Communicable Disease
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LEPROSY͙ 4 an ancient disease and is a leading cause of permanent physical disability among the communicable diseases. 4 a chronic mildly communicable disease that mainly affects the skin, the peripheral nerves, the eyes, and mucosa of the upper respiratory tract 4 a public health problem in the Philippines for several decades
Early signs and symptoms: Loss of sensation on the skin lesion Decrease/loss of sweating and hair growth over the lesion Thickened and / or painful nerves Muscle weakness or paralysis of extremities Pain and redness of the eyes Nasal obstruction or bleeding Change in skin color- either reddish or whitish Ulcers that do not heal
Late signs and symptoms Loss of eyebrow ʹ madarosis Inability to close eyelids lagophthalmos Clawing of fingers and toes Contractures Sinking of the nosebridge Enlargement of the breast in males or gynecomastia Chronic ulcers
Mycobacterium Leprae, an acid fast, rod-shaped bacillus which can be detected by Slit Skin Smear (SSS)
4 ²irborne ʹ inhalation of droplet/spray form coughing and sneezing of untreated leprosy patient 4 Prolonged skin ʹ to ʹ skin contact
Children especially twelve years old and below are more susceptible
! 4 ²voidance of prolonged skin-to-skin contact especially with a lepromatous case. 4Children should avoid close contact with active, untreated leprosy case. 4 BCG vaccination 4 Good personal hygiene 4 ²dequate nutrition 4 Health education
4 ²mbulatory chemotherapy through use of Multi-drug therapy. 4 Domiciliary treatment as embodied in R.². 4073 which advocates home treatment
î î 4 Paucibacillary ( tuberculoid and indeterminate) Non-infectious type Duration of treatment: 6 ʹ 9 months
4 Multibacillary ( Lepromatous and borderline) Infectious types Duration of treatment: 24 ʹ 30 months
" # $ 4 use of 2 or more drugs for the treatment of leprosy 4 proven effective cure for leprosy and renders patients non-infectious a week after starting treatment 4 makes home treatment of leprosy patients possible
½ Monthly treatment: Day 1 Rifamficin 600 mg Dapsone 100 mg
½
Monthly treatment: Day 1 Rifampicin 450 mg Dapsone 50 mg
Daily treatment: days 2 ʹ 28 Dapsone 100 mg
Daily treatment: Days 2 ʹ 28 Dapsone 50 mg
Duration of treatment: 6 blister pack to be taken monthly within a maximum period of 9 months
Duration of treatment: 6 blister pack to be taken monthly within a maximum period of 9 months
ª ½ ½ Monthly treatment: day 1 Rifampicin 600 mg Clofazimine 300 mg Dapsone 100 mg Daily treatment: Days 2-28 Clofazimine 50 mg Dapsone
100 mg
Duration of treatment: 12 blister packs to be taken monthly within a maximum period of 18 months
Monthly treatment: day 1 Rifampicin 450 mg Clofazimine 150 mg Dapsone 50 mg
Daily treatment: Days 2-28 Clofazimine 50 mg every other day Dapsone 50 mg Duration of treatment: 12 blister packs to be taken monthly within a maximum period of 18 months
ª
²ll patients who have complied with the above mentioned treatment protocol are considered and no longer regarded as a case of leprosy, even if some sequelac of leprosy remain.
#
! 4 Health education of patients, families and the community on the nature of the disease, symptomatology and its transmission. Children who are more susceptible to the disease should not be exposed to untreated leptromatous case. 4 ²dvocates healthful living through proper nutrition, adequate rest, sleep, and good personal hygiene. 4 BCG vaccination especially of infants and children.
ª 4 Recognize early signs and symptoms of leprosy and refers suspects to the RHU physicians or skin clinic for diagnosis and treatment. 4 Takes patient and family history and fills up patients records. 4 Conducts epidemiological investigation and report findings to MHO. 4 ²ssists physicians in physical examination of patients in the clinic/home. 4²ssesses health of family members and other household contacts. Performs/assists in examination of contacts 4 Integrates casefinding of leprosy cases in other activities such as MCH, EPI, inspection/examination of school children and other programs
4 Promotes healthful living by teaching the value of good personal hygiene, proper nutrition,adequate rest and sleep. 4 Helps patient/family understand and accept the problems brought about by the illness and assess their capacities to deal with them. 4 Provides and arranges for provision of nursing care of patients at home
4 Guides and supports patients/family throughout the treatment phase by giving them information on the importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time. 4 Gives mental and emotional support by encouraging self-confidence and self-reliance on the part of the patient/family and by maintaining an understanding and objective attitude 4 Refers patient to other health and allied workers as the physician, dentist, social worker, physiotherapist, mental hygienist, occupational therapist as needed.
OBJECTIVE: keep the patient, in so far, he/she is capable, to be an active, self-respecting member of society. 4 Helps create a congenial atmosphere essential to progressive recovery. 4Must be kind and maintain attitude of professional concern and interest. 4 Encourage patient͛s participation in occcupational activities suited to his interest, experience and capacity. 4 Refers patient to other person/agencies who can help in his/her physical, mental, and social rehabilitation.
Promotes family health by: 4 Providing information education to patient and his/her family on family planning and nutrition. 4 Encouraging utilization of available family planning and nutrition service. 4 Providing counseling and guidance aimed at improving health of every member of the family
ª # # 4 Participates in community assemblies and shares information on leprosy and its environment. 4 Participates in seminars/workshops/consultative meetings of other GOs and NGOs on leprosy control. 4 Participates in tri-media dissemination of leprosy facts and NLCP-MDT program.
= 4 Conducts orientation of student nurses, midwives and other students on leprosy and the control program. 4 Participates in orientation of new RHU/BHS staff on leprosy and its control. 4 Participates in studies on leprosy and its management.
# # ª ! % # & !'
1953 - Philippine hemorrhagic fever was reported 1958 ʹ H-fever became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever 1959 ʹ lowest rate was recorded with 0.1/100,000 and 0.04/100,000 morbidity and mortality rate respectively 1966 ʹ biggest epidemic occurred with 28/100,000 morbidity rate and 0.7/100,000 mortality rate
Dengue Virus Types 1, 2, 3, and 4 and ª S 4 Immediate source is a vector mosquito, the ²edes ²egypti or the common household mosquito. 4 the infected person
ª ²n acute febrile infection of sudden onset with clinical manifestation of 3 stages: 4 Febrile or invasive stage starts abruptly as high fever, abdominal pain, and headache; later flushing which may be accompanied by vomiting, conjuctival infection and epistaxis 4 Toxic or hemorrhagic stage ʹ lowering of temperature, severe abdominal pain, vomiting, and frequent bleeding from gastrointestinal tract in the form of hematemesis or melena. Unstable BP, narrow pulse pressure and shock. Death may occur. Tourniquet test which may be positive on 3rd day may become negative due to low or vasomotor collapse.
4 convalescent or recovery stage generalized flushing with interventing areas of blanching appetite regained and blood pressure already stable.
ª ª 4Sevee,e with flushing,sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock, and terminating in recovery or death. 4 ee with high fever, but less hemorrhage, no shock 4 with slight fever, with or without petichial hemorrhage but epidemiollogically related to typical cases usually discovered in the course of investigation of typical cases
Mosquito bite (²edes ²egypti) ª
Uncertain. Probably 6 days to one week. ª ( ª( ªªª ²ll persons are susceptible. Both sexes are equally affected. ²ge groupf predominantly affected are the preschool age and school age. ²dults and infants are not exempted. Peak age affected 5-9 years
ª ª Unknown. Presumed to be on the 1st week of illness when virus is still predent in the blood. ªªª Sporadic throughout the year. Epidemic usually occur during the rainy seasons June-November . Peak months are September and October. Occurs wherever vector mosquito exists. Susceptibility is universal. ²cquired immunity may be temporary but usually permanent
ª = eee e=e 4 Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. 4 Release cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital fossa. 4 Count the umber of petechiae inside the box. ² test is (+) when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.
4 Supportive 4 Symptomatic For fever, give paracetamol for muscle pains. For headache, give analgesic. Don͛t give ²SPIRIN. Rapid replacement of body fluids is the most important treatment Includes intensive monitoring/follow-up Give ORESOL to replace fluid as in moderate dehydration.
ª 4Eliminate vector by: changing water and scrubbing sides of lower vases once a week destroy breeding places of mosquito by cleaning surroundings, proper disposal of rubber tires, empty bottles and cans. keep water containers contaminated 4 ²void too many hanging clothes inside the house. 4 Residual spraying with insecticides
ª ! Protozoan ʹ = Usually passed by direct sexual contact. Can be transmitted through contact with wet objects, such as towels, washclothes and douching equipment ª 4 to 20 days, with average being 7 days.
Many women and most men have no symptoms. white or greenishyellow odorous discharge; vaginal itching and soreness, painful urination. Slight itching of penis, painful urination, clear discharge from penis.
Microscopic slide of discharge; culture tests; examination.
Curable with an oral medication. ª ª Long-term effects in adults not known. There is some evidence that infected individuals are more likely to develop cervical cancer.
½ ½
ª ! =
Passed by direct contact with infectious sore ª Ten days to 3 months, with average of 21 days.
0 Painless chancre (sore) at the site of entry of germs, swollen glands (usually appear 1 week to six months) Rash, patchy hair loss, sore throat, and swollen glands
Primary and secondary sores will go away even without treatment, but the germs continue to spread throughout the body. Latent syphillis may continue 5 ʹ 20+ years with no symptoms, but the person is no longer infectious to other people. ² pregnant woman can transmit the disease to her unborn child (congenital syphilis). varies from no symptoms to indication of damage to body organs such as the brain and heart and liver.
4 Dark field illumination test 4 Kalm test ²ntibiotics as prescribed ª ª Severe damage to nervous system and other body organs possible after many years: heart disease, brain damage and severe illness or ddeath of newborns.
#
4 an acute febrile infection of the tonsil, throat, nose, larynx, or a wound marked by a patch or patches of grayish membrane from which the diphteria bacillus is readily cultured. 4 Nasal diphteria is commonly marked by one sided nasal discharge and excoriated nostrils. ª ª (Klebs-Loeffler bacilus)
ª ª Discharges and secretions from mucus surface of nose and nasopharynx and from skin and other lesions. Contact with a patient or carrier or with articles soiled with discharges of infected persons. Milk has served as a vehicle.
ª
Usually 2 to 5 days, occasionally longer. ª ª Variable until virulent bacilli have disappeared from secretions and lesions usually 2 weeks and seldom more than 4 weeks.
! " ! " 4 Infants born of mothers who had diphteria infection are relatively immuned but the immunity disappears before the 6th month. 4 Recovery from an attack of diphteria is usually but not necessarily followed by persistent immunity. 4 Immunity is often acquired through unrecognized infection. 4 Two- thirds or more of the urban cases are in children under 10 years of age.
# ! ª 4 ²ctive immunization of all infants (6 weeks) and children with 3 doses of Diphteria. Pertussis and Tetanus (DPT) toxoid administered at 4 ʹ 6 weeks intervals and then booster doses following year after the last dose of primary series and another dose on the 4th or 5th year of age. 4 Pasteurization of milk 4 Education for parents. 4 Reporting of the case to the Health officer for proper medical care.
ª # # 4 Carry on continuous preventive education in the community to maintain a high level of immunity with emphasis on the infant and pre-school age groups. 4 Observe correct technique for taking nose and throat cultures for diphteria. 4 Encourage early prophylactic immunization of infants and children. 4 Teach procedures of disposal by burning of nose and throat discharges and uneaten food as concurrent disinfection.
ª 4 Follow prescribed dosage and correct technique in administering antitoxin infections. 4 Comfort of the paient shoild always be in mind. 4 ²s in any other nursing care of communicable disease patient, the visiting bag set up should be outside the room of the patient or should be far from the bedside of the patient and a separate set upon a paper towel as in temperature taking may be brought and placed on the bedside table or chair.
" " " ! "½ " "# ½ ! # #!
4 acute disease induced by toxin of tetanus bacillus growing anaerobically in wounds and at site of umbilicus among infants. 4 characterized by muscular contractions. # # " =
! $ "$ " Immediate source of infection is soil, street dust, animal and human feces.
Usually occurs through contamination of the unhealed stump of the umbilical cord. ª
Vary from 3 days to 1 month or more, falling between 7 and 14 days in high proportion of cases ª ª Not directly transmitted from man to man.
Susceptibility is general. ²n important cause of death in many countries in ²sia, ²frica, and South ²merica especially in rural tropical areas.
²ctive immunity is induced by tetanus toxoid anti-toxin.
½ $! % " " "½ " ! 4 Pregnant women should be actively immunized in regions where tetanus neonatorum is prevalent. 4 Licensing of midwives into professional supervision and education as to methods, equipment and techniques of sepsis in childbirth. 4 Health Education of mothers, relatives and attendants in the practice of strict aseptic methods of umbilical care in the newborn.
ª # # Report immediately to physician, including case history to determine circumstances of injury, especially competence of attendance at birth. ª Employ measures which decrease frequency and severity of convulsions. Keep patient away from noise, bright lights or anything else that will irritate him/her. ²dminister prescribed medication by physician and observe and report untoward effects to physician.
# #
4 the third most prevalent infection worldwide, second only to the diarrheal disease and tuberculosis 4 ranked 10th among the World͛s Top Ten infectious diseases killer according to WHO report, 1996 4 The prevalence of STH among the two to five years old is lesser but they suffer the greatest impact of the disease when they get infected
ª ª ª # # 4 ² 4 = 4 Hookworm ² They are classified as STH because their major development takes place in the soil.
4 ²nemia 4 Malnutrition 4 Stunted growth in height and body size 4 Decreased physical activity 4 Impaired mental development and school performance 2-5 years old ʹ easily infectes and should be given treatment 6-14 years old ʹ harbor the greatest local of infection and are significant source of infection
ª de 4 Good personal hygiene ʹ thorough washing of hands before eating and after using the toilet. 4 Keeping fingernails clean and short. 4 Use of footwear ( slipper, shoes, etc. ) 4 Washing fruits and vegetables very well 4 ²dvocate use of sanitary toilets 4 Sanitary disposal of refuse and garbage 4 Once signs and symptoms appear, consult RHU staff
½& & '& 4 Consult RHU or BHS staff 4 Laboratory/stool/blood exam 4 Ensure proper dosage of medication and completion of treatment 4 Referral and re-check up/follow up as needed.
ª#
4 acute bacterial entric diseases of the GIT characterized by profuse diarrhea, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock, acidosis and death. 4 Sometimes known as ² or e e e 4 originally endemic to the Indian subcontinent 4 now no longer considered a pressing health threat in Europe and North ²merica due to filtering and chlorination of water supplies, but still heavily affects populations in developing countries.
& 4 ª 4 The organisms are slightly curved rods (coma shape), gram negative (-) and motile with a single polar flagellum. 4 The organisms survive well at ordinary temperature and can grow well in temperature ranging from 22-40 degrees centigrade. 4 They can survive well in ordinary temperature and can survive longer in refrigerated foods. 4 ²n enterotoxin, choleragen, is elaborated by the organism as they grow in the intestinal tract.
!
4 Vomitus and feces of infected persons and feces of convalescent or healthy carriers. Contacts may be temporary carriers. "# ! !$
4 The incubation period ranges from a few hours to five days; usually one to three days. !$%% ! #"!&! '
4 The organisms are communicable during stool positive stage, usually a few days after recovery, however occasionally the carrier may have the organism for several months.
4 Fecal transmission passes via oral route form contaminated water, milk, and other foods. 4 The organisms are transmitted through ingestion of food or water contaminated with stool or vomitus of patient. 4 Flies, soiled hands and utensils also serve to transmit the infection.
4 Fluid loss is attributed to the enterotoxin elaborated by the organism as they lie in opposition with the lining cells of the intestines. 4 The toxin stimulates adenylate cyclase, which results in the conversion of the adenosine truphosphate (²TP) to cyclic adesine monophasphate (C²MP). 4 The mucosal cell is stimulated to increase secretion of chloride, associated with water and bicarbonate loss. 4 The toxin acts upon the intact epithelium on the vasculator of the bowel, thus, resulting in outpouring of intestinal fluids. 4 Fluid loss of 5 to 10 percent of the body weight resulting in dehydration and metabolic acidosis. 4 If treatment is delayed or inadequate, acute renal failure and hypokalemia become secondary problems.
ª There is an acute, profuse, watery diarrhea with no tenesmus or intestinal cramping. Initially, the stool is brown and contains fecal materials, but soon becomes pale gray, ͞rice-water͟ in appearance with an inoffensive, slightly fishy odor. Vomiting often occurs after diarrhea has been established. Diarrhea causes fluid loss amounting to 1 to 30 liters per day owing to subsequent dehydration and electrolyte loss. Tissue turgur is poor and eyes are sunken into the orbit.
The skin is cold, the fingers and toes are wrinkled, assuming the characteristic ͞washermoman͛s hand͟. Radial pulse become imperceptible and the blood pressure unobtainable. Cyanosis is present. The voice becomes hoarse and then, is lost, so that the patient speaks in whisper (aphonia). Breathing is rapid and deep. Despite marked diminished peripheral circulation, consciousness is present.
Patients develops oliguria and may even develop anuria. Temperature could be normal at the onset of the disease but becomes subnormal in later stage especially if the patient is in shock. When the patient is in deep shock, the passage of diarrhea stops. Death may occur as short as four hours after onset, but usually occurs on the first or second day if not properly treated.
( ) ! &
& 4 Susceptibility and resistance general although variable. Frank clinical attacks confer a temporary immunity which may afford some protection, for several years. 4 Immunity artificially induced by vaccine is of variable and uncertain duration. 4 ²ppears occasionally in epidemic form in the Philippines and in other parts of the world. ½& *' 4 Rectal Swab 4 Darkfield or phase microcopy 4 Stool Exam
)* + ,** 4 Treatment of cholera consist in correcting the basic abnormalities without delay ʹ restoring the circulating blood volume and blood electrolytes to normal levels. 4 Intravenous treatment is achieved by rapid intravenous infusion of alkaline saline solution containing sodium, potassium, chloride and bicarbonate ions in proportions comparable to that in water-stool. 4 Oral therapy rehydration can be completed by oral route (Oresol, Hydrites) unless contraindicated or, if the patient is not vomiting. 4 Maintenance of the volume of ee e to ensure rehydration. This is done by careful intake and output measurement.
4 ²ntibiotics Tetracycline 500mg every 6 hours might be administered to adults, and 125 mg/kg body weight for children every 6 hours to 72 hours. 4 Furazolidone 100 mg for adults and 125mg/kg for children, might be given every 6 hours for 72 hours. 4 Chlorampenicol may also be given 500 mg for adults and 18 mg/kg for children every 6 hours for 72 hours. 4 Cotrimoxazole can also be administered 8mg/kg for 72 hours.
4 Medical septic protective care must be provided. 4 Enteric isolation must be observed. 4 Intake and output must be be accurately measured. 4 ² thorough and careful personal hygiene must be provided. 4 Excreta must be properly disposed of. 4 Concurrent disinfection must be applied. 4 Food must be properly prepared. 4 Environmental sanitation must be observed.
+& & 4 Food and water supply must be protected from fecal contamination. 4 Water should be boiled or chlorinated. 4 Milk should be pasteurized. 4 Sanitary disposal of human excreta is a must. 4 Sanitary supervision is important.
SªS
4 a communicable disease of the skin caused by characterized by the eruptive lesions produced from the burrowing of the female parasite into the skin. ORG²NISM: 4 causative factor is the itch mite, Sarcroptes scabiei 4 female parasite is easily visible with magnifying glass and measures 0.33 to 0.45 mm in length by 0.25 to 0.33 in breath 4 male is smaller and resides on the surface
ª It occurs within 24 hours from the original contact, the length of time required from itch mite to (burrow) or infected skin and lay ova.
4 ²pperance of the lesion, and the intense itching and finding of the causative mite. 4 Scraping from its burrow with a hypodermic needle or curette, and then examined under lower power of the microscope by hard lens.
SIGNS AND SYMPTOMS 4 itching 4 When secondarily infected the skin may feel hot and burning but this is a minor discomfort. 4 When large areas are involved and secondary infection is severe there will be fever, headache and malaise. Secondary dermatitis is common.
! " 4 The whole family should be examined before undertaking treatment, as long as a member of family remains infected, other members will get the disease. 4 Treatment is limited entirely to the skin. 4 Benzyl benzoate emulsion ( Burroughs, Welcome) is cleaner to use and has more rapid effect. 4 Kwell ointment is also effective.
! ª 4 Good personal hygiene ʹ daily bath; washing the hands before and after eating, and after using the toilet; cutting off fingernails. 4 Regular changing of clean clothing beddings and towels. 4 Eating the right kind of food like rich in Vitamin ² and Vitamin C such as green leafy vegetable and plenty of fruits and fluids. 4 Keeping the house clean. 4 Improving the sanitation of the surroundings.
S 4 Weil͛s Dse, Mud fever, Canicola fever, Flood fever, Swineherd͛s Dse, Japanese Seven Days fever 4 a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles first described by ²dolf Weil in 1886 when he reported an ͞acute infectious disease with enlargement of spleen, jaundice and nephritis
ª 4 Leptospira-genus bacteria was isolated in 1907 from post mortem renal tissue slice 4 commonly found: Leptospira pyrogenes, Leptospira manilae, & other species like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica 4 in animals often is subclinical; an infected animal may appear healthy even as it sheds leptospires in its urine; humans are dead-end hosts for the leptospire
( &$ 4 age: < 15 years of age 4 sex: male 4 season: rainy months 4 geographic: prevalent in slum areas
½ 4 culture: blood (1st week) 4 CSF (5th to 12th day) Urine (after 1st wk til pd of convalescence) 4 agglutination tests ( 2nd or 3rd week)
,&, & 4 Infection comes form contaminated food and water, and infected wild life and domestic animals especially rodents. 4 Rats ( L. leterohemoragiae) are the source of Weil͛s disease frequently observed among miners, sewer, and abattoir workers. 4 Dogs (L. canicola) can also be the source of infection among veterinarians, breeders, and owners of dogs. 4 Mice (L. grippotyphosa) may alos be a source of infection that attacks farmers and flax workers. 4 Rats (L. bataviae) are the source of infection that attacks ricefield workers.
& ) & 4 6 ʹ 15 days/ 2 ʹ 8 weeks & &, & 4 } - onset of high remittent fever, chills, headache, anorexia, nausea & vomiting, abdominal pain, joint pains, muscle pains, myalgia, severe prostration, cough, respiratory distress, bloody sputum. 4 e e/= e - if severe, death may occur between the 9th & 16th day
2 types: 4 ²nicteric (without jaundice) ʹ return of fever of a lower degree with rash, conjunctival injection, headache, meningeal manifestations like disorientation, convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis) 4 Icteric (with jaundice) ʹ Weil syndrome; hepatic & renal manifestations: hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressive renal failure; shock, coma & congestive heart failure in severe cases 4 - Relapses may occur during 4th or 5th week
0 4 cause of death: renal & hepatic failure 4 disease usually last 1 ʹ 3 weeks but may be more prolonged; relapse may occur = = = 4 specific measures: beneficial if done < 4 days of dse 4 ²queous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenously for 7-10 days 4 Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years old 4 general measures 4 symptomatic & supportice care 4 administration of fluid, electrolytes & blood as indicated 4 peritoneal dialysis (for renal failure)
! 4 Isolation of patient: urine must be properly disposed 4 health teachings: keep a clean environment
ª
LEPROSY͙ 4 an ancient disease and is a leading cause of permanent physical disability among the communicable diseases. 4 a chronic mildly communicable disease that mainly affects the skin, the peripheral nerves, the eyes, and mucosa of the upper respiratory tract 4 a public health problem in the Philippines for several decades
Early signs and symptoms: Loss of sensation on the skin lesion Decrease/loss of sweating and hair growth over the lesion Thickened and / or painful nerves Muscle weakness or paralysis of extremities Pain and redness of the eyes Nasal obstruction or bleeding Change in skin color- either reddish or whitish Ulcers that do not heal
Late signs and symptoms Loss of eyebrow ʹ madarosis Inability to close eyelids lagophthalmos Clawing of fingers and toes Contractures Sinking of the nosebridge Enlargement of the breast in males or gynecomastia Chronic ulcers
Mycobacterium Leprae, an acid fast, rod-shaped bacillus which can be detected by Slit Skin Smear (SSS)
4 ²irborne ʹ inhalation of droplet/spray form coughing and sneezing of untreated leprosy patient 4 Prolonged skin ʹ to ʹ skin contact
Children especially twelve years old and below are more susceptible
! 4 ²voidance of prolonged skin-to-skin contact especially with a lepromatous case. 4Children should avoid close contact with active, untreated leprosy case. 4 BCG vaccination 4 Good personal hygiene 4 ²dequate nutrition 4 Health education
4 ²mbulatory chemotherapy through use of Multi-drug therapy. 4 Domiciliary treatment as embodied in R.². 4073 which advocates home treatment
î î 4 Paucibacillary ( tuberculoid and indeterminate) Non-infectious type Duration of treatment: 6 ʹ 9 months
4 Multibacillary ( Lepromatous and borderline) Infectious types Duration of treatment: 24 ʹ 30 months
" # $ 4 use of 2 or more drugs for the treatment of leprosy 4 proven effective cure for leprosy and renders patients non-infectious a week after starting treatment 4 makes home treatment of leprosy patients possible
½ Monthly treatment: Day 1 Rifamficin 600 mg Dapsone 100 mg
½
Monthly treatment: Day 1 Rifampicin 450 mg Dapsone 50 mg
Daily treatment: days 2 ʹ 28 Dapsone 100 mg
Daily treatment: Days 2 ʹ 28 Dapsone 50 mg
Duration of treatment: 6 blister pack to be taken monthly within a maximum period of 9 months
Duration of treatment: 6 blister pack to be taken monthly within a maximum period of 9 months
ª ½ ½ Monthly treatment: day 1 Rifampicin 600 mg Clofazimine 300 mg Dapsone 100 mg Daily treatment: Days 2-28 Clofazimine 50 mg Dapsone
100 mg
Duration of treatment: 12 blister packs to be taken monthly within a maximum period of 18 months
Monthly treatment: day 1 Rifampicin 450 mg Clofazimine 150 mg Dapsone 50 mg
Daily treatment: Days 2-28 Clofazimine 50 mg every other day Dapsone 50 mg Duration of treatment: 12 blister packs to be taken monthly within a maximum period of 18 months
ª
²ll patients who have complied with the above mentioned treatment protocol are considered and no longer regarded as a case of leprosy, even if some sequelac of leprosy remain.
#
! 4 Health education of patients, families and the community on the nature of the disease, symptomatology and its transmission. Children who are more susceptible to the disease should not be exposed to untreated leptromatous case. 4 ²dvocates healthful living through proper nutrition, adequate rest, sleep, and good personal hygiene. 4 BCG vaccination especially of infants and children.
ª 4 Recognize early signs and symptoms of leprosy and refers suspects to the RHU physicians or skin clinic for diagnosis and treatment. 4 Takes patient and family history and fills up patients records. 4 Conducts epidemiological investigation and report findings to MHO. 4 ²ssists physicians in physical examination of patients in the clinic/home. 4²ssesses health of family members and other household contacts. Performs/assists in examination of contacts 4 Integrates casefinding of leprosy cases in other activities such as MCH, EPI, inspection/examination of school children and other programs
4 Promotes healthful living by teaching the value of good personal hygiene, proper nutrition,adequate rest and sleep. 4 Helps patient/family understand and accept the problems brought about by the illness and assess their capacities to deal with them. 4 Provides and arranges for provision of nursing care of patients at home
4 Guides and supports patients/family throughout the treatment phase by giving them information on the importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time. 4 Gives mental and emotional support by encouraging self-confidence and self-reliance on the part of the patient/family and by maintaining an understanding and objective attitude 4 Refers patient to other health and allied workers as the physician, dentist, social worker, physiotherapist, mental hygienist, occupational therapist as needed.
OBJECTIVE: keep the patient, in so far, he/she is capable, to be an active, self-respecting member of society. 4 Helps create a congenial atmosphere essential to progressive recovery. 4Must be kind and maintain attitude of professional concern and interest. 4 Encourage patient͛s participation in occcupational activities suited to his interest, experience and capacity. 4 Refers patient to other person/agencies who can help in his/her physical, mental, and social rehabilitation.
Promotes family health by: 4 Providing information education to patient and his/her family on family planning and nutrition. 4 Encouraging utilization of available family planning and nutrition service. 4 Providing counseling and guidance aimed at improving health of every member of the family
ª # # 4 Participates in community assemblies and shares information on leprosy and its environment. 4 Participates in seminars/workshops/consultative meetings of other GOs and NGOs on leprosy control. 4 Participates in tri-media dissemination of leprosy facts and NLCP-MDT program.
= 4 Conducts orientation of student nurses, midwives and other students on leprosy and the control program. 4 Participates in orientation of new RHU/BHS staff on leprosy and its control. 4 Participates in studies on leprosy and its management.
# # ª ! % # & !'
1953 - Philippine hemorrhagic fever was reported 1958 ʹ H-fever became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever 1959 ʹ lowest rate was recorded with 0.1/100,000 and 0.04/100,000 morbidity and mortality rate respectively 1966 ʹ biggest epidemic occurred with 28/100,000 morbidity rate and 0.7/100,000 mortality rate
Dengue Virus Types 1, 2, 3, and 4 and ª S 4 Immediate source is a vector mosquito, the ²edes ²egypti or the common household mosquito. 4 the infected person
ª ²n acute febrile infection of sudden onset with clinical manifestation of 3 stages: 4 Febrile or invasive stage starts abruptly as high fever, abdominal pain, and headache; later flushing which may be accompanied by vomiting, conjuctival infection and epistaxis 4 Toxic or hemorrhagic stage ʹ lowering of temperature, severe abdominal pain, vomiting, and frequent bleeding from gastrointestinal tract in the form of hematemesis or melena. Unstable BP, narrow pulse pressure and shock. Death may occur. Tourniquet test which may be positive on 3rd day may become negative due to low or vasomotor collapse.
4 convalescent or recovery stage generalized flushing with interventing areas of blanching appetite regained and blood pressure already stable.
ª ª 4Sevee,e with flushing,sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock, and terminating in recovery or death. 4 ee with high fever, but less hemorrhage, no shock 4 with slight fever, with or without petichial hemorrhage but epidemiollogically related to typical cases usually discovered in the course of investigation of typical cases
Mosquito bite (²edes ²egypti) ª
Uncertain. Probably 6 days to one week. ª ( ª( ªªª ²ll persons are susceptible. Both sexes are equally affected. ²ge groupf predominantly affected are the preschool age and school age. ²dults and infants are not exempted. Peak age affected 5-9 years
ª ª Unknown. Presumed to be on the 1st week of illness when virus is still predent in the blood. ªªª Sporadic throughout the year. Epidemic usually occur during the rainy seasons June-November . Peak months are September and October. Occurs wherever vector mosquito exists. Susceptibility is universal. ²cquired immunity may be temporary but usually permanent
ª = eee e=e 4 Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. 4 Release cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital fossa. 4 Count the umber of petechiae inside the box. ² test is (+) when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.
4 Supportive 4 Symptomatic For fever, give paracetamol for muscle pains. For headache, give analgesic. Don͛t give ²SPIRIN. Rapid replacement of body fluids is the most important treatment Includes intensive monitoring/follow-up Give ORESOL to replace fluid as in moderate dehydration.
ª 4Eliminate vector by: changing water and scrubbing sides of lower vases once a week destroy breeding places of mosquito by cleaning surroundings, proper disposal of rubber tires, empty bottles and cans. keep water containers contaminated 4 ²void too many hanging clothes inside the house. 4 Residual spraying with insecticides
ª ! Protozoan ʹ = Usually passed by direct sexual contact. Can be transmitted through contact with wet objects, such as towels, washclothes and douching equipment ª 4 to 20 days, with average being 7 days.
Many women and most men have no symptoms. white or greenishyellow odorous discharge; vaginal itching and soreness, painful urination. Slight itching of penis, painful urination, clear discharge from penis.
Microscopic slide of discharge; culture tests; examination.
Curable with an oral medication. ª ª Long-term effects in adults not known. There is some evidence that infected individuals are more likely to develop cervical cancer.
½ ½
ª ! =
Passed by direct contact with infectious sore ª Ten days to 3 months, with average of 21 days.
0 Painless chancre (sore) at the site of entry of germs, swollen glands (usually appear 1 week to six months) Rash, patchy hair loss, sore throat, and swollen glands
Primary and secondary sores will go away even without treatment, but the germs continue to spread throughout the body. Latent syphillis may continue 5 ʹ 20+ years with no symptoms, but the person is no longer infectious to other people. ² pregnant woman can transmit the disease to her unborn child (congenital syphilis). varies from no symptoms to indication of damage to body organs such as the brain and heart and liver.
4 Dark field illumination test 4 Kalm test ²ntibiotics as prescribed ª ª Severe damage to nervous system and other body organs possible after many years: heart disease, brain damage and severe illness or ddeath of newborns.
#
4 an acute febrile infection of the tonsil, throat, nose, larynx, or a wound marked by a patch or patches of grayish membrane from which the diphteria bacillus is readily cultured. 4 Nasal diphteria is commonly marked by one sided nasal discharge and excoriated nostrils. ª ª (Klebs-Loeffler bacilus)
ª ª Discharges and secretions from mucus surface of nose and nasopharynx and from skin and other lesions. Contact with a patient or carrier or with articles soiled with discharges of infected persons. Milk has served as a vehicle.
ª
Usually 2 to 5 days, occasionally longer. ª ª Variable until virulent bacilli have disappeared from secretions and lesions usually 2 weeks and seldom more than 4 weeks.
! " ! " 4 Infants born of mothers who had diphteria infection are relatively immuned but the immunity disappears before the 6th month. 4 Recovery from an attack of diphteria is usually but not necessarily followed by persistent immunity. 4 Immunity is often acquired through unrecognized infection. 4 Two- thirds or more of the urban cases are in children under 10 years of age.
# ! ª 4 ²ctive immunization of all infants (6 weeks) and children with 3 doses of Diphteria. Pertussis and Tetanus (DPT) toxoid administered at 4 ʹ 6 weeks intervals and then booster doses following year after the last dose of primary series and another dose on the 4th or 5th year of age. 4 Pasteurization of milk 4 Education for parents. 4 Reporting of the case to the Health officer for proper medical care.
ª # # 4 Carry on continuous preventive education in the community to maintain a high level of immunity with emphasis on the infant and pre-school age groups. 4 Observe correct technique for taking nose and throat cultures for diphteria. 4 Encourage early prophylactic immunization of infants and children. 4 Teach procedures of disposal by burning of nose and throat discharges and uneaten food as concurrent disinfection.
ª 4 Follow prescribed dosage and correct technique in administering antitoxin infections. 4 Comfort of the paient shoild always be in mind. 4 ²s in any other nursing care of communicable disease patient, the visiting bag set up should be outside the room of the patient or should be far from the bedside of the patient and a separate set upon a paper towel as in temperature taking may be brought and placed on the bedside table or chair.
" " " ! "½ " "# ½ ! # #!
4 acute disease induced by toxin of tetanus bacillus growing anaerobically in wounds and at site of umbilicus among infants. 4 characterized by muscular contractions. # # " =
! $ "$ " Immediate source of infection is soil, street dust, animal and human feces.
Usually occurs through contamination of the unhealed stump of the umbilical cord. ª
Vary from 3 days to 1 month or more, falling between 7 and 14 days in high proportion of cases ª ª Not directly transmitted from man to man.
Susceptibility is general. ²n important cause of death in many countries in ²sia, ²frica, and South ²merica especially in rural tropical areas.
²ctive immunity is induced by tetanus toxoid anti-toxin.
½ $! % " " "½ " ! 4 Pregnant women should be actively immunized in regions where tetanus neonatorum is prevalent. 4 Licensing of midwives into professional supervision and education as to methods, equipment and techniques of sepsis in childbirth. 4 Health Education of mothers, relatives and attendants in the practice of strict aseptic methods of umbilical care in the newborn.
ª # # Report immediately to physician, including case history to determine circumstances of injury, especially competence of attendance at birth. ª Employ measures which decrease frequency and severity of convulsions. Keep patient away from noise, bright lights or anything else that will irritate him/her. ²dminister prescribed medication by physician and observe and report untoward effects to physician.
# #
4 the third most prevalent infection worldwide, second only to the diarrheal disease and tuberculosis 4 ranked 10th among the World͛s Top Ten infectious diseases killer according to WHO report, 1996 4 The prevalence of STH among the two to five years old is lesser but they suffer the greatest impact of the disease when they get infected
ª ª ª # # 4 ² 4 = 4 Hookworm ² They are classified as STH because their major development takes place in the soil.
4 ²nemia 4 Malnutrition 4 Stunted growth in height and body size 4 Decreased physical activity 4 Impaired mental development and school performance 2-5 years old ʹ easily infectes and should be given treatment 6-14 years old ʹ harbor the greatest local of infection and are significant source of infection
ª de 4 Good personal hygiene ʹ thorough washing of hands before eating and after using the toilet. 4 Keeping fingernails clean and short. 4 Use of footwear ( slipper, shoes, etc. ) 4 Washing fruits and vegetables very well 4 ²dvocate use of sanitary toilets 4 Sanitary disposal of refuse and garbage 4 Once signs and symptoms appear, consult RHU staff
½& & '& 4 Consult RHU or BHS staff 4 Laboratory/stool/blood exam 4 Ensure proper dosage of medication and completion of treatment 4 Referral and re-check up/follow up as needed.
ª#
4 acute bacterial entric diseases of the GIT characterized by profuse diarrhea, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock, acidosis and death. 4 Sometimes known as ² or e e e 4 originally endemic to the Indian subcontinent 4 now no longer considered a pressing health threat in Europe and North ²merica due to filtering and chlorination of water supplies, but still heavily affects populations in developing countries.
& 4 ª 4 The organisms are slightly curved rods (coma shape), gram negative (-) and motile with a single polar flagellum. 4 The organisms survive well at ordinary temperature and can grow well in temperature ranging from 22-40 degrees centigrade. 4 They can survive well in ordinary temperature and can survive longer in refrigerated foods. 4 ²n enterotoxin, choleragen, is elaborated by the organism as they grow in the intestinal tract.
!
4 Vomitus and feces of infected persons and feces of convalescent or healthy carriers. Contacts may be temporary carriers. "# ! !$
4 The incubation period ranges from a few hours to five days; usually one to three days. !$%% ! #"!&! '
4 The organisms are communicable during stool positive stage, usually a few days after recovery, however occasionally the carrier may have the organism for several months.
4 Fecal transmission passes via oral route form contaminated water, milk, and other foods. 4 The organisms are transmitted through ingestion of food or water contaminated with stool or vomitus of patient. 4 Flies, soiled hands and utensils also serve to transmit the infection.
4 Fluid loss is attributed to the enterotoxin elaborated by the organism as they lie in opposition with the lining cells of the intestines. 4 The toxin stimulates adenylate cyclase, which results in the conversion of the adenosine truphosphate (²TP) to cyclic adesine monophasphate (C²MP). 4 The mucosal cell is stimulated to increase secretion of chloride, associated with water and bicarbonate loss. 4 The toxin acts upon the intact epithelium on the vasculator of the bowel, thus, resulting in outpouring of intestinal fluids. 4 Fluid loss of 5 to 10 percent of the body weight resulting in dehydration and metabolic acidosis. 4 If treatment is delayed or inadequate, acute renal failure and hypokalemia become secondary problems.
ª There is an acute, profuse, watery diarrhea with no tenesmus or intestinal cramping. Initially, the stool is brown and contains fecal materials, but soon becomes pale gray, ͞rice-water͟ in appearance with an inoffensive, slightly fishy odor. Vomiting often occurs after diarrhea has been established. Diarrhea causes fluid loss amounting to 1 to 30 liters per day owing to subsequent dehydration and electrolyte loss. Tissue turgur is poor and eyes are sunken into the orbit.
The skin is cold, the fingers and toes are wrinkled, assuming the characteristic ͞washermoman͛s hand͟. Radial pulse become imperceptible and the blood pressure unobtainable. Cyanosis is present. The voice becomes hoarse and then, is lost, so that the patient speaks in whisper (aphonia). Breathing is rapid and deep. Despite marked diminished peripheral circulation, consciousness is present.
Patients develops oliguria and may even develop anuria. Temperature could be normal at the onset of the disease but becomes subnormal in later stage especially if the patient is in shock. When the patient is in deep shock, the passage of diarrhea stops. Death may occur as short as four hours after onset, but usually occurs on the first or second day if not properly treated.
( ) ! &
& 4 Susceptibility and resistance general although variable. Frank clinical attacks confer a temporary immunity which may afford some protection, for several years. 4 Immunity artificially induced by vaccine is of variable and uncertain duration. 4 ²ppears occasionally in epidemic form in the Philippines and in other parts of the world. ½& *' 4 Rectal Swab 4 Darkfield or phase microcopy 4 Stool Exam
)* + ,** 4 Treatment of cholera consist in correcting the basic abnormalities without delay ʹ restoring the circulating blood volume and blood electrolytes to normal levels. 4 Intravenous treatment is achieved by rapid intravenous infusion of alkaline saline solution containing sodium, potassium, chloride and bicarbonate ions in proportions comparable to that in water-stool. 4 Oral therapy rehydration can be completed by oral route (Oresol, Hydrites) unless contraindicated or, if the patient is not vomiting. 4 Maintenance of the volume of ee e to ensure rehydration. This is done by careful intake and output measurement.
4 ²ntibiotics Tetracycline 500mg every 6 hours might be administered to adults, and 125 mg/kg body weight for children every 6 hours to 72 hours. 4 Furazolidone 100 mg for adults and 125mg/kg for children, might be given every 6 hours for 72 hours. 4 Chlorampenicol may also be given 500 mg for adults and 18 mg/kg for children every 6 hours for 72 hours. 4 Cotrimoxazole can also be administered 8mg/kg for 72 hours.
4 Medical septic protective care must be provided. 4 Enteric isolation must be observed. 4 Intake and output must be be accurately measured. 4 ² thorough and careful personal hygiene must be provided. 4 Excreta must be properly disposed of. 4 Concurrent disinfection must be applied. 4 Food must be properly prepared. 4 Environmental sanitation must be observed.
+& & 4 Food and water supply must be protected from fecal contamination. 4 Water should be boiled or chlorinated. 4 Milk should be pasteurized. 4 Sanitary disposal of human excreta is a must. 4 Sanitary supervision is important.
SªS
4 a communicable disease of the skin caused by characterized by the eruptive lesions produced from the burrowing of the female parasite into the skin. ORG²NISM: 4 causative factor is the itch mite, Sarcroptes scabiei 4 female parasite is easily visible with magnifying glass and measures 0.33 to 0.45 mm in length by 0.25 to 0.33 in breath 4 male is smaller and resides on the surface
ª It occurs within 24 hours from the original contact, the length of time required from itch mite to (burrow) or infected skin and lay ova.
4 ²pperance of the lesion, and the intense itching and finding of the causative mite. 4 Scraping from its burrow with a hypodermic needle or curette, and then examined under lower power of the microscope by hard lens.
SIGNS AND SYMPTOMS 4 itching 4 When secondarily infected the skin may feel hot and burning but this is a minor discomfort. 4 When large areas are involved and secondary infection is severe there will be fever, headache and malaise. Secondary dermatitis is common.
! " 4 The whole family should be examined before undertaking treatment, as long as a member of family remains infected, other members will get the disease. 4 Treatment is limited entirely to the skin. 4 Benzyl benzoate emulsion ( Burroughs, Welcome) is cleaner to use and has more rapid effect. 4 Kwell ointment is also effective.
! ª 4 Good personal hygiene ʹ daily bath; washing the hands before and after eating, and after using the toilet; cutting off fingernails. 4 Regular changing of clean clothing beddings and towels. 4 Eating the right kind of food like rich in Vitamin ² and Vitamin C such as green leafy vegetable and plenty of fruits and fluids. 4 Keeping the house clean. 4 Improving the sanitation of the surroundings.
S 4 Weil͛s Dse, Mud fever, Canicola fever, Flood fever, Swineherd͛s Dse, Japanese Seven Days fever 4 a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles first described by ²dolf Weil in 1886 when he reported an ͞acute infectious disease with enlargement of spleen, jaundice and nephritis
ª 4 Leptospira-genus bacteria was isolated in 1907 from post mortem renal tissue slice 4 commonly found: Leptospira pyrogenes, Leptospira manilae, & other species like L. icterohemorrhagiae, L. canicola, L. batavia, L. Pomona, L. javinica 4 in animals often is subclinical; an infected animal may appear healthy even as it sheds leptospires in its urine; humans are dead-end hosts for the leptospire
( &$ 4 age: < 15 years of age 4 sex: male 4 season: rainy months 4 geographic: prevalent in slum areas
½ 4 culture: blood (1st week) 4 CSF (5th to 12th day) Urine (after 1st wk til pd of convalescence) 4 agglutination tests ( 2nd or 3rd week)
,&, & 4 Infection comes form contaminated food and water, and infected wild life and domestic animals especially rodents. 4 Rats ( L. leterohemoragiae) are the source of Weil͛s disease frequently observed among miners, sewer, and abattoir workers. 4 Dogs (L. canicola) can also be the source of infection among veterinarians, breeders, and owners of dogs. 4 Mice (L. grippotyphosa) may alos be a source of infection that attacks farmers and flax workers. 4 Rats (L. bataviae) are the source of infection that attacks ricefield workers.
& ) & 4 6 ʹ 15 days/ 2 ʹ 8 weeks & &, & 4 } - onset of high remittent fever, chills, headache, anorexia, nausea & vomiting, abdominal pain, joint pains, muscle pains, myalgia, severe prostration, cough, respiratory distress, bloody sputum. 4 e e/= e - if severe, death may occur between the 9th & 16th day
2 types: 4 ²nicteric (without jaundice) ʹ return of fever of a lower degree with rash, conjunctival injection, headache, meningeal manifestations like disorientation, convulsions & signs of meningeal irritations (with CSF finding of aseptic meningitis) 4 Icteric (with jaundice) ʹ Weil syndrome; hepatic & renal manifestations: hemorrhage, hepatomegaly, hyperbilirubinemia, oliguria, anuria with progressive renal failure; shock, coma & congestive heart failure in severe cases 4 - Relapses may occur during 4th or 5th week
0 4 cause of death: renal & hepatic failure 4 disease usually last 1 ʹ 3 weeks but may be more prolonged; relapse may occur = = = 4 specific measures: beneficial if done < 4 days of dse 4 ²queous penicillin G (50,000 units/kg/day in 4-6 divided doses intravenously for 7-10 days 4 Tetracycline (20-40 mg/kg/day in 4 doses); may not be given to children < 8 years old 4 general measures 4 symptomatic & supportice care 4 administration of fluid, electrolytes & blood as indicated 4 peritoneal dialysis (for renal failure)
! 4 Isolation of patient: urine must be properly disposed 4 health teachings: keep a clean environment
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