NCM 116 Lecture
but can be fatal to children younger than 1 year.
Gastrointestinal Communicable
Diseases
TYPHOID (ENTERIC FEVER)
● Typhoid is a bacterial infection that can lead to a high
fever, diarrhea, and vomiting. It can be fatal. It is
caused by the bacteria Salmonella typhi.
● Salmonella is a genus of rod-shaped Gram-negative
bacteria of the family Enterobacteriaceae.
● No known animal reservoirs.
● Shed in the urine or stool of infected persons
● Acute illness associated with fever It can also be
caused by Salmonella paratyphi, a related bacterium
that usually causes a less severe illness.
● Invading almost all the systems in the body; thus, it is
termed as a multi-systemic illness.
● Incubation period: typically 6 to 30 days
PARATYPHOID
 This is a condition which is caused by the bacteria,
Salmonella paratyphi. It mainly affects the
gastrointestinal system yet with time invades most of
the organs and systems in the body.
 Infectious disease caused by any of several organisms:
- S. schottmuelleri (paratyphi B),
- S. hirschfeldii (paratyphi C).
 Incubation period: 1 to 10 days
Incidence:
 An estimated 11–20 million people get sick from
typhoid and between 128 000 and 161 000 people die
from it every year, mostly in children
 Occurs worldwide, primarily in developing nations
whose sanitary conditions are poor. Typhoid fever is
endemic in Asia, Africa, Latin America, the Caribbean,
and Oceania
 Age- Children and young adults; 5 to 19 years of age
 Sex- both but common in Men due to Environmental
exposure, presumably due to sex-linked differences in
hygiene practices and dining-out behavior.
 Season- particularly common during summer- bacteria
spread faster in warmer weather
 Location- more prevalent in endemic areas.
Risk factors:
 Travel to endemic areas
 Poor hygiene habits
 Poor sanitation conditions
 Proximity to flying insects feeding on feces
 Contact with someone who recently suffered from
typhoid fever( Chronic Carrier An asymptomatic
patient who continues to have positive stool) from
acute illness
 Crowded housing
 Children and young adults
Cause:
 Caused by dangerous bacteria called Salmonella typhi
 After reaching the bloodstream, the bacteria attack the
gastrointestinal tract, including the liver, spleen, and
muscles. Sometimes, the liver and spleen also swell
Mode of transmission:
 Fecal-oral transmission route
 Salmonella typhi is passed in the feces and sometimes
in the urine of infected people
 If you eat food that has been handled by someone who
has typhoid fever and who hasn't washed carefully
after using the toilet, you can become infected
 Most people become infected by drinking
contaminated water.
 The bacteria may also spread through direct contact
with someone who is infected.
 - Abdominal pain, tenderness (Gastrointestinal
symptoms)

Nursing interventions:

 Assess the level of pain, location, duration, intensity,

and characteristics

 Provide warm compresses on areas with pain

 Administer analgesics as prescribed

- Rose spots develops usually 1-5mm in size

- The rose spots are blanchable papules; generally

resolve within 2-5 days.

3rd week “worsening symptoms”

- Intestinal bleeding
Clinical manifestations: Nursing intervention:
(Symptoms may vary from mild to severe, and usually begin 1  Assess for bleeding in stool
to 2 weeks after exposure)
- The patient may start passing blood or dark tar like
1. The manifestations can be summed up by fever, stool due to internal bleeding from the intestines.
Weakness, Headache and abdominal pain
 Monitor Hemoglobin (HGB)
2. The onset of symptoms occurs 5 to 21 days after
ingestion  Monitor heart rate and blood pressure

- It depends on the following how severe the  Administer blood products

symptoms will be:
 Administer pantoprazole (Protonix)
 Age
- Hepatosplenomegaly (liver and spleen)
 Overall health condition
- Intestinal perforation
 Number of organism that enters the body
Nursing intervention:

 Encourage increase in fluid intake

1st week “ Stepwise fever”
 Monitor the status of hydration as needed
- Rising body temperature over time
 Monitor the fluid intake daily
- Drop of temperature by the next morning
 Collaborate with other medical team for IV fluid
Nursing interventions: administration.
 Monitor patient temperature degree and patterns  Liver transplant
 Observe for chills and profuse diaphoresis  Gallbladder should be resected
 Provide tepid sponge baths and avoid the use of ice
water and alcohol

 Administer antipyretics as prescribed

Diagnostic Procedure:

2nd week “ Rose spots” THE PATHOGNOMONIC SIGN - Blood culture

 - CBC
- Liver function test
- Electrolyte panel
- Polymerase chain reaction
- Radiography
- CT scanning and MRI
- Bone marrow aspiration
- Stool test
1. Blood culture is the gold standard test for the diagnosis
of typhoid and must be sent before starting antibiotics
 At least 20ml of blood should be obtained from an
adult patient and inoculated (10ml each) in to the
aerobic and anaerobic blood culture bottles.
 For children the following volumes are
recommended in the single pediatric bottle:
 3-5 ml- for children < 5years
 5-10ml –from children 5-12 years
 10-15ml –from children >12 years
 blood cultures can turn positive as early as 4 hours
2. CBC
 Usually anemic
 Have normal blood counts
 Slightly raised erythrocyte sedimentation rate (ESR)
 Occasional thrombocytopenia, and relative
leucopenia
 CRP is not required
3. Liver function test- LFTs should be done to differentiate
from acute viral hepatitis, which can begin with non-
localizing fever.
 Liver transaminase usually rise to twice
 serum bilirubin values usually rise to twice
4. Electrolyte panel
 Mild hyponatremia and hypokalemia.
5. Polymerase chain reaction
 Rapid diagnosis method for Salmonella typhi
 Genomic DNA of Salmonella typhi is detected
 Offers the best sensitivity and specificity
6. Radiography- Radiography of the kidneys, ureters, and
bladder is useful if bowel perforation is suspected.
7. CT scanning and MRI- These studies may be warranted
to investigate for abscesses in the liver or bones, among
other sites.
8. Bone marrow aspiration
 The most sensitive method of isolating S typhi is
BMA culture.
 Culture of bone marrow aspirate is 90% sensitive
until at least 5 days after commencement of
antibiotics
 This technique is extremely painful, which may
outweigh its benefit
9. Stool test
 Stool culture results are positive for S typhi in
approximately 85%-90% of patients with typhoid
fever who present within the first week of onset.
 Stool culture showed 31.3% sensitivity, 91.5%
specificity
 Liquid stool foul, green-yellow (pea soup diarrhea)
containing large quantities of leukocytes and protein
and is resolved by treatment with chloramphenicol
(this group of patients showed daily improvement
with a drop in both fever and stool output)
Medical Management:
Pharmacologic therapy:
Antibiotic therapy is the only effective treatment for typhoid
fever
1. CIPROFLOXACIN- Inhibits enzyme, DNA gyrase, in
susceptible bacteria, interfering with bacterial cell
replication.
- First-line antibiotics, quinolone antibiotics
- Expensive
- Through:
❖ Oral
 - May be given with food to minimize GI upset, Give - Patient weight greater than 60kg: 1 gm q24hr
at least 2 hrs before or 6 hrs after antacids, calcium,
- NEONATES: 10–20 mg/kg once daily
iron, zinccontaining products.
- Dosage: 750mg ( twice daily)
❖ IV infusion
❖ IV route- Infuse over 60 min (reduces risk of venous
irritation). - ADULTS, ELDERLY: 250–500 mg once daily
- CHILDREN, NEONATES: 10 mg/kg once daily
- Dosage: 500 mg q6hr
- Duration of treatment: 14 days; twice daily - Duration of treatment: 7 – 10 days

Therapeutic Effect: Bactericidal Therapeutic Effect: Bacteriostatic or bactericidal, depending

on drug dosage.
Contraindications: Hypersensitivity to ciprofloxacin, other
quinolones. TOXIC REACTIONS:

Cautions: Renal impairment  Antibiotic-associated colitis, other super infections may

result from altered bacterial balance in GI tract.
NURSING CONSIDERATIONS:
 Acute interstitial nephritis, hepatotoxicity occur rarely
Question for:

- History of hypersensitivity to ciprofloxacin,

NURSING CONSIDERATIONS:
quinolones; myasthenia gravis, renal/hepatic
impairment. Asses for:

Intervention: - History of hepatitis

- Allergies to azithromycin, erythromycins.
 Obtain urinalysis for microscopic analysis for
- Infection (WBC count, appearance of wound,
crystalluria prior to and during treatment.
evidence of fever)
 Evaluate food tolerance
Check for:
 Monitor daily pattern of bowel activity, stool
- GI discomfort, nausea, vomiting. Monitor daily
consistency
pattern of bowel activity and stool consistency.
 Encourage hydration (reduces risk of crystalluria)
- Monitor LFT, CBC.
 Monitor for dizziness, headache, visual changes,
- Assess for hepatotoxicity: malaise, fever, abdominal
tremors, stomach upset, rash
pain, GI disturbances.
 Assess for chest, joint pain
- Be alert for super infection: fever, vomiting,
AZITHROMYCIN diarrhea, anal/genital pruritus, oral mucosal changes
(ulceration, pain, and erythema).
 Third line antibiotics
CEFTRIAXONE- Treatment of susceptible infections due
 Used for multidrug resistant typhoid
to gram-negative aerobic organisms, some gram-positive
 Binds to ribosomal receptor sites of susceptible organisms
organisms, inhibiting RNA dependent protein synthesis
 Second-line antibiotics, Third generation
 Through: cephalosporin.

❖ Oral  Through:

- Give without regard to food ❖ IM- Add 2.4 mL Sterile Water for Injection to
each 250 mg to provide concentration of 100 mg
- Patient weight less than 60kg: 1gm loading dose PO,
then 500mg q24hr for 7-10 days. ❖ IV- for IV push, administer over 1–4 min
(maximum concentration: 40 mg/mL). For
 intermittent IV infusion (piggyback), infuse over - Infections caused by penicillinase-producing
30 min organisms

Dosage: adult- 4g daily for 2 days, followed by 2g/ day till 2 Cautions:
days after fever subsides
- History of allergies, esp. cephalosporins, renal
Children- 75mg/kg/day impairment

Duration: 10-14 days NURSING CONSIDERATIONS

Contraindications: History of hypersensitivity/anaphylactic Question for:

reaction to cefTRIAXone, cephalosporins. Hyperbilirubinemic
- History of allergies, esp. penicillins, cephalosporins;
neonates, esp. premature infants, should not be treated with
renal impairment.
ceftriaxone
Intervention
Cautions: Hepatic impairment, history of GI disease
- Promptly report rash (although common with
NURSING CONSIDERATIONS
ampicillin, may indicate hypersensitivity) or diarrhea
Baseline assessment (fever, abdominal pain, mucus and blood in stool
may indicate antibiotic-associated colitis). Evaluate
- Obtain CBC, renal function tests. Question for history
IV site for phlebitis
of allergies, particularly cephalosporins, penicillins.

Intervention
CHLORAMPHENICOL
- Assess oral cavity for white patches on mucous
membranes, tongue (thrush) - First-line antibiotics
- Monitor daily pattern of bowel activity, stool
- Inhibits protein synthesis in susceptible bacteria at
consistency
the level of the 50S ribosome.
- Monitor I&O, renal function tests for nephrotoxicity,
CBC. - Not used much due to reliability
- Be alert for super infection: fever, vomiting,
diarrhea, anal/genital pruritus, oral mucosal changes - Less expensive
(ulceration, pain, erythema Through:

❖ Oral
AMPICILLIN- Treatment of susceptible infections, Inhibits
cell wall synthesis in susceptible microorganisms by ❖ IV
binding to PCN binding protein
Dosage: 500 mg q6hr till fever subsides, then 0.25g q6hr
- First-line antibiotics : Penicillin for another 5-7 days

- Through: Duration: 14 days

❖ Oral Therapeutic Effects: Bacteriostatic action

❖ IM Intervention:

❖ IV - Monitor signs of aplastic anemia, including unusual

fatigue, shortness of breath with exertion, and
Dosage: 1000-2000 mg q6hr bruising. Notify physician immediately if these signs
occur.
Duration: 14 days
- Monitor signs of angioedema, including rashes,
Contraindications: raised patches of red or white skin (welts),
burning/itching skin, swelling in the face, and
- Hypersensitivity to ampicillin or any penicillin
difficulty breathing. Notify physician immediately of
these signs.
 - Monitor newborns for signs of gray syndrome (also - All household members of a confirmed case (including
called chloramphenicol toxicity in newborns), adults and children over 6 months of age)
including gray/ashen skin color, cyanosis, respiratory
- All healthcare workers
distress, hypotension, vomiting, and hypothermia
- Monitor signs of CNS toxicity, including confusion, - All food handlers
delirium, depression, and headache. Report these
signs to the physician.  Hand washing

Supportive treatment:  Boiling of water before consumption

 Antipyretics as required  Avoid raw vegetables and fruits that cannot be

 Adequate rest, hydration, and correction of fluid-
electrolyte imbalance
 Adequate nutrition: a soft, easily digestible diet should
be continued unless the patient has abdominal
distension or ileus
peeled. When you eat raw fruit or vegetables that
can be peeled, wash them thoroughly and peel them
yourself. (Wash your hands with soap first.) Do not
eat the peelings
 Avoid foods and beverages from street vendors.

 In case of severe illness monitor blood pressure, blood

sugar, electrolytes, hemoglobin platelet counts and
liver functions as indicated
LESPTOSPIROSIS

Surgical Management:

 Surgery is usually indicated in cases of intestinal

perforation.

 Most surgeons prefer simple closure of the perforation

with drainage of the peritoneum.

 Small-bowel resection is indicated for patients with

multiple perforations.

Prevention:

 Vaccines: Two vaccines against typhoid are currently

available in Pakistan. Causative Agent: Leptospira Interrogans

- A single dose of injectable Vi polysaccharide vaccine Mode of Transmission: Through wound and mucous
for children > 2 years of age. Revaccination is membrane and ingestion of contaminated food
needed every 3 years for continued protection.
Incubation period: 2-3 days (CDC) and 7-19 days (WHO)
- A single dose typhoid conjugate vaccine is approved
for use in children ≥ 6 months of age. Offers
protection for at least 3 years to adults, children, and
infants over 6 months of age. Revaccination
schedule is under study at the moment.

Vaccinate everyone, including:

BACILLARY DYSENTERY
(SHIGELLOSIS)

Shigellosis – is a diarrheal disease cause by a group of

bacteria called Shigella.

CAUSATIVE AGENT: Shigella

- are Gram-negative, nonmotile, anaerobic, non-

spore-forming rods.
FOUR SPECIES: MANIFESTATIONS:

• Serogroup A - S. dysenteriae (12)  Fever

• Serogroup B – S. flexneri (6)  Nausea

• Serogroup C - S. boydii (18)  Vomiting

• Serogroup D - S. sonnei (1)  Stomach cramps

INCIDENCE:  Diarrhea

80–165 million cases  Blood and mucus in stool

600,000 deaths annually  Tenesmus
20–119 million illnesses and 6,900–30,000 deaths are
attributed to foodborne transmission. COMPLICATIONS:

 Dehydration
INCUBATION PERIOD: 12-72 hours
 Convulsion
SYMPTOMS LAST: 4-7 days
 Toxic megacolon
PERIOD OF COMMUNICABILITY: Lasts for 4 weeks from
 Intestinal perforation
onset of illness
 Rectal prolapse
RESERVOIR: Humans are the only significant natural
reservoir.  Hemolytic uremic syndrome
MODE OF TRANSMISSION: Fecal-oral route  Reactive arthropathy (Reiter’s syndrome)
-Contaminated food or water  Bacteremia
-Oral-anal sex

-Flies

RISK FACTORS:

 Being a toddler

 Living in group housing

 Living or traveling in areas that lack sanitation

 Being a sexually active gay male

DIAGNOSTIC TEST:  Amoebae are parasites that can be very easily found
in contaminated food or drink. They enter the body
 Stool Exam
through the mouth when the contaminated food or
 Sigmoidoscopy drink is swallowed. The amoebae are then able to
 Polymerase Chain Reaction move through the digestive system and take up
residence in the intestine and cause infections like
 Stool Culture
amoebiasis.

TREATMENT: B. Two types of Amoebiasis

 Oral rehydration solution  Intestinal Amoebiasis

 Antibiotics (ciprofloxacin, azithromycin)  Extraintestinal Amoebiasis

 OTC pain reliever

*Do not take OTC diarrheal medicine C. Causes: Entamoeba histolytica

2 developmental stages:
Prevent spread of Shigella to others:
1. Trophozoites/vegetative form
 Wash hands often 2. Cyst
 Do not prepare the food

 Do not swim D. Possible Causes:

 Do not have sex  Eating or Drinking contaminated water or food
 Stay at home  Touching, and bringing to your mouth.
Personal Prevention:  Eating a food on which mosquito had sat, after
sitting on the stool of a person infected with
 Good personal hygiene
entamoeba histolytica
 Clean and cook foods thoroughly.
 Eating vegetables and fruits which have been
 Minimizing fecal–oral exposures during sexual contaminated by the harmful bacteria.
activity
 Eating Non-Veg foods (meat and intestines of
 When traveling internationally, follow safe food and animals – goat, pig, beef, etc.),
water habits
 vegetables grown in soil contaminated by faeces can
 Control flies transmit the disease.

 amoebiasis is a highly contagious disease, it may be

transmitted from one person to other through direct
AMOEBIASIS/AMOEBIC contact.
DYSENTERY/AMEBIASIS/ENTAMOE  Unhygienic Conditions and Poor Sanitation areas
BIASIS
 Amoebic dysentery can also be spread by anal sex or
A. Definition directly from person to person contact

 Amoebiasis is an infection of small intestine, which is

caused by an protozoan called Entamoeba E. Source: Human Excreta
histolytica. It is simply called – Amoebic dysentery. F. Incubation Period:
This is usually contracted by ingesting water or food
The incubation period in severe infection is three
contaminated by amoebic cysts. Amoebic abscesses
days. In subacute and chronic form it lasts for several
may form in the liver , lungs , and brain and
elsewhere in the body.
 months. In average cases the incubation period varies  Indirect hemagglutination (IHA)
from three to four weeks
 Antigen Detection

G. Period of Communicability: The microorganism is  Molecular Diagnosis

communicable for the entire duration of the illness.
 Recto sigmoidoscopy and colonoscopy
H. Modes of Transmission:  Radiography, Ultrasonography, Computed
1. Passed from one person to another through fecal- tomography (CT) and Magnetic resonance imaging
oral transmission. (MRI)
2. Transmitted through direct contact, through sexual
contact by urogenital, oroanal, and rectogenital
sexual activity. L. Medical Management:
3. Through indirect contact, the disease can infect  Metronidazole (Flagyl)
humans by ingestion of food especially uncooked
leafy vegetables or foods contaminated with fecal  Tinidazole (Tindamax, Fasigyn)
materials containing E. histolytica cysts.
 Three luminal drugs; iodoquinol (Diquinol and
4. Food or drinks maybe contaminated by cyst through
others), paromomycin (Humatin) and diloxanide
pollution of water supplies, exposure to flies, use of
furoate (Furamide)
night soil for fertilizing vegetables, and through
unhygienic practices of food handlers.  Lost fluid and electrolytes should be replaced

I. Risk Factors: M. Nursing Management:

 Alcoholism
1. Observe isolation and enteric precaution and
 Cancer
Provide health education
 Malnutrition
 Immunosuppression 2. Proper collection of stool specimen
 Older or younger age
3. Skin care
 Pregnancy
 Recent travel to a tropical region 4. Mouth care
 Recent sexual history with unprotected anal or
5. Provide optimum comfort.
oral-anal contact
6. Diet
J. Signs and Symptoms:
 diarrhea (which may contain blood)
 stomach pains N. Nursing Intervention:
 cramping  Pain Management
 nausea  Environmental Management
 loss of appetite  Fluid Management
 fever.  Diarrhea Management
 Fluid Monitoring
 Perineal Care
K. Diagnostic Tests:  Energy Management
 Stool examination  Exercise Promotion
 Temperature Regulation
 Biopsy  Nutrition Management
 Weight Gain Assistance
 Culture of stool
 Eating Disorders Management
 Blood Test  Pressure Ulcer Care
 Infection Protection
 Enzyme immunoassay (EIA)
 Infection Control
  Surveillance
O. Prevention:
 Improved water supply
 Sanitation
 Food safety
 Health education of the public as well as health
personnel at all levels about sanitation and food
hygiene
 General social and economic development
CHOLERA “blue death”
Definition
Acute bacterial disease of GIT characterized by
profuse secretory diarrhea. People can get sick when they
swallow food or contaminated water with the bacteria. The
bacteria is often mild or without symptom, but can
sometimes be severe and life-threatening.
Causative Agent: VIBRIO CHOLERAE
• Gram-negative bacteria
• Facultative anaerobe and comma-shaped bacteria
• Toxin producing variants are known as O1 and O139
Incubation Period: It takes between 2 hours to 5 days for a
person to show symptoms after ingesting contaminated food
or water. 12 hours to 5 days.
Etiology:
 Cholera remains a global threat to public health and an
indicator of inequity and lack of social development. 
 Estimated that every year, there are roughly 1.3 to 4.0
million cases, and 21 000 to 143 000 deaths
worldwide.
 Cholera is endemic in Benin with cases reported
annually since 2016. In 2021, First epidemic wave of
cholera between March and April, in the commune of
So-Ava, Atlantique Department, with 103 cases
 A second epidemic wave began in September 2021,
with 1430 cases and 20 deaths (CFR: 1.4 %) reported
from 1 September 2021 to 16 January 2022.
Mode of Transmission:
• Fecal-Oral Transmission
• 5 Fs : Fingers, flies, fields, fluids & food
Signs & Symptoms:
Rice-water stool
Abdominal cramps
Vomiting
Intravascular Dehydration (muscle cramps)
Shock
Risk Factors:
1. Poor sanitary condition
2. Raw or undercooked foods
3. Hypochlorhydia
4. Type O blood
Diagnostic Procedure:
1. Stool Culture – A definitive diagnosis of cholera is
based on isolation of the organism from clinical
samples, which also permits a determination of the
antibiotic susceptibility profile.
2. Rapid Cholera Dipstick Test – The test is based on
immunochromatography and colorimetric reporting,
and detects V. cholerae O1 and O139 antigens binding
to antibodies fixed on a nitrocellulose strip.
A VC test dipstick was placed in the test tube such
that approximately the last centimetre of the strip was
immersed in the faeces. After 10 min (or upon
appearance of the positive control band), the dipstick
was removed and test results were read. Tests were
judged as positive, negative, or indeterminate
Treatment:
1. Lactated Ringer’s Solution
2. Oral rehydration therapy: ORS (oral rehydration salt)
 3. Vitamin A Mode of Transmission: Person-to-person contact.

4. Antibiotic: Tetracycline (drug of choice); Doxycycline;  The virus can be spread through respiratory
Chloramphenicol droplets/secretions such as saliva.

 An infected person in contact with a healthy

Nursing Management: individual may acquire the disease through a direct
and close contact.
1. Maintain and restore the fluid and electrolyte balance
2. Enteric Isolation  Sneezing
3. Sanitary disposal of excreta  Coughing
4. Adequate provision of safe drinking water
 Talking
5. Good personal hygiene
 Sharing personal items (utensils, cups)
Prevention:  Activities such as: singing, dancing, kissing.
1. Vaccines
Incubation period:
 Vaxchora
Usually 7-25 days.
 Dukoral
Ave- 16-18 days
 ShanChol

 Euvichol-Plus

2.  Make sure to drink and use safe water to brush your teeth,
wash and prepare food, and make ice

3. Wash your hands often with soap and safe water

4. Use latrines or bury your poop; do not poop in any body of

water

5. Cook food well (especially seafood), keep it covered, and

eat it hot. Peel fruits and vegetables

6. Clean up safely in the kitchen and in places where the

family bathes and washes clothes

MUMPS VIRUS
What is MUMPS?

 it is a viral infection that primarily affects the saliva-

producing glands or salivary glands that are located
near the ears.

 Mumps may cause swelling in one or both of these

glands.

Causative Agent:

 Mumps virus (paramyxovirus)

Risk Factors:  Encephalitis

 location  Deafness
 exposure
 unvaccinated
 immunocompromised Diagnostic Tests:

1. CBC (COMPLETE BLOOD COUNT)

Clinical Manifestations:
A complete blood cell count reveals a normal,
PRODROMAL PHASE decreased, or elevated white blood cell (WBC) count, with
predominating lymphocytes in differential count.
 low-grade fever

 headache 2. INFLAMMATORY MARKERS

 Malaise Sera inflammatory markers, such as C-reactive
protein or erythrocyte sedimentation rate (ESR), can be
 muscle pain
elevated to show a nonspecific systemic inflammatory
 loss of appetite response.

 sore throat
3. SERUM AMYLASE
EARLY ACUTE PHASE
Serum amylase (amylase-S) is elevated in mumps parotitis.
 Parotitis

4. SERUM LIPASE

Serum lipase (amylase-P) is elevated in pancreatitis.

5. rRT-PCR

Real-time reverse transcription polymerase chain reaction

(rRT-PCR) - can be used to detect MuV RNA.
ESTABLISHED ACUTE PHASE
6. ULTRASOUND
 Orchitis
Ultrasounds such as Echo color doppler ultrasound is more
effective at detecting orchitis than ultrasound alone.

Oophoritis
Medical Management:
 Mastitis
 Administer analgesics to the patient such as

acetaminophen or ibuprofen.
Meningitis
 Perform a proper application of warm or cold packs
to help manage the swollen an painful area.

Teach the patient the same procedure as a home remedy.

 Advise the client to perform a light diet. Acidic foods

and liquids must be avoided to lessen the oral pain
and discomfort.
  Encourage the patient to have adequate rest and  Ectoparasitism
fluid intake.  Endoparasitism
 Teach the patient the importance of proper hand  Mesoparasitism
washing, and how to properly perform hand
washing.
Main Classes:
 Stronger analgesics are needed along with bed rest,
scrotal support and application of an ice pack to 1. Protozoa
manage patients who develop complications such as - Microscopic one-celled organisms
orchitis. - free-living or parasitic in nature
 Advise the patient to remain isolated for a couple of - They are able to multiply in humans
days from the onset of symptoms to minimize the
- Include: malaria, leishmania, pneumocystis,
risk of infecting others.
amoeba, babesia, flagellates, trichomonas,
 Consult the patient about being immunized, and microsporidia, and coccidian.
consider to have immunization through vaccines to
be protected. 2. Helminths
- large, multicellular organisms

Prevention:
 Avoid Exposure.
 Be Vaccinated.
The mumps vaccine is usually given as a combined
measles-mumps-rubella (MMR) inoculation. Two doses of the
MMR vaccine are recommended before a child enters school.
Those vaccines should be given when the child is: Between
the ages of 12 and 15 months and between the ages of 4 and
6 years old.
- generally visible to the naked eye in their adult
stages
- live inside the host in the intestine or other
organs
- includes: flatworms, roundworms, thorny-headed
worms
3. Ectoparasites
- Live outside on the surface of the host and are
dependent on the host to complete their life-
cycle.
- broadly include blood-sucking arthropods
- includes: lice, mites, scabies, bedbugs, ticks, fleas

PARASITISM
Incidence:
Parasitism is defined as the relationship between
WORLDWIDE
different species in which one organism lives on or in the
other organism and benefits from it by causing some harm. Protozoan
The organism that is benefitted is called the parasite, • According to WHO reports there are 450 million
while the one that is harmed is called the host. people infected with intestinal parasites in the world
(2016)
The parasites can be microscopic or large enough to
see with the naked eye, and they survive by feeding from the • It is estimated that more than two billion people are
host. affected globally, mostly in tropical and sub- tropical
parts of the world (2021)
They can also spread parasitic infections
Helminths
Types of Parasitism:
• More than 1.5 billion people, or 24% of the world's
 Obligate Parasitism population. (2022)
 Facultative Parasitism
Ectoparasites • work in childcare, work with soil regularly, or work in
other contexts where you come into contact with
• Ectoparasites in the general population is low, but
feces on a consistent basis
can become high in vulnerable groups. (according to
PAHO)
Diagnostic Exam:

PHILIPPINES • Fecal (stool) exam

• Trichiura (whipworm), the mean observed • Endoscopy/ Colonoscopy

prevalence was 27.9% for Luzon, 53.6% for the • Blood test
Visayas and 16.8% for Mindanao. • Imaging test
• The mean observed prevalence of hookworm was
4.5% for Luzon, 18% for the Visayas and 11.3% for
Prevention:
Mindanao.
• finding out which parasites are prevalent in their
area or in locations they may travel
Route of Transmission:
• taking precautions, such as using insect repellant in
1. Fecal-oral (oral route) places where mosquitoes are common
2. Nasal route
• being careful to eat only well-cooked fish and meat
3. Urogenital route
• drinking water only from bottles with a sealed top
4. Anal route while traveling
5. Skin and mucous membrane route • Wash your hands regularly, especially after handling
uncooked food or feces.
• taking care when bathing in freshwater lakes or
Incubation Period:
rivers
The incubation period ranges from 1–2 days (enteral • Avoid swallowing water from lakes, streams, or
phase) to 2 to 8 weeks (parenteral phase) or more, depending ponds.
on the infectious dose and possibly the species of parasite.
• using mosquito nets
How do I know if I have parasite?
• wearing protective clothing
• unexplained constipation
• eliminating stagnant water
• diarrhea or persistent gas
• Skin issues such as rashes, eczema, hives, and itching • following safe sexual practices
• Continuous muscle and joint pain
• Fatigue, even when you get enough sleep

Who is at risk?

• have a compromised immune system or are already

sick with another illness

• live or travel in tropical or subtropical regions of the

world

• lack a clean supply of drinking water

• swim in lakes, rivers, or ponds where Giardia or PARASITIC IN HUMANS

other parasites are common
PROTOZOA
HELMINTHS

HEPATITIS inflammation of the liver

Several causes:

• Alcoholism Hepa B Hepatitis B virus 6 wks to 6 mons

• Chemical intoxication
• Drug intoxication
• Microorganisms Heap C Hepatitis C virus 5-12 wks

• Hepatis A Hepa D Hepatitis D virus 3-13 wks

• Hepatis B Hepa E Hepatitis E virus 3-6 wks
• Hepatis C Unknown but
• Hepatis D HGVRNA can be
Hepa G Hepatitis G virus isolated from
• Hepatis E
blood 2 weeks
• Hepatis G after exposure
• Hepatis H Ranges from 15-
Hepa H Hepatitis H virus 50 days (28 days
average)

TYPES OF
OTHER NAMES MOT
HEPATITIS
Infectious Hepatitis

Hepa A Catarrhal Jaundice Fecal-oral

Epidemic Hepatitis
Serum Hepatitis Percutaneous
blood;
Hepa B Homologous hepatitis Oral;
Sexual
Viral hepatitis Transmission
Post transfusion Percutaneous
Heap C
hepatitis blood Manifestations: 3 Phases
Percutaneous
1. Pre-icteric Phase
blood;
• fever
Dormant type of Oral;
Hepa D • R upper guardant pain
Hepatitis B Sexual
Transmission; • easy fatiguability
vertical • weight loss
Hepa E Enteric hepatitis Fecal-oral • body malaise
Percutaneous • anorexia
Hepa G Human pegivirus
blood
• nausea
Hepa H
• vomiting
• anemia
TYPES OF
CA INCUBATION P 2. Icteric Phase
HEPATITIS
• with itchiness and pruritus
Hepa A Hepatitis A virus 2-6 weeks
• (+) tea colored urine
• (+) alcoholic stool
 • fever
• abdominal pain Nursing Management:
• symptoms persist
1. Provide adequate rest
• SELF LIMITING
2. Diet

3. post-icteric phase • low fat diet

• disappearance of jaundice starts • high CHO Butter ball diet
• s/s starts to disappear • CHON-moderate-infected patient High-recovering
patient
• patient is on the road to recovery
• energy level increases
Low-patient with complications

 No permanent immunity
Nursing Alert!

3 to 4 months is needed for the liver to  Hepa B is most fatal Preventive Measures
recover/regenerate
1. Immunization- Hepa B vaccine-given 6 weeks after birth
(front Liners)
Diagnostic Exams:
2. Avoid mode of transmission
1. Liver Enzyme Test determines the extent of liver
damage
 ALT
 AST
 ALP
 GGT
 LDH

2. Serum Antigen Antibody Test

HBsAg positive or reactive-patient is infected with

heap B and is able to pass the infection to others

Medical Management:

1. Symptomatic

2. Give hepatic protection

• Liver Aid
• Essentiale
• Silymarin
• Jetipar

3. Antiviral agent

• Lamivudine (Epivir HBV) 100 mg po for 1 yr

• Interferon 2 to 3x per week for 6 months