1

----------------------------WEEK 13------------------------- ▸ Metabolic acidosis

Diagnostic Exams
▸ Stool or vomitus culture
HEPATITIS Serum electrolytes
Hepatitis A
▸ Dark field or Phase Microscopy
a Infectious hepatitis, Catarrhal-jaundice hepatitis a Mode of
Transmission: fecal-oral, oral-anal sex
Medical Management
▸ Correction of dehydration and fluid imbalance
Hepatitis B
▸ Antibiotics- Tetracycline (drug of choice)
a Serum Hepatitis
MOT: percutaneous, sexual contact, mother to child.

Hepatitis C
a Post-transfusion hepatitis
MOT: percutaneous, sexual intercourse

Clinical Manifestations:
Preicteric phase: anorexia, nausea, RUQ pain, malaise,
headache, low grade fever
Icteric phase: dark urine (increase bilirubin), pruritus, clay
colored stools, jaundice
Post icteric phase: malaise, fatigue, hepatomegaly for several
weeks

Diagnostic exams: Hepatitis Profile Liver function test Liver

UTZ

Complications: chronic hepatitis, cirrhosis TYPHOID FEVER

The first effective vaccine for typhoid was developed by
Meds for chronic hepatitis B: Almroth Edward Wright and was introduced for military use in
Antivirals: lamivudine, interferon 1896.

Nursing Interventions: Georg Gaffky was a pathologist that confirmed the bacillus
1. Bed rest Eberthella typhi, which is known today as Salmonella enterica.
2. SFF, high CHO
3. Avoid alcohol and OTC drugs Period of Communicability
4. Implement Standard precaution ▸ As long as the bacilli appears in the excreta

Prevention: Mode of Transmission

Hepatitis B vaccination @ 0, 6, 14 weeks 0.5 cc IM ▸ Fecal - oral route
▸ Ingestion of contaminated food and water 5 F's fingers, feces,
flies, food, fomites
CHOLERA
Filippo Pacini, discovered of Vibrio cholera.

Russian-Jewish bacteriologist Waldemar Haffkine developed

the first cholera vaccine in July 1892.

Dr. John Snow is regarded as one of the founding fathers of

modern epidemiology and discovered how cholera was spread
in London.

Cholera has been nicknamed the "blue death" because a person

dying of cholera may lose so many body fluids that their skin
turns bluish-gray.

Causative Agent
► Vibrio coma or vibrio cholera
Clinical Manifestations
Incubation Period ▸ Gradual onset
▸ From a few hours to 5 days (average of 3 days)
▸ A-norexia and abdominal pain
▸ B-radycardia
Period of Communicability
C-onstipation
▸ As long as microorganisms are present in the bowel excreta
Clinical Manifestations
Clinical Manifestations ▸ D-iarrhea, D-evelop skin eruptions on the abdomen, back and
▸ Mild-diarrhea that becomes voluminous
chest (ROSE SPOTS)
Rice-watery stool (pathognomonic sign) ▸ E-nlarged spleen
▸ Washer woman's hands
► F-ever and chills
▸ Effortless vomiting ▸ G-eneralized body weakness
‣ H-eadache
3 Deficits During Cholera ▸ What are the three cardinal signs of Pyrexial stage?
Severe dehydration and ECF volume deficit
▸ Hypokalemia
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Diagnostic Exams
CBC
Widal test
➤Typhidot exam
▸ Blood culture
▸ Urine and stool culture
RED TIDE POISONING
A "red tide" is a common term used for a harmful algal bloom
(HAB), occur when colonies of algae—simple plants that live in
the sea and freshwater-grow out of control while producing
toxic effects on people, fish, shellfish, marine mammals, and
birds.
Is caused by a "population explosion" of toxic, naturally
occuring microscopic phytoplanktons, specifically subgroup a
known as dinoflagellates.
Explosions or "Blooms"are coastal phenomena caused by
environmental conditions which promote the explosive growth
of microorganisms.
Factors which are favorable for growth are.
1. Warm surface temperatures;
2. High-nutrient content;
3. Low salinity and calm seas; and
4. Rainy days followed by sunny weather
DOES IT REALLY COLOR THE WATER?
Yes. water in the coastal areas can be colored red by the algae,
thus, the term red tide.
Only certain kinds of seafood accumulate red tide toxins.
Shellfish are particularly prone to contamination as they feed
by filtering microscopic food out of the water.
These shellfish are filter feeders and, therefore, accumulate
toxins produced by microscopic algae in the form of
dinoflagellates and diatoms.
Lobster, crabs, shrimps and fish do not accumulates toxins and
are safe to eat even if they are from affected waters.
PATHOPHYSIOLOGY
Eating toxic shellfish can cause paralytic shellfish poisoning
(PSP) in humans. PSP is caused by saxitoxin, which is produced
by A. catanella and is one of the most potent toxins known.
Saitoxin acts by blocking sodium movement in muscle tissue.
Conduction block primarily occurs in the neurons and muscles.
The toxins responsible for shellfish poisoning are water-
soluble, heat-and acid stable, and are not inactivated by
ordinary cooking. Cooking or freezing does not destroy the red
tide toxin.
After ingestion, the toxin immediately affects the nervous
system, with symptoms usually appearing within 30. minutes.
Severity depends on the amount of toxins consumed.
There are four Syndromes of shellfish poisoning
1. Paralytic Shellfish Poisoning
2. Diarrheal Shellfish Poisoning
3. Amnesic Shellfish Poisoning
4. Neurologic Shellfish Poisoning
CLINICAL MANIFESTATION
1.The initial sign is tingling of the lips and tongue which
spreads to the face, neck, fingertips and toes
2. Headache, dizziness and nausea follow, symptoms which
may be mistaken as being due to a drunken condition
3. Such symptoms are aggravated by alcohol consumption
4. In severe cases, muscular paralysis and breathing difficulty
may occur in five to twelve hours due to paralysis of the
diaphragm; the victim can survive only with the aid of a
respirator
5. Fatalities from respiratory arrest have been reported
Modalities of treatment
1. The patient is induced to vomit.
2. Charcoal hemoperfusion is a process done by pumping the
arterial blood through an activated charcoal filter to remove
the toxin.
3. Alkaline fluids, such as sodium bicarbonate, are thought to be
helpful because the toxins in unstable in alkaline condition.
4. Artificial respiration is required if the patient exhibits
respiratory stress.
PREVENTION AND CONTROL
1.All shellfish-producing areas should have a monitoring
program to test water, sediments, and shellfish for
contamination.
2. The Department of Environmental Quality Engineering
(DEQE) is responsible for year-round testing of shellfish and
shellfish-growing area.
3. When blooms subside, shellfish has purifies themselves of
the toxin and when testing indicates a return to safe levels, the
areas are reopened.
4. If accidental ingestion of toxic shellfish is suspected, seek
medical attention immediately
5. Recreational shellfish gatherers should look for posted
warnings and pay close attention to local media
announcements.
LEPROSY
Synonym: Hansen's disease
Chronic disease of the skin, peripheral nerves and nasal
mucosa
"Living dead", Was perceived to be caused by sin
Causative agent: Mycobacterium leprae
MOT:
a. Intimate skin to skin contact
b. Droplet
Types:
1.Multibacillary (MB) - infectious, malignant
- Numerous macules, papules and nodules
2.Paucibacillary (PB)- hypopigmented macule
Late Manifestation
o Lagophthalmos - inability to close eyelids
o Madarosis - loss of eyebrows
o Sinking of the bridge of the nose
o Leonine face
o Contractures (clawing of fingers and toes)
o Gynecomastia
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Slit Skin smear - to demonstrate M. leprae (-) in all site = It should be replaced by human tetanus immunoglobulin.
Paucibacillary (+) in all sites = Multibacillary
Tetanus antiserum provides temporar passive immunity
Number of lesions = 2-5 PB against tetanus for weeks.
5 MB
Child and adult: 1500 IU single dose; 3000 IU if more than 24
Treatment: hours has elapsed. It is administered as soon as possible after
Multi drug therapy (MDT) RA 4073 injury, along with the tetanus vaccine, in a separate syringe and
injection site.
A. Paucibacillary: Rifampicin (600mg) /once a mo Dapsone
(100mg) OD (6-9 mos) Nursing Management
B. Multibacillary: Rifampicin, dapsone, lamprine Day 1: R-600 Keep the room dim and quiet. Avoid stimuli of spasm
D-100 C-300 once month ▸ Avoid unnecessary handling
Day 2-28: Dapsone 100 OD Close monitoring of v/s and muscle tone
Clofazimine (Lamprine ▸ Provide adequate airway

Health education Nursing Diagnoses

o Dapsone: cutaneous eruptions, also iritis, orchitis ▸ Ineffective breathing pattern related to muscles spasm and
o Lamprine: Brownish black skin discoloration, dryness and neurologic impairment.
flakiness ▸ Risk for injury related to muscle spasms.
o Skin care: Prevent injury
o Nursing Diagnosis Prevention
o Altered body image ▸ Immunization with tetanus toxoid for adults
o Social stigma DPT for babies and children

Preventive: BCG @birth POLIOMYELITIS

Causative Agent
TETANUS Legio debilitans
Causative Agent
▸ Clostridium tetani Type I - Brunhilde: permanent immunity; most paralytogenic
Type II - Lansing: temporary immunity
Two types of toxin: Type III - Leon: temporary
•> tetanospasmin
•> tetanolysin PREDISPOSING FACTORS
Age. About 60% of patient are under 10 years of age.
Sources of Infection
 Soil ➤Sex. Males are more prone to the disease than females. Death
 Street dust rate is proportionately higher in males.
 Animal and human feces ➤Heredity. Not heredity
 Rusty materials Environment and hygienic condition. The rich are more often
spared than the poor.
Clinical Manifestations
Neonates Excessive work, strain and marked overexertion are also
Malaise, high fever factors causing the
Difficulty in sucking disease.
Excessive of crying
Stiffness of jaw Mode of Transmission
► fecal-oral: through saliva, vomitus and feces
Adult ▸ Direct contact from one person to another
Trismus lock jaw ▸ Ingestion through of contaminated food (fecal-oral route)
Risus sardonicus (sardonic smile) - pathognomonic sign
▸ Opisthotonus Incubation Period
▸ Muscular spasm ›7 - 14 days
Low grade fever, diaphoresis
(Picture) Period of Communicability
▸ Not accurately known
Diagnostic Exam ▸ Polio virus can be found in throat secretions as early as 36
►Clinical manifestations hours and in the feces 72 hours after exposure to infection.
History of wound ▸ Risk of spreading the microorganism is highest during the
prodromal period
Medical Management
ATS, TAT, TIG Signs and Symptoms
Pen G,Metronidazole
▸Diazepam 1) Inapparent/ Subclinical Stage asymptomatic stage (90-95%)
►Muscle relaxant 2) Abortive (Minor Illness Stage)
Fever
It is used for both preventing and curing Tetanus. ATS is a Sore throat
solution of purified antibodies prepared from Equine Blood. Gl symptoms
Skin test is needed. Low lumbar backache/ cervical stiffness on ante-flexion of
spine
Equine tetanus antitoxin should no longer be used, as there is a 3) Major Illness Stage
risk of hypersensitivity and serum sickness. a) Non-paralytic/ pre-paralytic or meningitic type
· Recurrence of fever
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Poker spine (stiffness of the back) Blurring of vision; papilledema; diplopia

• Tightness and spasm of hamstring
Hypersensitiveness of the skin Clinical Manifestations
• Deep reflexes are exaggerated ▸ Signs of meningeal irritation
b) Paralytic Kernig's sign
• With paralysis depending on the part affected Nuchal rigidity pathognomonic sign
• Positive hoyne's sign: head O drop Opisthotonus
(+) kernig's and brudzinkisigns Brudzinski's sign
O paralysis
▸ Late Signs
Decerebration
Diagnostic Exams • Decortication
Blood and throat culture
Lumbar tap (pandy's test) Diagnostic Tests
EMG ▸ Blood Culture and Sensitivity
Stool exam ‣ CSF Analysis/ Lumbar Puncture/ Lumbar Tap

Polio Treatment Complications

Pain relievers (like ibuprofen) ▸ Bronchitis
A ventilator (a device that helps breathing) ▸ Pneumonia
Physical therapy that can help keep the muscles working. ▸ Otitis media/ Mastoiditis
Bed rest and fluids for flu-like symptoms. ‣ Blindness
Antispasmodic medications to relax muscles. Hydrocephalus
Antibiotics for urinary tract infections.
A heating pad for muscle aches and spasms. Medical Treatment
▸ Antibiotic
There are two vaccines for polio: • Penicillin G-drug of choice
Oral Polio Vaccine (OPV) and the Inactivated Polio Vaccine • Alternative: Chloramphenicol
(IPV).
▸ Mannitol
In the Philippines still using OPV, IPV does not replace the OPV ▸ Pyrentinol/Encephabol CNS stimulant
vaccine, but is used with OPV to strengthen a child's immune
system and protect them from polio. Anticonvulsant
• Diazepam
TWO TYPES OF POLIO VACCINE
IPV (Salk) – Jonas Phenytoin (Dilantin)
•Killed formulized virus ‣ Corticosteroid
••Given SC or MI • Prednisone
•Include circulating antibodies but not local (intestinal
immunity) Nursing Management
•Prevents paralysis but does not prevent re-infection ▸ Respiratory Isolation: 24 hours after onset of antibiotic
•Difficult to manufacture and costly therapy
Not useful with controlling epidemics ▸ Provide non-stimulating environment
▸ Initiate seizure precaution
OPV (Sabin) - Albert Bruce ▸ Avoid factors that increase ICP
•Live attenuated virus
••Given orally Preventive Measures
•Immunity is both humoral and intestinal. Vaccination: Hib- for children
Induces antibody quickly. ▸ Avoid MOT
•Prevents paralysis and prevent re-infection Easy to Rifampicin-prophylactic treatment
manufacture and cheaper Alternative: Ciprofloxacin
•Can be effectively use in controlling epidemics
You sent LEPTOSPIROSIS

MENINGITIS Adolf Weil of Heidelberg reported the clinical entity of fever,

Other Name jaundice, hemorrhage, and renal failure in 1886.
►Cerebrospinal fever
Other Names
Etiologic Agent  Weil's disease
▸ Neisseria meningitides  Canicola Fever
▸ Streptococcus pneumonia  Mud Fever
‣ Haemophilus influenza  Hemorrhagic jaundice
▸ Streptococcus agalactae and Listeria monocytogenes  Swineherd's Disease
Clinical Manifestations
► Fever Etiologic Agent
› Petecchial/purpuric rashes A spirochete of genus Leptospira (Leptospira
interrogans)
Signs of increased ICP
Severe frontal headache Incubation Period
Altered level of consciousness ▸6-15 days
Restlessness
Projectile vomiting
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Period of Communicability
▸ Leptospira is found in the urine between 10 to 20 days after
the onset Prevention and Control
Sanitation in homes, workplaces, and farms is a must.
Modes of Transmission
1) Ingestion or contact with the skin and mucous membrane of › There is a need for proper drainage system and control of
the infected urine or carcasses of wild and domestic animals. rodents (40 to 60 percent infected).
2) Through the mucous membrane of the eyes, nose, and ▸ Animals must be vaccinated (cattle, dogs, cats, and pigs).
mouth, and through a break on the skin.
3) Direct human to human transmission is rare. ENCEPHALITIS
Encephalitis, also, known as brain fever is an acute
inflammation (swelling) of the brain usually resulting from
Clinical Manifestations either a viral infection or due to the body's own immune
a) Septic Stage system mistakenly attacking brain tissue.
• This stage is marked with febrile lasting for four to seven
days. The disease is most prevalent in SOUTHEAST ASIA and the FAR
Abrupt onset of remittent fever EAST
chills
headache Who's behind?
• anorexia FLAVIVIRUS
abdominal pain The most common cause is a viral infection. The brain becomes
severe prostration inflamed as a result of the body's attempt to fight off the virus.
respiratory distress and fever subsides by lysis Encephalitis occurs in 1 in every 1,000 cases of measles

b) Immune or Toxic stage THE VECTOR OF ENCEPHALITIS

• Iritis -Culex tritaeno rhynchus
Headache -Culex vishnui
Meningeal manifestations -Culex gelidus
Disorientation
Convulsions Primary encephalitis occurs when a virus directly infects the
with CSF findings of aseptic meningitis. brain and spinal cord. Secondary encephalitis occurs when an
Oliguria and anuria with progressive renal failure. infection starts elsewhere in the body and then travels to the
Shock, coma, and congestive heart failure brain.
are also seen in severe cases
Encephalitis can develop as a result of a direct infection to the
c) Convalescent Stage brain by a virus, bacterium, or fungus, or when the immune
At this stage, relapse may occur during the 4th to 5th week system responds to a previous infection; the immune system
mistakenly attacks brain tissue.
Diagnostic Test
1) Blood urea-nitrogen and urea Primary (infectious) encephalitis can be split into three main
2) Enzyme Link Immuno-sorbent categories of viruses:
Assay (Elisa)
3) Leptospira Antigen-antibody test (LAAT) (1) Common viruses, including HSV (herpes simplex virus) and
4) Leptospira Antibody Test (LAT) EBV (Epstein-Barr virus);
5) Liver function test (2) Childhood viruses, including measles and
mumps,
Complications (3) Arboviruses (spread by mosquitoes, ticks, and other
▸ Meningitis insects), including Japanese encephalitis, West Nile
Respiratory Distress encephalitis, and tick-borne encephalitis.
Renal interstitial tubular necrosis that result to renal failure
(Weil's disease) Secondary encephalitis could be caused by a complication of a
Cardiovascular problems viral infection.

Symptoms start to appear days or even weeks after the initial

Management infection. The patient's immune system treats healthy brain
cells as foreign organisms and attacks them.
1) Medical Treatment of leptospirosis is geared toward:
• Suppressing the causative agent The incubation period is 4 to 21 days.
Fighting possible complications
• Penicillin G-drug of choice ·Ampicillin, Amoxicillin Japanese Encephalitis generally begins with fever, nausea,
• For prophylaxis, doxycycline chills, and headache, vomiting with stiffness/ neurologic
2) Peritoneal Dialysis manifestations within 24 hours, dizziness, conjunctivitis,
• Administration of fluid and electrolyte and blood as indicated. athralgia, myalgia and decreased IQ and serious brain damage.

Nursing Management The symptoms rapidly worsen, with signs and symptoms of
▸ Isolate the patient, urine must be properly disposed of. rigidity, ataxia, speech difficulties, ocular palsy, flaccid
Darken patient's room. paralysis, seizures confusion, loss of consciousness, and even
coma.
› Observe meticulous skin care
Keep clients under close surveillance Encephalitis can be life-threatening, but this is rare. Mortality
depends on a number of factors, including the severity of the
For home care, clean near dirty places, pools, and stagnant ater disease and age. Younger patients tend to recover without
Facilitate health education of the modes of transmission of the many ongoing health issues, whereas older patients are at
disease. higher risk for complications and mortality.
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▸ Dotted mosquito
Encephalitis is more likely to affect children older adults, ▸ Usually bite a person in motion
individuals with weakened
You sent › Anopheles
immune systems, and people who live in areas where ▸ Night biting
mosquitoes and ticks that spread specific viruses are common. ▸ Breeds in clear, flowing and shaded streams
Brown colored and bigger in size
Laboratory Diagnosis ▸ Usually do not bite a person in motion
• Detection of Antigen from serum or cerebrospinal fluid (CSF)
to detect virus specific IgM antibodies within 7 days of onset of
disease.
• Compliment Fixation Test: To detect the antibodies for DENGUE
infection. Other Names
• Neutralization Test: To detect the presence of virus infections.  Breakbone fever
•Immunofluorescence Assay: To detect the
 Dandy fever
antigen & antibodies
 Infectious
 Thrombocytopenic purpura
Diagnosis and Treatment
•Clinical  H-fever
•Laboratory Tests
-Tentative diagnosis Etiologic agent:
-Group B Arbovirus(I,II,III,IV)
• Antibody titer: eq. ELISA
JE-specific IgM in serum or CSF -Flavivirus
-Chikungunya virus
-Definitive diagnosis
• Virus isolation : CSF sample, brain -Zika Virus

Treatment Incidence
 Age -may occur at any age but peak in 4 to 9 years old
-No Specific treatment
-Supportive care  Sex - both sexes can be affected
 Season - more frequently during rainy seasons; but
The medical management is symptomatic and supportive cases are all year round
 Location - more prevalent in urban than rural
management. Treatment for encephalitis focuses on alleviating
symptoms. communities

For patients with mild symptoms, the best treatment is rest,

Mode of Transmission
plenty of fluids, and Tylenol (paracetamol) for fever and
headaches. ▸ Bite of infected female AEDES AEGYPTI mosquito

Antiviral agents - acyclovir; success is limited for most Incubation Period

3- 14 days
infections except when the condition is due to herpes simplex.
Clinical Manifestations
Corticosteroids - to reduce the brain's
inflammation, especially in cases of post infectious (secondary)
▸ Grade 1: Symptomatic and Supportive
encephalitis.
•Fever
Anticonvulsants - seizures. (if Dilantin - check for WBC) •Headache
• Malaise
•Anorexia
Sedatives -also, effective for seizures,
restlessness, and irritability. •Chills
•Pain (Abdominal, Bone and Joint, and Ocular) Rashes
If the patient has severe symptoms, they may need mechanical •+ Herman's Sign: Flushing of the skin
• + Tourniquet Test (Rumple Leeds Test)
ventilation to help them breathe and other supportive
treatment.
Tourniquet Test for Dengue
The nursing management are: Take the patient's blood pressure and record it, for example,
100/70
(1) Provide comfort - keep patient in a quiet, well ventilated
room; encourage hygiene and bed bath. oral Inflate the cuff to a point midway between SBP and DBP and
maintain for 5 minutes. (100+70) + 2 = 85 mm Hg
(2) Prevent from complications turn the patient at least every 2
hours, encourage increase oral fluid intake, encourage high Reduce and wait 2 minutes.
Count petechiae below antecubital fossa.
caloric diet, moisten lips with mineral oil.
(3) Monitor intake and output.
▸ Grade II: Manifestations of grade I plus spontaneous
PREVENTION AND CONTROL bleeding -
BED REST
-The prevention are identification of vectors and eliminating
breeding and grounds, destruction of larvae, screening homes Epistaxis
Gingival Bleeding
and use of repellants.
-Personal protective measures and mosquito elimination are Petechiae or ecchymosis
Gastro intestinal bleeding
the most pertant
-Travellers going to endemic areas may consider vaccination • Ground coffee colored vomitus
• Hematemesis
DF mosquito versus Malaria mosquit • Melena
• Hematochezia
▸ Aedes aegypti
▸ Day biting
▸ Breeds in stagnant water
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▸ Grade III: Colloids- Dextran, Haemacel, Haesteril at 10ml/kg bolus in <10

• Manifestations of Grade II plus Beginning symptoms of minutes
circulatory failure d) Still no improvement
-Monitor V/S and Watch out for complication of shock Fresh Frozen Plasma at 15cc/kg in 2 hours and start inotropes
• Hypotensiona nd narrowing of pulse pressure Dopamine 7-15 ug/kg/m
• weak and thready pulse
• cold, clammy skin 5S
• restlessness ▸ Search and destroy (sustain vector control measures)
Self protection measures
▸Grade IV › Seek early consultation
Manifestation of grade III plus shock ▸ Say no to indiscriminate fogging but support fogging,
PROPER POSITIONING spraying, and misting in hot spot areas;
Sustain hydration
• Undetected BP and pulse
Cyclical variation is the number of cases usually increases
CLASSIFICATIONS: towards the ends of the rainy season.
Mild DHF: slight fever, with or without petechial hemorrhage
MALARIA
Moderate DHF: high fever, but less hemorrhage, no shock Other Names
"AGUE"
Severe DHF: frank type: flushing, sudden high
fever, severe hemorrhage, followed by sudden drop of ▸ King of Tropical and Sub tropical Diseases
temperature, shock and terminating in recovery or death.
Charles Louis Alphonse Laveran discovered that malaria was
Diagnostic Tests caused by a protozoan parasite in 1880
• Tourniquet Test- Presumptive diagnosis; detects capillary
fragility
•Platelet Count: Confirmatory test→ Result: <100,000
cells/mm³
•Hemoconcentration- Increase in 20% Hematocrit Count
•Dengue NS1 Ag

NS1 antigen test (nonstructural protein 1), is a test for dengue,

introduced in 2006. It allows rapid detection on the first day of
fever, before antibodies appear some 5 or more days later. The
method of detection is through enzyme linked immunosorbent
assay.

The accuracy of the NS1 antigen rapid test is considered high

with sensitivity 55%-82% and specificity 97%-100%. Since the Four Plasmodium species are responsible for human malaria:
NS1 rapid test aims to detect dengue NS1 antigen, it should be  P. falciparum malignant tertian malaria
performed within 5 days of onset of fever.  P. vivax,benign tertian malaria
 P. ovale ovale tertian malaria
A positive NS1 test confirms dengue virus infection.  P. malariae. quartan malaria

A negative NS1 test result does not rule out infection. Mode of transmission
- Bute of infected female ANOPHELES mosquito
People with negative NS1 results should be tested for the - through blood transfusion
presence of dengue IgM antibodies to determine possible - contaminated needles and syringes
recent dengue exposure. - congenital transmission (RARE)

Clinical Manifestations
Cold stage: severe recurrent chills
Hot stage: fever 4-6 hrs.
Wet stage: profuse sweating 2-4 hrs.

•Early Sign of anemia:repeated chronic symptoms:CBQ

a) Pallor
b) Easy fatigability
COMPLICATIONS c) dizziness
•Shock-death
Diagnostic Exams
Medical Treatment Malarial smear: Confirmatory test
▸ Antipyretic/ Analgesic: Do not administer NSAID for Fever o detects malaria parasite o best done during the height of
Intravenous Fluid Therapy fever
o The (quantitative)thick blood smear determines the presence
and percentage of parasite in the blood, while the (qualitative)
a) Protocol for Fluid correction with NO SHOCK thin blood smear determines the specific species in the blood.
• IVF Crystalloids- DSLR or D5 0.9 NaCl or PLR at 5-7 ml/kg/hr
b) Protocol for fluid correction with SHOCK • IVF Crystalloids- QUANTITY BUFFY COAT (QBC)/RAPID DIAGNOSTIC
PLR or P 0.9 NSS at 20ml/KBW IV bolus in <20 minutes TEST(RDT)
c. if no improvement -detects malarial antigen
8

-taken anytime,the faster test Lmphangitis

Funiculitis, orchitis, epididymitis
Complications
1. Cerebral Malaria: Chronic Stage:
most severe neurological complication of infection with H-ydrocele
Plasmodium falciparum malaria. It is a clinical syndrome E-lephantiasis
characterized by seizures and coma L-ymphedema

2. Blackwater fever: Diagnostic exams

also called malarial hemoglobinuria, one of the less common yet ▸ Nocturnal blood exam
most dangerous complications of malaria. ▸ Immunochromatographic test (ICT)

The distinctive color of the urine (dark) is due to the presence Management
of large amounts of hemoglobin, released during the extensive Diethlycarbamazine citrate (Hetrazan)
destruction of the patient's red blood cells by malarial parasites
that leads to kidney failure. ----------------------------WEEK 14-------------------------
The antimalarials that can be used in pregnancy include: ANTRAX
(1) chloroquine
Anthrax is a serious infectious disease caused by gram positive,
(2) amodiaquine
rod-shaped bacteria known as Bacillus anthracis. Anthrax can
(3) quinine
be found naturally in soil and commonly affects domestic and
(4) azithromycin
wild animals around the world.
(5) sulfadoxine-pyrimethamine
(6) mefloquine
Although it was of the trea one signatories, the Soviet Union
(7) dapsone-chlorproguanil
continue researching and producing biological weapons and in
(😎 artemisinin derivatives April 1979 an accidental release of anthrax spores from a
(9) atovaquone-proguanil military facility near Sverdlovsk caused 68 known deaths.
(10) lumefantrine
1.The bacteria known as Bacillus Anthracis produce dormant
Medical Management spores (not active) that can live in the environment, like soil,
▸ First line: Artemether-lumefantrine combination tablet for a long time, even decades.
› Second line: Chloroquine, Primaquine Pyrimethamine and 2. When spores get into the body of an animal or person (a
Sulfadoxine place rich with waters, sugars and other nutrients), they can be
For Complicated Malaria: Multi drug resistant Falciparum: "activated" and turn into active growing cells.
*Artemether 20mg/ Lumefantrine 120mg (CO-Artem) 3. When they become activ the bacteria can multiply spread out
Erythrocyte Exchange Transfusion in the body, produce toxins (poisons) and cause severe illness
and death.
Prevention Mode of transmission
CHEMOPROPHYLAXIS Contact with anthrax can cause severe illness in both humans
 Doxycycline: 1 day before going and 4 weeks and animals. This can happen when people breathe in spores,
after leaving malaria endemic area eat food or drink water that is contaminated with spores, or get
 Chloroquine: 1 week before going and 4 weeks spores in a cut or scrape in the skin. It is very uncommon for
after leaving malaria endemic area people to get infected with anthrax. The incubation period is 2
 Mefloquine: 2-3 weeks before going and 4 to 7 days.
weeks after leaving malaria endemic area
ZOOPROPHYLAXIS Anthrax is most common in agricultural regions Central and
- Typing of domestic animals to divert attention of mosquitoes Southwestern Asia. Anthrax is rare in the United States, but
sporadic outbreaks do occur in wild and domestic grazing
Preventive Measures animals such as cattle or deer. Anthrax is more common in
-No vaccine yet developing countries and countries that do not have veterinary
- Chemically-treated mosquito nets public health programs that routinely vaccinate anima against
- Larvae-eating fish anthrax.
- Environmental sanitation
- Anti-mosquito soap The types of anthrax are:
- Natural anti-mosquito plants (1) Cutaneous most common form of anthrax infection, anthrax
can occur when workers who handle contaminated animal
FILARIASIS products get spores entering into a open wound, and is
CAUSATIVE AGENT considered to be the least dangerous. Infection usually
 Wucherer develops from 1 to 7 days afte exposure
 Brugia malayi (2) Inhalation - inhalation anthrax is considered to be the most
 Brugia timori deadly form of anthrax as the human breathes the spores
 Loa loa through the nose and into the lungs. Infection usually develops
within a week after exposure, but it can take up to 2 months.

MODE OF TRANSMISSION: SYMPTOMS

Bite of Aedes poecilius The symptoms of anthrax depend on the type of infection:

INCUBATION PERIOD: 8-16 months (1) Cutaneous anthrax symptoms can include: a group of small
blisters or bumps that may itch, swelling can occur around the
MANIFESTATIONS sore, a painless skin sore (ulcer) with a black center that
Acute Stage: appears after the small blisters or bumps, most often the sore
Lymphadenitis will be on the face, neck arms, or hands.
9

(2) Inhalation anthrax symptoms can include: fever and chills, SCHISTOMIASIS
chest discomfort, shortness of breath, confusion or dizziness, ▸ Is an endemic protozoan infection that affects the liver and
cough, nausea, vomiting, or stomach pains, headache, sweats GIT
(often drenching), extreme tiredness and body aches. ▸ Capable of producing obstructive jaundice and liver
SCHISTOMIASIS
CDC Guidance and case definitions are to available to help ▸ Is an endemic protozoan infection that affects the liver and
doctors diagnose anthrax, take patient histories determine how GIT
exposure may have occurred, and order necessary diagnostic ▸ Capable of producing obstructive jaundice and liver cirrhosis
tests. If inhalation anthrax is suspected, chest X-rays or CT
scans can confirm if the patient has mediastinal widening or Other Name
pleural effusion, which are X-ray finding typically seen in ▸ Bilharziasis
patients with inhalatio anthrax.
The etiology of schistosomiasis in humans was first discovered
DIAGNOSIS: in 1851 by the German physician Theodor Bilharz.
The only ways to confirm an Anthrax diagnosis are: (1) to
measure antibodies or toxin in blood, and (2) to test directly for Causative Agent
Bacillus anthracis in a sample of blood, skin lesion swab, spinal  Schistosoma japonicum
fluid, and respiratory secretions. Samples must be taken before  Schistosoma mansoni
the patient begins taking antibiotics for treatment.  Schistosoma haematobium

TREATMEMT
Doctors have several options for treating patients with anthrax, Stages
including antibiotics and antitoxin, continuous fluid drainage ▸ Adult female and male parasites
and help breathing through mechanical ventilation, ▸ Ova
intravenous antibiotics such as penicillin, doxycycline, ▸ Miracidium - infective stage in snails
tetracycline, erythromycin, chloramphenicol and ▸ Cercaria - infective stage in man and animals
ciprofloxacin.
Intermediate Host
PEDICULOSIS Snail (Oncomelania quadrasi)
Pediculosisations
Mode of Transmission
Types: About 2-6 weeks from skin penetration by cercaria
a. Pediculosis capitis - head lice
b. Pediculosis corporis - body lice Clinical Manifestations
C. Phthirus pubis - pubic or crabs lice MOT: direct contact, ▸ Abdominal pain
beddings, towel, clothes and hairbrush ▸ Diarrhea with bloody stools
▸ Portal hypertension and signs of liver cirrhosis
Clinical manifestations: ▸ Anemia
1. Intense pruritus, leads to secondary excoriation
2. Eggs (nits) attached to the hair shaft The classic form of presinusoidal portal hypertension is caused
by the deposition of Schistosoma oocytes in presinusoidal
Parasitic Infestations portal venules with the subsequent development of
Scabies: an infestation of the skin by Sarcoptes scabiei mites granulomata and portal fibrosis. Schisto somiasis is the most
a. Intense itching common noncirrhotic cause of variceal bleeding worldwide
b. Superficial burrows, especially between fingers, the surface
of the wrist and in axilla Diagnostic Exams
c. Redness, swelling may be noted ▸ Kato-katz - specimen is stool
► Circumoval precipitin test (COPT) - specimen is blood
Treatment ► HBT - UTZ
A. Pediculosis ► Liver function tests
FAMILY PACK
Lice Killing Creme Rinse Medical Management
Nix  Praziquantel (biltricide) - drug of choice
includes 2 bottles Plus 2 pit combs  Oxamniquine (vansil), metrifonate
Net WT2 or CD/LEACH
1. Permethrin 1% (Nix) Prevention
2. Pyrethrine compunds (Rid) ▸ Travelers to endemic areas should avoid exposure to fresh
water that is likely to be contaminated
B. Scabies ▸ No accepted prophylactic regimens have been developed and
1. Permethrin 5% cream (Elimite) no vaccines are currently available
▸ Eradication of snails
Parasitic Infestations
Home care: HELMINTHES
1. All family members and close contacts need to be treated A parasite is an organism that lives on or in a host organism
2. Concurrent Disinfection and gets its food from or at the expense of its host. There are
3. a. Daily washing of recently worn clothes, towels and three main classes of parasites that can cause disease in
bedding. humans: protozoa, helminths, and ectoparasites. Helminths are
b. Areas such as shared toilet and shared commode chair seats large, multicellular organisms that are generally visible to the
need to be thoroughly wiped after each use naked eye in their adult stages.

MOT: INGESTION
10

1. Pinworm- Enterobius, Seatworm s/s: Nocturnal itchiness of 6. Virus travels from brain via nerves to other tissues such as
anus (female pinworm lays eggs on the anal sphincter) eye, kidneys, salivary glands
2. Giant Roundworm (Ascariasis) Potbelly
3. Whipworm (Trichuriasis)
4.Tapéworm Taenia saginata- raw beef Taenia solium- raw Clinical Manifestations
pork Diphyllobotrium latum - raw fish Rabid animal
Dumb stage - quiet, stays in corner with copious salivation
Antihelminthic use should always be under steroid cover that Furious stage - easilyx agitated, hydrophobia
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 Rabid Man
are not pregnant or breastfeeding, or praziquantel 50mg/kg 1) Prodromal / Invasion stage
can be given once daily in divided doses for 15 days. • Mental depression, headache, sore throat, low-grade fever
• Copious salivation
RABIES • Quiet
2) Excitement stage
Republic Act 9482 Restless, irritable
The national government has implemented the Anti-Rabies Act Hydrophobic
of 2007, which mandates the creation of the National Rabies Aerophobic
Prevention and Control Program (NRPCP). It is the goal of the Drooling of saliva
NRPCP to eliminate rabies in the country and declare the 3) Paralytic
Philippines rabies-free by the year 2020. Flaccid ascending symmetric paralysis
Coma, death
Executive Order No. 84 series of 1999
March is Rabies Awareness Month
Diagnostic Exams
Other Names Fluorescent rabies anti body (FRA)- Confirmatory test
 Lyssa ▸ Brain biopsy of the animal (Negri bodies)
 Hydrophobia ► 14 days observation of the animal

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 th first human to receive this
vaccine.
Causative Agent
► Rhabdo virus
a bullet-shaped virus with strong affinity to CNS tissues
Medical Management
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

Modes of Transmission
▸ Bite of an infected animal
▸ Licking of open wounds by a rabid animal
Scratch of a rabid animal
▸ Man to man transmission (10%)

Source of Infection
▸ Saliva of infected animals or human

Incubation Period
► 10-14 days (dogs)
1 day - 5 yrs. (humans)

Incubation period depends on the following factors

1. Distance of the bite to the brain How effective is the rabies vaccine?
2. Extensiveness of the bite The rabies vaccine works remarkably well. Studies indicate that
3. Species of the animals if the vaccine is given immediately and appropriately to
4. Richness of the nerve supply in the area of the bite someone who was bitten by a rabid animal, it is 100 percent
5. Resistance of the host effective.

A vaccine can confer active immunity against a specific

1. Virus enters via animal bite harmful agent by stimulating the immune system to attack the
2. Virus replicates in muscle at site of bite agent.
3. Virus infects nerve in peripheral nervous system Moves by
retrograde transport A serum can confer passive immunity (rabies immune globulin)
4. Virus replicates in dorsal root ganglion and travels up spinal is commonly used after a certain type of wild animal bites an
cord to brain individual.
5. Brain infected
11
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
Purified Vero Cell Rabies Vaccine (PVRV)- 0.5ml/vial Purified
Chick Embryo Cell Vaccine (PCECV)
1.0ml/vial
Prevention
›Immunization
Keep away from stray animal
BUBONIC PLAGUE
Black Death / Blue Sickness / La Pest / The Great Mortality
Flea Bite
Definition
▸ The term bubonic is derived from the Greek word boubon,
meaning "groin
▸ The term "buboes" is also used to refer to the swollen 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 50 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.
What were the symptoms of the plague?
Day 1 Painful swellings called buboes appeared in the victim's
armpits and groin. These were usually about the size of an egg.
but could sometimes be as big as an apple.
Day 2 The victim vomited and developed a fever.
Day 3 Bleeding under the skin caused dark blotches all over the
body.
Day 4 The disease attacked the nervous system. This caused the
victim to suffer spasms. The victim was in terrible pain.
Day 5 Sometimes the buboes burst and a foul smelling black
liquid oozed from the open boils. When this happened the
victim usually lived. However, in most cases the victim suffered
a painful
Signs and symptoms
The most infamous symptom of bubonic plague is an infection
of the lymph glands (lymphadenitis), known as buboes, which
become swollen and painful. After being transmitted via the
bite of an infected flea, the Y. pestis bacteria become localized
in an inflamed lymph node, where they begin to colonize and
reproduce.
▸ Buboes associated with the bubonic plague are commonly
found in the armpits, upper femoral, groin and neck region.
Acral gangrene (i.e., of th fingers, toes, lips and nose) is another
common symptom.
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
Fluorescence antibody positivity is observed as bright, intense
green staining around the cell wall of Yersinia pestis, the plague
bacillus
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.
12

Confirmation of plague requires lab testing. The best - Vaginitis(Inflammation of Vagina)

practice is to identify Y. pestis from a sample of pus from a - Cervicitis (Inflammation of Cervix)
bubo, blood or sputum.
CERVICITIS:
TREATMENT  Abnormal Vaginal
Several classes of antibiotics are effective in treating  Discharge (Micropurulent)
bubonicplague. These include:  Cervical Erosion
aminoglycosides such as streptomycin and gentamicin,  Pelvic Pain
tetracyclines (especially doxycycline), and the fluoroquinolone  Dyspareunia (Pain during Sex)
ciprofloxacin.
ENDOMETRITIS/SALPHINGITIS: S/S of Pelvic Inflammatory
People potentially infected with the plague need immediate Disease:
treatment and should be given antibiotics within 24 hours of  Pain and Tenderness in Abdomen, Cervix, Uterus, and
the firs symptoms to prevent death. Other treatment include Lymph Nodes.
oxygen, intravenous fluids, and respiratory route
 Chills and Fever
 Bleeding After Intercourse
Managing plague outbreaks are usually
(1) Find and stop the source of infection. Identify the most
 Painful Scrotal Swelling
likely source of infection in the area where the human case(s)
was exposed, institutes appropriate infection, prevention and  Urethral Discharge
control procedures and rodent control.
(2) Protect health workers. Inform and train them on infection COMMON IN MEN AND WOMEN:
prevention and control. Workers in direct contact with  Painful Urination (Dysuria)
pneumonic plague patients must wear standard precautions  Purulent Discharge
and receive a chemoprophylaxis with antibiotics for the  Persistent Sore Throat
duration of seven days or at least as long as they are exposed to  Inflammation of the Eye Infective Arthritis
infected patients.
(3) Ensure correct treatment. Verify that patients are being Some patients may have:
given appropriate antibiotic treatment.  Diarrhea
(4) Isolate patients with pneumonic plague. Patients should be  Tenesmus
isolated so as not to infect others via air droplets.  Pruritus
(5) Providing masks for pneumonic patients can reduce spread.  Bloody or mucopurulent Discharge
Surveillance: identify and monitor close contacts of pneumonic  Ulceration in the rectosigmoid colon
plague patients and
(6) Disinfection. Routine hand-washing is recommended with Diagnostic Exam
soap and water or use of alcohol hand rub.  Swab from the site of infection
(7) Ensure safe burial practices.  Culture of aspirated materials
(😎 Surveillance and control requires developing  ELISA (enzyme-linked immunosorbent assay)
environmental management programs.  Direct fluorescent antibody test - rapid visualization
of bacteria.
Madagascar has experienced several outbreaks of bubonic and
pneumonic plague in the 21st century. In the outbreak PHARMACOLOGICAL TREATMENT
beginning in 2014, 71 died; in 2017, 202 died, January 2008, 18 DRUG OF CHOICE:
deaths Doxycyline Oral (for 7 days) Azithromycin in single dose

Chlamydia COMPLICATIONS
 Known as the silent epidemic because in many cases,  Epididymitis
it shows no symptoms.  Salphingitis
 One of the most common sexually transmitted disease  Pelvic Inflammatory Disease
(STD)  Eventually, Sterility.
 Caused by a bacteria called Chlamydia Trachomatis
 Symptoms may not show until 1-3 wks. after contact. Common Nursing Diagnosis
 It can infect both men and women. 1. Anxiety
 When transmitted through sexual contact, the 2. Ineffective Coping
bacteria can infect the urinary and reproductive 3. Sexual dysfunction
organs. 4. Social Isolation
5. Knowledge deficit
TYPES of BACTERIA:
 Chlamydia Trachomatis - STD Nursing Management
 Chlamydia Pneumoniae - through coughing and 1. Practice Universal Precaution
sneezing. 2. If suspected, seek treatment as soon as possible
 Chlamydia Psittaci - birds to humans. 3. Suggest that both partners should submit for HIV Testing.
4. Check newborn for signs of chlamydial infection.
MODE of TRANSMISSION You sent
- Sexual Intercourse:
- Vaginal Mononucleosis(kissing disease)
- Anal • Infectious mononucleosis, or mono, refers to a group of
- Oral symptoms usually caused by the Epstein-Barr virus (EBV), also
- Mothers can pass the infection to newborn babies known as herpesvirus 4. It typically occurs in teenagers, but you
can get it at any age. The virus is spread through saliva, which
during delivery.
is why some people call it "the kissing disease."
SIGNS AND SYMPTOMS
Vary according to the part affected
13

Many people develop EBV infections as children after age 1. In test looks for EBV-specific antibodies. This test can
very young children, symptoms are usually nonexistent or so detect mono as early as the first week ou have
mild that they aren't recognized as mono. Once you have an symptoms, but it takes longer to the results.
EBV infection, you aren't likely to get another one. Any child
who gets EBV will probably be immune to mono for the rest of TREATMENT
their life Over-the-counter (OTC)medicines to reduce fever and
techniques to calm a sore throat, such as gargling salt water
SYMPTOMS - getting a lot of rest
 A fever - staying hydrated, ideally by drinking water
 A sore throat - eating warm chicken soup
 Swollen lymph glands in your neck and armpits - using QTC pain medications such as acetaminophen
 A headache (Tylenol)
 Fatigue
 Muscle weakness HERPES SIMPLEX VIRUS 1 & 2
 Swollen tonsils National Epidemic Sentine Surveillance System (NESSS)
 Night sweats
A program of the government that is a hospital is based
Incubation period information system that monitors infectious diseases with
The incubation period of the virus is the time between when potential outbreak
you contract the infection and when you start to have
symptoms. It lasts four to six weeks. Herpesviridae
- A large family of DNA viruses that cause diseases in
Risk factor animals, including humans.
 young people between the ages of 15 and 30 • HERPEIN (Greek "to creep or to crawl")
 Students • It is
 Medical personnel comes in contact with patient Lifelong
 People who take medications that suppress the Latent
immune system Re-occurring infections
Persistent infections
Cause Periodic reactivation
 Epstein Barr Virus Incurable.
 EBV is a member of the herpes virus family and is one of
the most common viruses to infect humans around the BOTH establish latent infections in sensory neurons
world. Trigeminal Ganglion for HSV 1
 The virus is spread through direct contact with saliva from Sacral Ganglion for HSV2
the mouth of an infected person or other bodily fluids such
as blood. It's also spread through sexual contact and organ HSV-1 and HSV-2 have a similar genetic composition
transplantation. You can be exposed to the virus by a
cough or sneeze, by kissing, or by sharing food or drinks  One important difference in the 2 viruses is their
with someone who has mono. glycoprotein G genes.
 it usually takes four to eight weeks for symptoms to  Glycoprotein G of Herpes Simplex Virus 2 as a Novel
devalor after you're infected. Vaccine Antigen for Immunity to Genital and Neurological
Disease diseases with potential outbreak
DIAGNOSTIC EXAM  One of the most wide-spread infections in adults.
 Initial exam
 Once you visit your doctor, they'll normally ask how NO animal reservoirs or vectors
long you've had symptoms. If you're between age 15 HUMAN is the only reservoir.
and 25, your doctor might also ask if you've been i
contact with any individuals who have mono. Age is  In healthy people it's self-limiting, symptomatic and needs
one of the main factors for diagnosing mono along supportive treatment.
with the most common symptoms: fever, sore throat  In immunocompromised and newborn, the infection may
and swollen glands. be severe and significantly deadly.
 HSV-2 also increased steadily with females than male.
 Your doctor will take your temperature and check the
lands in your neck, armpits, and groin. Your doctor Other factor increases with:
might also check the pe left part of your stomach to 1. Less education
determine if spleen is enlarged. 2. Poverty
3. Cocaine use
 Complete blood count 4. Multiple sexual partners
- Sometimes your doctor will request. a complete blood
count. This blood test help your doctor determine HSV1
how severe you illness is by looking at your levels of - SYNONYMS: ORAL HERPES, HUMAN ALPHA HERPES
various blood cells. For example, a high lymphocyte VIRUS 1
count often indicates an infection such as mono.
 White blood cell count - Usually causes oro-facial infections and encephalitis
- Among Infection typically causes your body to
produce more white blood cells as it tries to defend HSV2
itself. A High white blood cell-count can't confirm an - SYNONYMS: GENITAL HERPES, HUMAN ALPHA
infection with EBV, but the result suggests that it's a HERPES VIRUS 2
strong possibility.
 EBV arribody test - Usually causes genital infections and can be diseases
- If your monospot test comes back negative, your with potential outbreak
doctor might order an EBV antibody test This blood
14

MICROSCOPY SPECIMEN FOR DIAGNOSIS: SALIVA, CSF,

Transmission VESICLE
• HSV 1 •VIRAL ISOLATION
Oral-oral transmission (Saliva through kissing) Sharing objects SEROLOGY
Prolonged skin and epithelial contact • Serology is the scientific study of blood serum. In practice, the
• HSV 2 term usually refers to the diagnostic identification of antibodies
Maternal to newborn infection Infection through defects in in the serum
mucosal membrane, skin, oro-pharyngeal lesions. Direct sexual We can detect antigens too
contact (Body secretions)

• HSV-1 is spread by contact with infected saliva. DRUG OF CHOICE

• It usually infects skin above the waist. Acyclovir
• HSV-2 is transmitted sexually or from a maternal genital Valacyclovir
infection to a newborn. Famcyclovir
• It usually infects skin below the waist.
MANAGEMENT AND PREVENTION
• HSV-1 • Good hygienic practices, including hand washing and minimal
- Acute gingivostomatitis contact as possible with lesions and secretions during active
- Recurrent herpes labialis herpes outbreaks.
- Herpetic whitlow - a lesion (whitlow) on a finger or • Schools and day-care centres should clean shared toys.
thumb, toes and nail cuticle  Compliance to drugs like oral acyclovir, valacyclovir, or
- Keratoconjunctivitis famciclovir.
- Encephalitis
Herpes Zoster (SHINGLES)
HSV-2 An acute viral infection of the nerve cells and surrounding skin.
- Genital herpes • Characterized by a rash of blisters, can be very painful but is
- Neonatal herpes (may be by HSV-1 as well) not life-threatening.
• Caused by the etiologic agent (varicella zoster virus) that
CLINICAL SIGNIFICANCE also causes chickenpox.
• Primary infections of the genital tract
• Latency Shingles usually appears, band of blisters on one side of the
HSV-1: Trigeminal ganglia chest or back, but it can occur anywhere on the body, including
HSV-2: Sacral ganglia on the face and near the eyes (unilateral and clusttred)

Factors of Reactivation 2 clinically distinct forms of disease

 Hormonal changes • Varicella (chickenpox)
 Fever • Herpes zoster (shingles)
 Emotional stress
 UV light Primary infection results in varicella (chickenpox)
 Physical damage Recurrent infection results in herpes zoster (shingles)

Severity of any systemic symptoms is considerably less REACTIVATION OF CHICKENPOX VIRUS

than that of a primary infection. • UNKNOWN
Many recurrences are characterized by shedding of • FACTOR OF WEAKENED IMMUNE SYSTEM
infectious virus in the absence of visible lesions FACTOR OF DEGENERATIVE OR AGING BODY
HSV-1: Reactivation frequency- none to several a year
Herpes labialis or cold sores, fever blisters Shingles Epidemiology
HSV-2: Reactivation frequency- monthly asymptomatic; Transmission
viral shedding Direct contact with open sores of shingles rash Can pass to
someone who has never had the
Neonatal Herpes. chickenpox
In Uterus High incidence groups
At Birth Anyone who had chickenpox (Recurrent
• After Birth. infection)
• Delivery By Caesarean Section to Reduces the Infection People over the age of 50 (Aging) Immunocompromised
Incubation period
Herpes simplex 1 infecting eye
Herpes 2 producing Genital Lesions Pathophysiology
Herpes lesions in the oral cavity 1. VZV enters through the respiratory tract Viral replication in
Skin Infections regional lymph nodes
Infect abrasions 2. Primary viremia in bloodstream
• Dentists, (Herpetic Whitlow) Health care workers, 3. Further viral replication in liver and spleen
• Eczema, Burns 4. Secondary viremia
5. Enter into nerve endings and transport to dorsal root ganglia
OTHER INFECTIONS (DRG) where it lies DORMANT in sensory nerve ganglia, dorsal
 Meningitis, root.
 Encephalitis 6.Reactivation in dorsal root ganglia Infection of nerves and
 Multi organ Involvement dermatome
 Increased incidence in Immune compromised AIDS, 7.Herpes zoster
 Haematological Malignancies.
Causes & Risk factors
Age
LABORATORY AND DIAGNOSTICS - common in people older than 50.
15
Diseases
- that weaken the immune system, such as HIV/AIDS and
cancer.
Cancer treatments
- Undergoing radiation or chemotherapy can lower the
resistance to diseases and may trigger shingles.
Immunosuppressant Drugs
- prolonged use of steroids, such as prednisone.
Prodromal stage
Begins 3 to 4 days before the rash appears.
• Unusual skin sensations
 Pain within the affected dermatome that signals the onset
of lesions by 48-72 hours.
• Malaise
• Myalgia
• Headache
• Photophobia
• Fever
PRE-ERUPTIVE STAGE
• 3-5 days after the initial pain, a few tiny pimple like spots will
appear (MACULO-PAPULE)
Quickly it will multiply into clusters, forming a rash that feels
prickly to the touch.
From there, sometimes within minutes or hours, the pimples
will develop into water-filled blisters (MACULO-PAPULO-
VESICULAR), then pus will form inside that will consolidate
into larger blisters. (MACULO-PAPULO-VESICULO-PUSTULAR
RASH)
CONVALESCENT PERIOD
• As the rashes heals, open blisters or erupted blisters will scab.
• The scab will peel.
• It will then leave a branny desquamation.
Although it will heal within 2-4weeks, the pain that
accompanies it, sometimes so excruciating that simply grazing
the skin with clothing can set off what feels like an electric
shock, can last for weeks, months, or even years.
• For most people, the pain associated with the rash decreases
as it heals.
Complications
1. Post herpetic neuralgia (PHN)
Post herpetic neuralgia can cause severe nerve pain that
persists after the rash. PHN occurs most often in elderly people
and in people whose immune systems have been compromised.
2. Ophthalmic shingles
Shingles in or around an eye can cause painful eye infections
that may result in vision loss.
3. Ramsay Hunt syndrome
Otherwise known as herpes zoster oticus, inflammation of
several of the nerves that come out of the brain. The symptoms
of Ramsay Hunt syndrome are facial or ear pain.
Encephalitis
Hearing problems
Bacterial infections on the skin.
Medication can decrease the pain related to an outbreak and
can shorten healing time. They can also decrease the total
number of outbreaks.
There are three major drugs commonly used to treat genital
herpes symptoms: acyclovir (Zovirax), famciclovir (Famvir),
and valacyclovir (Valtrex). These are all taken in pill form.
Severe cases may be treated with the intravenous (IV) drug
acyclovir.
Management of acute herpes zoster
Antiviral medication to reduce pain and complications.
Should be started within 24 hours of first symptom .These
medications include:
 Acyclovir (Zovirax)
 Valacyclovir (Valtrex)
 Famciclovir (Famvir)
Management of Post herpetic Neuralgia
Tricyclic antidepressants, such as amitriptyline.
Opioids, such as methadone, morphine.
Lidocaine patch.
Anticonvulsants, such as gabapentin.
Capsaicin cream.
Topical anesthetics, including benzocaine.
Non-pharmacologic treatment
Apply cool water compresses to the skin or soak in a
bathtub filled with cool water
Add finely ground oatmeal to the bathtub.
Apply calamine lotion to th affected areas.
Trim your fingernails to avo infection.
Wear loose-fitting clothing.
Prevention
o Shingles vaccine (Zostavax)
➤ It is given to people 60 years of age and older who have
already had the chickenpox.
The shingles vaccine is a live vaccine given as a single injection,
usually in the upper arm. The most common side effects of the
shingles vaccine are redness, pain, tenderness and swelling at t
at the injection site, and headaches.
Prognosis
Many cases of shingles go away by themselves, with or without
treatment
• The rash and pain should be gone in two to three weeks
• However, shingles may last longer and be more likely to recur
if the person is older, especially older than 50 years of age, or if
they have a serious medical problem
Candidiasis
MONILIASIS / CANDIDOSIS / Yeast Infection
Infectious agent: candida albicans
➤ An infection that ranges from mild superficial fungal
infection, to systemic and potentially life-threatening disease.
Candidiasis
It's a type of yeast that normally lives in small amounts in
places like your mouth and belly, or on your skin without
causing any problems. But when the environment is right, the
yeast can multiply and grow out of control.
PATHOGNOMONIC SIGN- cheese like discharge
A Yeast Infection Discharge...Looks Like Cottage Cheese
Beauvaria Bassiana - is a fungus which causes a disease
known as the white muscadine disease in insects.
They cause infection when:
a) There is rise in blood glucose, as in diabetes mellitus,
b) The person's resistance is lowered, especially when due
to cancer;
c) The person is taking an immunosuppressive drug, exposed
to radiation, aging or when infected with the human
immunodeficiency virus. (HIV).
16
d) The level of estrogen rises in pregnant woman;
e) They may be introduced systematically by intravenous or
urinary catheters, drug abuse, hyperalimentation,
f) Broad-spectrum antibiotics are used, as these depress
normal flora and allow candida microbes to proliferate
Signs and symptoms
Nails (onychomycosis)
Onychomycosis is a fungal infection of the toenails or
fingernails that may involve any component of the nail unit,
including the matrix, bed, or plate. Onychomycosis can cause
pain, discomfort, and disfigurement and may produce serious
physical and occupational limitations, as well as reducing
quality of life.
The skin (diaper rash)
Though diaper rashes are usually caused by leaving a wet or
soiled diaper on too long, once the baby's skin is irritated,
infection is more likely. Check to see if the bottom is red and
sensitive, and if there's a raised red border around the sores.
Have the pediatrician check for candidiasis. It can be treated
with an antifungal cream.
Vagina (monilasis)
Three out of four adult women will get at least one yeast
infection during their lifetime. This occurs when too much
yeast grows in the vagina. (Men also can get a genital yeast
infection, but it's much less common).
A yeast infection typically happens when the balance in the
vagina changes. This can be caused by pregnancy, diabetes, use
of some medicines, lubricants, or spermicides, or a weakened
immune system. Occasionally, the infection can be passed from
person to person during sex.
Esophagus
Esophageal candidiasis is an opportunistic infection of the
esophagus by Candida albicans. The disease usually occurs in
patients in immunocompromised states, including post-
chemotherapy and in AIDS.
TREATMENT
Nystatin - for oral thrush
Clitrimazole, Fluconazole, Ketoconazole - for mucous
membrane and vaginal infection
Fluconazole or Amphotericin for systemic infection
Prevention:
It may not be possible for all women to prevent yeast
infections, but here's what they can do to lower the odds.
Wear breathable underwear. Cotton is the best choice. It doesn't
hold onto heat or moisture. It will help keep women dry.
Keep things loose. Make sure the jeans, skirts, underwear, yoga
pants, tights, pantyhose, etc. aren't too snug. They can boost the
body temperature and increase the amount of moisture around
the private parts and raises the chances for a yeast infection
AIDS
Acquired immune deficiency syndrome or Acquired
immunodeficiency syndrome (AIDS) is disease of the human
immune system caused by the human Immunodeficiency
virus (HIV)
HIV refers to the Human Immunodeficiency Virus which causes
AIDS
RA 8504 - 1998
RA 11166 -2019 repealed - 21 y/o for HIV testing
Section 1. Title. - This Act shall be known as the "Philippine
AIDS Prevention and Control Act of 1998."
Sec. 2. Declaration of policies. Acquired Immune Deficiency
Syndrome (AIDS) is a disease that recognizes no territorial,
social, political and economic boundaries for which there is no
known cure. The gravity of the AIDS threat demands strong
State action today, thus:
(a) The State shall promote public awareness about the causes,
modes of transmission, consequences, means of prevention and
control of HIV/AIDS through a comprehensive nationwide
educational and information campaign organized and
conducted by the State. Such campaigns shall promote value
formation focus on the family as a basic social unit, and be
carried out in all schools and training centers, workplaces, and
communities. This program shall involve affected individuals
and groups, including people living with HIV/AIDS.
(b) The State shall extend to every person suspected or known
to be infected with HIV/AIDS full protection of his/her human
rights and civil liberties. Towards this end:
(1) compulsory HIV testing shall be considered unlawful unless
otherwise provided in this Act;
(2) the right to privacy of individuals with HIV shall be
guaranteed;
(3) discrimination, in all its forms and subtleties, against
individuals with HIV or persons perceived or suspected of
having HIV shall be considered inimical to individual and
national interest; and
(4) provision of basic health and social services for individuals
with HIV shall be assured.
CAUSATIVE AGENT
Virus classification
Group: Group VI (ssRNA-RT)
Family:Retroviridae
Genus:Lentivirus
Retroviruses are a family of viruses that are grouped together
based on how they are structured and how they replicate
within a host.
Retroviruses differ from other viruses in that each virion
contains two complete copies of the single-stranded RNA
genome.
Full-length genome is copied by the reverse transcriptase.
Origin
HIV is thought to have originated in non-human primates in
sub-Saharan Africa and transferred to humans early in the 20th
century
In 1981, cases of a rare lung infection called Pneumocystis
carinii pneumonia (PCP) were found in five young, previously
healthy gay men in Los Angeles.
There were reports of a group of men in New York and
California with an unusually aggressive cancer named Kaposi's
Sarcoma.
By the end of the year, there were 270 reported cases of severe
immune deficiency among gay men - 121 of them had died.
It is widely believed that HIV originated in Kinshasa, in the
Democratic Republic of Congo around 1920 when HIV crossed
species from chimpanzees to humans.
HIV was unknown and transmission was not accompanied by
noticeable signs or symptoms.
HIV primarily infects vital cells in the human immune system
such as:
 Helper T cells(specifically CD4+ T cells)
17

 macrophages Time from infection to the development of detectable

 Dendritic cells. antibodies is generally 1 -3 months, the time from HIV infection
to diagnosis of AIDS has been observed range of less than 1
When HIV is in circulation, it invades severa types of cells, the year to 15 years or longer
organism attaches to a protein molecule called CD4 and found
in the surface of the CD4 cells. Once the virus enters the CD4 DIAGNOSIS
cells, it inserts its genetic materials into the cells nucleus, •Enzyme Linked Immuno - Sorbent Assay (ELISA)
taking over the cell to replicate itself and eventually the CD4 - WESTERN BLOT
cell dies after having been used to replicate HIV. Ora Quick HIV test - oral swab results in 20 minutes Home
Access HIV test - finger prick result in 24 hours
A normal CD4 count is from 500 to 1,500 cells per cubic
millimeter of blood. CD4 counts decrease over time in persons
who are not receiving ART. At levels below 200 cells per cubic
millimeter, patients become susceptible to a wide variety of Ols,
many of which can be fatal.

Main symptoms of AIDS

Neurological
- Encephalitis
- Meningitis
Eyes
- Retinitis
Lungs
- Pneumocystis
pneumonia – Tuberculosis (multiple organs)
- Tumors
Skin
- Tumors
Gastrointestinal
Esophagitis Reverse transcriptase inhibitors:
- Chronic diarrhea Zedovudine (ZDV) - Retirvir
- Tumors Zalcitabine - Havid
Stavudine - Zerit
Minor Signs: Lamivudine -Epivir
1. Persistent cough for one month Nevirapine - Viramune
2. Generalized pruritic dermatitis Didanosine - Videx
3. Recurrent herpes zoster
4. Oropharyngeal candidiasis Protease inhibitors:
5. Chronic disseminated herpes simplex Saquinavir - Invarase
6. Generalized lymphadenopathy Ritonavir - Norvir
Indinavir - Crixivan
TB LYMPH NODE
Its the most frequent presentation of extrapulmonary Non- reverse transcriptase inhibitors:
tuberculosis, usually occurring in the cervical region Efavirenz
("scrofula"). Delavirdine

In HIV-negative individuals, lymphadenitis tends to be unifocal Current treatment for HIV infection consists of highly active
and localized. antiretroviral therapy, or HAART.

HIV-positive people, on the other hand, almost always have Current HAART options are combinations (or "cocktails")
multifocal disease, systemic symptoms, and either pulmonary consisting of at least three drugs belonging to at least two
or other organ involvement by active tuberculosis. types, or "classes,"

1. Pneumocystitis carinii pneumonia The development of antiretroviral drugs, have enabled people
2. Oral candidiasis with access to treatment to live long and healthy lives with HIV.
3. Toxoplasmosis of the CNS
4. Oropharyngeal candidiasis Health Education
5. Pulmonary / extra - pulmonary tuberculosis 1. Know the patient
6. Cancer 2. Avoid Fear tactics
a. Kaposi's sarcoma 3. Avoid judgmental and moralistic messages
b. Cervical dysplasia and cancer. 4. Be consistent and concise
c. Non-Hodgkin's lymphoma 5. Use positive statement

HOW CAN IT BE TRANSMITTED? Practice universal / standard precaution

 Blood transfusion -handwashing
 Breast feeding
 Perinatal transmission THE FOUR Cs in the Management of HIV/AIDS
 Sexual relations Compliance
 Sexual contact Counseling/education
 Contaminated Syringes
HIV TREATMENT as PREVENTION
INCUBATION PERIOD (A HIGHLY EFFECTIVE STRATEGY TO PREVENT THE SEXUAL
.VARIABLE TRANSMISSION OF HIV)
18

People living with HIV who take HIV medication daily as

prescribed and get and keep anze Condoms undetectable viral
load
have effectively no risk of sexually transmitting HIV
Gonorrhea
Causative agent: Neisseria gonorrheae (GC)
Gram negative diplococci
Mode of Transmission
► Contact with exudates from the mucous membrane of
infected persons, usually as a result of sexual activity
► May occur in the uterus upon rupture of the membranes
▸ Direct contact with contaminated vaginal secretions of the
mother as the baby passes comes out of the birth canal
Incubation Period:
>> 2-3 days with most symptoms occurring between 4-6 days
Causative Agent
▸ Treponema pallidum- a Gram (-), motile spirochete
Incubation Period
► 10-90 days, average of 3-6 weeks
PRIMARY SYPHILIS
▸ Typically via direct sexual contact with the infectious lesions
of a syphilitic person
► 10-90 days after the initial exposure, a skin lesion appears at
the site of contact usually the GENITALIA
► CHANCRE
A firm, painless skin ulceration localized at the point of initial
exposure to the spirochete
Often on the penis, vagina, or rectum
May persist up to 4-6 weeks and usually heals without
treatment
‣ Chancre associated with lymphadenopathy

In women SECONDARY SYPHILIS

Less advanced symptoms ▸ RASHES
Infection can affect the: Symmetrical, reddish-pink, non-itchy
- Uterus Usually on the trunk and extremities and can involve the palms
- Fallopian tubes of the hands and soles of the feet
- Ovary ▸ Mucous patches may also appear on the genitals or in the
Development of Pelvic Inflammatory Disease (PID) mouth
- Cramps and pain -Condyloma lata
- Bleeding between menstrual period
- Vomiting LATENT SYPHILIS
▸ No clinical symptoms, but serologic test proves to be reactive
▸ Flu-like symptoms
In Men
▸ Yellowish discharge from the penis
LATE (TERTIARY) SYPHILIS
▸ Epididymitis
LATE BENIGN
▸ Dysuria and discharges
CARDIOSYPHILIS
▸ Urethritis
NEUROSYPHILIS
▸ Infection may affect the:
- Prostate
DARK FIELD ILLUMINATION TEST
- Seminal vesicles
- Epididymis VENEREAL DISEASE RESEARCH LABORATORY (VDRL) TEST
- Testicles
. FLUORESCENT TREPONEMAL ANTIBODY ABSORPTION (FTA-
OPHTHALMIA NEONATORUM ABS)

Diagnostic Exams TREATMENT

Penicillin G Benzathine IM
In Female First choice treatment for all manifestations of syphilis
► THAYER MARTIN MEDIUM
Oral tetracycline or doxycycline
In Male > Given to nonpregnant patients who develop allergy to
▸ Gram Staining penicillin

MEDICAL TREATMENT
1. Ceftiaxone (Rocephin) Doxycycline
- For uncomplicated nonpregnant patients
2. Ceftiaxone (Rocephin) Doxycycline
- For uncomplicated gonorrhea in nonpregnant
patients
3. Ceftriaxone (Rocephin) Erythromycin
- For pregnant women with gonorrhea
4. Ceftriaxone with doxycycline or azithromycin
- In areas with coinfection with Chlamydia

Prevention and Control

▸ Sex education
▸ Case finding
▸ Contact tracing

SYPHILIS
Lues Venereal
Morbus gallicus