The Nurse and the Communicable Diseases

GERARDO A. NICOLAS RN, RM, RPT, MAN

Adolf Weil of Heidelberg reported the clinical
entity of fever, jaundice, hemorrhage, and
renal failure in 1886.
Weil’sdisease
Canicola Fever
Mud Fever
Hemorrhagic jaundice
Swineherd’s Disease
A spirochete of genus
Leptospira (Leptospira
interrogans)
 6-15 days

 Leptospira
is found in the urine
between 10 to 20 days after the
onset
1) Ingestion or contact with the skin
and mucous membrane of the
infected urine or carcasses of wild
and domestic animals.
2) Through the mucous membrane of
the eyes, nose, and mouth, and
through a break on the skin.
3) Direct human to human transmission
is rare.
a) Septic Stage
◦ This stage is marked with febrile lasting
for four to seven days.
◦ Abrupt onset of remittent fever
◦chills
◦headache
◦anorexia
◦abdominal pain
◦severe prostration
◦respiratory distress and fever
subsides by lysis
b) Immune or Toxic stage
◦ Iritis
◦ Headache
◦ Meningeal manifestations
 Disorientation
 Convulsions
 with CSF findings of aseptic meningitis.
 ◦ Oliguria and anuria with progressive renal
failure.
◦ Shock, coma, and congestive heart failure
are also seen in severe cases

c) Convalescent Stage
◦ At this stage, relapse may occur
during the 4th to 5th week
1) Blood urea-nitrogen and urea
2) Enzyme Link Immuno-sorbent
Assay (Elisa)
3) Leptospira Antigen-antibody test
(LAAT)
4) Leptospira Antibody Test (LAT)
5) Liver function test
 Meningitis
 Respiratory Distress
 Renal interstitial tubular
necrosis that result to renal
failure (Weil’s disease)
 Cardiovascular problems
1) Medical Treatment of
leptospirosis is geared toward:
◦ Suppressing the causative agent
◦ Fighting possible complications

 Penicillin G – drug of choice

 Ampicillin, Amoxicillin
 For prophylaxis, doxycycline
2) Peritoneal Dialysis
◦ Administration of fluid and
electrolyte and blood as
indicated.
 Isolate the patient, urine must be
properly disposed of.
 Darken patient’s room.
 Observe meticulous skin care
 Keep clients under close surveillance.
 For home care, clean near dirty
places, pools, and stagnant water.
 Facilitate health education on the
modes of transmission of the
disease.
 Encourage oral fluid intake.
 Sanitation in homes, workplaces,
and farms is a must.
 There is a need for proper
drainage system and control of
rodents (40 to 60 percent
infected).
 Animals must be vaccinated
(cattle, dogs, cats, and pigs).
Encephalitis, also, known as brain fever
is an acute inflammation (swelling) of
the brain usually resulting from either a
viral infection or due to the body’s own
immune system mistakenly attacking
brain tissue.
This disease is most prevalent in
Southeast Asia and the Far East
 FLAVIVIRUS

The most common cause

is a viral infection. The
brain becomes inflamed
as a result of the body’s
attempt to fight off the
virus. Encephalitis occurs
in 1 in every 1,000 cases
of measles.
Culex tritaeno rhynchus

Culex vishnui

Culex gelidus
Primary encephalitis occurs when a virus
directly infects the brain and spinal cord.
Secondary encephalitis occurs when an
infection starts elsewhere in the body and then
travels to the brain.

Encephalitis can develop as a result of a direct

infection to the brain by a virus, bacterium, or
fungus, or when the immune system responds
to a previous infection; the immune system
mistakenly attacks brain tissue.
Primary (infectious) encephalitis can be split
into three main categories of viruses:

(1)Common viruses, including HSV (herpes

simplex virus) and EBV (Epstein-Barr
virus);
(2)Childhood viruses, including measles and
mumps,
(3) Arboviruses (spread by mosquitoes, ticks,
and other insects), including Japanese
encephalitis, West Nile encephalitis, and
tick-borne encephalitis.
Secondary encephalitis could be caused by a
complication of a viral infection.

Symptoms start to appear days or even

weeks after the initial infection. The patient’s
immune system treats healthy brain cells as
foreign organisms and attacks them.

The incubation period is 4 to 21 days.

Japanese Encephalitis generally begins with
fever, nausea, chills, and headache, vomiting
with stiffness/ neurologic manifestations within
24 hours, dizziness, conjunctivitis, athralgia,
myalgia and decreased IQ and serious brain
damage.
The symptoms rapidly worsen, with signs and
symptoms of rigidity, ataxia, speech difficulties,
ocular palsy, flaccid paralysis, seizures ,
confusion, loss of consciousness, and even
coma.
Encephalitis can be life-threatening, but this
is rare. Mortality depends on a number of
factors, including the severity of the disease
and age. Younger patients tend to recover
without many ongoing health issues,
whereas older patients are at higher risk for
complications and mortality.
Encephalitis is more likely to affect children,
older adults, individuals with weakened
immune systems, and people who live in areas
where mosquitoes and ticks that spread
specific viruses are common.
The medical management is symptomatic and
supportive management. Treatment for
encephalitis focuses on alleviating symptoms.
For patients with mild symptoms, the best
treatment is rest, plenty of fluids, and Tylenol
(paracetamol) for fever and headaches.
Antiviral agents - acyclovir; success is limited
for most infections except when the condition
is due to herpes simplex.
Corticosteroids - to reduce the brain’s
inflammation, especially in cases of post-
infectious (secondary) encephalitis.
Anticonvulsants - seizures. (if Dilantin - check
for WBC)
Sedatives – also, effective for seizures,
restlessness, and irritability.
If the patient has severe symptoms, they may
need mechanical ventilation to help them
breathe and other supportive treatment.
The nursing management are:
(1)Provide comfort – keep patient in a quiet,
well ventilated room; encourage oral
hygiene and bed bath.
(2)Prevent from complications – turn the
patient at least every 2 hours, encourage
increase oral fluid intake, encourage high
caloric diet, moisten lips with mineral oil.
(3)Monitor intake and output.
 The prevention
are identification
of vectors and
eliminating
breeding
grounds,
destruction of
larvae, screening
homes, and use
of repellants.
 Aedes aegypti  Anopheles
 Day biting  Night biting

 Breeds in stagnant  Breeds in clear,

water flowing and

 Dotted mosquito
shaded streams
 Brown colored and
 Usually bite a
person in motion bigger in size
 Usually do not bite
a person in
motion
 Breakbone fever
 Dandy fever
 Infectious
Thrombocytopenic purpura
 H-fever
 Group B Arbovirus (I,II,II,IV)
 Flavivirus
 Chikungunya virus
 Zika virus
Incidence
 Age – may occur at any age but peak in 4 to 9 years
old
 Sex – both sexes can be affected

 Season – more frequently during rainy seasons; but

cases are all year round
 Location – more prevalent in urban than rural
communities
 Bite
of infected female AEDES
AEGYPTI mosquito

3 – 14 days
 Grade I: Symptomatic and
Supportive
◦Fever
◦Headache
◦Malaise
◦Anorexia
◦Chills
◦ Pain (Abdominal, Bone and Joint, and
Ocular)
◦ Rashes
◦ + Herman’s Sign: Flushing of the skin
◦ + Tourniquet Test (Rumple Leeds Test)
 Grade II: Manifestations of grade
I plus spontaneous bleeding –
BED REST
◦Epistaxis
◦Gingival Bleeding
◦Petechiae or ecchymosis
◦Gastro intestinal bleeding

 Ground coffee colored vomitus

 Hematemesis
 Melena
 Hematochezia
 Grade III:

◦ Manifestations of Grade II plus Beginning

symptoms of circulatory failure -Monitor
V/S and Watch out for complication of
shock
◦ Hypotension & narrowing of pulse
pressure

◦ Weak and thready pulse

◦ Cold, clammy skin

◦ Restlessness
 GRADE IV: Manifestations of
Grade III plus Shock-
PROPER POSITIONING

◦Undetected BP and pulse

CLASSIFICATIONS:
Mild DHF: slight fever, with or without petechial
hemorrhage
Moderate DHF: high fever, but less
hemorrhage, no shock
Severe DHF: frank type: flushing, sudden high
fever, severe hemorrhage, followed by sudden
drop of temperature, shock and terminating in
recovery or death.
 Tourniquet Test- Presumptive
diagnosis; detects capillary fragility

 Platelet Count: Confirmatory test→

Result: <100,000 cells/mm3

 Hemoconcentration- Increase in 20%

Hematocrit Count
Dengue NS1 Ag

Dengue Duo
NS1 antigen test (nonstructural protein 1), is a
test for dengue, introduced in 2006. It allows
rapid detection on the first day of fever, before
antibodies appear some 5 or more days later.
The method of detection is through enzyme-
linked immunosorbent assay.
The accuracy of the NS1 antigen rapid test is
considered high with sensitivity 55%-82% and
specificity 97%-100%. Since
the NS1 rapid test aims to detect dengue
NS1 antigen, it should be performed within 5
days of onset of fever.
A positive NS1 test result
confirms dengue virus infection.
A negative NS1 test result does not rule
out infection.
People with negative NS1 results should
be tested for the presence
of dengue IgM antibodies to determine
possible recent dengue exposure.
 Shock ----> DEATH
 Antipyretic/ Analgesic: Do not administer
NSAID for Fever

 Intravenous Fluid Therapy

a) Protocol for Fluid correction with NO SHOCK

 IVF Crystalloids- D5LR or D5 0.9 NaCl or PLR at 5-7
ml/kg/hr
b) Protocol for fluid correction with SHOCK
 IVF Crystalloids- PLR or P 0.9 NSS at 20ml/KBW IV
bolus in <20 minutes
c. if no improvement
◦ Colloids- Dextran, Haemacel,
Haesteril at 10ml/kg bolus in <10
minutes

d) Still no improvement
◦ Fresh Frozen Plasma at 15cc/kg in 2
hours and start inotropes Dopamine
7-15 ug/kg/m
Cyclical variation is the number of
cases usually increases towards the
ends of the rainy season.
 Search and destroy (sustain vector
control measures)
 Self protection measures
 Seek early consultation
 Say no to indiscriminate fogging
but support fogging, spraying,
and misting in hot spot areas;
 Sustain hydration
 “AGUE”
 Kingof Tropical and Sub-
tropical Diseases
Charles Louis Alphonse
Laveran discovered that
malaria was caused by a
protozoan parasite in
1880
 Anopheles mosquito
 Bite of infected female ANOPHELES
mosquito

 Through blood transfusion

 Contaminated needles and syringes

 Congenital transmission (RARE)

 Cold stage: severe recurrent
chills

 Hot stage: fever 4-6 hrs.

 Wetstage: profuse sweating

2-4 hrs.
 Early
signs of anemia: repeated
chronic symptoms: CBQ

a) Pallor

b) Easy fatigability

c) Dizziness
 Malaise
 Splenomegaly
 Hepatomegaly
Malarial smear: Confirmatory test
o detects malaria parasite
o best done during the height of fever
o The (quantitative)thick blood smear
determines the presence and percentage
of parasite in the blood, while the
(qualitative) thin blood smear determines
the specific species in the blood.
Quantitative Buffy Coat (QBC)/
Rapid Diagnostic Test (RDT)
o Detects malarial antigen
o taken anytime, the faster test
Cerebral Malaria:
most severe neurological
complication of infection with
Plasmodium falciparum malaria.
It is a clinical syndrome
characterized by seizures and
coma
Blackwater fever:

also called malarial hemoglobinuria, one of

the less common yet most dangerous
complications of malaria.

The distinctive color of the urine (dark) is due

to the presence of large amounts of
hemoglobin, released during the extensive
destruction of the patient's red blood cells by
malarial parasites that leads to kidney failure.
The antimalarials that can be used
in pregnancy include:
(1) chloroquine
(2) amodiaquine
(3) quinine
(4) azithromycin
(5) sulfadoxine-pyrimethamine
(6) mefloquine
(7) dapsone-chlorproguanil
(8) artemisinin derivatives
(9) atovaquone-proguanil
(10) lumefantrine
 First line: Artemether-lumefantrine
combination tablet

 Second line: Chloroquine, Primaquine

Pyrimethamine and Sulfadoxine
 ForComplicated Malaria: Multi
drug resistant Falciparum:
*Artemether 20mg/ Lumefantrine
120mg (C0-Artem)

 Erythrocyte Exchange Transfusion

 CHEMOPROPHYLAXIS
◦ Doxycycline: 1 day before going and 4
weeks after leaving malaria endemic area

◦ Chloroquine: 1 week before going and 4

weeks after leaving malaria endemic area

◦ Mefloquine: 2-3 weeks before going and 4

weeks after leaving malaria endemic area
 ZOOPROPHYLAXIS

◦ Typing of domestic animals to divert

attention of mosquitoes
 No vaccine yet
 Chemically-treated mosquito nets
 Larvae-eating fish
 Environmental Sanitation
 Anti-mosquito soap
 Natural anti-mosquito plants
 Wuchereria bancrofti
 Brugia malayi
 Brugia timori
 Loa loa

MODE OF TRANSMISSION:
Bite of Aedes poecilius

INCUBATION PERIOD:
8-16 months
Acute Stage:
Lymphadenitis
Lmphangitis
Funiculitis, orchitis, epididymitis

Chronic Stage:
H-ydrocele
E-lephantiasis
L-ymphedema
 Nocturnal blood exam
 Immunochromatographic test (ICT)

Management
Diethlycarbamazine citrate (Hetrazan)