Amoebiasis (Amoebic Dysentery)

Etiologic Agent: Entamoeba histolytica

Two developmental stages:

1. Trophozoites - are the facultative form of the parasite that may invade tissues.
They are found in the parasitized tissues and liquid colonic contents.
2. Cysts - are passed out with formed stools and are resistant to environmental
condition. This are considered the infective stage in the life cycle of E.
histolytica.

Incubation period: Usually one to four hours but may shorter. Hepatic amebiasis can
present longer, from two to five months after exposure.

Mode of Transmission:
1. Fecal - oral transmission
2. Human most commonly acquire the disease by ingesting viable cys from water,
food, and hands
3. Less common through sexual contact
4. Vectors, such as flies, coach roaches, and rodents can also transmit infection

Source of infection: Human Excreta

Period of Communicability: For duration of the illness

Diagnostic Procedures:
1. Stool exam (cysis, pus maybe white or yellow with pienty of amoeba)
2. Blood exam (leukocylosis)
3. Liver scan via MRI
4. Proctoscopy/sigmoidoscopy is carried out by a specialized physician to prevent
perforfation
5. Barium enema

Treatment Modalities:
1. Metronidazole (Flagyl)800mg TID for five days
2. Tetracycline 250mg every 6 hours
3. Ampicillin, quinolones, sulfadiazine
4. Streptomycin sulfate, chloramphenicol
5. Fluid and electrolytes should be replaced

Nursing Management:
1. Isolation, enteric precautions
2. Educate patients, their families and communities. Emphasize the points limited
below.
Boil water for drinking/drink purified water
Avoid washing food with the water taken from open drums or pails
Cover leftover foods
Wash hands after defecation or before eating
Avoid ground vegetables (lettuce carrots etc.)

2. Cholera or Cholera - El Tor

Etiologic Agent: Vibrio cholerae, Vibrio Comma
Mode of Transmission:
1. Fecal - oral route
2. Ingestion of food or water contaminated with stools or vomitus of
the patient
3. Flies, soiled hands, and utensils can also harbor V.cholerae
Incubation Period: from few hours to 5 days usually 3 days

Period of communicability: the time the stool test positive for the
organism.
Diagnostic Test:
1. Stool culture
2. rectal swab
3. Dark field or phase microscopy
Pathognomonic Sign: Rice watery stool

Treatment Modalities:
• IVF
• Oral therapy.
• Maintenance
• Antibiotics
a. Tetracycline 500mg every 6 hours for adults and 125mg/kg body weight for
children every 6 hours for 72 hours.
b. Furazolidone - 100 mg for adults and 125mg/kg for children every 6 hours x 72
hours
b. Chloramphenicol - 500mg for adults and 18mg/kg for children every 6 hrs. x72hrs.
c. Co-trimoxazole 8mg/kg for 72hrs.
Nursing Management
1. Carry out strict medical aseptic practices as protective care
2. Implement enteric isolation
Obtain accurate vital sign and record accordingly
4. Ensure accurate measurement of intake and output to determine the level of
hydration
6. Provide thorough and careful personal hygiene
7. Proper disposal of excreta
8. Carry out concurrent disinfection
9. Instruct the patient and significant other about proper preparation and
storage of food
10. Maintain environmental sanitation.

3. BACILLARY DYSENTERY Other name - Shigellosis

Etiologic agent:
1. Shigella flesneri (common in the Phil)
2. S. Boydii
3. S. Connel
4. S. Dysenterae
• Considered as the most infectious
• Their habitat exclusively GIT of human
• Like other Gram-negative bacilli, they develop resistance against antibiotics
• They rarely invade the bloodstream

Incubation Period. seven hours to seven days the aberage of three to five days
Mode of Transmission: Fecal - oral route, 5F's - Finger, foods, Feces, Flies,
Fomites
Pathognomonic sign: abdominal cramping, bloody mucoid stool, Tenesmus
Diagnostic Exam:
• Fecalysis or microscopic examination of the stools
• Isolation of the causative organism from rectal swab or culture
• Peripheral blood examination
• Blood culture
• Sheets of polymorphonuclear leukocytes seen in staining with methylene blue

Treatment Modalities:
• Antibiotics such as ciprofioxacin, ofloxacin, levofloxacin, or azithromycin
• lodoquinol and co trimoxazole maybe useful in severe cases
• IV infusion with normal saline (with electrolyte) to prevent dehydration
• A bland diet (bananas, rice, soda cracker) is recommended. AVOID MILK PRODUCTS
• Anti-diarrheal drugs are contraindicated
4. TYPHOID FEVER |
Etiologic agent: Salmonella typhosa, typhoid bacilus
Mode of Transmission: Ingestion of food or drink contaminated by feces or urine of
contaminated
Person
Source of infection: 5F's feces, fies. food, fingers, fomites
Incubation period. 5-40 days; mean 10 - 20 days
Pathognomonic sign: Rose spots in the abdomen - due to bleeding cause by the
Peyer's patche:
Sign and Symptoms:
• Fever
• Headache
• Abdominal pain
• Fatigue
• Rash

Diagnostic Test:
• Typhi dot - confirmatory test, specimen is feces
• Widal's test -agglutination of patient's serum
Drug of choice: Chlorampenicol
Prevention:
• Proper handwashing
• Proper food and water sanitation

6. HEPATITIS A
Other names - hepatitis, epidemic hepatitis, catarrhal jaundice
Etiology: Hepatitis A virus
Mode of Transmission: ingestion of contaminated food and water
through direct contact with contaminated person.
Incubation period: 15 - 50 days, depending on dose, average of 2l
- 30 days
Pathognomonic sign: Icteric sclera

Sign and symptoms:

• Fever
• Anorexia (early sign
• Headache
• Jaundice (late sign)
• Clay colored stool
• Lymphadenopathy

Management and Treatment:

• Prophylaxis - "IM injection of gamma globulir
• Complete bed rest
• Low fat but high in sugar
• Avoid alcohol

Prevention and Control:

• Ensure safe water for drinking
• Sanitary method in preparing handing and serving food
• Proper disposal of feces and urine
• Washing hands very well before eating and after using toilet
• Separate and proper cleaning of articles used by patient

7. PARALYTIC SHELLFISH POISONING - (PSP I Red Tide Poisoning)

Causative Agent: Dino flagellates, Plankton
Mode of transmission: Ingestion of raw or inadequately cooked seafood
usually bi -valve shellfish or mollusk during red tide season.
Incubation Period: 30 minutes to several hours after ingestion of poisonous
shellfish.
Pathognomonic sign: numbness of the face especially around the mouth.
Sign and symptoms:
• Vorniting and dizziness
• Headache

Treatment:
• No definite medication indicated
• Induce vomiting
• Drinking pure coconut milk weakens toxic effect of red tide
• Sodium bicarbonate solution (25 grams in ½ glass of water)
Management:
• Avoid eating shelifish such as tahong, talaba, halaan etc.
• Don't mix vinegar to shellfish it will increase toxic effect 15 times greater
NOTE: Persons who survived the first 12 hours after ingestion have a greater chance
of
survival.

Sexually Transmitted infection (STDs)

• These infections are predominantly transmitted by sexual contact including
vaginal, ana
oral sex. Some are contracted through non-sexual means such as through blood or
blood products These diseases have a profound impact on sexual and reproductive
health worldwide
• These are more than 30 different bacteria, viruses and parasites that are
transmitted
through sexual contact. Eight of these pathogens are linked to the greatest
incidence of
STis. Of these, four are currently curable:
1.
Syphilis
Gonorrhea
Chlamydia
Trichomoniasis