CD PDF
CD PDF
CD PDF
- spread from one person to another, through the wind, water, or direct or indirect mode
- highly infectious.
Contagious disease
- communicable disease
- Easily Transmitted (Direct exposure)
B. Epidemiology – the science of the patterns of disease, its occurrence, distribution, or spread and the prevention and control.
C. Triad of Disease Causation or the Epidemiologic Triad (by Leavell & Clark) – factors that interact to cause a disease.
Characteristics of Agent:
Infectivity – ability to enter the human body and to move into tissues Virulence – strength, potency, or power of the agent to cause
a disease Antigenicity – ability to stimulate an antibody response
Pathogenicity – ability to cause infection or disease
b. Environment – the medium for survival and multiplication of causative agents.
c. Host – the area where the agent gets its nourishment (e.g. humans, animals, plants, soil,
water, air, milk, and fomites)
Types:
a. Direct - a person to person transmission; physical/ intimate contact (body surface to body surface)
b. Indirect - contaminated object (fomites)
Examples:
● Vehicle-borne Transmission - Nonliving things (water food medicine and blood)
● Vector-borne Transmission - living things (mosquitoes)
c. Break-in Skin Transmission – Inoculation
d. Airborne Transmission
- respiratory secretions
- Fine particles more than 3 feet and more than 30 minutes.
E. Droplet
- Respiratory secretions
- large particles within 3 feet
5. Portal of Entry – it is the venue where the organism gains entrance into the susceptible host.
Types of Immunity
1. Natural Immunity - immunity that is inherent in the body
a. Active – acquired through recovery from a certain disease.
b. Passive – acquired through placental transfer.
2. Artificial
a. Active – acquired through the administration of vaccine and toxoid.
b. Passive – acquired through the administration of antitoxin, antiserum, convalescent serum, and immunoglobulins.
● natural passive
- Transplacental end of 2nd remaster to 3rd trimester (IgG)
- Breast-feeding (igA)
● artificial passive
- Antibodies most abundant antibodies is gamma
Types of Antigen
a. Inactivated (killed organism) – not long-lasting, multiple doses and booster dose needed.
b. Attenuated (live, weakened organism) – single - dose needed and long-lasting immunity (not for pregnant and
immunocompromised)
C. Toxoid - modified toxins
1. Prevention (HES)
a. Health Education
b. Environmental Sanitation
c. Specific Protection e.g. nutrition,
immunization, personal hygiene
2. Control Aspect ( done when s/s are already present; the presence of infection) (NICE)
a. Notification and prompt intervention
b. Isolation and quarantine
● Isolation – separation of an infected individual from healthy one; used in case finding
● Quarantine – limitation of the freedom of movement of exposed individual or animal; used in contract tracing.
Infection
- Presence on my pathogenic microorganisms in the body
Types of Isolation
a.Strict isolation - intended to protect other persons (not the patient) from infection. It prevents highly contagious or virulent
infections.
b. Contact Isolation – prevents the spread of infection primarily by close or direct contact.
c. Protective or Reverse Isolation – intended to protect the immunocompromised patient from infection.
d. Respiratory Isolation – intended for respiratory diseases and prevents the transmission of infectious diseases over a short
distance through the air.
e. Enteric Precaution – intended for GIT diseases(e.g. direct contact with
feces)
F. Wound and Skin Precaution – intended for persons with skin diseases g. Blood and Body Fluids
Standard / Universal Precaution – first line of precaution; used when the disease is unknown; usage of gloves, masks, caps, mask,
and goggles
Medical asepsis
- Clean Technique
- Eyes, GIT, Vagina
Surgical Asepsis
- Sterile technique
- Not all microorganism
- Almost all invasive procedure
● Airborne Precaution
- Use of N95 mask / respi mask
- Private room
- Negative air pressure room with 2 ventilator (sucks out dirty air and sterile)
- 6 to 12 hr/exchange
- (measles, TB,Varicella, Covid, disseminated herpes zoster - MTVCoD)
● Droplet Precaution
- Respiratory minus MTVCoD
- Private room
- Surgical mask – the ordinary mask will do
- Use goggles (for meningitis, mumps, pertussis, German measles, diphtheria)
● Contact Precaution
- Avoid person to person contact (highly contagious)
- Use gloves/ gown
- Personalized equipment
- Fecal-oral, skin to skin, diarrheal diseases, typhoid, cholera, hepatitis, skin diseases like ringworm, scabies, and pediculosis
COMMUNICABLE DISEASES
1. TETANUS (Lockjaw)
Clinical Manifestations
a. Localized
- Spasm
- Increased muscle tone in the wound
b. Generalized
- Marked muscles hypertonicity
- Hyperactive deep tendon reflexes
- Tachycardia
- Profuse sweating
- Low-grade fever
- Painful, involuntary muscle contractions: Lockjaw (trismus), Risus sardonicus (“devil smile”/sardonic smile), Arched back
rigidity (opisthotonus)
Complications: Pneumonia, Atelectasis, Respiratory obstruction from secretion to laryngospasm > DEATH
Bedside: Tracheostomy
Management:
a. Administration of antibiotic (e.g. Metronidazole and Pen G)
B. Administration of tetanus immunoglobulin (TIG) – neutralize the toxin
C. Give muscle relaxant via IV route(Diazepam / Valium)
D. Recover, muscle relaxant per Orem may be used (e.g. Lioresal (Baclofen), Methocarbamol (Robaxin)
Clinical Manifestations
● Invasive or Abortive Stage
- Localized
- Does not invade the CNS
- Sore throat, tonsillitis, enlarged lymph (cervical)
- Recovery within 72 hours
● Paralytic Type
- most common
- CNS and spinal cord involvement
- Presence of Flaccid paralysis
- Asymmetric and affects lower extremities
- Urine retention and constipation
A. Bulbar Type
- most fatal
- Brain (oblongata) damaged
- Respi paralysis
B. Spinal Type
- affects ANTERIOR HORN CELLS and MOTOR FUNCTION
Administer vaccine
● Sabin (oral polio vaccine; given per Orem with 2-3 drops for 3 doses with an interval of 4 weeks — do not feed children for 30
min. after administration of OPV for better absorption.
● Salk (inactivated polio vaccine; given IM)
Incubation Period: 3 to 8 weeks, but may be as short as 9 days or as long as 7 years, depending on the amount of virus introduced,
the severity of the wound, and its proximity to the brain.
Prodromal/Invasion Phase
- Flu-like symptoms (fever, headache, sore throat)
- Slight photosensitivity
- Numbness
Excitement Phase
- hydrophobia, aerophobia, maniacal behavior
Paralytic stage
- generalize paralysis (respiratory paralysis - most dangerous)
Diagnostic Tests
a. Observed dog for 10 to 14 days
B. Brain biopsy (Negri bodies)
C. Fluorescent rabies antibody (RFA) – most definitive
Treatment Modalities
1. Active immunization (Lyssavac, Imovax, anti-rabies vax)
2. Passive Immunization (Imogab, and anti-Rabies serum, Ig, Equine)
3. Antibiotics and anti-tetanus immunization
4. Non Stimulating environment
5. Strict Isolation
6. Cover IVF
7. No fluid stimulation
8. Restraints
4. DENGUE — (Break bone Fever / Hemorrhagic Fever / Dandy fever / Infectious Thrombocytopenic, Purpura)
Etiologic Agents: Dengue virus 1, 2, 3, and 4 Chikungunya virus, Onyong –nyong virus, West Nile Virus
Characteristics: Day biting, Low flying, Stagnant water, and Urban area
Clinical Manifestations
1. DHF Grade 1
- High-grade fever (lasts 3 – 5 days)
- Biplastic/Saddleback
- Flushing of the skin
- Pain is present - headache, abdomen, joint and bone.
- Nausea and Vomiting
- Petechiae
- Herman sign
2. DHF Grade 2
● Grade 1 + bleeding from:
- Epistaxis
- Gum bleeding
- Hematemesis
- Melena
- Hematochezia
3. DHF Grade 3
- Hypotension
- Tachycardia
- Tachypnea
Diagnostic Tests
A. tourniquet or Rumpel Leede Test
B. CBC - Platelet Count - Decreased
C. Serological test
D. Elisa Test
E. Dengue NS1 Test - confirmatory
Treatment Modalities
a. Give analgesic paracetamol (don’t give aspirin)
b. Rapid replacement of body fluids
c. Supportive only
Etiologic Agents:
Plasmodium Parasites:
- Falciparum ( most common in ph)
- Vivax
- Ovale
- Malariae
Mode of Transmission: Female Anopheles Mosquito (FAM), Blood transfusion and Trans-placental transmission
Characteristics: Night time biting, High flying, Clear running water and Rural, mountainous, forested areas (Palawan, Dumaguete,
and Surigao)
Clinical Manifestations
1. Stage 1 – Cold Stage
- 10 to 15 minutes
- A chilling sensation is present
- Shaking, chattering of the lips is present
Diagnostic Tests
a. Blood Smear/ Malarial Smear
- Best time to collect at the HOT STAGE
Management
1. Antimalarial Agents
- Chloroquine ( Drug of Choice)
- Arthmeter
- Primaquine
- Quinine - severe malaria
6. FILARIASIS (Elephantiasis)
Clinical Manifestations
1. Asymptomatic Stage
- No clinical signs and symptoms of the disease
2. Acute Stage
- Lymphadenitis
- Lymphangitis
- Epididymitis
- Orchitis
- Funiculitis
3. Chronic Stage
- Hydrocele
- Lymphedema
- Elephantiasis
Diagnostic Tests
a. Nocturnal blood examination (NBE)
- 8 pm
- Diethylcarbamazine
- Carbama
- Epine
7. HEPATITIS
- COMMUNICABLE DISEASES OF THE GASTROINTESTINAL TRACT AND ITS ACCESSORY ORGANS
- Self - linking
- No cure
Types of Hepatitis
1. Hepatitis A & E virus – infectious hepatitis; oral-fecal
2. Hepatitis B virus – serum hepatitis; blood and body fluids
3. Hepatitis C virus – non-A and non B, post-transfusion hepatitis; blood and body
fluids
4. Hepatitis D virus – Delta hepatitis or dormant hepatitis; blood and body fluids
5. Hepatitis G virus
D aka Dormant Hepatitis D virus/Delta Percutaneous Oral to Same with Hepatitis B 3 weeks to 12 weeks
Type of Hepatitis B virus oral Sexual
E aka Enteric Hepatitis Hepatitis E virus Fecal – Oral route Same with Hepatitis A 2 to 6 weeks/ 3-6
weeks
Mode of Transmission
1. Contact with mucous membranes
2. Utero – ruptured membranes
3. Direct Contact – vaginal secretions
4. Sexual Contact
Risk Factors
Residence in large urban areas
Multiple sex partners
Drug use
Prostitution
Clinical Manifestations
1. In Females
a. 80% are asymptomatic
b. Burning sensation and frequent urination
c. Yellowish purulent vaginal discharge
2. In Males
a. Dysuria, burning pain, burning sensation upon urination
b. Rectal infection
Diagnostic Tests
a. Culture and Sensitivity
Causative Agent
Human Immuno-Deficiency Virus - Retrovirus
HIV Infection
- The initial stage of AIDS
AIDS
- This is the end-stage of HIV infection
Important Concepts!
o If the virus leaves the body of an individual infected with AIDS (i.e. through the semen), the virus will survive for only four (4) hours.
o If it does not penetrate another person, the virus WILL DIE.
o But if the virus goes out with blood, the VIRUS WILL REMAIN ALIVE, as long as the BLOOD IS FRESH.L
o Once a person dies with AIDS, the virus remains in the body of the individual, as long as, the body is HUMID.
o Therefore, the body of an AIDS victim should be cremated within twenty-four hours after death or sealed in a metal coffin, also
within twenty-four (24) hours from death.
o The body of an AIDS victim COULD NOT BE EMBALMED. o The virus will INFECT THE EMBALMERS.
Mode of Transmission
1. Sexual intercourse
2. Blood transfusion, sharing of infected syringes/needles among IV drug users
3. Several ways of receiving infected blood
a. Blood transfusions
b. Sharing of syringes and needles
c. Trans placental
d. Organ donation
e. Accidental exposure in hospitals/clinics
Management
A. Western Blot Analysis – Confirmatory
B. Reverse Transcriptase Inhibitor - cannot kill the virus, but slows its progression and prolongs life. e.g. Zedovudine (ZDV)
(Retirvir), Zalcitabine (Havid), Stavudine (Zerit), Lamivudine (Epivir), Nevirapine (Viramune), Didanosine (Videx)
C. Mnemonics ABCD (Abstinence, Be truthful, Condom use, Do not use Drugs)
Period of Communicability: One week before and four days after the appearance of rashes.
Contaminated urine; Direct/indirect contact with an infected person; Ingestion of contaminated food, water, and milk
Prodromal
- Gradual elevation of fever (step-ladder like fever) Rose spots in the abdomen, chest, and back
Complications
- Reiter’s syndrome (joint pain and eye irritation)
Management
A. Typhidot – confirmatory test (a blood examination is conducted and an antibody is detected)
B. Widal’s test – agglutination test of the patient’s serum (2nd week); antigen is detected.
C. Administer antibiotics (CHLORAMPHENICOL) – drug of choice.
D. Avoid the five (5) Fs (Feces, Foo, Fingers, Flies, and Fomites)
Source of Infection: Viruses that normally infect only birds and less commonly pigs.
Management
1. Administer medication as ordered (e.g. Amantadine, Oseltamivir (Tamiflu))
Diagnostic Tests: Nose and Throat swab, Urinalysis and Blood exams (single raised IgM or rise Ig G)
Complications
a. Bronchopneumonia
b. Otitis media
c. Pneumonia
d. Nephritis
e. Encephalitis
Management
A. Administer medications as prescribed such as antibiotics and antiviral agents (Isoprenosine).
B. Administer oxygen inhalation and IV fluids as ordered.
C. Immunization if needed such as MMR vaccine (live attenuated virus)
Prodromal stage
- Low-grade fever Headache Malaise
- Mild coryza Conjunctivitis
Eruptive stage
- Forchheimer’s spot (pinkish rash on the soft palate)
Complications
a. Neuritis
b. Encephalitis
c. Arthritis
d. Arthralgias
e. Rubella syndrome manifested by microcephaly, mental retardation, cataract, deaf- mutism, and heart disease
Mode of Transmission: Ingestion of contaminated water; Penetration through the skin pores;
- The pruritic rash known as “swimmer itch” occurs 24 hours after penetration of cercariae in the skin.
- Katayama Fever – a clinical constellation of the following (Fever, headache, cough, chills and sweating, Lymphadenopathy
and hepatosplenomegaly