Communicable diseases

- 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)

Types of Communicable Disease

1. Infectious – disease is NOT easily transmitted from person to person. It requires inoculation.
2. Contagious – easily transmitted from one person to another through the droplet, direct, or indirect contact

B. Epidemiology – the science of the patterns of disease, its occurrence, distribution, or spread and the prevention and control.

Patterns of Disease Occurrence

1. Sporadic – on-and-off attack of the disease (e.g. rabies)
2. Endemic – constantly present in a certain locality (e.g. Filariasis, Malaria, and
Schistosomiasis)
3. Epidemic (outbreak) – the number of cases exceeds the normal number of cases for a
short period.
4. Pandemic – worldwide epidemic (e.g. HIV/AIDS, SARS, and Covid19)

C. Triad of Disease Causation or the Epidemiologic Triad (by Leavell & Clark) – factors that interact to cause a disease.

Three Factors/ Components

a. Agent – intrinsic property of microorganisms to survive and multiply in the environment to produce 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)

D. Chain of Infection (ARPEMPS)

1. Causative Agent – Microorganism (e.g. bacteria, spirochete, virus, rickettsia, chlamydia, fungi, protozoa, and parasites)
2. Reservoir – the source of infection; where micro organism lived in multiply
3. Portal of Exit – path or way the organism leaves the reservoir. (Common portal of exit: Respiratory system, GIT / Alimentary tract,
GUT, Skin and mucous membrane, and placenta)
4. Mode of Transmission – the infectious agent passes through from the portal of exit of the reservoir to the susceptible host.

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.

6. Susceptible Host – prone individuals/ person’s risk for infection.

Note: Easiest to break Link is mode of transmission

E. Stages of Diseases
a. Incubation period
- first exposure
- Asymptomatic
- No signs and symptoms
b. Prodromal period (catarrhal period)
- appearance of the first signs and symptoms
- Specific signs and symptoms
C. Acute period
- pathognomonic sign
c. Stage of Illness – a manifestation of all signs and symptoms of the disease.
d. Convalescence – stage of recovery.

F. Immunity –state of being free from infection; state of having resistance

a. Immunization – The process of
rendering the individuals immune
b. Antigen – a substance that induces
antibody formation
c. Antibody – a protein substance in
response to antigen stimulation

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

G. Prevention and Control of Communicable Diseases

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

c. Case finding – looking for the infected individuals

d. Epidemiological investigation

3. Standard Precaution previously known as universal precaution

- The best strategy is to prevent infections
- Applies to all patients regardless of their diagnosis
- Applies to blood and all body fluids, excretions, and secretions except sweat.

Elements included in Standard Precautions

a. hand washing
- For contact with body fluids of the patient
- Duration is 10 – 15 seconds
- What is important is the friction that is applied

b. Use of Protective Barriers or Use of (PPEs).

Donning PPE (Putting on).

- Mask
- Goggles
- Cap / Bonnet Gown
- Gloves

Doffing PPE (Taking off)

 - Gloves
- Do hand washing
- Gown
- Cap / Bonnet Goggles
- Mask

Medical asepsis
- Clean Technique
- Eyes, GIT, Vagina

Surgical Asepsis
- Sterile technique
- Not all microorganism
- Almost all invasive procedure

C. Avoidance of Needle Stick or Sharps Injury

- Do not recap, bend or break needles

Transmission Based Precaution

● 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

4. Control Measures other than Isolation

a. Disinfection- the killing of microorg by physical or chemical means (i.e. boiling, soaking)
b. Disinfestation- the killing of undesirable small animal forms such as arthropods, rodents, insects by physical or chemical means.
c. Fumigation - use of gaseous agents to kill arthropods, rodents, and insects.
d. Asepsis – the absence of pathogen or disease-causing microorganisms.
e. Hand washing – single most effective way of preventing microorganisms.

COMMUNICABLE DISEASES

1. TETANUS (Lockjaw)

Etiologic Agent: Clostridium Tetani

Source of Infection: Soil, Feces
Mode of Transmission: Direct inoculation through a broken skin

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)

2. POLIOMYELITIS (Infantile Paralysis; Heine-Medin Disease)

Etiologic Agent: Legio debilitans (virus)

Type 1 – Brunhilde
Type 2 – Lansing
Type 3 – Leon
Mode of Transmission: fecal - oral

Clinical Manifestations
● Invasive or Abortive Stage
- Localized
- Does not invade the CNS
- Sore throat, tonsillitis, enlarged lymph (cervical)
- Recovery within 72 hours

● Non paralytic polio

- systemic
- Flu like symptoms
- Bloodstream
 ● Pre – paralytic or Meningetic Type
- Slight involvement of the CNS no paralysis
- Pain and spasm of muscles
- Stiffness of the hamstring
- The patient will be positive for HOYNE’S Sign and exhibit a HEAD DROP POKER SPINE
● Opisthotonus with head retraction
● TRIPOD POSITION

● 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)

3. RABIES (Hydrophobia; Lyssa; La Rage)

Etiologic Agent: Rhabdovirus (Bullet Shape Virus)

Mode of Transmission: the bite of an infected animal; contact with the saliva of a rabid animal and open wounds

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)

Two kinds of Rabies

a. Urban or Canine – transmitted by dogs
b. Sylvatic – a disease of wild animals and bats that sometimes spread to dogs, cats, and livestock.

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

Mode of Transmission: Bite of a female infected mosquito (Aedes aegypti)

Characteristics: Day biting, Low flying, Stagnant water, and Urban area

Incubation Period: 3 to 15 days Period of Communicability

Pathognomonic sign: Herman sign

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

4. DHF Grade 4 (Dengue Shock Syndrome)

- with signs and symptoms of DHF Grade 3 plus with shock

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

5. MALARIA – (King of Tropical Disease / Ague / Marsh fever)

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

2. Stage 2 – Hot Stage

- Last for 4 to 6 hrs
- Fever, headache, abdominal pain, and vomiting

3. Stage 3 – Wet Stage/Diaphoretic stage

- profuse sweating and feeling of weakness

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)

Etiologic Agents: Wuchereria bancrofti Brugia malayi

Brugia timori Loa loa
Mode of Transmission: Person-to-person by mosquito bites and Bite of Aedes poecillus; Aedes flavirostris

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

Hepatitis AGENT M. TRANSMISSION INDIVIDUAL AT I. PERIOD

RISKS

A - aka Infectious Hepatitis A virus Rarely percutaneous Those living in 2 to 6 weeks

Hepatitis/ Catarrhal (RNA- containing or by blood unsanitary conditions
Jaundice Hepatitis virus) transmission and who practice
anal– oral sex

B - aka Serum Hepatitis B virus Percutaneous Healthcare workers 6 weeks to 6 months

Hepatitis Homologous (DNA- containing Oral to oral Blood recipients
Hepatitis virus) Transmission Sexual Hemodialyzing
Viral Hepatitis Transmission patients Drug addicts
Swallowing of amniotic Promiscuous
fluid by the baby individuals with
multiple sex partners

C Hepatitis C virus Percutaneous Hemodialyzing 5 to 12 weeks

aka post- transfusion patients Healthcare
Hepatitis workers Drug addicts
Blood Recipients

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

G Hepatitis G virus Percutaneous Unknown

Manifestations of Hepatitis (Three (3) Stages

1st Stage – Pre-Icteric Stage (occurs before jaundice arises)
- The end-product of RBC breakdown is bilirubin
- Accumulation of bilirubin into the system leads to the 2nd Stage – Icteric Stage
2nd Stage – Icteric Stage - patient exhibits:
- Jaundice, Pruritus, Tea-colored Urine or Brown-colored Urine, Clay-colored Stool, Hepatomegaly
3rd Stage – Post-Icteric Stage
- Signs and symptoms subside
- The patient is on the road to recovery

8. GONORRHEA – (Clap / Flores Blancas / Gleet)

Etiologic Agent: Neisseria gonorrhoeae - Gram-negative (-) coccus found in pairs

Mode of Transmission
1. Contact with mucous membranes
2. Utero – ruptured membranes
3. Direct Contact – vaginal secretions
4. Sexual Contact

Incubation Period: 3 to 21 (average from 2 to 5 days)

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

9. ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

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)

10. LEPROSY (Hansenosis; Hansen’s disease)

Etiologic Agent: Mycobacterium leprae

Mode of Transmission: Airborne and Prolonged skin to skin contact

Incubation Period: It reduces the communicability period of leprosy in 4-6 weeks.

Period of Communicability: One week before and four days after the appearance of rashes.

Three Distinct Forms

 1. Lepromatous (Multibacillary) Leprosy
- Most serious type, not infectious.
2. Tuberculoid (Paucibacillary) Leprosy
- Affects the peripheral nerves and sometimes the surrounding skin, especially on the face, eyes, and testes as well as nerves
and skin.
3. Borderline (Dimorphous)
- both lepromatous and tuberculoid leprosy.

11. TYPHOID FEVER

Etiologic Agent: Salmonella typhi or Typhoid bacillus

Source of Infection: Feces and urine of infected persons

Mode of Transmission: Fecal – oral transmission;

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)

12. BIRD FLU (Avian Influenza)

Etiologic Agent: Avian Influenza virus; H5N1

Mode of Transmission: Inhalation of feces and discharge of an infected bird

Source of Infection: Viruses that normally infect only birds and less commonly pigs.

Incubation Period: 3 to 5 days

Management
1. Administer medication as ordered (e.g. Amantadine, Oseltamivir (Tamiflu))

13. MEASLES (Rubeola/ Morbilli/ 7- day Measles)

Etiologic Agent: Filterable virus of measles (Paramyxoviridae)

Source of Infection: Secretions of nose and

throat of infected persons

Mode of Transmission: Direct contact with infected person/ Droplet spread

- Indirect (contact with contaminated linen and fomites) Airborne

Pathognomonic sign - Koplik spots

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)

14. GERMAN MEASLES (Rubella/ Three-day Measles)

Etiologic Agent: Rubella virus

Mode of Transmission: Droplet spread

Pathognomonic sign - Forchheimer spots ( petechial spots)

Prodromal stage
- Low-grade fever Headache Malaise
- Mild coryza Conjunctivitis
Eruptive stage
- Forchheimer’s spot (pinkish rash on the soft palate)

Diagnostic Tests: Cell cultures confirm the presence of the virus.

Complications
a. Neuritis
b. Encephalitis
c. Arthritis
d. Arthralgias
e. Rubella syndrome manifested by microcephaly, mental retardation, cataract, deaf- mutism, and heart disease

15. SCHISTOSOMIASIS (Snail Fever / Bilharziasis)

Etiologic Agent: Schistosoma mansoni – South America Africa, Arab Middle East S.
haematobium – Africa and the Middle East
S. japonicum – endemic in the Philippines and China

Source of Infection: Stool and urine of infected persons or animals

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

Administer drug as prescribed PRAZIQUANTEL (Biltracide) – drug of choice