Communicable Diseases

NAP 1- December 2, 2023

LYMPHATIC SYSTEM
FILARIASIS
• NURSING MANAGEMENT
• Lymphatic worm infection
o Maintain hygiene
• Elephantiasis=chronic version o Adequate nutrition and fluids
• CAUSATIVE AGENT o DOC: Hetrazan (diethylcarbamazinecitrate)
o Wuchereria bancrofti o Prophylaxis: diethylcarbamazinecitrate salt
o Brugia malayi
o Brugia timori
• MODE OF TRANSMISSION
o vector-borne: mosquito bite (Aedes foeoelius)
▪ night biting, bites stationary extremities
o Culex tarsalis
o Culex fatigen
• INCUBATION PERIOD
o 8-16 months
• LOCATION
o Sarangani Province and Marinduque
o Regions 5, 8, 11
• SIGNS AND SYMPTOMS
o Asymptomatic Stage
▪ No symptoms
▪ Circulating only outside the lymphatic system
o Acute Stage
▪ Lymphangitis- inflammation of lymphatic vessels
▪ Lymphadenitis- inflammation of lymph nodes
▪ Orchitis- inflammation of scrotum
o Chronic Stage
▪ Lymphedema- inflammation of whole lymphatic vessels
and lymph nodes; swelling
▪ Elephantiasis- swelling of foot, can be unilateral or
bilateral
▪ Hydrocele- severe swelling of scrotum
• DIAGNOSTIC TEST
o Nocturnal Blood Examination- blood collection during night,
8PM
o Immunochromatographic Test- anytime
• PREVENTION AND CONTROL (CLEAN method)
o Chemically treated mosquito net (permethrin)
o Larvae eating fish (4 fish per cubic meter)
o Environmental sanitation (DOH Program: 4 o’clock habit)
o Anti-mosquito lotion (fumigation)
o Neem tree (citronella, oregano, eucalyptus)
Communicable Diseases
NAP 1- December 2, 2023
RESPIRATORY SYSTEM • Vitamin B6 for solving peripheral neuritis
TUBERCOLOSIS ▪ Pyrazinamide: hyperuricemia
• AKA: Koch’s Infection, phitis, Pott’s Disease (bone TB), Miliary • Watch our for gout or other kidney disease
(extrapulmonary TB) ▪ Ethambutol: optic neuritis
• CAUSATIVE AGENT • Temporary blindness
o Mycobacterium tuberculae ▪ Streptomycin: ototoxicity
o Mycobacterium africanum o Check for liver function
o Mycobacterium bovis (from cattle) o Diet: high calorie, high protein
• INCUBATION PERIOD o For patient with hemoptysis: rest for 30 minutes, NPO for 1 hour
o 2-10 weeks o Do not perform chest physiotherapy
• MODE OF TRANSMISSION o Medications:
o Primarily Droplet; Secondary Airborne ▪ Take before meals
• SIGNS AND SYMPTOMS ▪ DOTS (Direct Observation Treatment Short course
o Hemoptysis- coughing of blood chemotherapy)
o Night Sweats ▪ Single drug formulation
o Night Fever ▪ Fixed dose formulation: for patients with liver problems
o Anorexia, Body malaise, Weight loss ▪ Codes
o Coughing for more than 2 weeks • H- Isoniazid
o Chest pain not related to musculoskeletal • R- Rifampicin
• DIAGNOSTIC TEST • Z- Pyrazinamide
o Sputum Smear Microscopy- confirmatory test • E- Ethambutol
▪ Acid Fast Bacilli Staining
▪ Direct Sputum Smear Microscopy (DSSM)
▪ PBQ: Sino nagcocollect and analyze? MEDTECH
▪ PBQ: Sino nagcocollect and analyze kapag sa
malayong area? BHW
▪ PBQ: Sputum with blood= NPO then balik bukas,
Massive hemoptysis= bring to hospital
o PPD Testing
▪ Mantoux Test
▪ Tuberculin Test
o Xray
• PREVENTION AND CONTROL
o Vaccine: BCG
o Exposure of articles to sunlight
o Do not use disposable eating utensils
• NURSING MANAGEMENT
o Watch out for side effects
▪ Rifampicin: red or orange urine
• Do not use contact lens
• Only capsule among all TB drugs
▪ Isoniazid: peripheral neuritis
Communicable Diseases
NAP 1- December 2, 2023
• SINGLE DOSE FORMULATION • FIXED-DOSE FORMULATION
CATEGORY CRITERIA TREATMENT REGIMEN INTENSIVE
WEIGHT IN KG CONTINUATION PHASE
Intensive Phase Continuation PHASE
Phase RIPE RI E
• New smear • Two months • Four Less than 37 2 2 1
positive PTB of RIPE months 38-54 3 3 2
• New smear • Sputum of RI 55-70 4 4 3
negative PTB collection Greater than 70 5 5 3
with extensive after 2
I
parenchymal months
lesions on CXR • If positive, PNEUMONIA
• Severe take another • Inflammation of the lungs with fluid and hemorrhagic exudates
concomitant HIV month • INCUBATION PERIOD
disease o 14-72 hours
• Treatment failure • Two months • Five • MODE OF TRANSMISSION
• Relapse of RIPES months o Droplet
(gumaling pero • IM injection of RIE • TYPES OF ATYPICAL PNEUMONIA
bumalik) (streptomycin o Lobar Pneumonia- entire lobe is affected
• Return after everyday, 56
o Lobular Pneumonia- part of the lobe
default IM injection
o Bronchopneumonia- only the distal bronchioles and alveoli
(nagmedication kasi 2
II pero hindi months) • CAUSATIVE AGENT
gumagaling) • Sputum o Community Acquired Pneumonia
collection ▪ Streptococcus pneumoniae (most fatal)
after 2 ▪ Mycoplasma pneumoniae
months ▪ Hemophilus influenza
• Plus 1 month ▪ Legionella pneumophilia
of RIPE, kahit ▪ Klebsiella pneumonia
negative o Atypical Pneumonia
• New smear • Two months • Four ▪ Viruses
negative PTB of RIPE months ▪ Chlamydia
with minimal • Sputum of RI ▪ Legionella pneumophilia
parenchymal collection ▪ Mycoplasma pneumoniae
III lesions on CXR after 2 o Hospital Acquired Pneumonia
months
▪ Enterobacter species (methicillin resistant)
• If positive,
▪ Enterococcus
take another
▪ Staphylococcus
month
▪ Pseudomonas aeruginosa (UTI)
• Chronic • Refer to specialized facility or
o HIV Pneumonia
• Still smear- DOTS Plus Center
positive after • Refer to provincial or city NTP ▪ Pneumocystic jinovecci
IV ▪ Pneumocystic carinii (old name)
supervised coordinator
retreatment • National Center for
Tubercolosis
Communicable Diseases
NAP 1- December 2, 2023
• PATHOGENESIS • VECTOR
1. Stage of Lung Engorgement o Bats (original), Camels to Humans
➢ inflammation of the lungs with fluid and hemorrhagic • ORIGIN
exudates o Middle East
➢ exudates form 2019: SARS-Cov2
2. Stage of Red Hepatization • Mutated version of SARS 2002
➢ the affected lung tissue appears like a liver • INCUBATION PERIOD
➢ the exudate, coagulates o 2-14 Days
3. Stage of Gray Hepatization o Home Quarantine: 5-7 days
➢ the exudate becomes purulent o Facility Quarantine: 14 days
4. Resolution Stage • VECTOR
➢ exudates liquefy or reabsorbed o Bats and Pangolins
• SIGNS AND SYMPTOMS • ORIGIN
o Fever with chills o Wuhan, China
o PATHOGNOMONIC SIGN: Rusty sputum • FIRST CASE
o Hypochloremia- urine becomes very yellow o World: Mexico, December 31, 2019
o Chest pain aggravated by coughing and respiration o Philippines: January 30, 2020; Confirmed: February 1, 2020
• DIAGNOSTIC TEST • COMMUNITY OUTBREAK
o Xray (smokes) o March 2, 2020
o Culture and Sensitivity Test
• PREVENTION AND CONTROL A. MODE OF TRANSMISSION
o Vaccination: Pneumovax o Droplet (2002 and 2012)
o Prompt treatment of URTIs o Airborne (2019)
• NURSING MANAGEMENT B. SIGNS AND SYMPTOMS
o Chest physiotherapy o Fever
o Steam inhalation o Dry cough
o Give salt per orem or IV o Dyspnea
o DOC: Amoxicillin (1st line); Cotrimoxazole (2nd line) o SOB
o PATHOGNOMONIC SIGN: sudden onset of anosmia, ageusia,
SARS dysgeusia (dysfunction of taste)
2002: SARS C. COMPLICATIONS
• CAUSATIVE AGENT o Pneumonia
o Novel coronavirus o ARDS
o Mutated adenovirus o Renal Failure
• INCUBATION PERIOD o Exacerbation of comorbidities
o 2-10 Days D. PREVENTION AND CONTROL
• VECTOR o Isolation and quarantine
o Civet cat o Vaccination
• ORIGIN E. NURSING MANAGEMENT
o Guandong, China o Oxygen therapy
2012: MERS-Cov o Corticosteroids
• INCUBATION PERIOD o Treatment of comorbidities
o 2-10 Days
Communicable Diseases
NAP 1- December 2, 2023
DIPTHERIA PERTUSSIS
• Bacterial infection with pseudo membrane (grayish to greenish) • AKA: Whooping cough
• Toxemia • CAUSATIVE AGENT
• CAUSATIVE AGENT o Bordatella pertussis
o Corynebacterium diphteriae • INCUBATION PERIOD
• INCUBATION PERIOD o 7-10 days
o 2-5 days • MODE OF TRANSMISSION
• MODE OF TRANSMISSION o Droplet
o Droplet • SIGNS AND SYMPTOMS
• SIGNS AND SYMPTOMS 1. Catarrhal Stage- watery or swampy
o Pharyngeal Diptheria- most common and dangerous; can cause o Most communicable stage
myocarditis o Coryza
▪ High fever o Sneezing
▪ Bull neck o Lacrimation
o Laryngeal Diptheria- dangerous because of airway obstruction 2. Paroxysmal Stage
(tracheostomy set on beside) o Whooping cough and its complications
▪ Brassy or metallic coughing o Successive cough followed by inhalation
▪ Dyspnea o Eyes pop out
▪ Cyanosis o Nose and ear bleeding
o Nasal Diptheria- most contagious 3. Convalescent Stage
▪ pseudo membrane o Patient is no longer communicable
▪ excoriated nostrils o Watch out for residual paroxysm
o Cutaneous or Surface Diptheria- not common in Ph ➢ Avoid stressing the child for the next 6 months
▪ pseudo membrane • DIAGNOSTIC TEST
• DIAGNOSTIC TEST o Bordet Gengou Agar Test
o Shick’s Test- test for susceptibility to diptheria ▪ Patient will cough in the agar plate
▪ (-) rashes: immune to diptheria ▪ Done during paroxysmal stage
▪ (+) rashes: susceptible • PREVENTION AND CONTROL
o Moloney Test- hypersensitivity to toxoid o Vaccination: DPT Vaccine
o Culture and Sensitivity • NURSING MANAGEMENT
• PREVENTION AND CONTROL o Promote rest
o Vaccination: DPT vaccine o Do not feed the child during paroxysm (prevent aspiration)
• NURSING MANAGEMENT ▪ Feed 20-30 minutes after paroxysm
o Complete bed rest o Fruit juice over milk (milk thickens the secretions)
▪ R: to avoid myocarditis o Oxygen inhalation
o Tracheostomy care o Apply abdominal binder or hug a teddy bear
o DOC: Penicillin, Erythromycin (alternative), Chlorompenicol o DOC: Erythromycin, Azithromycin, Penicillin (alternative)
o Antitoxin: DAT (Diptheria Anti Toxin)
 JOEMIE D. VALERA, M.D, FFCP, DPSN
General Medicine

VALERA MEDICAL CLINIC CLINIC HOURS:

Tuesday-Thursday: 11:00 am- 2:00 pm- 4:00 pm
Apt 2 RFG. Bldg., 425 Brgy. San Lorenzo, Gapan
Saturday: 10:00 am- 12:00 nn BY APPOINTMENT
City, Nueva Ecija │ Tel. No.: (044) 486-2376

Date: November 29, 2023

MEDICAL CERTIFICATE

This is to certify that Ms. Stephanie N. Villanueva, Female, 21 years old, came for

consultation on November 28, 2023, for colds and fever. Therefore, I consider that a period of

absence is necessary for the restoration of her health.

This certification is being issued upon request of the parents of the patient for whatever

purposes she may deem proper, except for medico legal purposes.

DR. JOEMIE D. VALERA

Lic.: Nov. 79471
PTR No.: 1584331
Communicable Diseases
NAP 1- December 2, 2023
CIRCULATORY SYSTEM • PREVENTION AND CONTROL
DENGUE o Chemically treated mosquito net (permethrin)
• AKA: Hemorrhagic fever, Breakbone fever (Chikungunya), Dandy fever, o Larvae eating fish (4 fish per cubic meter)
Infectious Thrombocytopenia Purpura o Environmental sanitation (DOH Program: 4 o’clock habit)
• CAUSATIVE AGENT o Anti-mosquito lotion (fumigation)
o Flavivirus (4 strains) o Neem tree (citronella, oregano, eucalyptus)
o Chikungunya • NURSING MANAGEMENT
o Onyong nyong virus o Hydration
• INCUBATION PERIOD o Complete bed rest
o 6-7 days o Antipyretics
• MODE OF TRANSMISSION o Loose clothing
o Bite of female mosquito o Avoid dark colored food and beverages
▪ Aedes aegypti- indoor o Blood transfusion
▪ Aedes albopictus- outdoor
o Characteristics of mosquito
▪ Day biting (6-8 AM or 4-6 PM)
▪ Low flying
▪ Stagnant water
▪ Urban areas
• NIMANITYA DENGUE CLASSIFICATION
GRADE 1 GRADE 2 GRADE 3 GRADE 4
1. Flu-like Grade 1 symptoms Grade 1 and 2 + Hypovolemic shock
symptoms + bleeding circulatory failure characterized by:
2. Fever, characterized by:
myalgia, 1. Blood
arthralgia 1. Hypotension pressure
3. Periorbiotal with narrowed unobtainable
pain (not seen pulse pressure 2. Pulse
in 2. Tachycardia, imperceptible
chikungunya) rapid but with
4. Herman’s sign thready pulse
(generalized 3. Tachypnea
flushing of with cold
skin) clammy skin
5. Greater than
petechial With impending
rashes shock

If chikungunya,
patient has more
pronounced
arthralgia (joint
pain) -> breakbone
fever
Communicable Diseases
NAP 1- December 2, 2023
MALARIA ▪Chloroquine (1 tablet per week as prophylaxis; at least
• Protozoal infection 2 tablets before going to malaria infested area; then
• AKA: Ague, Marsh Disease, King of Tropical Disease take 6 tablets after going to the area)
• CAUSATIVE AGENT ▪ Screening of doors and windows
o Plasmodium falciparum ▪ Avoid loitering in the forest at night
o Plasmodium vivax • NURSING MANAGEMENT
o Plasmodium ovale o Complete bed rest during attack
o Plasmodium malariae o Record onset and duration of attack
o Plasmodium knowlesi o Blood transfusion
• MODE OF TRANSMISSION o DOC:
o Vector: Anopheles flavirostris ▪ Arthemeter lumefantrine, Co Artren (1st line)
▪ Brown long legged mosquito ▪ Chloroquine (2nd line)
▪ Night biting (9PM-3AM) ▪ Sulfadoxinepyrimethamine (3rd line)
▪ High flying mosquito
▪ Bites people not in motion
▪ Breeds in spring water
• SIGNS AND SYMPTOMS
1. Cold Stage
➢ Chills and gooseflesh
➢ 15 minutes-2 hours
2. Hot Stage
➢ Pyrexia
➢ Diagnostic test
➢ 4-6 hours
3. Diaphoretic Stage
➢ Profused sweating
➢ Generalized weakness
➢ 2-4 hours
• DIAGNOSTIC TEST
o Blood Smearing
▪ During hot stage
▪ Not for community setting
o Quantitative Buffy Coating: confirmatory test
▪ Anytime
• PREVENTION AND CONTROL
o Biologic Control
▪ Stream seeding (larvae eating fish; 4 per cubic meter)
▪ Zooprophylaxis (carabao placed near window)
o Environmental Control
▪ Stream clearing (removing vegetation along stream
banks)