❑Aka cerebrospinal fever

❑Inflammation or infection of the

meninges
❑Causes
❑Ingestion of poison/drugs
❑Reaction to a vaccine or a pathogen
❑Etiologic agents ❑Bacterial meningitis
❑Viral meningitis ❑Causes
❑Directly invades the ❑HiB
meninges ❑Neisseria meningitis
❑Immune reaction ❑Streptococcus
❑Less severe pneumoniae
❑Types ❑Streptococcus
❑Enteroviruses agalactiae
❑Arboviruses ❑Fungal meningitis
❑Poliovirus ❑Chemical meningitis
❑Antibiotics, NSAIDs
❑MODE OF TRANSMISSION
❑During labor and birth
❑Droplet
❑Respiratory droplet
❑Direct invasion
❑Fever, severe headache, ❑(+) Kernig sign
and stiffness of the neck ❑Signs of ↑ ICP
and spine ❑Bulging fontanels in
❑Exaggerated and infants
❑Projectile vomiting
symmetrical DTR ❑Severe frontal headache
❑Signs of meningeal ❑Blurring of vision
irritation ❑Altered sensorium
❑Nuchal rigidity ❑Delirium, deep stupor,
❑Opisthotonos coma
❑(+) Brudzinski’s sign
❑Patient’s ❑Smear and blood
symptoms culture
❑Physical ❑Smear from
examination petechiae
❑CSF analysis ❑CT scan/MRI of the
❑Diagnostic head
❑Therapeutic
❑CSF gram staining
❑Antibiotic therapy
❑IV antibiotics for 2 wks
❑Oral antibiotics afterwards
❑Digitalis
❑Mannitol
❑Anticonvulsants/Sedatives
❑Paracetamol
❑HiB vaccine
❑Assess neurologic condition
❑Observe LOC
❑WOF for signs of ↑ ICP
❑Monitor fluid balance
❑Position the patient
❑WOF deterioration of patient’s condition
❑Maintain adequate nutrition
❑Isolation
❑A.K.A. Infantile Paralysis/Heine-Medin
Disease

❑An acute infectious disease characterized by

changes in the CNS which may result in
pathologic reflexes, muscle spasms, and
paresis or paralysis
❑CAUSATIVE AGENT ❑MODE OF
❑Polio virus (Legio TRANSMISSION
debilitans) ❑Direct contact
(oropharyngeal
❑Three strains: secretions)
❑Brunhilde ❑Indirect contact
❑Lansing
❑Leon
 Ingestion of the Polio Virus

Multiplication in the throat and small intestine

Invasion of tonsils and lymph nodes (neck and ileum)

Viremia halted (no clinical Persistent viremia

disease)

Penetration of capillary
PARALYSIS wall and entry to CNS

Multiplication in the
High affinity of the virus to
cytoplasm and nerve
motor nerve cells
cell death
❑Isolation of virus (throat swab)

❑Stool culture

❑CSF culture
❑ABORTIVE
❑Does not invade CNS
❑Headache and sore throat
❑Slight or moderate fever
❑Patient usually recovers within 72 hours
❑NON-PARALYTIC
❑All signs of abortive type
❑Hamstring muscle spasm
❑Changes in deep and superficial reflexes
❑Inability to place the head between the knees
❑(+) Pandy’s Test
❑Usually lasts for about a week
❑PARALYTIC
❑All signs of abortive and non-paralytic type
❑(+) Hoyne’s sign
❑Paralysis occurs
❑Less tendon reflex
❑(+) Kernig and Brudzinski neck sign
❑Urinary retention, constipation, abdominal
distenstion
❑Analgesics and moist heat application (pains
and leg spasms)
❑Morphine is contraindicated

❑Bed rest

❑Paralytic type (PT, braces, corrective shoes)

❑Carry out enteric isolation
❑Observation for signs of paralysis
❑WOF signs of fecal impaction
❑Repositioning
❑Hand hygiene
❑Proper disposal of excreta
❑Emotional support
❑Oral and skin care
❑Polio Vaccines ❑Sabin vaccine
❑ Salk vaccine ❑OPV
❑IPV ❑Predominant
❑Inactivated vaccine
❑IM or ID ❑Attenuated,
❑No VAPP trivalent vaccine
❑Risk of VAPP but
due to
immunodeficiency
and/or susceptibility
to illness
❑Polio Vaccines (OPV)

❑Most sensitive to heat

❑Kept in freezer (-15 to -25 OC)
❑No breast feeding for 15-30 minutes
❑A.K.A. Hansen’s Disease / Hansenosis

❑Chronic systemic infection

characterized by progressive cutaneous
lesions
❑Associated with stigma
❑CAUSATIVE AGENT ❑MODE OF
❑Mycobacterium TRANSMISSION
Leprae ❑Respiratory droplet
❑Attacks cutaneous ❑Inoculation through
tissue and peripheral skin break and mucus
nerves
❑Produces skin lesions,
membranes (prolonged
anesthesia, infection and contact)
deformities
 Entry of Mycobacterium Leprae

Attack in peripheral nerves

Damage to skin’s fine nerves

Anesthesia, Anhidrosis, and Dryness

of skin
❑TUBERCULOID ❑LEPROMATOUS
(neural/indeterminate) – (progressive/borderline) –
PAUCIBACILLARY(WHO MULTIBACILLARY(WHO
classification) classification)
❑Characterized by regions ❑Skin cells are infected,
of skin that have lost and disfiguring nodules
sensation and are form all over the body
surrounded by border of ❑Infectious type
nodules
❑Non-infectious type
❑NEURAL INVOLVEMENT

❑Clawhand (atrophy of the hand muscles)

❑Paralysis and peripheral anesthesia
❑Corneal insensitivity
❑Eyelid paralysis (lagophthalmos)
❑SKIN
❑Lepromatous
❑Leonine facies
❑Loss of eye brows and eye lashes (Madarosis)
❑Tuberculoid
❑May be purely neural or simultaneously affect
skin
❑Raised , large, erythematous plaques with
clearly defined borders
❑Identification of signs and symptoms
❑Slit-skin smear
❑Blood tests
❑Increased RBC and ESR
❑Decreased serum Ca, albumin, and
cholestrerol
❑Lepromin test
❑Sulfone therapy
❑Rehabilitation, recreational, and
occupational therapy
❑Multiple Drug Therapy (MDT)
❑Multibacillary (lepromatous)
❑rifampicin, clofazimine and dapsone
❑Paucibacillary (tuberculoid)
❑rifampicin and dapsone
❑Multibacillary (lepromatous)
❑After taking 12 monthly doses of MDT
(considered cured)

❑Paucibacillary (tuberculoid)
❑After taking 6 monthly doses of MDT
(considered cured)
❑If admitted in hospital
❑Isolation and medical asepsis
❑Moral support and encouragement
❑Full, wholesome, and nutritious diet
❑Attention to personal hygiene
❑Terminal disinfection
❑Avoidance of prolonged skin-to-skin
contact
❑BCG vaccination
❑Good personal hygiene
❑Adequate nutrition
❑Health Education
❑A.K.A. Lock Jaw

❑Infectious bacterial disease which produces

a potent exotoxin with prominent systematic
neuromuscular effects such as generalized
spasmodic contractions of the skeletal
muscles
❑CAUSATIVE AGENT spasm
❑Clostridium tetani ❑Tetanolysin
❑Anaerobic Gram (+) ❑Responsible for RBC
❑Drumstick appearance destruction
❑Seen commonly in soil ❑MOT
with animal feces ❑Puncture wound
❑Releases two types ❑Umbilical stump
of toxins: ❑Cleaning of ears with
❑Tetanospasmin sharp objects
❑Responsible for muscle ❑Circumcision
 Entry of Clostridium Tetani in wounds or break in skin

Local multiplication and release of exotoxins

Toxin absorbed by bloodstream and lymphatics and into

peripheral motor nerves

Tetanospasmin (high affinity to CNS tissue and

spinal motor ganglia)

Inhibition of muscle
relaxation

HYPEREXCITABILITY/SPASMS
❑NEONATE

❑Feeding and sucking

difficulties
❑Cry excessively
❑An attempt to suck
results in spasm and
cyanosis
❑Tonic or rigid
muscular contractions
❑Older children and adult
❑Localized tetanus (increased muscle tone
near the wound)
❑Systemic or generalized
❑Hypertonicity and hyperactive DTR
❑Trismus
❑Risus Sardonicus – PATHOGNOMONIC sign
❑Opisthotonos
❑SPECIFIC ❑NON-SPECIFIC
❑ATS, TAT, TIG ❑Oxygen
within 72 hours ❑NGT feeding
❑Tetanus Toxoid ❑Tracheostomy
❑Pen G Na (infection) ❑Fluid and
❑Muscle relaxant electrolytes
❑Maintain adequate airway
❑Cardiac monitoring
❑Maintenance of IV line
❑Wound care
❑Avoid stimulation
❑Prevent contractures and pressure sores
❑Monitor vital signs
❑Comfort measures
❑Paralytic Shellfish Poisoning (PSP)

❑Red tide is caused by population explosion of

toxic, naturally occurring microscopic
phytoplanktons (dinoflagellates)

❑A syndrome of characteristic symptoms

predominantly neurologic which occur within
minutes or several hours after ingestion of
poisonous shellfish
❑CAUSATIVE AGENT preceded by prolonged
❑Single-celled organism summer
(dinoflagellates) ❑Low salinity and calm
seas
❑Explosions are ❑Seafoods that are
caused by unsafe to eat
❑Quahogs
environmental ❑Soft-shell clams
conditions that ❑Oysters
promotes growth of ❑Scallops
microorganism: ❑Moon snalis
❑Heavy rainfall
❑Tingling of the lips and tongue that spreads to
the face, neck, fingertips, and toes – initial sign
❑Drunken condition – loss of coordination
❑Symptoms aggravated by alcohol consumption
❑Floating sensation and weakness
❑Total muscle paralysis with respiratory
paralysis
❑*victims who survive the first 12 hours have a
greater chance of survival
❑No definite medication indicated
❑Induce vomiting
❑Charcoal Hemoperfusion (CHP)

❑Early stage:
❑Alkaline fluids (NaHCO3)
❑Coconut milk
❑Health teaching cooking
❑Shellfish affected ❑Avoid bi-valve
by red tide must mollusks
not be cooked with ❑Tahong
vinegar ❑Talaba
❑Halaan
❑Toxin of red tide
❑Kabiya
is not totally
❑Abaniko
destroyed by ❑Tulya