REFRESHER PHASE

HANDOUTS
COMMUNICABLE DISEASE
Prepared By: PROF. JAIDEE R. ROJAS, RN
NOV 2023 Philippine Nurse Licensure Examination Review
Airborne
Droplet nuclei (small particles of 5 mm or smaller in size)
Communicable diseases
Vehicle route
Caused by infectious agent that is spread form person to Food, Water, Blood
person
Vector borne
Contagious vs Infectious Chikungunya virus
Plasmodium falciparum
Flavivirus
Definition of terms
Infection Infection Control
Pathogenicity
Virulence Standard Precautions
-used for all patient care

Immunity Includes:
Body’s protection against diseases, especially infectious 1. Hand hygiene
diseases

Antigen- substance that prompts your body to trigger an

immune response against it.
Antibody- Y-shaped proteins that the body produces when it
detects antigens

1. Innate/ Natural
2. Adaptive/ Acquired
a. Active immunity
-when exposure to a disease organism
triggers the immune system to produce antibodies to that
disease. 2.
- could be natural or through vaccines Use
of
b. Passive immunity Personal Protective Equipment
- When a person is given antibodies to a Sequence of donning PPE:
disease rather than producing them through his or her own Gown 🡪 mask 🡪 eye shield 🡪 gloves
immune system.
- Could be through placental transmission, Sequence of removing PPE:
breastfeeding, or immunoglobulins Gloves 🡪 eye shield 🡪 gown 🡪 mask

5 Types of Immunoglobulins 3. Respiratory hygiene/ cough etiquette

4. Sharps safety
Stages of disease 5. Safe injection practices
6. Sterile instruments and devices
1. Incubation 7. Clean and disinfected environmental surfaces
2. Prodromal
3. Acute/ illness Transmission based precautions
4. Convalescence
1. Contact precautions
Main routes of transmission: 2. Droplet precautions
Direct contact 3. Airborne precautions
Direct body contact with the tissues or fluids of an
infected individual.
DIPTHERIA
Indirect contact
Contact between a person and a contaminated object. Causative agent: Corynebacterium diphtheria or
Klebbs-loffler
Droplet Mode of transmission: Droplet
Relatively large and travel only short distances (up to 6 Incubation Period: 2 – 5 days
feet/ 2 meters).

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Mode of transmission: Droplet especially secretions from Drug of choice: Erythromycin or Penicillin 20,000 - 100,000
mucous membranes of the nose and nasopharynx and from units
skin and other lesions; Milk has served as a vehicle
Isolation and complete bed rest
SIGNS AND SYMPTOMS: For paroxysmal stage: Avoid dust pollutants, oxygenation, calm
Respiratory Diphtheria atmosphere
● Sore throat, Fever Watch out for airway obstructions
● Difficulty swallowing Promote effective coughing. 
● Bull neck appearance Educate about proper positioning. 
● Pathognomonic sign: Pseudomembrane Encourage increase in oral fluid. 
Administer medications as prescribed. 
Laryngeal Diphtheria Provide chest physiotherapy. 
● Gradually increasing hoarseness, cough, stridor
Prevention:
Nasal Diphtheria
● Clear nasal discharge but every becomes blood Active immunization: DPT immunization
stained Booster: 2 years and 4-5 years
Patient should be segregated until after 3 weeks from the
Cutaneous Diphtheria appearance of paroxysmal cough
● Skin ulcers commonly in the legs
Passive immunization: Gamma globulin
Diagnostic test:
● Nose/throat swab
● Moloney’s test TETANUS
● Schick’s test
“Lock jaw”
Interventions: Causative agent: Clostridium tetani – anaerobic
spore-forming heat-resistant and lives in soil or intestine
✔ Isolate the child until two negative nose and throat Mode of transmission: Indirect contact – inanimate
culture are negative (24 hours apart) objects, soil, street dust, animal and human feces, punctured
✔ ANTIBIOTIC, ANTIPYRETIC wound
✔ Bed rest is necessary (except for nasal diphtheria) Incubation Period: Varies from 3 days to 1 month, falling
✔ Oral hygiene (warm mouth wash, NEVER between 7 – 14 days
TOOTHBRUSH)

Prevention: Signs and symptoms

✔ Active immunization: DPT immunization Convulsion is the first warning symptom among children
✔ Passive immunization: Anti-toxin Restlessness and irritability
Muscular stiffness progresses
Drug-of-Choice: Erythromycin 20,000 - 100,000 units IM Trismus : Tight jaw, inability to open mouth
once only Stiff arm and legs, then whole body
Resus sardonicus: Facial muscle spasm
Complication: MYOCARDITIS Opisthotonus: Backward arching of the back as a result of
dominance
of extensor muscles of the spine, head draws back.
PERTUSSIS
NO DIAGNOSTIC TEST FOR TETANUS.
“Whooping cough”
Causative agent: Bordetella pertussis; Hemophilus pertussis; Treatment:
Bordet-gengou bacillus; Pertussis bacillus
Mode of transmission: Droplet especially from laryngeal and Aggressive wound care
bronchial secretions Drugs to control muscle spasms (Diazepam)
Incubation Period: 7 – 10 days but not exceeding 21 days Antibiotics (Penicillin G)
Tetanus vaccination
Three stages: 6 WEEK DISEASE. Isolation.
1. Catarrheal or Prodromal stage: Protect the child for any stimuli, so place child in dark room
1. 7-14 days Protect from falling, record convulsion episodes
2. Mild fever, headache, colds IV for nutrition if inability to swallow
3. Persistent cough Oxygenation. Possible tracheostomy

2. Paroxysmal stage (Spasmodic or whooping

stage)
1. 14-28 days
2. Paroxysmal cough (Several sharp coughs in
one expiration, followed by deep inspiration,
which may be accompanied by. Whoop)
3. Cough is worse at night
4. Anorexia
Prevention:
Active immunization: DPT immunization
Tetanus toxoid (artificial active) immunization among pregnant
women
Passive immunization: Tetanus immuno-globulin or antitoxin

3. Convalescent stage:
1. Lasts 21 days
2. Less cough and vomiting

Diagnostic:
Bordet-gengou agar test POLIOMYELITIS

Management: Causative agent: Poliovirus (Legio debilitans)

Man is the only reservoir

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Mode of transmission: Fecal – oral Causative agent: RNA containing paramyxovirus
Incubation period: 5-14 days Period of Communicability: 4 days before the appearance
of rash to 5 days after rash appearance
Signs and symptoms: Mode of transmission: Airborne -droplet secretions from
nose and throat
Abortive Poliomyelitis Incubation period: 10 days – fever ;14 days – rashes appear
Upper respiratory tract infection symptoms (8-13 days)
Fever, Headache, Vomiting
Signs and symptoms:
Non-Paralytic polio Coryza
Stiffness of neck, back and limbs Common colds and occur before rash appearance
Nausea and vomiting Fever (Highest just before the appearance of the rash)
Increase protein in CSF Barking cough
Conjunctivitis and photophobia; Enlarged posterior cervical
Paralytic Polio lymph nodes
Spinal: Paralysis appear within a day or two after above
manifestations; Limb paralysis most common; chest, Koplik’s spots: Appear on day before rash. Whitish spots with
diaphragm, bladder and bowel paralysis may also occur. reddish base on the inside of the mouth

Bulbar Polio Rash: Appears on 2nd to 5th day and remain about a week
Life threatening; swallowing problem and regurgitation; Itchy rash
aspiration may occur; Encephalitis

Diagnostic test: CSF analysis / lumbar tap No specific diagnostic test

Management: Management:
Rehabilitation involves ROM exercises Isolation and bed rest.
Symptomatic: Supportive and symptomatic
Proper body alignment Eye care with warm saline solution
Place child on firm mattress Antipyretics for fever; Encourage fluids
Use footboard to prevent foot drop Mouth care for Koplik’s spots
Application of heat to relax muscles Disinfection of soiled articles

Prevention:
Prevention:
Active immunization: OPV, IPV vaccination (Trivalent poliovirus Active immunization: Live attenuated vaccine
vaccine) Passive immunization: Newborn through the mothers; Gamma
Sabin: Attenuated; Orally globulin
Salk: Killed virus; Injection

Passive immunization: Gammaglobulin CHICKEN POX

Etiologic agent: Varicella-zoster virus

MUMPS Period of Communicability: From as early as 1 to 2 days
before the rashes appear until the lesions have crusted.
Etiology: Paramyxovirus Mode of transmission: Airborne
Incubation Period: 14-21 days Incubation Period: 2-3 weeks, commonly 13 to 17 days
Communicability Period: One to six days before the first
symptoms appears until swelling disappears Signs and symptoms:
Mode of transmission: Droplet; Direct or indirect contact
Prodromal stage:
Signs and symptoms: Mild fever, anorexia, headache

Prodromal Phase: Acute Phase:

Coryza’ Vesiculo-pustular rashes
Low grade fever Centrifugal appearance of rashes
Vomiting, headache, malaise Pruritus

Acute Phase: No specific diagnostic exam

Pain in or behind ears; Pain on swallowing or chewing
Swelling and pain in glands (unilateral or bilateral)
Orchitis and mastitis may occur
Complication: Sterility
Management:
Symptomatic treatment
Isolation and bed rest until swelling disappears
Encourage fluids and soft foods
Apply hot or cold compress for swelling.
Orchitis: Support scrotum, use cold compress for 20 minutes.
Drug-of-choice: Acyclovir / Zovirax
Management:
To relive itching, antihistamine, or calamine lotion.
Cool sponge bath. Mittens may be used to avoid scratching
Keep in isolation until lesions have been crusted.
NEVER give ASPIRIN. Aspirin when given to children with
viral infection may lead to development of REYE’S SYNDROME.
GERMAN MEASLES

Prevention: “Rubella”
Active immunization: Live attenuated vaccine
Passive immunization: Gamma-globulin Causative agent: Rubella virus or RNA containing Togavirus
(Pseudoparamyxovirus)
MEASLES Teratogenic infection, can cause congenital heart disease and
congenital cataract.

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Mode of transmission: Droplet, Direct/ Indirect contact Occurrence is sporadic throughout the year
Incubation Period: 14-21 days Epidemic usually occur during the rainy seasons (June to
Communicable Period: During Prodromal period and 5 days November)
after the rash. Peak months: September and October

Signs and symptoms: MOT: Bite of infected mosquito (Aedes Aegypti) - characterized
by black and white stripes
Prodromal stage: Daytime biting Low flying Stagnant clear water Urban
Mild fever (Disappears when rash appear)
Malaise, headache, anorexia Incubation Period:
Runny nose, sore throat Uncertain. Probably 6 days to 1 week
Forscheimer spots – red pinpoint patches on the oral cavity
Faint maculopapular rashes. Small pinpoint pink or pale red
macules which fades on pressure. Manifestations:
Enlargement of posterior cervical and postauricular lymph First 4 days: Febrile/Invasive Stage - starts abruptly as
nodes fever - abdominal pain
- headache
Diagnostic Test: Rubella Titer (Normal value is 1:10); below - vomiting
1:10 indicates susceptibility to Rubella. - conjunctival infection -epistaxis

Instruct the mother to avoid pregnancy for three months after 4th – 7th days: Toxic/Hemorrhagic Stage
receiving MMR vaccine. - decrease in temperature
MMR is given at 12 months of age and is given intramuscularly. - severe abdominal pain - GIT bleeding
- unstable BP (narrowed pulse pressure)
Prevention: - shock
MMR vaccine (live attenuated virus) - Derived from chick - death may occur
embryo
Contraindication: Allergy to eggs 7th – 10th days: Recovery/Convalescent Stage
- appetite regained
HEPATITIS B - BP stable

Serum hepatitis Diagnostic Test:

Causative agent: Hepatitis B virus Torniquet test (Rumpel Leads Test / capillary fragility test) –
Mode of transmission: Blood and body fluids; Placental presumptive; positive when 20 or more petechiae per 2.5 cm
transmission square or 1 inch square are observed

Incubation period: Platelet count – confirmatory

45 – 100 days ave 90 days
Treatment:
Signs and symptoms: Supportive and symptomatic
Paracetamol for fever
1. Right-sided Abdominal pain Analgesic for pain
2. Jaundice Rapid replacement of body fluids – most important treatment
3. Yellow-colored sclera ORESOL
4. Anorexia Blood transfusion
5. Nausea and vomiting
6. Joint and Muscle pain Diet: low-fat, low-fiber, non-irritating, non- carbonated.
7. Steatorrhea Noodle soup may be given. ADCF (Avoid Dark-Colored Foods)
8. Dark-colored urine ALERT! No Aspirin
9. Low grade fever

Diagnostic test: MALARIA

Hepatitis B surface agglutination (HBSAg) test
Plasmodium Parasites:
Anti-HBs or HBsAb (Hepatitis B surface antibody) Vivax
Falciparum (most fatal; most common in the Philippines)
Management: Ovale
Hepatitis B immunization Malariae
Hepatitis B Immunoglobulin
-attacks the red blood cells
Diet: high in carbohydrates Mode of transmission : Bite of infected anopheles mosquito
Wear protected clothing
Hand washing SIGNS AND SYMPTOMS
Observe safe-sex Cold Stage: severe, recurrent chills (30 minutes to 2 hours)
Sterilize instruments used in minor surgical-dental procedures Hot Stage: fever (4-6 hours)
Screening of blood products for transfusion Wet Stage: Profuse sweating
Episodes of chills, fevers, and profuse sweating are associated
with rupture of the red blood cells.
DENGUE - intermittent chills and sweating
- anemia / pallor
Causative agent: Dengue virus 1, 2, 3, and 4 and - tea-colored urine
Chikungunya virus - malaise
Types 1 and 2 are common in the Philippines - hepatomegaly
- splenomegaly
Period of communicability: Unknown. Presumed to be on - abdominal pain and enlargement
the 1st week of illness up to when the virus is still present in - easy fatigability
the blood
Early Diagnosis and Prompt Treatment

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Early diagnosis – identification of a patient with malaria as
soon as he is seen through clinical and/or microscopic method TREATMENT: Short Course Chemotherapy, Direct –observed
Clinical method – based on signs and symptoms of the treatment short course/DOTS; Rifampicin (R), Isoniazid (H),
patient and the history of his having visited a malaria-endemic Pyrazinamide (Z), Ethambutol (E), Streptomycin (S)
area
Microscopic method – based on the examination of the SIDE EFFECTS:
blood smear of patient through microscope (done by the Rifampicin
medical technologist) • body fluid discoloration
QBC/quantitative Buffy Coat – fastest • hepatotoxic
Malarial Smear – best time to get the specimen is at height • permanent discoloration of contact lenses
of fever because the microorganisms are very active and easily
identified Isoniazid
Chemoprophylaxis • Peripheral neuropathy (Give Vit B6/Pyridoxine)
Only chloroquine should be given (taken at weekly intervals
starting from 1-2 weeks before entering the endemic area). In Pyrazinamide
pregnant women, it is given throughout the duration of • hyperuricemia /gouty arthritis (increase fluid intake)
pregnancy.
Ethambutol
Treatment: • Optic neuritis
Blood Schizonticides - drugs acting on sexual blood stages • Blurring of vision
of the parasites which are responsible for clinical (Not to be givento children below 6 y.o. due to inability to
manifestations complain blurring of vision)
1. QUININE – oldest drug used to treat malaria; from the bark • Inability to recognize green from blue
of Cinchona tree; ALERT: Cinchonism – quinine toxicity
2. CHLOROQUINE Streptomycin
3. PRIMAQUINE – sometimes can also be given as • Damage to 8th CN
chemoprophylaxis • Ototoxic
4. FANSIDAR – combination of pyrimethamine and sulfadoxine • Tinnitus
• nephrotoxic
NURSING CARE:
1. Tepid sponge bath (Hot Stage) Japanese Encephalitis
2. Keep patent warm (Cold Stage)
3. Change wet clothing (Wet Stage) Causative Agent: JE virus (flavivirus)
4. Encourage fluid intake Vector: Culex mosquito
5. Avoid drafts Incubation period: 5-15 days

TUBERCULOSIS Signs and symptoms:

Causative agent: Mycobacterium tuberculosis ● Initial symptoms often include fever, headache, and
Mode of transmission: Airborne-droplet vomiting.
Incubation period : 4 – 6 weeks ● Mental status changes, neurologic symptoms, weakness,
and movement disorders might develop over the next few
Diagnostic test: days.
• Sputum examination or the Acid-fast bacilli (AFB) / ● Seizures are common, especially among children.
sputum microscopy ● Although some symptoms improve after the acute illness,
• Chest X-ray 30%-50% of survivors continue to have neurologic,
1. Determine the clinical activity of TB, whether it is inactive (in cognitive, or psychiatric symptoms.
control) or active (ongoing)
2. To determine the size of the lesion: Management:
a. Minimal – very small Supportive.
b. Moderately advance – lesion is < 4 cm Japanese encephalitis (JE) vaccine (manufactured as IXIARO)
c. Far advance – lesion is > 4 cm
• Tuberculin Test – purpose is to determine the history of
exposure to tuberculosis FILARIARIS

Other names: Causative agent: mosquito-borne filarial nematodes

Mantoux Test – used for single screening, result interpreted Wuchereria bancrofti, Brugia malayi, B. timori
after 72 hours Mode of transmission: bite of Culex mosquito
Interpretation: Incubation period: from 4 weeks to 10-12 months
0 - 4 mm induration – not significant
5 mm or more – significant in individuals who are considered Signs and symptoms:
at risk; positive for patients who are HIV-positive or have HIV
risk factors and are of unknown HIV status, those who are Usually symptomatic
close contacts with an active case, and those who have chest Lymphangitis, Lymphedema
x-ray results consistent with tuberculosis. 10 mm or greater Elephantiasis
– significant in individuals who have normal or mildly impaired Fever
immunity
Diagnosis:
SIGNS AND SYMPTOMS: Microscopic detection of microfilariae

1. Usually asymptomatic Management:

2. Low-grade afternoon fever Drug of choice: diethylcarbamazine (DEC)
3. Night sweating
4. Loss of appetite The best way to prevent lymphatic filariasis is to avoid
5. Weight loss mosquito bites. The mosquitoes that carry the microscopic
6. Easy fatigability – due to increased oxygen demand worms usually bite between the hours of dusk and dawn . If
7. Temporary amenorrhea you live in an area with lymphatic filariasis:
8. Productive dry cough
9. Hemoptysis At night

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Sleep in an air-conditioned room or
Sleep under a mosquito net
Between dusk and dawn
Wear long sleeves and trousers and

Use mosquito repellent on exposed skin.

SCHISTOSOMIASIS

Causative agent: Schistosoma haematobium, S. japonicum,

and S. mansoni
Mode of transmission: Contaminated freshwater with
freshwater snails
Incubation period: 4-6 weeks

Signs and symptoms:

Abdominal pain, diarrhea, bloody stool, or blood in the urine.

Chronically infected: liver damage, kidney failure, infertility, or
bladder cancer.
In children, it may cause poor growth and learning difficulty.

Diagnosis:
Stool or urine samples can be examined microscopically for
parasite eggs (stool for S. mansoni or S. japonicum eggs and
urine for S. haematobium eggs). The eggs tend to be passed
intermittently and in small amounts and may not be detected,
so it may be necessary to perform a blood test. (CDC)

Management:
Drug of choice: Praziquantel

No vaccine is available.

Avoid swimming or wading in freshwater.

Drink safe water.
Water used for bathing should be brought to a rolling boil for 1
minute to kill any cercariae, and then cooled before bathing to
avoid scalding.
Water held in a storage tank for at least 1 – 2 days should be
safe for bathing.
Vigorous towel drying after an accidental, very brief water
exposure may help to prevent parasites from penetrating the
skin. However, do not rely on vigorous towel drying alone to
prevent schistosomiasis.

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