the plague
need immediate treatment and should be
given antibiotics within 24 hours of the first
symptoms to prevent death. Other treatments
include oxygen, intravenous fluids, and
respiratory support.
Managing plague outbreaks are usually

(1)Find and stop the source of infection.

Identify the most likely source of infection
in the area where the human case(s) was
exposed, institutes appropriate infection,
prevention and control procedures and
rodent control.
(2) Protect health workers. Inform and train
them on infection prevention and control.
Workers in direct contact with pneumonic
plague patients must wear standard
precautions and receive a
chemoprophylaxis with antibiotics for the
duration of seven days or at least as long as
they are exposed to infected patients.
(3) Ensure correct treatment. Verify that
patients are being given appropriate
antibiotic treatment.

(4) Isolate patients with pneumonic plague.

Patients should be isolated so as not to
infect others via air droplets.
(5) Providing masks for pneumonic patients
can reduce spread. Surveillance: identify and
monitor close contacts of pneumonic plague
patients and give them a seven-day
chemoprophylaxis.
(6) Disinfection. Routine hand-washing is
recommended with soap and water or use of
alcohol hand rub.

(7) Ensure safe burial practices.

(8) Surveillance and control requires

developing environmental management
programs.
Madagascar has
experienced
several outbreaks
of bubonic and
pneumonic plague
in the 21st century.
In the
outbreak beginning
in 2014, 71 died; in
2017, 202 died,
January 2008, 18
deaths.