Communicable

diseases

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 COMMUNICABLE DISEASES
I. GLOSSARY OF TERMS:
COMMUNICABLE DISEASE
• A disease that can be transmitted from one person to the other either by direct or indirect method of
transmission.
CONTAGIOUS DISEASE
• A communicable disease that is easily transmitted from one person to the other.

Comm D’se & Infection

Contagious

Diagram: “All communicable diseases are infectious but not all infectious are communicable, not
all communicable are contagious but all contagious are communicable.”

INFECTION
• Invasion and Multiplication of pathogenic microorganisms in the body
RESERVOIR
• Environment in which microorganisms live and multiply.
NORMAL MICROBIAL FLORA
• Microorganisms present in the body but do not cause harm.
CARRIER
• A person with infection but does not manifest signs and symptoms of the disease.

*NOTE: He/She is more dangerous than a person manifesting signs and symptoms.
CONTACT
• A person known to have been in close association with a person with an infectious disease.

ISOLATION

Illustration 1.1 Separation of the individual during the period of communicability.

SRG Integrals 2nd Ed. Communicable Diseases 567

PERIOD OF COMMUNICABILITY
• The time in which the patient is highly contagious and may vary according to the disease.

CONTAMINATION
• The presence of infectious agent on a body surface, also clothes, toys, beddings, sur- gical instruments,
and other inanimate articles or substances.

VEHICLE
• Matter in or upon which pathogenic agents are present and survive until there is
physical contact with persons.

VECTOR
• A living non-human carrier of pathogenic microorganisms from the sick to a wellperson.

ANTISEPTIC
• Agents that inhibits the growth of some microorganisms and safe to use in skin
tissue. (e.g. Providone Iodine, Chlorhexidine gluconate)

FUMIGATION
• Process of killing animal forms accompanied by the employment of gaseous agent.

DISINFECTION
Types
A. Concurrent – type of disinfection when the patient is still the source of infection
B. Terminal - type of disinfection when the patient is not still the source of infection
• killing of pathogenic agents by physical or chemical means (does not kill spores.)
(e.g. Chlorine, Isoprophyl Alcohol)

STERILIZATION
• Killing of all living organisms and bacterial spores.
(e.g. Autoclaving, Etylene Oxide gas, UV light, Ionizing Radiation)

(a) Factors that Affect the Agent To Develop a Disease

INFECTIVITY
• Ability to enter and move into the body
PATHOGENECITY
• Ability to cause a disease
VIRULENCE
• Strength or potency of pathogenic organism
INFECTIVITY DOSE
• Number of sufficient microorganism needed to produce a disease
ANTEGENECITY
• Ability of pathogenic organism to stimulate antibody response

SRG Integrals 2nd Ed. Communicable Diseases 568

 STAGES OF INFECTION
“A TIMELINE”

EXPOSURE • Entrance of pathogenic

organism

INCUBATION • Appearance of first sign and

symptom

PRODROMAL • Presence of pathognomonic

sign

ACUTE
• All signs and symptoms are
present

CONVALESCENT

RESOLUTION • Recovery period

Illustration 1.2 Stages of Infection

SRG Integrals 2nd Ed. Communicable Diseases 569

 NURSE’s ROLE: BREAK THE CHAIN.

CAUSATIVE AGENT:
e.g bacteria, viruses

SUSCEPTIBLE RESERVIOR:
HOST: e.g. humans, plants,
e.g. Immunocompromised, animals, street, dust,
Post inanimate objects (fomites)

PORTAL OF ENTRY:
RESPIRATORY (A nurse’s POTRAL OF EXIT:
concern) GIT, GUT, broken Secretions
skin, mucous membrane Excretions
Wounds (skin)

MODE OF TRANSMISSION:
Contact
Airborne

Nursing Alert:
Illustration 1.3 Chain of Infection The nurse’s Primary
role of knowing the 6
elements in the chain
is to BREAK the chain
in order to prevent the
spread of infection.

IMMUNITY
• The state of being resistant to diseases

FIRST LINE OF DEFENSE

• External and Mechanical Barrier
(Skin, Hair, Coughing, Cilia)
SRG Integrals 2nd Ed. Communicable Diseases 570
SECOND LINE OF DEFENSE
• includes NONSPECIFIC response and SPECIFIC response

NONSPECIFIC RESPONSE:
Signs of Acute Inflammation are the (S.L.I.R)
Mnemonic: “What a cute pair of SLiPpeRs”.
Swelling
Loss of function
Increased Heat
R edness
LOCAL INLFAMMATORY RESPONSE

SPECIFIC RESPONSE: (sometimes considered as Third line of Defense)

CELL – MEDIATED IMMUNITY -Involves T – cell which synthesize and secrete lymphokines

There are 5 types of immunoglobulins. They are GAMED. The most

important is IgM. It is immediate in its effect and the most abundant.
Mnemonic : M.D. The first antibodies to go at the site is
IgM then IgD.

Immunoglobulin which crosses the placenta and the breast.

IgG – crosses the placenta during gestation.

A. Natural

ACTIVE – antibodies is produced PASSIVE – antibodies is given to the

by himself (long term effectivity individual (long term effectivity )
)

ARTIFICIAL
of Immunity
NATURAL PASSIVE NATURAL
• Antitoxin
• Recovery from • Vaccination • Transplacental
• Ex. Live Attenuated • Antiserum
disease • Breastfeeding
Vacinne, Inactivated
Vaccine • Immunoglobulin

A. NATURAL IMMUNITY – B. ACQUIRED IMMUNITY –

inherent in the body through environmental exposure

Illustration 1.4 Types of Immunity

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 Illustration 1.5 Control Measures

CONTROL MEASURES:

• “The use of the Revised CDC(1997) Isolation Precautions”

TWO TIER:

1. STANDARD PRECAUTION
• Primary strategy for preventing Nosocomial infection designed for ALL patients.
Precautions apply to: (All Birds Move North)
1) All body fluids, secretions, and excretions except sweat
2) Blood
3) Mucous membranes.
4) Nonintact skin

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2. TRANSMISSION BASED PRECAUTION
• Designed for highly contagious cases or epidemiologically important pathogens.
Nurse still use Standard Precaution in addition to this TBP.

PRECAUTION CONTACT DROPLET AIRBORNE

Transmission Skin to skin Large particle Airborne
Gastrointestinal droplets (5 microns droplet nuclei (less than 5
or more) microns)
Close face to
face (within 3
Diseases/C.A. Skin: “Dr. PIMP” “MTV”
Diphteria Diphteria Measles
(cutaneous) Rubella (Rubeola)
Impetigo (German Tuberculosis
Pediculosis Measles) Varicella
Scabies Pertussis (**plus contact
Cellulitis Influenza P.)
ENTERIC: Meningitis
Shigella Pneumonia
Hepa A
Escherichia
coli
Rotavirus
PRIVATE YES YES YES;
ROOM/ negative
COHORT air
pressure
room
CLEAN YES Yes, if I Yes, if I
(clean) will will
handle handle
secretions secretions.
GOWN YES Yes, if my Yes, if my
patient patient
is actively coughing. is actively coughing.
MASK NO Yes, if I’m Yes, it
3 feet should
Near my patient. be
HEPA
(High
Efficiency
Particulat
e Air)
respirator
mask
like N
- 95
DOOR May keep May keep ALWAYS
open Open closed
Table 1.1 Standard Precautions

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 II. CIRCULATORY DISEASES
DISEASE DENGUE Dengue Hemorrhagic Fever
OTHER NAME: Breakbone Fever, H – Fever, Dandy Fever
CAUSATIVE AGENT Dengue Virus type 1, 2, 3 and 4 (Arbo V)
Chikungunya V.
Onyong – Yong V.
Flavi V.
SOURCE OF INFECTION: Female Aedes Aegyptii Mosquito
CHARACTERISTIC:
D ay Biting
L ow Flying
S tagnant Water
U rban
INCUBATION PERIOD: 3 – 14 days
MODE OF TRANSMISSION: Mosquito Bite
SIGNS AND SYMPTOMS: GRADE I
Fever, Headache, joint pain,
conjunctivitis, Herman’s
Sign, Petechiae, Anorexia, abdominal pain, N and V.

GRADE II
Grade I + ecchymosis, purpura, epistaxis, melena.

GRADE III
Grade II + SHOCK

GRADE IV
Grade III + Profound Shock
COMPLICATIONS: Thrombocytopenia Hypovolemic Shock

DIAGNOSTIC TESTS: 1. Tourniquet Test/ Rumpel Lead Test/Capillary Fragility Test

2. Platelet Count
3. Viral Isolation
4. Serologic Test (ELISA)
MEDICAL MANAGEMENT: 1. BORIC ACID/ Saline Compress.
2. Codeine, DO NOT GIVE ASPIRIN
3. Calamine Lotion
4. BLOOD TRANSFUSION
***FRESH FROZEN PLASMA.
NURSING MANAGEMENT Rest
Ice Packs on the forehead and abdomen
Prevent and control bleeding
TSB and Increase Fluid intake
DIET: LOW FAT, LOW FIBER, NON irritating and High in Vit. C

Table 2.1 Dengue Hemorrhaging Fever

SRG Integrals 2nd Ed. Communicable Diseases 574

 DISEASE MALARIA
OTHER NAME: Ague, Marsh Fever
CAUSATIVE AGENT PLASMODIUM VIVAX
PLASMODIUM FALCIFARUM
PLASMODIUM MALARIAE
PLASMODIUM OVALE
PLASMODIUM KNOWLESII
SOURCE OF INFECTION: Female Anopheles Mosquito
CHARACTERISTIC:
Night Biting
High Flying
Free Flowing Water
Rural
INCUBATION PERIOD: 10 to 12 days
MODE OF TRANSMISSION: Mosquito Bite
BT, contaminated needles and syringes
SIGNS AND SYMPTOMS: COLD STAGE:
chills, chatter teeth, shakes and shivering.
HOT STAGE:
HIGH FEVER ( >40 degree C, Headache, skin is red and HOT)
WET STAGE:
diaphoresis
****THESE THREE STAGES occur in a cycle usually in the THIRD DAY.
LATER, patient will develop MALARIAL CACHEXIA
****SEVERE ANEMIA (due to destruction of the RBC
COMPLICATIONS: BLACK WATER FEVER
Cerebral Malaria (common in Falcifarum)
DIC (Disseminated Intravascular Coagulation)
DIAGNOSTIC TESTS: 1. Malarial Smear/ Peripheral Blood Smear
Taken at the height of the patient’s fever
A. Thick – Quantitative (number of protozoa)
B. Thin – Qualitative ( Type of Protozoa)
1. Use of Antimalarial Drug
CLASS: Aminoquinolones
These drugs are schizonticidal. e.g. Chloroquine (Aralen) Quinine,
Primaquine, Sulfadoxine
***Quinine is given in emergency situation (IV) but watch out for
symptoms
of neurologic toxicity like confusion, twitching, delirium, convulsions
and coma.
***Chloroquine – given if client is pregnant
CLASS: PRIMAQUINE
NOT ONLY SCHIZONTICIDAL but also destroy gametocytes.
CLASS: Sulfadoxine
USE for resistant P. Falcifarum strains.
NURSING MANAGEMENT 1. TSB and increase fluid intake
2. Monitor vital signs & abnormal bleeding
3. Iron rich food

Table 2.2 Malaria

SRG Integrals 2nd Ed. Communicable Diseases 575

 DISEASE FILARIASIS
OTHER NAME: Elephantiasis
CAUSATIVE AGENT Wucheriaria Bancrofti
Brugia Malayi
Brugia Timori
SOURCE OF INFECTION: Female Aedes Poecillus
Anopheles Minimus Flavirostis
Culex Quenquefastiatus
CHARACTERISTIC
Dirty Water
Abaca Area
Rural
Night Biting
INCUBATION PERIOD: 8 – 16 months
MODE OF TRANSMISSION: Mosquito Bite
SIGNS AND SYMPTOMS: Asymptomatic Stage
Acute Stage
“LLFOE”
Lymphadenitis
Lymphangitis
Funiculitis
Epidydimitis
Orchitis
Chronic Stage
“HEL”
Hydrocele
Elephantiasis
Lymphedema

COMPLICATIONS: Renal involvement

Superinfection
DIAGNOSTIC TESTS: 1. Nocturnal Blood Exam (NBE)
Giemsa stained thick blood film.Taken after 8:00 PM
2. Immunochromatographic Test (ICT)
Rapid assessment test that can be done at daytime.
3. Bentonite Flocculation Test
MEDICAL MANAGEMENT: 1. Diethycarbamazine Citrate - DEC (Hetrazan/Beltrazan)
2. Albendazole (Albenza)
3. Steriods
“Sugical Management is done to correct chronic signs and
symptoms.”
NURSING MANAGEMENT 1. Teach patient about personal hygiene (e.g. wash affected
areas with soap and water).
2. Elevate and Exercise affected part.

Table 2.3 Filariasis

SRG Integrals 2nd Ed. Communicable Diseases 576

 DENGUE HEMORRHAGIC MALARIA FILARIASIS
FEVER

Specific PREVENTIVE NO VACCINE Blood Screening 1.Mass Treatment in

MEASURES: USE OF PHROPHYLACTIC DRUG endemic communities
ZOOPROPHYLAXIS *Consider the
MOST effective way to
reduce or prevent
morbidity and transmission

Eradicate Mosquitoes Good environmental Sanitation

Eradicate its Breeding Sites Seeding Lavarious Fish (e.g. Tilapia)
COMMON PREVENTIVE Protect Against Mosquito Use of long sleeves, long pants, socks
MEASURES: Bites Use of mosquito net (maybe insecticide treated)
Use of repellants
Use of anti-mosquito plant (e.g. Neem tree)

Table 2.4 Common Preventive Measures for DHF, Malaria and Filariasis

SRG Integrals 2nd Ed. Communicable Diseases 577

 III. RESPIRATORY DISEASES

DISEASE PNEUMONIA TUBERCULOSIS

CAUSATIVE AGENT Streptococcus pneumonia Mycobacterium tuberculosis

Staphylococcus aureus Mycobacterium africanum
Hemophilus influenza Mycobacterium bovis
Klebsiela pneumoniae Mycobacterium Cannettii

INCUBATION PEROID 1-3 days 2-10 weeks

PERIOD OF Non specific Active phase

COMMUNICABILITY
MODE OF TRANS- • Direct (Droplet) Direct (Droplet)
• Indirect (Contaminated objects)
SIGNS AND • Fever and chills (D’ SON is CHUBi)
SYMPTOMS: • stabbing chest pain Dyspnea, hoarseness of
• aroxysmal cough voice
• rusty/ prune juice-colored Sputum positive for
sputum AFB
• body malaise Occasional chest pain
• Flaring of nares Night sweats
• Labored respiration Cough, dry to
• rapid & bounding pulse productive
• Diaphoresis Hemoptysis
Afternon rise of
• Convulsion & vomiting in
temperature
children
Body malaise and weight
loss
DIAGNOSTIC -Chest X-ray - Direct Sputum Smear Microscopy (DSSM)
TESTS: - Sputum analysis -Sputum analysis for AFB - confirmatory
-Sputum smear and culture -Chest x-ray ( Determines extent of lesion)
- blood/ serologic exams -tuberculin testing
a. mantaux test (PDD)
= Read: After 48 hours
= Result
5 mm – immunocompromised
10 mm – with risk
15 mm – without risk

b. tine test (OT)

c. heaf test (LT)

Klebsiela- Aminoglycosides and Anti-TB drugs

Cephalosporins • Rifampicin
Streprococcus- Nafcillin or Oxacillin for • Isoniazid
14 days • Pyrazinamide
Pneumonitis carinii- Cortimoxazole • Ethambutol
• Streptomycin
-Penicillin G
SRG Integrals 2nd Ed. Communicable Diseases 580
 -Bronchodilators
-Expectotants
-Analgesics
NURSING (A,B,C’S) (“IW! I BETTER EAT”)
MANAGEMENT Airway and If receiving ethambutol,
SPECIFIC PREVENTIVE adequate WOF optic neuritis; rifampicin, WOF
MEASURES: oxygenation hepatitis and purpura
Breathing Exercises Isolation precaution
Be alert for signs of
drug reaction

C
oughing exercises Encourage to stop
ontrol spread of smoking
infection
Teach to cough, sneeze
alm environment
ontrol temperature into tissue paper and
dispose secretions
properly
Sputum exam as needed
Teach the patient all
about PTB
*Monitor closely for danger signs:
Encourage questions to
(DEATHS)
air feelings
Dyspnea
Rest and balanced meals
Exhaustion &
Emphasize importance
cyanosis
of follow up
An extreme
Administer meds as
restlessness
ordered
with delirium
To check sputum for
THread, small
blood or purulent
irregular pulse
expectoration
Skin is cold and
moist
COMMON (P.I.E) (S.A.N.A)
PREVENTIVE Prevent common Submit all babies for
MEASURES colds BCG immunization
Immunization Avoid overcrowding
Environmental Nutritional and health
modification status improvement
Advise those who have
been exposed to
receive tuberculin test
Table 3.1 Pneumonia and Tuberculosis

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 DISEASE DIPHTHERIA PERTUSSIS (WHOOPING INFLUENZA
COUGH)
CAUSATIVE AGENT Corynebacterium Diphtheriae Haemophilus pertussis Influenza Virus A, B, C
(Klebs – Loeffler Bacillus) Bordet Gengou Bacillus
INCUBATION PE- 2 -5 days 7 to 21 days 1 to 3 days

PERIOD OF 2 weeks Catarrhal Stage (highly 3 days from onset of

COMMUNICABILITY communicable stage) even symptoms
until 3 weeks after onset of
paroxysmal stage.
MODE OF TRANSMISSION Direct (Droplet) Direct (Droplet) Direct (Droplet)

SIGNS AND A. NASAL Diphtheria Invasive/ Catarrhal Stage (7 to • Fever

SYMPTOMS: • Coryza 14 days) • Chills
• Epistaxis • Fever, watery eyes • Generalized Aches
• Adenitis • Cough which is worse • Coryza
B. PHARYNGEAL Diphtheria at night(dry and • Marked Prostation
• SORE throat • irritative)
• Tonsillitis • Coryza
• “BULL NECK • Spasmodic Stage (4 to
• APPEARANCE” 12 weeks)
C. Laryngeal Diphtheria • Paroxysmal cough
• Hoarseness of with a prolong
• voice inspiratory phase
• Protrusion of eyeballs
• Swollen neck and
veins
• Abdominal hernia
COMPLICATIONS: Bronchopneumonia BRONCHOPNEUMONIA Pneumonia – MOST common
Peripheral Neuritis HERNIA and MOST dangerous
CArditis HEMORRHAGES
Nephritis
DIAGNOSTIC 1. Nose and Throat Culture 1. Throat Culture 1. Viral Isolation
TESTS: 2. Schick’s Test 2. WBC – decrease
Determines susceptibility and
immunity to diphtheria
3. Maloney’s Test
Hypersensitivity to Diphtheria
toxoid.
MEDICAL MANAGEMENT: 1. Antibiotics 1. Antibiotics 1. Antibiotics – if with
2. Passive Immunization 2. Codeine pulmonary bacterial
Diphtheria antitoxin complication.
NURSING MANAGEMENT 1. Strict Isolation (Droplet 1. Respiratory Isolation 1. Respiratory Isolation
SPECIFIC PREVENTIVE Precautions)/ (Droplet Precautions) (Droplet)
MEASURES: Contact Precaution for 2. Abdominal Support 2. Rest
Cutaneous D. 3. Rest 3. Keep patient warm and free
2. Rest 4. Small Frequent Feeding from drafts in bed.
3. Soft Diet (Influenza Vaccine) 4. TSB
2. Clothing contaminated with 1. Immunization
discharges should be boiled
1. Pasteurization of Milk for 30 minutes before
laundering.
COMMON PREVENTIVE 1. Immunization with DPT
MEASURES 2. Proper Disposal of Nasopharyngeal secretions
3. Cover mouth when coughing and sneezing.
4. Avoid use of common towels, glasses and eating utensils.

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 Table 3.2 Diphtheria, Pertussis and Influenza
EXANTHEMOUS DISEASE:
IV. INTEGUMENTARY DISEASES 1. MEASLES 2. GERMAN MEASLES 3.CHICKEN POX

DISEASE MEASLES • GERMAN MEASLES CHICKEN POX

OTHER NAME Rubeola Rubella Varicella

CAUSATIVE AGENT Morbilli Paramyxoviridae Rubi Togaviridae Varicella Zoster V.

MOT Airborne Droplet Airbone

Skin to skin contact
IP 1 – 2 weeks 2 – 3 weeks 2 -3 weeks
POC 9 days/ 4 days before and 5 12 days/ 1 week before and 5 7 days/ 1 day before
days after rash appearance days after rash appearance and more than 6 days
after the first crop of
vesicles.
SIGNS AND “Both would start with colds “Both would start with colds and Without conjunctivitis
SYMPTOMS and later with conjunctivitis” later with conjunctivitis.” PATTERN OF RASH
• Koplik’s Spots • Lymphadenopathy APPEARANCE:
• Cephalocaudal • Cephalocaudal 1. Macule
Maculopapular maculopapular 2. Papule
• Rashes • rashes 3. Vesicle
• High Fever • Confluent Rashes. 4. Crust/Scab
• Stimson’s Sign – • Forscheimer’s Spots.
fullness of eyes
DX TEST Wright Staining Serologic Test Vesicular Fluid Test is
positive for Varicella
Virus.
Tzanck smear
MANAGEMENT: PREVENTIVE: PREVENTIVE: PREVENTIVE:
1. Measles Immunization 1. Rubella Vaccine esp. for 1. Varivax, Oka
Given at 9 months women who never had German Given for person more
subcutaneously. Measles. than 13 years old who
SUPPORTIVE MANAGEMENT: SUPPORTIVE MANAGEMENT: never had chicken
1. Rest 1. Rest pox.
2. Resp. Isolation (Airborne 2. Teach pregnant to avoid sick SUPPORTIVE
Precaution) and those who receive MMR. MANAGEMENT:
3. Darken Room 3. GammaGlobulin for those 1. Rest
4.Antipyretic pregnant women who were 2. Calamine lotion
exposed. 3. Cut fingernails short
4. Baking soda with
Warm Water PASTE)
5. Acyclovir
(ZOVIRAX). Not a cure
but only hasten the
acute stage.
COMPLICATIONS (P.O.D.E) For Pregnant Woman: (Come (P.I.E.S)
Pneumonia Move My Dear) Pneumonia
Otitis Media Congenital Cataract Impetigo
Diarrhea Mutism Encephalitis
Encephalitis Mental Retardation Secondary Bacterial

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 Deafness Infection

TABLE 4.1 MEASLES, GERMAN MEASLES AND CHICKEN POX

DISEASE LEPROSY SCABIES

OTHER NAME HANSEN’S DISEASE/ HANSENOSIS/ LEPRA The Itch

CAUSATIVE AGENT MYCOBACTERIUM LEPRAE Sarcoptes scabiei

A. Hominis – Human
B. Canis - Dog
MOT DROPLET -Direct transmission
INOCULATION THROUGH THE SKIN BREAK -Sleeping in an infested bed or wearing infested
clothes
-Contact with dogs, cats, and small animals
IP 5 ½ MONTHS - 8 YEARS Within 24 hours

SIGNS AND NEURAL INVOLVEMENT: (“BE VIP’s” )

SYMPTOMS • ATROPHY OF MUSCLES OF HANDS Bacterial
RESULTING IN CLAWHAND superinfection
• PARALYSIS AND PERIPHERAL ANESTHESIA Excoriations and
SKIN: crusts
• LOSS OF EYEBROWS AND LASHES Vesicles
• LOSS OF FUNCTION OF SWEAT AND Ithchiness
SEBACEOUS GLANDS

P
• ROUGH, HAIRLESS AND HYPOPIGMENTED apules
SKIN ustules
• ANESTHETIC SCAR
EYE:
ronounced at night
• PHOTOPHOBIA
• CONJUNCTIVITIS
• IRIDOCYELITIS
• OPACITY OF THE CORNEA
• INSENSITIVITY AND ULCERATION
• BLINDNESS
UPPER RESPIRATORY TRACT:
• EPISTAXIS
• ULCERATION OF THE UVULA AND TONSILS
• SEPTAL PERFORATION
• NASAL COLLAPSE
DX TEST TISSUE BIOPSY A drop of mineral oil placed over the burrow
TISSUE SMEAR followed by superficial scraping and
BLOOD TESTS examination under a microscope
LEPROMIN TEST – HYPERSENSITIVITY TO LEPROSY
MANAGEMENT: • SULFONE THERAPY • Application of pediculocide
• MDT • Crotamiton cream
RIFAMPICIN • Neosporin ointment
CLOFAZIMINE MULTIBACILLARY • Eurax and Kwell lotion
DAPSONE PREVENTIVE: (G.O.A.L)
Good personal hygiene
RIFAMPICIN Ol members of
DAPSONE PAUCIBACILLARY household should be
treated
PREVENTIVE: (.B.E.S.T) Avoid contact with
BCG VACCINE infected persons
Education On Mot Launder clothes,
SRG Integrals 2nd Ed. Communicable Diseases 584
 Separate Newborns from Leprous Mother beddings worn and
To Report Cases And used properly
Suspects Of Leprosy
Table 4.2 Scabies and Leprosy
V. GASTR0 - INTESTINAL DISEASES
GASTROENTERITIS
• Is an inflammation of the GI; it most commonly affects the small intestine.
• A.K.A Traveler’s diarrhea, dysentery.
• History – will differentiate from other conditions
Etiology and Incidence
1. Bacterial (“BE A SAVER”)
By way of fecal-oral
E. Coli – Traveler’s Diarrhea
Affects all ages
Shigellosis – Bacillary Dysentery
Affects in warm climates
Viral gastroenteretits
Enter by way of the respiratory system.
Rotavirus and parvovirus-type

The Pathophysiology and Manifestations:

• Symptoms common to all types of gastroenteritis include:
a. Nausea
b. Vomiting
c. Diarrhea
Bacterial – stool specimens with high WBC, possibly high RBC
Viral - high WBC and the presence of pus
*Fever depends on microorganism, bacterial usually causes higher temp.

S/Sx of viral gastroenteritis include (M.A.N.H.I.D)

Muscle aches and pains/ weakness
Abdominal distention and tenderness
No rebound tenderness
Headache
Infection can last anywhere from 2 to 7 days.
Deficient fluid volume if diarrhea and vomiting become severe

Nursing Intervention
1. Drugs – anti-infective agents, analgesics, and electrolyte replacement medications (eg, potassium). No drugs
to suppress gastric motility.
2. Monitor I & O
3. Watch out for F & E imbalances
4. Dietary changes (I.C.L.A.P.P.A.P.A)
Intake of clear liquids initially
Collect stool specimen.
Lactose-free foods for 1 to 2 weeks (after symptoms subside)
Parenteral therapy for severe cases.
Provide meticulous perianal skin care.
Adherence to medication regimen
Provide patient teaching covering:
Appropriate sanitary methods for cooking and personal hygiene
SRG Integrals 2nd Ed. Communicable Diseases 585
 COMMUNICABLE CAUSATIVE INCUBATION MODE OF DIAGNOSTIC TEST CLASSIC SIGNS AND TREATMENT
DISEASE AGENT PERIOD TRANSMISSION SYMPTOMS

THYPOID FEVER Salmonella 1-3 weeks 5F’s CBC – Leukopenia Ladder / Step Like Fever Chloramphenicol
thyposa
Feces, Food, Finger, Widal Reaction – Headache Others:
Fomites, Fly agglutination of the
organism to the patient’s GIT Manifestations Ampicillin
serum
Rose spots Cotrimoxazole
Thypidot
Brady/ Tachycardia

CHOLERA Vibrio Cholera Few hours – 5 F’s Culture: Vomitus and Colorless diarrhea/ RICE Tetracycline – DOC
5 days Feces WATERY STOOL
(Violent Dysentery)
Dark Field Microscopy Nausea and Vomiting

Severe DHN

Vascular Collapse

BACILLARY Shigella 1-4 days 5Fs Stool Exam Fever Chloramphenicol –

DYSENTERY dysentriae DOC
Nausea and Vomiting
(Shigellosis/ Bloody S. flexneri
Flux) Tenesmus
S. Boydii
Bloody and mucoid stool
S. Sonnei

SCHISTOSOMIASIS Schistosoma 2 – 6 weeks Water containing free Stool Exam Dermatitis Praziquantel – DOC
japonicum swimming larval
(Bihilariasis or snail forms in snails (small Kato- Katz Technique Hepatomegaly Oxaminiquine
fever) S. mansoni main host)
Bloody stoll Metrifonate
S. haematobium
Diarrhea

Anemia

Table 5.1 Gastrointestinal Diseases

SRG Integrals 2nd Ed. Communicable Diseases 586

 VI. CNS DISORDERS

DISEASE SIGNS AND SYMPTOMS MEDICAL MANAGEMENT NURSING MANAGEMENT PREVENTION

(T.O.R) 1. Promote Airway 1. Prevent Seizures 1. Wound Care
TETANUS (Lockjaw) Trismus • Maintenance and • Raise side rails 2. Immunization
Causative Agent Opisthotonus Reduce Muscle Spasm • Promote Rest Passive Immunization:
• Clostridium tetani Risus Sardonicus (NPO during muscle • Quiet environment • Equine Tetanus
• Anaerobic spasm) • Dim lights Antitoxin (TAT)
• Gram (+) Tetanus Neonatorum • Sedatives • Avoid unnecessary • Tetanus Immune
• Toxigeni • Difficulty in Sucking e.g. Diazepam handling globulin
• Spore Forming – FIRST sign • EMERGENCY 2. Promote Nutrition • (Hyper Tet) – within
Mode of Transmission/ • Excessive crying equipment • High Caloric Diet 72 hours.
• Direct Inauculation or later leading to a strangled – • @ bedside • Fluid Diet, NGT, TPN • Active
break into the skin soundless voiceless noise. • E.g. Tracheostomy, ET 3. Monitor for Possible Immunization: DPT
• Improper handling of tube, Mechanical Complications: • Tetanus Toxoid
cord Diagnostic Test Ventilation • Aspiration 3. Steriliziation of Hospital
Incubation Period 1. Clinical Diagnosis 2. Kill the Bacteria Pneumonia Supplies
• Period 3-4 weeks History of wounds • Antibiotic • Cardiac
Immunization Status • Penicillin Dysrhthymias Tetanus Neonatorum
2. Blood Culture 1. Active Immunization
3. Tetanus Antibody (Pregnant Mother with TT)
test 2. Strict Asepsis during
delivery.
3. Licensing of Health
Personnel like the Midwifes,
Nurses.
Table 6.1 Tetanus

SRG Integrals 2nd Ed. Communicable Diseases 587

 DISEASE SIGNS AND SYMPTOMS MEDICAL MANAGEMENT NURSING MANAGEMENT PREVENTION
TYPES: Table 2. Relief of 1. Rest 1. Immunization
POLIOMYELITIS Table 2. Abortive Polio Painful Muscle 2. Relief of Muscle A. Trivalent Oral Polio
(Infantile Paralysis; Heine • Slight Fever • Spasm • Spasm Vaccine (TOPV)
Medin Disease) • Malaise • Aspirin • Hot Moist • Sabin
• Sore Throat • Codeine • Packs B. Inactivated Polio
Causative Agent: 2. Nonparalytic Polio • Sedative Drugs (e.g. 3. Monitor for Possible Vaccine
• Polio Virus/ • Moderate Fever Phenobarbital) Complications: • Salk
• Filterable Virus, • Headache *Caution for Bulbar Polio • Respiratory Paralysis
• Legio Debilitans • Neck, back pain 2. Ventilatory Support • Hypertension 2. Prevent spread of
a. Leon 3. Paralytic Polio • Respirator 4. Promote Rehabilitation Infection
b. Lansing • Asymmetrical Flaccid • Oxygen Therapy • Refer to Physical and Enteric Isolation
c. Brunhilde Paralysis • Tracheotomy Occupational Therapy until the
Mode of Transmission: • Tripod sign • Mechanical • Braces, orthopedic end of fever.
Inhalation of Oropharyngeal • Hoyne’s Sign Ventilation shoes Proper disposal
secretions, Feco –Oral • Poker’s Spine of Nasopharyngeal
Incubation Period: 7 – 14 4. Bulbar Polio and excreta.
• Respiratory Paralysis
• Encephalitis
• Hypertension

Diagnostic Test
1. Throat Culture
2. Stool Culture

Table 6.2 Poliomyelitis

SRG Integrals 2nd Ed. Communicable Diseases 588

 DISEASE SIGNS AND SYMPTOMS MEDICAL MANAGEMENT NURSING MANAGEMENT PREVENTION
1.Prodromal/Invasive Stage • Symptomatic Table 2. Prevent Table 2. Be a
RABIES (Hydrophobia, • Mental Depression – • Management Seizure responsible Pet
Lyssa) FIRST SYMPTOM • Chloral Hydrate • Rest Owner
• Fever • Quiet Environment Immunized pet @ 3 months of
Causative Agent: Rhabdo • Headache • Dark environment. age and then annually
virus • Photophobia 2. Promote Safety and Take care of your pet
2. Acute/Excitement Period Prevent 2. Utilization of National Rabies
Mode of Transmission: • Hydrophobia spread of infection Prevention
Bite or scratch of rabid • Aerophobia • Rest and Control Program of DOH.
animal, • Excessive Salivation • Restraint PRN Manpower Development
Transplant, • Maniacal behavior • Strict Isolation Social Mobilization
Aiborne 3. Paralytic Period 3. Prevention of Agitation Local Prgram Implementation
• Gradual, generalized due to Hydrophobia Dog Immunization
Incubation Period: 10 – flaccid • Avoid bathing the 3. Wound Care and Tetanus
14 days Immunization
• paralysis patient
• Turn off the faucets. “If possible don’t suture the
• Cover IVF wound
Diagnostic Test
and immediately stop the
Table 2. Clinical
bleeding.”
Diagnosis
4. Immunization
• History of Animal Bite
Post Exposure Treatment –
• Signs and Symptoms
Active
2. Observe the pet for 10- 14
Immunization
days.
Human Diploid Cell Vaccine
3. Brain Biopsy of Animal Negri
(Imovax)
Bodies
Passive Immunization
4. Fluorescent Rabies Antibody
Rabies Immunoglobulin
Test (FAT)
(Rabuman, Imogam)

Table 6.3 Rabies

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 DISEASE SIGNS AND SYMPTOMS MEDICAL MANAGEMENT NURSING MANAGEMENT PREVENTION
• Symptomatic 1.Provide comfort 1.Identification of vectors
ENCAPHALITIS (Brain Fever) Japanese Enchephalitis: • Supportive • Keep patient in a 2.eliminating breeding
• Flu-like symptoms management quiet, well- grounds, destruction of
Causative Agent: (Father ‘N Child Has Vanity) ventilated room larvae, screening homes,
Culex trieaniorhynchus Fever • Encourage oral use of repellants
Nausea hygiene
MOT: Chills • Bed bath
-bite of an infected Vomiting 2.Prevent from complications
mosquito • Stiff neck/ neurologic • Turn patient at least
manifestations within every 2 hrs
Incubation Period:4-21 days 24hours • Encourage IOF intake
• Decreased IQ • Encourage high
• Serious brain damage caloric diet
• Moisten lips with
General Manifestations: mineral oil
Prodromal: 3.Monitor I&O
• Fever
• Hedache
• Dizziness
• Conjunctivitis
• Arthralgia
• Myalgia
Later:
• Rigidity
• Ataxia
• Speech difficulties
• Convulsions
• Ocular palsy
• Flaccid paralysis
Table 6.4 Encephalitis

SRG Integrals 2nd Ed. Communicable Diseases 590

 DISEASE SIGNS AND SYMPTOMS MEDICAL MANAGEMENT NURSING MANAGEMENT PREVENTION

MENINGITIS A. Cardinal Signs 1.IV antibiotics for 2 weeks 1. Assess for sings of 1. Vaccines against certain
• Chills • Ampicillin increased ICP types of meningitis
Causative Agent: • Fever • Cephalosporins
-Neiseria meningitides • Malaise • (Ceftriaxone) 2. WOF for deterioration of 2. teach patient that
• Signs of increased ICP • Aminoglycosides condition chronic sinusitis or other
Incubation Period: 2-3 • Altered LOC infections the importance
days 2. Digitalis glycoside (digoxin) 3. monitor fluid balance of proper and prompt
B. Meningeal Irritation • To control arrhythmias medical treatment
MOT: • Stiff neck or nuchal 4. WOF reactions to
-Droplet rigidity 3. Mannitol antibiotics
-Direct invasion through • Opisthotonos • To teduce cerebral
otitis media • (+) Brudzinski’s sign edema 5. Position carefully to
-skull fructures • (+) Kernig’s sign prevent joint stiffness
• Exaggerated and 4. Anticonvulsants to reduce
restlessness and convulsions 6. Maintain adequate
symmetrical DTR’s
nutrition and elimination
• Sinus arrythmias
5. Acetaminophen to relieve
fever 7. Follow strict aseptic
technique with head
wounds or skull fractures

Table 6.5 Meningitis

SRG Integrals 2nd Ed. Communicable Diseases 591

 VII. SEXUALLY TRANSMITTED DISEASES
COMMUNICABLE DISEASE INCUBATION PERIOD DIAGNOSTIC TEST CLASSIC SIGNS AND SYMPTOMS TREATMENT
CAUSATIVE AGENT MODE OF TRANSMISSION

HIV/AIDS 3-6mo. Up to 8-10 HIV: HIV: • Antiretroviral Therapy

Retrovirus/ Human years ELISA • Asymptomatic • Zidovudine (Retrovir)
T-cell Lymphotropic • Sexual contact Presumptive Test • Flu like symptoms
Virus 3 • BT Western Blot/ AIDS:
(HTLV3) • Contaminated needles Immunofluorescence • (+) Opportunistic
and syringes Assay— Confirmatory infections/ Rare
• Transplacental AIDS: Cancers:
• Breastfeeding CD4 T cell Count • Kaposi’s Sarcoma
• Pneumocystis Carinii
Pneumonia
• Candidiasis
• Herpes zoster

SYPHILIS 10 days to 3 mo. • Dark Field Exam STAGES: • Penicillin

(Bad Blood/POX) • Sexual Contact • Immediate Diagnosis PRIMARY: - DOC
Treponema pallidum • Congenital • VDRL • painless CHANCRE SORE • Probenicid
(Spirochete) • Detect nonspecific • SECONDARY -Slows down the excretion of
antibodies • Lymph node Penicillin.
• Fluorescent enlargement
Treponemal • Flu-like symptom
• Antobody Absorption • Alopecia
Test • Skin rash
• Identifies antigens of LATENT:
• T. Pallidum • ASYMPTOMATIC
• TERTIARY
• SYSTEMIC (FATAL)
GONORRHEA 2-10 days Culture MALES: • Penicillin
(clap, drip, morning • Sexual Contact • Burning upon urination • Probenicid
drop) • Congenital (Vaginal • Pus discharges
Neisseria Gonorrheae Delivery) FEMALES:
• Asymptomatic

CHLAMYDIA 2-3 wks Same with gonorrhea. Almost the SAME with • Doxycycline
Chlamydia trachomatis • Sexual Contact gonorrhea
• Congenital (Vaginal
Delivery)
SRG Integrals 2nd Ed. Communicable Diseases 592
 Table 7.1 Sexually Transmitted Infections

VIII. OUTBREAK DISEASES

COMMUNICABLE CAUSATIVE INCUBATION MODE OF DIAGNOSTIC TEST CLASSIC SIGNS AND SYMPTOMS TREATMENT
DISEASE AGENT PERIOD TRANSMISSION

SARS Corona virus 2-7 days up Direct & indirect Reverse Transcription • High fever Symptomatic
to 10 days Polymerase • Headache management
Chain • Body aches
reaction (RTPCR) • Overall feeling of
• discomfort
• Dry cough
• DOB
BIRD FLU Avian 2 – 4 days Close contact Nasal/Throat Fever, cough, sorethroat, severe Symptomatic
influenza with infected Swab respiratory distress. management
virus birds and person Molecular test
H5N1 avian to person to detect the virus.
virus (H5N1)

MENINGOCOCCEMIA Neisseria 2-10 days Droplet Blood Culture Fever, petechiae Penicillin G-DOC
meningitidis (FIRST SIGN of the disease) Chloramphenicol
Hemorrhage or (If resistant to Pen- G)
thrombosis under the skin Ceftriaxone for children
Rifampicin –
prophylaxis
ANTHRAX Bacillus 2-7 days -Direct CUTANEOUS: Parenteral Penicillin G-
Anthracis transmission Toxemia 2missiol units every 6 hours
through infected High Fever Penicilin- sensitive:
Regional painful lymphadenopathy Tetracycline
animals
Extensive edema Erythromycin
Death Chloramphenicol
-Indirect
Shock
transmission
INHALATION:
through animal (Woolsorter’s disease)
bites/ ingestion of Hypotension; Hypoxia
contaminated Increasing fever
meat Dyspnea
Stridor
-Airborne Death in 24o
GASTROINTESINAL:
SRG Integrals 2nd Ed. Communicable Diseases 593
 Fever
Abdominal pain
N/V, and Diarrhea:bloody

Table 8.1 Outbreak Diseases

SRG Integrals 2nd Ed. Communicable Diseases 594

 C.D. SUPPLEMENTS!!!
*Antibiotics contraindicated during Pregnancy.
(Me.Ch.A.T)
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline
*Common Characteristic of Aminoglycoside (A.M.I.N.O)
Active agent against gram (-)
Mechanism of resitance. Modifying enzymes
Inhibit protein synthesis
Nephrotoxic
Ototoxic
*Patients who are taking Metronidazole should avoid drinking alcohol.

*If you forget your TB drugs, you’ll die and might need a (P.R.I.E.S)
Pyrazinamide
Rifampin
Izoniazid (INH)
Ethambutol
Streptomycin
*(+) Elisa test is considered as presumptive test for AIDS.

*Western Blot and Immunofluorescence Assay are the confirmatory test for AIDS.
Mnemonic: “President Elisa continue to Immunize the World”.

*Mononucleosis like syndrome is the initial manifestation of HIV infection.

*The incubation period for infants with AIDS is shorter than Adults.
Mnemonic: “Infants mas lower age, faster incubation period”

*Kaposi’s Sarcoma and Pneumocystis Carinii Pneumonia are two of the most common
diseases associated with AIDS.
Mnemonic: “KAPUSO with AIDS.”

*Purplish skin lesions are the early signs of Kaposi’s Sarcoma.

SRG Integrals 2nd Ed. Communicable Diseases 594

*Triad Symptoms of “Amoebiasis”
High Fever
Bloody Mucoid Diarrhea
Tenesmus
Mnemonic: “High Blood yung Tae”

*Ascariasis is a type of roundworm infection. A common first clue of patient’s with ascariasis is vomiting of worms or
passing worms in the stool.
Mnemonic: Ascariasis think of Ascof – for COUGH “the big “O”
- The primary treatment for Ascariasis is Mebendazole. Mebendazole is contraindicated in
pregnancy and in heavy infections. (provoke ectopic migrations)

*The use of Pyrantel or Piperazine temporarily paralyze the worms.

- This drug is also safe for Pregnant women.
Mnemonics: “Para sa Pregnant na may bulate.”
(permitting peristalsis)
- Pyrantel produces red stool.
Mnemonics:. “Pare Pula yung tae.”

*Contact Precaution is usually not applied for patient with Ascariasis.

[there is no direct person to person transmission]

*X- ray of the intestine with ascariasis will show “dot” sign.
[adult ascaris look like strands of sphaghetti]

*Acute symmetrical Cranial Nerve Impairment (Ptosis, Diplopia, Dysarthria) is the cardinal sign of Botulism.
- IV or IM botulism antitoxin the treatment of choice for Botulism.
[neutralize circulating toxins]
- Check Skin test before administering Botulism antitoxin
- Avoid Antibiotics and Aminoglycoside of patient develop Botulism.
[Increase risk of Neuromuscular Blockade]

*The most common predisposing factor for Candidiasis is the use of Broad spectrum antibiotics.
*Cream colored patches on the mouth is the pathognomonic sign for oral thrush(candidiasis)
*Nystatin (Mycostatin) is administered by instructing the patient to SWISH the solution in the mouth for one minute and
then SWALLOW.

*The most common agents of cellulitis are Streptococcus pyogenes and Staphylococcus Aureus.

*Penicillin is the drug of choice for strepcoccal cause cellulitis.

*The classic sign of cellulitis are (S.E.E)

Sudden tenderness
Erythema
Edema

SRG Integrals 2nd Ed. Communicable Diseases 595

*The most common symptom of Lymphogranuloma venereum (causative agent: Chlamydia trachomatis) is unilateral
enlarged inguinal lymph nodes

*The main symptoms of Cholera are (H.A.R.D)

Hypovolemic shock
Acidosis
Rice watery stool
Diarrhea (profuse).
*Prophylactic use of oral tetracycline is given to protect the transmission of cholera among family members.

*Oral or Parenteral rehydration therapy is the most important modality of treatment for patient with cholera.

*Patient with cholera is placed on contact precautions.

*The most common causative agent for common cold is rhinovirus.

*The patient is usually afebrile and runny nose is its classic symptom.

*Differential Diagnostic test for conjunctivitis.

Bacterial – increase neutrophils.
Viral – increase Lymphocytes.
Allergy – Increase Eosinophils

*Don’t irrigate the eyes of the child with conjunctivitis. [promotes the spread of infection]

*Cytomegalovirus (CMV) is usually dangerous to immunocompromised and pregnant mothers.

*Differentiation between two tests for Diphtheria:

• Schick Test – Susceptibility for diphtheria.
• Moloney’s Test – determine hypersensitivity to Diphteria toxoid (masamang reaction sa vaccine)

*In Ebola Virus infection, the patient remains contagious after he died.

*Herpetic Whitlow, an herpes virus hominis (HVH), commonly affects health care workers.

*Postherpetic neuralgia, a common complication among elderly patients with herpes, is characterized by intractable
pain.

* The common drug of choice for Leptospirosis.

Mnemonics: “Dito Papasa sa SRG”
Doxycycline
Penicillin
Streptomycin

SRG Integrals 2nd Ed. Communicable Diseases 596

*Dapsone antibiotic is the primary treatment for Leprosy.
Drugs for Leprosy: “Read ‘D Lines”
Rifampin
Dapsone
Lamprene

*Patient who have been infected with leptospirosis should not donate blood for at least 12
months after recovery.

*Plasmodium Falcifarum is the most common causative agent in the Philippines and the most serious type of malaria.

*The three stages of malaria infection are the cold stage, hot stage and wet stage.

*The pathognomonic sign of Diphtheria is patchy grayish green membrane

(pseudomembrane) over the pharynx and Bull neck Appearance.

*Thrombophlebitis is a common adverse effect of Erythromycin.

*Ventricular Fibrillation is a common cause of sudden death in diphtheria patients.

*Penicillin Benzathine (IZA)[one single IM dose] is a preferable prophylactic treatment for high risk diphtheria clients.

*Erythromycin can also be used. [decrease compliance]

*Diphtheria toxin usually attack vital organs which include [PAK]

*Peripheral Nervous System, Heart (ART), Kidney

SRG Integrals 2nd Ed. Communicable Diseases 597

SRG Integrals 2nd Ed. Communicable Diseases 598