COMMUNICABLE & INFECTIOUS DISEASES (LEAP) ✓ Sign and symptoms of illness begin to

decline
EPIDEMIOLOGIC PATTERNS ✓ In this stage, the client is prone for
1) SPORADIC secondary infection due to their
✓ Intermittent Occurrence temporary suppressed immune
✓ Irregular interval system.
✓ Random locations 5) CONVALESCENT/DEFERVESCENT
✓ Scattered cases ✓ CONVALESCENT = Recovery
✓ E.g. rabies ✓ DEFERVESCENT = Complication/
2) ENDEMIC Death
✓ Continuous occurrence
✓ Steady frequency CHAIN OF INFECTION
✓ Over a period of time 1) INFECTIOUS AGENT
✓ Inherent in that locality  Bacteria, Virus, Fungi, Protozoa
✓ E.g. Schistosomiasis in Leyte, Malaria  How to break the CHAIN?
in Palawan a) Rapid organism identification
3) EPIDEMIC (DIAGNOSIS)
✓ Outbreak b) Prompt treatment
✓ Greater than usual c) Decontamination
✓ Short period of time VIRULENCE ✓ Ability to cause a disease
4) PANDEMIC ✓ Overall strength to cause a
✓ Concurrent occurrence disease
✓ Same disease INFECTIVITY ✓ Capacity of agent to enter and
✓ Different countries multiply in a susceptible host
INVASIVENESS ✓ Ability to penetrate an intact
DIFFERENCE of NOSOCOMIAL and COMMUNITY skin
ACQUIRED INFECTION PATHOGENICITY ✓ Capacity if agent to cause a
NOSOCOMIAL/HOSPITAL COMMUNITY clinical disease in the infected
ACQUIRED ACQUIRED host
TOXIGENICITY ✓ Capacity of agent to produce a
Infection that is acquired Infection that is toxin or poison
after 48-72 hours of acquired within 48-72 ANTIGENICITY ✓ Ability to combine specifically
hospital stay hours of hospital stay with the final products of the
mention responses (i.e.
antibodies and/or cell-surface
STAGES OF ILLNESS: receptors)
1) INCUBATION PERIOD
✓ When the pathogen enters, no signs 2) RESERVOIR (any site where the pathogen can
and symptoms yet multiply or merely survive until it is transferred
✓ Insufficient number of pathogens to a host)
2) PRODROMAL PERIOD  Human Reservoirs
✓ Appearance of initial signs and  Animal Reservoirs
symptoms (fever, sore throat)  Environmental Reservoirs (plants, soil and
✓ Pathogens continues to multiply water)
3) PERIOD OF ILLNESS/ACUTE STAGE  How to break the CHAIN?
✓ All signs and symptoms appears a) Environmental sanitation
✓ Signs and symptoms are MOST b) Good health & hygiene
OBVIOUS and SEVERE c) Decontamination/ Sterilization
✓ Pathognomonic signs appears d) Dressing change
(characteristic signs of a specific e) Appropriate linen disposal
disease) f) Proper feces and urine disposal
4) PERIOD OF DECLINE 3) PORTAL OF EXIT (path by which the organism
✓ Number of pathogens begins to leaves the reservoir)
decrease  Mouth (vomit, saliva)
 Cuts in the skin (blood)
  During diapering and toileting (stool)
 How to break the CHAIN? 6) SUSCEPTIBLE HOST
a) Control of secretions  How to break the CHAIN?
b) Hand hygiene a) Recognize High-Risk Patients
c) Proper waste disposal b) Prompt Treatment
d) Avoid taking, coughing or sneezing c) Maintain Skin Integrity
over open wounds/sterile fields d) Balanced Diet
e) Cover mouth and nose when e) Immunization
coughing/sneezing  RISK FACTORS OF A SUSCEPTIBLE HOST
4) MODE OF TRANSMISSION (means by which the a) Children
agent passes through from the portal of exit of b) Elderly
the reservoir to the host) c) People with a weakened immune
DIRECT CONTACT INDIRACT CONTACT system
CONTACT VEHICLE d) Unimmunized people

Skin to skin contact, Indirectly transmit an INFECTION CONTROL

sexual contact infectious agent 1) Aseptic Technique
2) Standard Precaution
5 F’s: 3) Transmission-based Precaution
Feces, Food, Fluids, 4) Isolation Technique
Fingers, Flies, Fomites
CDC and Prevention Isolation Guidelines
NO DEVELOPMENT of A. TIER ONE
agent 1) STANDARD PRECAUTIONS
AIRBORNE ✓ Designated for the care of ALL hospital
patients.
Suspended longer ✓ Hand Hygiene
Travels more than 3 ft. VECTOR ✓ PPE (depending on the care rendered
DROPLET to a patient)
Animals/insects that can ✓ Respiratory Hygiene
Travels less than 3 ft. transmit the disease ✓ Puncture-Resistant Containers
AEROSOL ❖ In PPE:
DEVELOPMENT of agent ✓ Upon WEARING in SEQUENCE:
Tuberculosis, Measles, GoMEGlo
Chickenpox e.g. Mosquitoes, Fleas, a) Gown
Ticks b) Mask
DROPLET OF SALIVA c) Eyewear
d) Gloves
Mumps, Rabies, ✓ Upon REMOVING in SEQUENCE
Infectious mononucleosis (GlEGoMa)
a) Gloves
 How to break the CHAIN? b) Eyewear
a) Hand Hygiene c) Gown
b) Isolation Precautions d) Mask
c) Disinfection/Sterilization B. TIER TWO
d) Use Of PPE 1) TRANSMISSION-BASED PRECAUTIONS
e) Aseptic Technique ✓ AIRBORNE-PRECAUTIONS
5) PORTAL OF ENTRY 1. Isolate
 Mouth, Cuts in the skin, Eyes 2. Negative Air Pressure Room
 How to break the CHAIN? 3. N95 Mask
a) Hand Hygiene ✓ DROPLET PRECAUTIONS
b) Aseptic Technique 1. Isolate
c) Wound Care 2. Mask (Not Necessarily N95)
d) Puncture-Resistant Containers 3. Maintain 3 Ft Distance
✓ CONTACT PRECAUTIONS
 1. Isolate
2. Wear PPE MEDICAL ASEPSIS SURGICAL ASEPSIS
✓ Protective Environment REDUCES number of ELIMINATES ALL
1. People underground gene pathogens pathogens
therapy, organ transplant CLEAN TECHNIQUE STERILE TECHNIQUE
2. Administered drugs that cause USES FOR:
immunosuppression Administration of DRESSING CHANGES
✓ Hand hygiene MEDICATIONS
✓ PPE (depending on the care rendered ENEMAS CATHETERIZATIONS
to a patient) TUBE FEEDING SURGICAL PROCEDURES
✓ Respiratory Hygiene DAILY HYGIENE Operating Room
✓ Puncture-Resistant Containers Proper Cleaning of Labor & Delivery Room
supplies and equipment
CATEGORIES RECOMMENDED IN ISOLATION Proper Disposal Of Special Diagnostic Areas
1) STRICT ISOLATION Needles, Contaminated
a) COVID-19 Materials And
b) Measles Infectious Wastes
c) Chickenpox
Disinfection
2) CONTACT ISOLATION
a) Herpes Simplex Virus
BLACK  Dry
b) Impetigo
 Non-Infectious Waste
c) Parasitic Mites
GREEN  Wet
d) Chickenpox/Shingles (if ruptured
 Non-Infectious Waste
vesicles)
3) RESPIRATORY ISOLATION YELLOW  Infectious
a) COVID-19  Pathologic Waste
b) Measles  Chemical Waste
4) TB ISOLATION YELLOW WITH BLACK  Heavy Metal
5) ENTERIC ISOLATION BAND
a) Hepatitis A ORANGE  Radioactive Waste
b) Cholera RED  Sharps
c) Diarrheal Diseases
6) DRAINAGE/SECRETION ISOLATION CONSIDERATIONS FOR COHORTING
a) Jackson-Pratt Drainage of Patients  Placement and care of individuals who are
having Brain Abscess infected or colonized with the same
b) Burn Patients microorganism in the same room.
7) BLOOD & BODY FLUIDS ISOLATION 1) Client’s Diagnosis
a) AIDS 2) Presence Or Absence Of Infection
b) Hepatitis B 3) Infectious clients are considered DIRTY
c) Malaria 4) Postoperative clients are considered
d) Syphilis CLEAN
8) REVERSE ISOLATION/PROTECTIVE OR
NEUTROPENIC ISOLATION ISOLATION TECHNIQUE
a) Leukemia SOURCE PROTECTIVE
b) Neutropenia ROOM - +
PRESSURE
PROTECTED OTHERS PATIENT
PERSON
MOVEMENT IN OUT
OF AIR
 A severe form of DF that cause
TRANSMISSION-BASED PRECAUTIONS severe bleeding.
AIRBORNE 3) Dengue Shock Syndrome
PATIENT  Chickenpox
 Measles DAYS
 TB 1-3 FEBRILE  FEVER typically lasts
PLACEMENT NEGATIVE PRESSURE DAYS 2-7 days can be
PRIVATE ROOM biphasic.
PPE  N95 (95% of air  S/Sx:
particular filter a) Severe headache
respirator) b) Retro-orbital eye
TRANSPORT  Limited to essential pain
purpose c) Muscle, joint, and
 Place a surgical bone pain
mask d) Macular or
maculopapular
DROPLET rash
PATIENT  Diphtheria e) Minor
 Meningitis hemorrhagic
 Pertussis manifestations
PLACEMENT PRIVATE ROOM (petechial,
PPE  Mask ecchymosis,
TRANSPORT  Limited to essential purpura,
purpose epistaxis,
 Place a surgical bleeding gums,
mask hematuria, (+)
tourniquet test)
 Dehydration: High
CONTACT
fever may cause
PATIENT  Decubitus ulcer
neurological
 Discharges
disturbances and
PLACEMENT PRIVATE ROOM
febrile seizures in
PPE  Gloves
young children.
 Gown
4-7 CIRCULATORY  CRITICAL PHASE of
TRANSPORT  Limited to essential
DAYS dengue begins at
purpose
DEFERVESCENCE
and typically lasts
VECTOR-BORNE & ZOONOTIC DISEASES 24-48 hours
A. DENGUE FEVER  Most patient
➢ Acute febrile disease transmitted by a clinically improve
mosquito during this phase
➢ CAUSATIVE AGENT: Aedes aegypti  Can develop severe
➢ It is a DAY-BITING mosquito dengue to those
➢ It breeds on STAGNANT water having substantial
➢ DF can be infected 4 times plasma leakage
➢ 3 CLASSIFICATIONS: resulting a marked
1) Dengue Fever increase in vascular
✓ VIRUSES: permeability
a) Dengue Virus 1, 2, 3, 4 a) Shock from
b) Chikungunya Virus plasma
c) Arboviruses leakage
✓ Pregnant women can pass DF to b) Severe
their child (crosses placental hemorrhage
barrier). c) Organ
2) Dengue Hemorrhagic Fever impairment
 8-10 RECOVERY  As plasma leakage b) Inflate the cuff to appoint midway
DAYS subsides, patient between SBP and DBP and maintain
enters the for 5 minutes.
convalescent phase o (100 + 70)/2 = 85 mmHg
 Begins to reabsorb c) Reduce and wait 2 minutes
extravasated IV d) Count petechiae below antecubital
fluids and pleural fossa
and abdominal e) (+) Tourniquet test: 10 or more
effusions petechiae per 1 square inch.
 Hemodynamic status
stabilizes (may MANAGEMENT OF DF
manifest 1) Hydration
bradycardia), and 2) Analgesics
diuresis ensues. 3) Antipyretics
 Hematocrit stabilizes 4) Administer Blood Transfusions
or may fall because of 5) Environmental Control
the dilutional effect 6) Encourage Bed Rest
of the reabsorbed 7) O2 therapy
fluid 8) On Trendelenburg Position
 WBC count usually 9) Oral Rehydration Solution (ORS)
starts to rise 10) Use Sedatives
 Platelet count
recovery PREVENTION OF DF: MAG 4S KONTRA DENGUE
 Convalescent phase 1) SEARCH & DESTROY
rash desquamates ad 2) SELF-PROTECTION MEASURES
be pruritic. 3) SEEK EARLY CONSULTATION
 Hypervolaemia (only 4) SAY NO TO INDISCRIMINATE FOGGING
IV therapy has been
excessive and/or has B. FILARIASIS
extended into this ➢ Parasitic disease which causes an extremely
period) debilitating and stigmatizing disease
➢ CAUSATIVE AGENTS:
DF GRADING a) Wuchereria bencrofti
GRADE I  Non-specific b) Lymph vessels
symptoms c) Cules or Anopheles
 (+) Tourniquet test
GRADE II  Grade 1 symptoms
 Spontaneous
bleeding
GRADE III  Grade 2 symptoms
 Circulatory failure
GRADE IV  Grade 3 symptoms
 Profound shock

WHO DEFINITION OF DHF:

1) Fever
2) Hemorrhagic Episode
3) Platelet (<100,00/m3)
4) Increased vascular permeability

DIAGNOSIS OF DF
1) Tourniquet Test (Rumple Leeds Test)
a) Take the patient’s blood pressure and
record it
o e.g. 100/70 mmHg
 Mosquito takes a blood
meal
(L3 larvae enter skin)

HUMAN STAGES
MIGRATE TO HEAD AND •ADULTS IN
MOSQUITO'S LYMPHATICS
PROBOSCIS

ADULTS PRODUCE
SHEATHED
L3 LARVAE MICROFILLARIAE THAT
MIGRATE INTO LYMPH
AND BLOOD CHANNELS

MOSQUITO TAKES A
L1 LARVAE BLOODMEAL (INGESTS
MICROFILLARIAE

MICROFILLARIAE SHED
SHEATHES, PENETRATES
MOSQUITO'S MIDGUT,
AND MITIGATE TO
THORACIC MUSCLES
MANIFESTATIONS OF FILARIASIS
1) ASYMPTOMATIC
2) ACUTE
SPOROZOITES MEROZOITES
3) CHRONIC ENTER
LIVER
AFTER
INVASION
CIRCULATION INCUBATION
DIAGNOSIS OF FILARIASIS
1) NOCTURNAL BLOOD EXAMINATION
2) IMMUNOCHROMATOGRAPHIC TEST
SCHIZONTS
RBC INVASION
MANAGEMENT OF FILARIASIS FORMATION
1) SURGERY
2) HYGIENE
3) ON DEC or HERTRAZAN ➢ SIGNS & SYMPTOMS: CHASE
4) ELASTIC BANDAGE a) CHILLS
5) START ANTIBIOTICS/ANTIFUNGALS b) HEPATOMEGALY
c) ANEMIA
PREVENTION OF FILARIASIS  Lysis of infected and uninfected
1) DAY RBCs
a) Environmental sanitation  Suppression of hematopoiesis
b) House spraying  Increased clearance of RBCs by
2) NIGHT spleen
a) Use of mosquito net d) SWEATING (PROFUSE)
b) Long sleeves and pants e) ELEVATED TEMPERATURE
➢ PREVENTION: CLEAN
C. MALARIA a) Chemoprophylaxis
➢ Acute and chronic parasitic disease b) Larva-eating fish
transmitted by the bite of infected mosquitos c) Environmental sanitation
➢ CAUSATIVE AGENTS: d) Anti-mosquito repellents
a) Plasmodium falciparum e) Neem Tree/ Oregano Tree
b) Plasmodium malariae ➢ CONTROL: Sustainable preventive and vector
c) Plasmodium vivax control measures
d) Plasmodium ovale a) Insecticide Treatment
➢ VECTORS: b) On Stream Seeding
a) Breeds in clear, flowing, shaded c) House Spraying
streams d) On Stream Clearing
b) Brown in color e) Zooprophylaxis
c) Assumes a 36 degrees position when it f) Chemoprophylaxis
alights g) Avoiding outdoor nighttime activities
d) NIGHT BITING h) Using of mosquito repellents
➢ MOT: i) Planting Neem Trees
a) Bite of an infected mosquito j) Wearing Long sleeved clothes
b) Parenterally through BT
c) Shared contaminated needles D. SCHISTOSMIASIS
d) Transplacental transmission ➢ Known also as:
➢ PATHOPHYSIOLOGY a) SNAIL FEVER
b) BILHARZIA
c) KAYTMA FEVER
➢ CAUSATIVE AGENTS:
a) Schistosoma japonicum
b) Schistosoma mansoni
c) Schistosoma haematobium
d) Oncomelania quadrasi
➢ MOT:
➢ DIAGNOSTIC TEST:
a) CERCUM OVA PRECIPETIN TEST
➢ PREVENTION:
1) REDUCE SNAIL DENSITY
a) Clearing vegetation
b) Constructing drainage
c) Improving farming
2) DIMINISH INFECTION RATE
a) Disposing of urine and feces
properly
b) Avoiding bathing in infected
streams
c) Building foot bridges over
streams
d) Providing water supply
3) PREVENT EXPOSURE
a) Using rubber boots
b) Towel-drying
c) Applying alcohol
E. LEPTOSPIROSIS
➢ Zoonotic infectious bacterial disease carried
by animals whose urine contaminates food
and water.
➢ CAUSATIVE AGENT: Leptospira interrogans
➢ DIAGNOSIS:
 a) Clinical c) Skin is cold and clammy
b) Culture & Sensitivity d) Severe and painful spasm of
c) Serologic Test the mouth, pharynx, and
➢ MANAGEMENT: larynx
1) ANTIBIOTICS e) Profuse drooling of saliva
a) PENICILLIN G (SEVERE) f) Tonic-clonic contractions of
b) DOXYCYCLINE (MILD) muscles
c) CEFTRIAXONE (MILD) 3) TERMINAL/PARALYTIC PHASE
2) BLOOD TRANSFUSION a) Patient becomes quiet and
3) CONFRONT AND CONTROL unconscious
4) DALYSIS IF NECESSARY b) Loss of bowel and urinary
5) ELECTROLYTES control
c) Spasm ceases with progressive
➢ PREVENTION paralysis
a) Protective clothing, boots and gloves d) DEATH:
b) Educate people at risk 1. Respiratory failure
c) Rat eradication program 2. Circulatory collapse
d) Segregate domestic animals 3. Heart failure
e) Chemoprophylaxis (DOXYCYCLINE) ➢ MANAGEMENT:
1) Immunize household dogs and cats at
F. RABIES 3 mos. Of age
➢ CAUSATIVE AGENT: Rhabdovirus 2) Immunize people who are expose to
➢ CARRIERS: animals
a) Bats 3) Carefully and thoroughly clean and
b) Skunks flesh wounds with soap and water
c) Raccoons 4) Povidone iodine or alcohol may be
d) Cats used
e) Dogs 5) Patients may be given antibiotics,
➢ FACTORS AFFECTING INCUBATION PERIOD: Tetanus toxoid, or ATS
1) Distance of the bite to the brain 6) Animals that bite are observed for 10-
2) Extensiveness of the bite 14 days;
3) Specie of the animal a) If SICK: should be euthanized
4) Richness of nerve supply and their brains examined
5) Resistance of the host ➢ PREVENTION
➢ DIAGNOSIS 1) PRE-EXPOSURE VACCINE
1) Virus isolation from the patient’s a) IM administration in the deltoid
saliva b) Days 0, 7, and 21 or 28
2) Fluorescent Rabies Antibody Test 2) POST EXPOSURE VACCINE
3) Presence of Negri bodies a) Previously unimmunized
➢ PHASES: 1. 1 mL vaccine IM on days
1) PRODROMAL/INVASION PHASE 0, 3, 7, 14, 28
a) 1ST SYMPTOM: Flu-like 2. Administer HRIG
symptoms b) Previously immunized
b) Pain at the original site of bite 1. 1 mL vaccine IM on days 0
c) Sensitivity to light, sound, and day 3
temperature 2. Do not administer HRIG
d) Pain and aches in different
body part
e) Mild difficulty swallowing GASTROINTESTINAL DISEASES
f) Numbness, tingling, burning A. PARALYTIC SHELLFISH POISONING
sensation ➢ Food borne marine toxin disease with both GI
2) EXCITEMENT/NEUROLOGICAL and Neurologic symptoms
PHASE Occurs within minutes or several hours after
a) Marked excitation ingestion of poisonous shellfish
b) Eyes become fixed and glossy ➢ CAUSATIVE AGENT: Dinoflagellates
 ✓ Become poisonous after a heavy 4) Hydration And Food
rainfall preceded by prolonged 5) Oral Care
summer 6) Safety Is A Priority
➢ MOT: through INGESTION 7) Antibiotics: Chloramphenicol
➢ CLINICAL MANIFESTATION :
a) Tingling of lips and tongue C. CHOLERA
b) Tingling of the face, neck ➢ Acute bacterial enteric disease
c) Tingling of fingertips and toes ➢ CAUSATIVE AGENT: Vibrio cholerae
d) Dysphagia ➢ MOT: FECAL-ORAL ROUTE
e) Headache, Dizziness, Nausea a) Flies
f) Muscular Paralysis b) Food
g) Respiratory Difficulty c) Fingers
➢ DIAGNOSTICS: d) Fomites
a) Clinical e) Feces
b) Urine test ➢ CLINICAL MANIFESTATIONS: HARD
➢ PREVENTION: a) Hypovolemic Shock
a) Monitoring program to test water b) Acidosis
b) Avoid eating shellfish during red tide c) Rice Watery Stool
➢ MANAGEMENT: 4 A’s d) Diarrhea
a) Allow/induce vomiting ➢ DIAGNOSTIC:
b) Alkaline fluids are given a) Culture & Sensitivity (Gold Standard)
✓ E.g. Coconut water b) Dip Stick Test
c) Activated charcoal c) Stool examination
d) Artificial respiration ➢ PREVENTION: BREAK THE CHAIN of fecal, hand
and oral route
B. TYPHOID FEVER ➢ MANAGEMENT:
➢ Bacterial infection of the GIT affecting the 1) High Calorie, Low Fiber Diet
➢ CAUSATIVE AGENT: Salmonella typhi 2) IV Treatment
➢ MOT: FECAL-ORAL ROUTE 3) Antibiotics (Tetracycline)
a) Flies 4) Monitor I&O with VS
b) Food 5) Oral Rehydration Therapy
c) Fingers
d) Fomites LEPROSY (HANSEN’S DISEASE)
e) Feces ➢ Chronic systemic infection characterized by
➢ CLINICAL MANIFESTATIONS progressive cutaneous lesion
a) Neurological Changes ➢ CAUSATIVE AGENT: Mycobacterium leprae
b) Pea-Soup Diarrhea ➢ AFFECTED ORGANS:
c) Rose Spots (Rash) a) Skin
➢ DIAGNOSTIC: TyphiDot b) Peripheral nerves
✓ Presence of Salmonella typhi c) Eyes
➢ COMPLICATION: d) Testes
 It can spread VASCULARLY e) Mucosa of the URT
a) Meningitis ➢ MOT:
b) Waterhouse-Friderichsen a) Aerosol spread from infected nasal
Syndrome and oral mucosa
c) Skin lesions b) Prolonged skin to skin contact
d) Vascular collapse ➢ CLINICAL MANIFESTATIONS
e) Pulmonary insufficiency 1) FINE NERVES
f) Adrenal necrosis a) Anesthesia
➢ PREVENTION: BREAK THE CHAIN of fecal, hand b) Anhidrosis
and oral route c) Dryness
➢ MANAGEMENT: TYPHOSA 2) LARGE NERVES
1) TSB a) Pain then anesthesia
2) You have to monitor S/Sx closely b) Paralysis
3) Position Changes c) Atrophy
 3) Changes in skin color b) Renders patients non-infectious 1 week
4) Loss of sensation on the lesion after initiation of therapy
5) Decrease or loss of sweating 1) RIFAMPICIN
6) Thickened or painful nerves  600 mg once a month
7) Muscle weakness 2) DAPSONE
8) Pain and redness of the eyes  100 mf daily
9) Nasal obstruction or bleeding 3) CLOFAZIMINE
10) Ulcers that do not heal  50 mg daily
11) LEONINE FACIES (Pathognomonic)  S/E: skin discoloration
12) Madarosis (loss of eyebrows) ➢ NURSING MANAGEMENT:
13) Lagopthalmos (inability to close a) Moral support and encouragement
eyelids) b) Diet should be wholesome
14) Clawing of fingers and toes c) Terminal disinfection
15) Contractures ➢ PREVENTION AND CONTROL
16) Gynecomastia a) Reporting of all cases and suspects
17) Chronic ulcers b) Separating newborns from leprous
➢ DIAGNOSIS mothers
a) Presence of signs and symptoms c) BCG vaccination
b) History contact of People with leprosy d) Adequate nutrition
c) 1 of the 3 symptoms: e) Health education on the MOT
1. Hypopigmented or reddish
patches with definite loss of HEPATITIS
sensation ➢ CLASSIFICATION:
2. Damaged peripheral nerves 1) HEPATITIS A
3. Acid Fast Bacilli on Skin Slit ✓ CAUSATIVE AGENT: Hepatitis A virus
Smear ✓ May be Asymptomatic
✓ MOT: Fecal-Oral Route
BACTERIAL CLASSIFICATION ✓ Vaccine Preventable
PAUCIBACILLARY MULTIBACILLARY ✓ Curable
NON- INFECTIOUS/ ✓ Contagious before they feel sick
INFECTIOUS/TUBERCULOID LEPROMATOUS 2) HEPATITIS B (Serum Hepatitis)
Incubation period of 2-5 Incubation period of 8-12 ✓ CAUSATIVE AGENT: Hepatitis B virus
years years ✓ Usually no symptoms
<5 Lesions >5 Lesions ✓ MOT:
Normal Cell-mediated Deficient CMI a) Sexual Contact
Immunity (CMI)/ Partially b) Contaminated Needles
deficient CMI c) Body fluids (Blood or Semen)
Rapid peripheral nerve Rapid peripheral nerve ✓ Vaccine preventable
involvement involvement ✓ Can become CHRONIC
✓ Treatable but no cure exists
(+) LEPROMIN (Skin test) (-) LEPROMIN (Skin test) 3) HEPATITIS C
Few Bacilli Numerous Bacilli ✓ CAUSATIVE AGENT: Hepatitis C virus
PHARMACOLOGIC MANAGEMENT ✓ Usually no symptoms
1) RIFAMPICIN 1) RIFAMPICIN ✓ MOT: Blood-blood transmission
2) DAPSONE 2) DAPSONE ✓ NO VACCINE
3) CLOFAZIMINE ✓ Usually become chronic
✓ Curable
➢ MODALITIES OF TREATMENT: 4) HEPATITIS D (Delta Hepatitis)
a) MDT ✓ CAUSATIVE AGENT: Hepatitis D virus
b) Rehabilitation ✓ MOT:
c) Sulfone Therapy a) Sexual Contact
➢ TREATMENT: MULTIDRUG THERAPY b) Contaminated Needles
a) Use of two or more drugs for the treatment ✓ Can only be infected if have current
of leprosy Hepatitis B
✓ Hepatitis D resides inside Hepatitis B
 ✓ HREATER RISK of Liver failure
✓ Increased risk + Progression to liver
cirrhosis
5) HEPATITIS E
✓ CAUSATIVE AGENT: Hepatitis E virus
✓ MOT: Fecal-Oral Route
✓ INCUBATIONPERIOD: 2-8 weeks
✓ CLINICAL SYMPTOMS:
a) Jaundice
b) Nausea
c) Fatigue
✓ CHRONIC STAGE:
a) Weak immune system
b) Pregnancy
✓ GREATER RISK:
a) Fulminant liver failure
b) Cirrhosis
➢ RA 7846
✓ An Act Requiring Compulsory
Immunization Against Hepatitis B For
Infants And Children Below 8 Years
Old.
➢ MANIFESTATIONS: PHASES
1) PREICTERIC PHASE
a) Flu-like symptoms:
 Malaise
 Fatigue
 Fever
b) GI symptoms
 Anorexia
 Nausea
 Vomiting
 Diarrhea/Constipation
c) Muscle aches
d) Mild RUQ pain and tenderness
2) ICTERIC PHASE
a) Jaundice
b) Pruritus
c) Clay-colored stool
d) Brown or tea-colored urine
e) Decrease in PREICTERIC
PHASE symptoms
3) POSTICTERIC OR RECOVERY
a) Disappearance of Jaundice
b) Urine & stool color become
NORMAL
c) Appetite improves
d) GI symptoms disappears
e) COMPLETE RECOVERY of liver
may take up to 6 months
➢ NURSING INTERVENTIONS
1) Use Standard Precautions
2) Encourage planned rest periods
3) Diet:
a) Moderate Fat
b) High Caloric
c) High Carbohydrates
d) High Proteins
4) Small frequent feedings
5) Majority of caloric intake should be
scheduled in the morning
6) Avoid alcohol intake and diet drinks
7) Use warm water when bathing,
8) Use mild soap or no soap
9) Limit duration of baths and shower
10) Keep fingernails short and wear cotton
mittens
TREATMENT
HEPATITIS 1) INTERFERON ALPHA
B  Interferes with viral
replication
 Given IM or SC
 S/E: flu-like symptoms
2) LAMIVUDINE
 Reduces liver inflammation
HEPATITIS 1) INTERFERON ALPHA + RIBAVIRIN
C  Ribavirin adverse effects:
a) Hemolytic anemia
b) Birth defects
PREVENTION AND CONTROL
HEPATITIS A AND E
1) HANDWASHING
2) TRAVELERS SHOULD AVOID WATER AND
ICE IF UNSURE OF THEIR PURITY
3) FOOD HANDLERS SHOULD BE CAREFULLY
SCREENED
4) SAFE FOOD PREPARATION AND HANDLING
5) PUBLIC SHOULD BE EDUCATED ON THE
MODE OF TRANSMISSION
PREVENTION AND CONTROL
HEPATITIS B, C, AND D
1) AVOID SHARING NEEDLES
2) CAUTIOUS USE OF SHARPS BY HEALTH
WORKERS
3) SCREENING OF BLOOD AND BLOOD
PRODUCTS
4) ABSTINENCE
5) CONDOM
 Td (4): 1 year
after Td (3)

Td (5): 1 year
after Td (4)
JE SC Upper arm 9 months
HPV IM Outer Female: 9-10
upper arm years old
Influenza IM Outer 60 years old
Vaccine upper arm and above
annually
(every year)
EPI-PREVENTABLE COMMUNICABLE AND PULMONARY TUBERCULOSIS (KOCH’S DISEASE)
INFECTIOUS DISEASES ➢ CAUSATIVE AGENTS:
1) Mycobacterium tuberculosis
VACCINE ROUTE INJECTION SCHEDULE 2) Mycobacterium avium
SITE 3) Mycobacterium africanum
BCG ID Upper right At birth 4) Mycobacterium bovis
arm ➢ INCUBATION PERIOD: 2-10 weeks
HepB IM Outer mid- At birth ➢ SOURCES OF INFECTION
thigh 1) Saliva
OPV PO Mouth 6-10-14 weeks 2) Sputum
IPV IM Outer left 14 weeks 3) Nasal Discharge
upper thigh 4) Blood from Hemoptysis
PENTA IM Outer right 6-10-14 weeks ➢ MOT:
upper thigh 1) Airborne (Coughing, Singing, Sneezing)
PCV IM Outer left 6-10-14 weeks 2) Direct invasion through mucous
upper thigh membranes or breaks in the skin
PPV IM Upper right Adults 60 and 3) Ingestion of unpasteurized milk
arm 65 years old 4) Contact with contaminated eating or
Rotavirus PO Mouth 6-10 weeks drinking utensils
Vaccine ➢ CLINICAL MANIFESTATIONS:
MMR SC Upper right 9 months and 1) Cough for 2 weeks
arm 12 months 2) tiredness
3) Loss Of Appetite
MR SC Upper right Grade 1 and 7
4) Weight Loss
arm
5) Fever
Td IM Outer left Grade 1 and 7
6) Night Sweats
upper arm for children.
➢ SCREENING:
1) Intradermal PPD: MANTOUX TEST
Pregnant
Mothers: a) 0.1 mL of PPD injected ID into the
forearm
Td (1): As MANTOUX TEST POSITIVE RESULTS
early as IMPLICATION
possible in > 5 mm  HIV Positive
pregnancy.  Recent contact with an
active TB patient
Td (2): 4  Nodular or fibrotic
weeks after Td changes on CXR
(1)  Organ transplant
>10 mm  Recent arrivals (<5 years)
Td (3): 6 from high-prevalence
months after countries
Td (2)  IV drug users
  Resident/employee of
high risk congregate
settings
 Mycobacteriology lab
personnel
 Comorbid conditions
 Children <4 years old
 Infants, children, &
adolescents exposed to
high risk categories
>15 mm  Persons with no known
risk factors for TB
2) CHEST X-RAY
➢ DIAGNOSIS:
1) Direct Smear Sputum Microscopy
✓ Primary diagnostic tool in NTP case
finding prescribed to all TB
symptomatic
✓ 3/6 Symptoms: (+)
a) Coughing or wheezing for 2 weeks
b) Unexplained fever of 2 weeks or
more
c) Failure to respond to 2 weeks of
antibiotic for LRTI
d) Loss of appetite/weight or failure
to gain weight
e) Failure to regain previous state of
health 2 weeks after viral infection
f) Fatigue, reduced playfulness or
lethargy
✓ Any person with cough for 2 or more
weeks with or without the following
symptoms:
a) Fever
b) Chest and/back pains
referable to any musculoskeletal
disorder
c) Hemoptysis or recurrent blood-
streaked sputum
d) Significant weight loss
e) Other symptoms:
1. Sweating
2. Fatigue
3. Body malaise
4. SOB
2) Acid Fast Bacilli: RED
COMMUNITY
SYMPTOMATIC
DOTS FACILITY
CASE FINDING
MICROSCOPY CENTER
DIAGNOSIS
➢ SPUTUM SPECIMEN
a) SPOT SPECIMEN
b) SPOT/EARLY MORNING SPECIMEN
➢ OTHER DIAGNOSTIC TESTS:
a) VISION EXAMINATION
b) LIVER FUNCTION TESTS
c) AUDIOMETRIC TESTING
➢ PREVENTION: PROPHYLAXIS
a) ISONIAZID (INH) 300 mg/day for 6-12
months
➢ TREATMENT: DOTS
a) RIFAMPICIN (R)
✓ Adverse effect: HEPATOTOXIC
✓ Contact lenses should not be worn
✓ With meals
not b) ISONIAZID (H)
✓ HEPATOTOXIC\Avoid alcohol
✓ Peripheral neuropathy
✓ Take with Vitamin B6 (Pyridoxine)
✓ Take on empty stomach
✓ CONTRAINDICATION: Pregnancy
c) PYRAZINAMIDE (Z)
✓ Hyperuricemia
✓ HEPATOTOXIC
✓ Avoid using alcohol
✓ Administer with meals
d) ETHAMBUTOL (E)
✓ Optic neuritis
✓ Monitor vision daily
✓ Schedule visual examination
e) STREPTOMYCIN (S)
✓ Administered IM
✓ Sites are rotated
✓ Maintain fluid intake of 2-3 L/day
 ✓ Monitor urine output, BUN, Creatinine a) COUGH ETIQUETTE
✓ Assess balance b) SIGNS OF DRUG REACTION
✓ Reinforce safety
BACILLE-CALMETTE-GUERIN (BCG) VACCINE
SIDE EFFECTS DRUG(S) WHAT TO DO ➢ Minimum age at 1st dose: AT BIRTH
RESPONSIBLE ➢ Dosage: 0.05 mL
MAJOR SIDE EFFECTS: DISCONTINUE TAKING ➢ Number of doses: 1 dose
MEDICINES AND REFER TO MHO/CHO/PHYSICIAN ➢ Interval between doses: None
IMMEDIATELY ➢ Route: Intradermal (ID)
Severe Skin Any kind of Discontinue and ➢ Site: Deltoid
Rash drug refer ➢ Vaccine type: Attenuated
(especially,
Streptomycin) PREVENTION AND CONTROL
Jaundice Due Any kind of Discontinue and 1) Submit all babies for BCG
To Hepatitis drug refer 2) Avoid overcrowding
(especially, 3) Improve health status
HRZ) If symptoms 4) CONTRAINDICATION:
subside, resume a) Patients who have compromised
treatment and immune system
monitor
Impairment Of Ethambutol Discontinue and
Visual Acuity refer
And Color ophthalmologist A. MEASLES (RUBEOLA)
Vision ➢ Acute highly communicable infection
Hearing Streptomycin Discontinue and characterized by fever, rash and respiratory
Impairment refer symptoms
➢ CAUSATIVE AGENT: Morbilli Paramyxoviridae;
CATEGORY 1st Sputum 2nd 3rd an RNA virus
Follow-up Sputum Sputum ➢ INCUBATION PERIOD: 8-12 days
Exam Follow-up Follow-up ➢ MOT:
Exam Exam a) DIRECT (DROPLETS, AIRBORNE)
I Towards Towards End of 6th b) INDIRECT (FOMITES)
end of 2nd end of 5th month ➢ PERIOD OF COMMUNICABILITY
month month a) CONTAGIOUS 4 days before
II Towards Towards End of 8th appearance of rash
end of 3rd end of 5th month b) CONTAGIOUS 4 days after appearance
month month of rash
➢ CLINICAL MANIFESTATIONS: STAGES
5 ELEMENTS OF DOTS a) PRE-ERUPTIVE STAGE
1) SUSTAINED POLITICAL COMMITMENT  Flu-like symptoms
2) ACCESS TO QUALITY-ASSURED SPUTUM  Cough
 Conjunctivitis
MICROSCOPY
3) UNINTERRUPTED OR REGULAR SUPPLY OF  Body ache
QUALITY-ASSURED DRUGS  KOPLIK’S SPOTS (Pathognomonic)
4) STANDARDIZED RECORDING AND − Bluish-whitish spots on
REPORTING SYSTEM soft palate or buccal
5) STANDARDIZED TREATMENT WITH SHORT- mucosa
COURSE CHEMOTHERAPY b) ERUPTIVE STAGE
 Maculopapular Rashes (starts form
PTB - NURSING MANAGEMENT the hairline down to behind the ears
1) COVER NOSE WHEN COUGHING OR SNEEZING to trunk and limbs)
2) HAND WASHING  Pruritus
3) RESPIRATORY ISOLATION c) STAGE OF CONVALESCENCE
4) ADMINSTER MEDICATION AS ORDERED  Rashes desquamates (peeling)
5) PATIENT EDUCATION  Fever dissipates
 ➢ MANAGEMENT: MEASLES – NURSING MANAGEMENT
a) Active Immunity (MMR & Measles 1) ISOLATE PATIENT
Vaccine) 2) TSB FOR FEVER
b) Passive Immunity (Measles 3) SKIN HYGIENE
Immunoglobulin) 4) ORAL & NASAL HYGIENE
c) Lifetime Immunity for primary 5) RESTRICT TO QUIET ENVIRONMENT
infection (Active Natural) 6) DIM LIGHT
➢ OTHER FACTS OF MEASLES: 7) ANTIPYRETICS
a) It is EXTREMELY CONTAGIOUS
b) Breastfed babies of mothers have 3 MEASLES – MANAGEMENT
month immunity for measles 1) MOUTH AND NOSE CARE
c) MOST COMMON COMPLICATION: 2) APPETITE IS CONCERN
 Otitis Media 3) HYDRATION STATUS
d) MOST SERIOUS COMPLICATIONS 4) IN HEAT/FEBRILE
 Pneumonia 5) YES, RASHES WILL FADE
 Encephalitis 6) A (VITAMINS)
➢ DIAGNOSTICS:
a) Physical Examination (CLINICAL) MEASLES VACCINE
b) Nose & Throat Swab (not routinely ➢ Minimum age at 1st dose: 9 MONTHS
done) ➢ Dosage: 0.5 mL
c) U/A ➢ Number of doses: 1 dose
d) CBC ➢ Interval between doses: None
DAY 0-1 PRODROME ➢ Route: SUBCUTANEOUS
COUGH ➢ Site: OUTER PART OF UPPER ARM
CORYZA ➢ Vaccine type: Attenuated
CONJUNCTIVITIS
DAY 2-3 KOPLIK SPOTS APPEAR B. GERMAN MEASLES (RUBELLA)
DAY 4-5 MORBILLIFORM RASH ➢ POST NATAL: an infection that primarily
APPEARS affects the skin and lymph nodes
DAY 6 KOPLIK SPOTS REGRESS ➢ CONGENITAL: fetal infection which results to
DAY 7-8 RASH IS MOST INTENSE congenital abnormalities
DAY 10 RASH BEGINS TO ➢ Known as 3 DAY MEASLES (After 3 days,
RESOLVE measles disappears)
3 C’S OF MEASLES ➢ CAUSATIVE AGENT: Rubi Togaviridae; a
 FIRST SIGN: Mild-Moderate Fever rubella virus; RNA
1) CORYZA ➢ INCUBATION PERIOD: 14-21 days
2) COUGH ➢ MOT:
3) CONJUNCTIVITIS a) DIRECT
− DROPLETS spread through
MEASLES – MANAGEMENT: the nasopharynx
1) OBSERVE RESPIRATORY ISOLATION b) INDIRECT:
2) SUPPORTIVE MANAGEMENT OF SYMPTOMS − TRANSPLACENTAL
3) HYDRATION ➢ CLINICAL MANIFESTATIONS:
4) PROPER NUTRITION a) Maculopapular Rashes (diffuse/ non-
5) VITAMIN A confluent, no desquamation, spreads
6) ANTIBIOTICS (if with secondary bacterial from face downwards)
infection) b) Blueberry Muffin Appearance
7) MEASLE VACCINE at 9 MONTHS c) FORSCHEIMER’S SPOTS
8) MMR VACCINE at 12-15 MONTHS (Pathognomonic)
− Petechial reddish spots on soft
MEASLES – PREVENTION palate or buccal mucosa
1) ISOLATION d) Cervical lymphadenopathy (swelling of
2) DISINFECTION cervical lymph nodes)
3) VACCINATION e) Low-grade fever compared to measles
➢ DIAGNOSTICS:
 a) CLINICAL ➢ Acute & highly CONTAGIOUS characterized by
b) Serologic testing vesicular eruptions
➢ COMPLICATIONS: ➢ Childhood disease & adolescents
a) Pneumonia ➢ Human beings are the only source of infection
b) Meningoencephalitis ➢ CAUSATIVE AGENT: Varicella Zoster Virus
c) Congenital Rubella Syndrome: ➢ INCUBATION PERIOD: 10-21 days
1. Deafness ➢ MOT: DROPLETS spread
2. Cataracts a) Nose & throat secretions
3. Heart defects b) INDIRECT CONTACT
4. Microcephaly c) Vesicles (contagious in early stage of
5. Mental retardation eruption)
6. Bone alterations d) Airborne
7. Liver and spleen damage ➢ CLINICAL MANIFESTATIONS:
➢ COMPLICATIONS TO PREGNANT WOMEN: a) PRODROMAL PERIOD:
a) Severe birth defects (acquired German  Headache
measles on 1st trimester)  Vomiting
b) Abortion (acquired German measles on  Anorexia
2nd trimester)  Malaise
c) Premature baby (acquired German  Mild Fever
measles on 3rd trimester)  Papulovesicular Rashes
d) 100% = 1st trimester appear on trunk (spreads to the
e) 4% = 2nd and 3rd trimester face and extremities –
f) 90% = excretion o virus at birth CENTRIFUGAL)
g) 10% = contagious until 1 year
➢ MANAGEMENT:
MACULES PAPULES
a) Active Natural Immunity
(PERMANENT or Lifetime after
primary infection)
b) Active Immunity (MMR & Rubella
Vaccine) VESICLES WITH
c) Passive Immunity (Gamma globulin) PUSTULE CLEAR FLUID
➢ PERIOD OF COMMUNICABILITY INSIDE
a) CONTAGIOUS for 7 DAYS BEFORE
appearance of rash
b) CONTAGIOUS for 7 DAYS AFTER
appearance of rash SCAR
CRUSTING
c) During Catarrhal Stage FORMATION
➢ NURSING CONSIDERATIONS:
a) MMR immunization
b) Use of Immunoglobulin ➢ PERIOD OF COMMUNICABILITY
c) Prevention of congenital measles a) CONTAGIOUS for 5 DAYS BEFORE
d) Avoid exposure appearance of rash
b) CONTAGIOUS for 5 DAYS AFTER
RUBELLA – PREVENTION: appearance of rash (Crusting)
1) DISINFECTION c) CONTAGIOUS a DAY BEFORE the
2) ISOLATION eruption of first lesion
3) DROPLET PRECAUTION ➢ COMPLICATIONS:
a) Pneumonia
RUBELLA – MANAGEMENT (POST NATAL) b) Meningoencephalitis (rare)
1) BED REST c) Hepatitis
2) STARCH BATH d) Skin lesions may develop secondary
3) ANTIHISTAMINE bacterial infections
e) Reye’s Syndrome (associated with
C. CHICKENPOX (VARICELLA) Aspirin use)
➢ DORMANT:
 a) Remain at the dorsal root ganglion and ➢ PERIOD OF COMMUNICABILITY
may recur as SHINGLES. a) CONTAGIOUS for 3 days before the
➢ MANAGEMENT: onset
a) ANTIVIRALS b) CONTAGIOUS for 4 days after the start
b) ANTIHISTAMINES of parotitis
c) ANTIPRURITIC LOTIONS ➢ COMPLICATIONS:
d) ANTIPYRETICS a) Meningitis
e) Mild/bland, soft foods b) Encephalitis
f) Acyclovir, Antihistamines c) Pancreatitis
g) Nasal and Oral care d) Oophoritis
h) Observe proper hygiene e) Orchitis
i) Keep fingernails short ➢ DIAGNOSIS : CLINICAL
➢ NURSING CONSIDERATIONS: ➢ PREVENTION:
a) If itchy, give antihistamines PO or local 1) Isolation
b) Avoid rupture of lesions 2) Disinfection
c) Cut nails short 3) Distance
d) Pay attention to nasopharyngeal ➢ MANAGEMENT: SADAACO
secretions/discharges 1) Soft diet
e) Prophylactic antibiotics 2) Aqua therapy
f) Exclusion from school for 1 week after 3) Discharges
eruption appears 4) Aspirin
g) An attack gives lifetime immunity 5) Allow Bed Rest
(Active Natural) 6) Control scratching
h) DOC: Acyclovir (topical cream applied 7) Oral Antiseptics
to crusts) 8) Orchitis
➢ PREVENTIVE MEASURES:
a) Active Immunization with LIVE
ATTENUATED VARICELLA VACCINE
b) Avoid exposure as much as possible to
infected person

CHICKENPOX HERPES
ZOSTER
(SHINGLES)
DISTRIBUTIO GENERALIZE UNILATERAL
N D
MAIN ITCHINESS BURNING PAIN
CONCERN
MANAGEMEN ACYCLOVIR ACYCLOVIR
T ANTIPYRETIC ANALGESIC
ANTIPRURITI ANTI-
C INFLAMMATOR
Y
PREVENTION  IMMUNIZATION
 AVOIDING EXPOSURE
 DISINFECTION
 WEARING PPE

D. MUMPS (PAROTITIS)
➢ Inflammation of the parotid glands
➢ Human beings are the only RESERVOIR
➢ CAUSATIVE AGENT: Paramyxovirus
➢ MOT: DROPLETS spread
a) CONTACT
b) IINDIRECT CONTACT