JO Micro Common Bacterial Diseases v. 3

COMMON BACTERIAL
DISEASES
RESPIRATORY SYSTEM
Common Nursing Management for Bacterial
Respiratory Diseases:
 Maintain patient’s airway and adequate oxygenation
 elevate head and shoulders
 Bed rest
 must not be permitted to bathe himself
 must avoid exertion when defecating
 purposes:
 to conserve energy
 to decrease workload of the heart

 Maintain adequate nutrition; Encourage fluids
 Small frequent feedings of soft food
 Encourage patient to drink fruit juices rich in vitamin C
 Airborne and Contact transmission precaution

 Dispose secretions properly
 Cover mouth when sneezing or coughing preferably with a
disposable tissue
 Handwashing after sneezing and coughing
 Teach an adult patient cough and deep breathing exercises
 back rub
 bronchial tapping
 Advise patient to stop smoking

 Mass education on the mode of bacterial transmission
 stress importance of good personal hygiene
 Administer antibiotics as ordered

TUBERCULOSIS
 Koch’s infection
 Primary Complex / Primary Koch’s Infection
 among children
 EA : Mycobacterium tuberculosis (Koch’s Bacilli)

TUBERCULOSIS
 MOT:
 Inhalation of airborne droplets (Droplet or Airborne)
 Prolonged direct contact (controversial)
 Ingestion of sputum (common among children)

TUBERCULOSIS
 Most infectious period:
 AFB (+) sputum
 Active Tuberculosis
 Primary Complex in children is NOT contagious

 but it is communicable
TUBERCULOSIS
 S/Sx of Chronic Pulmonary Tuberculosis
 Generalized:
 Malaise
 Fever usually in the late afternoon
 Night sweats
 Weight loss, anorexia

TUBERCULOSIS
 S/Sx of Chronic Pulmonary Tuberculosis
 Pulmonary:
 Productive cough
 Fine crepitant rales over the apical areas
 Chest/Pleural pain
 Hemoptysis (coughing up blood)
 often considered as pathognomonic sign by other
authors
 Dyspnea
TUBERCULOSIS
 Primarily affects the lungs but may affect other organs such as:
 Kidney
 Fallopian tube
 Meninges
 causes TB meningitis
 most common type of meningitis in the Philippines

TUBERCULOSIS
 Primarily affects the lungs but may affect other organs such as:
 Urinary bladder
 Intestines
 Bones especially the spine/vertebra

 Pott’s disease (TB of the Spine)
TUBERCULOSIS
 *Miliary TB / Disseminated TB
 large number of bacteria spread throughout the body via blood
stream
 potentially life-threatening
 results in gradual wasting of the body

TUBERCULOSIS
 Tx:
 Multiple Drug Therapy / Multiple Anti-Koch’s therapy which may
include:
 Rifampicin (RIF)
 red-orange urine
 Isoniazid (INH)
 hepatotoxicity
 peripheral neuropathy
 must be taken with Vitamin B6

TUBERCULOSIS
 Tx:
 Multiple Drug Therapy / Multiple Anti-Koch’s therapy which may
include:
 Ethambutol (EMB)
 optic neuritis
 Pyrazinamide (PZA)
 hepatotoxicity
 Streptomycin
 CN VIII damage
 vertigo due to
TUBERCULOSIS
 Rifampicin (RIF) and Isoniazid (INH)
 most effective drugs for the treatment of TB
 but these 2 drugs should never be given alone

 these are always used in combination with each other as
well as with other drugs
 because resistance to one drug alone occurs very
rapidly
 Good compliance to medications renders the patient NOT contagious

2 to 4 weeks after initiation of treatment
TUBERCULOSIS
 Prevention:
 BCG (Bacillus of Calmette and Guerin)
 administered during:
 early neonatal period
 before entering primary school

TUBERCULOSIS
 Persons at risk:
1. Adults whose initial infection was acquired many years
previously
2. Persons in close contact with someone who has infectious
tuberculosis
3. Persons with lowered resistance
4. Elderly persons who have healed dormant lesions living in
extended facilities
5. Alcoholics
6. Persons who have significant reaction to tuberculin test

TUBERCULOSIS
 Nursing interventions:
 All babies should be vaccinated with BCG
 Always check sputum for blood
 Maintain respiratory isolation until patient:

 responds to treatment
 is no longer contagious
TUBERCULOSIS
 TB education program
 stress importance of:
 continuing to take medications for the prescribed
time; and
 regular follow-ups
 these are the highest priority in nursing

intervention
TUBERCULOSIS
 controlling spread of TB
 Handwashing after sneezing and coughing
 Cover mouth when sneezing or coughing preferably

with a disposable tissue
 do not use bare hands
TUBERCULOSIS
 High CHON, CHO, Caloric, and Vit. C diet
 small frequent meals
 Plenty of rest
 Be alert for side effects of anti-TB drugs

TUBERCULOSIS
TUBERCULOSIS
TUBERCULOSIS
TUBERCULOSIS
TUBERCULOSIS
TUBERCULOSIS
TUBERCULOSIS
TUBERCULOSIS
MILIARY TUBERCULOSIS
MILIARY TUBERCULOSIS
POTTS DISEASE
POTTS DISEASE
POTTS DISEASE
WHOOPING COUGH or PERTUSSIS
 100 days cough
 EA : Bordetella pertussis
 MOT:
 Direct contact
 Indirect contact via fomites contaminated with respiratory
secretions or saliva
 Droplet / Airborne
 Stages:
1. Prodromal / Catarrhal stage
2. Paroxysmal stage
3. Recovery stage
 PRODROMAL / CATARRHAL STAGE

 mild flu-like symptoms
 cough becomes irritating, hacking, nocturnal, and becoming more

severe
 most communicable stage

 PAROXYSMAL STAGE
 Cough occurs in a series of successive explosive outbursts,
usually 5-10 coughs in one expiration

↓
 Ending in a sudden noisy inspiration associated with a long,
high-pitched crowing sound (“whoop”) and usually followed by

vomiting
 PAROXYSMAL STAGE
 cough is usually provoked by crying, eating, drinking, or physical
exertion
 child becomes cyanotic during coughing fits, and eyes appear to

bulge or “pop-out”
 tongue protrudes
 Can lead to:

 Lung rupture
 Bleeding of the eyes and brain

 RECOVERY STAGE
 gradual decrease in paroxysms of coughing
 Prevention : Immunization (DPT)
 Tx : Antibiotic therapy (Erythromycin)

 Nursing management
 major objective: prevent complications
 isolation and medical asepsis
 patient should not be left alone during coughing fits;

suctioning equipment should be ready at all times
 child should be kept as quiet as possible
 provide warm baths and keep linens dry and free from
soilings
BACTERIAL PNEUMONIA
 Inflammation of the mucous membrane lining of the alveoli
BACTERIAL PNEUMONIA
 EA:
 Escherichia coli
 MC: among neonates and infants
 Haemophilus influenza
 MC: among children (5 months to 5 years old)
 Streptococcus Pneumoniae
 MC: among adults
 Pseudomonas aeruginosa
 MC: Nosocomial pneumonia
BACTERIAL PNEUMONIA
 EA:
 Other bacteria:
 Mycoplasma pneumoniae
 Primary Atypical Pneumonia
 Walking Pneumonia
 Legionella pneumoniae
 Legionnaire’s disease
 found in water of air-conditioners
 can cause some epidemics in hotels, business districts,

spas, etc.
BACTERIAL PNEUMONIA
 EA:
 Other bacteria:
 Staphylococcus Aureus
 Klebsiella pneumoniae
 Bacillus anthracis
BACTERIAL PNEUMONIA
 MOT :
 Inhalation via droplets (Droplet / Airborne)
 Direct and Indirect contact with respiratory secretions

BACTERIAL PNEUMONIA
 S/Sx :
 Fever and chills
 Productive cough
 Tachycardia and tachypnea
 Acute chest pain with DOB
 Body malaise
BACTERIAL PNEUMONIA
 Tx : Antimicrobial/antibiotic therapy
 Prevention : Vaccination
 HiB (Haemophilus influenza)
 Pneumovaccine (Pneumococcus)
BACTERIAL PNEUMONIA
BACTERIAL PNEUMONIA
BACTERIAL PNEUMONIA
DIPHTHERIA
 EA : Corynebacterium diphtheriae
 also known as Klebs-Loeffler bacillus
 secretes an exotoxin
 MOT :

DIPHTHERIA
 starts as sore throat (most common manifestation)
 progresses in the formation of Pseudomembrane

 made up of:
 Leukocytes
 Fibrin
 Necrotic tissue
 Microorganism
DIPHTHERIA
 Pseudomembrane
 grayish in appearance at first but becomes dull-white as it
thickens
 located at the back of the throat that may cause:

 DOB
 Sore throat
 Tender cervical lymph nodes
 Neck swelling (“bull-neck” appearance)
 adherent to the underlying tissues and leaves a raw bleeding

area when detached
DIPHTHERIA
 Prev : Vaccination (DPT)
 Tx : Anti-microbial therapy (Penicillin)

Anti-toxin ASAP
DIPHTHERIA
 Nursing management:
 Absolute bed rest for at least two weeks
 Ice collar must be applied to the neck
 Nose and throat care

DIPHTHERIA
DIPHTHERIA
DIPHTHERIA
DIPHTHERIA
DIPHTHERIA
DIPHTHERIA
DIPHTHERIA
STREPTOCOCCAL PHARYNGITIS /
“STREP THROAT”
 EA : Group A Streptococcus (Streptococcus Pyogenes)

 which produces Erythrogenic Toxin
 MOT:

“STREP THROAT”
 S/Sx:
 sore throat (syempre), fever, chills and headache
 if a sunburn-like, pink-red rash develops with the characteristic

“Strawberry tongue”
 sand paper-feel papules on trunk towards extremities sparing
the palm and soles

SCARLET FEVER
 Tx : Antimicrobial therapy
“STREP THROAT”
“STREP THROAT”
“STREP THROAT”
“STREP THROAT”
“STREP THROAT”
“STREP THROAT”
SCARLET FEVER
SCARLET FEVER
SCARLET FEVER
SCARLET FEVER
SCARLET FEVER
ANTHRAX
 EA : Bacillus anthracis
 MOT:
 Entry of spores through:
 Skin injury
 skin contact
 animal bite
 Ingestion
 Inhalation
ANTHRAX
 Disease of sheep, cattle, horses, goats, and swine, affecting mostly
farmers and veterinarians
 Highly contagious and potentially fatal disease
 spores from B. anthracis can survive for years in soil but can be
destroyed by boiling for ten minutes
ANTHRAX
 types:
 Skin Anthrax
 Gastro-intestinal Anthrax
 Inhalation / Pulmonary Anthrax

ANTHRAX
 SKIN ANTHRAX
 results from direct skin contact with spores
 presents with:
 Malignant pustules of the skin leading to septicemia
 Eschar formation occurs and sloughs off
 black scab
 skin becomes thick and crusty which restricts blood
flow
ANTHRAX
 SKIN ANTHRAX
 After the eschar sloughs off

Hematogenous spread
Sepsis may occur

Shock (Septic Shock)
ANTHRAX
 GASTROINTESTINAL ANTHRAX
 results from ingestion of inadequately-cooked meat from animals
with Anthrax
 very rare compared to the other types of Anthrax

ANTHRAX
 INHALATION / PULMONARY ANTHRAX
 “Wool sorter’s disease”
 results from inhalation of spores
 initially presents with flu-like symptoms
 involves mediastinitis, sepsis, meningitis, and hemorrhagic

pneumonia
 Almost always fatal
 Tx : Penicillin (mortality rate is high despite antibiotic therapy)

ANTHRAX
ANTHRAX
ANTHRAX
ANTHRAX
ANTHRAX
ANTHRAX
ANTHRAX
ANTHRAX
ANTHRAX
DIGESTIVE SYSTEM
Common Nursing Management for
Bacterial Digestive Diseases:
 Restore and maintain fluid and electrolyte balance to prevent
dehydration
 thru oral and/or IV
 Monitor VS and I & O
 Good personal hygiene and oral care

 Wash hands thoroughly
 before preparing food.
 after using the bathroom, changing infant diapers, or
cleaning up animal feces.

 Proper environmental sanitation
 proper disposal of excreta
 disinfection
 Proper food preparation

 wash hands, utensils, and kitchen surfaces with hot soapy water
after they touch raw meat or poultry.

 wash fruits and vegetables thoroughly, especially those that will
be eaten raw
 Cook food properly
 especially hamburgers, poultry, and eggs
 water should be boiled or chlorinated
 milk should be pasteurized
 Refrigerate leftovers within 2 hours after cooking.
 Drink only pasteurized milk and juices, and treated surface water.
 Administer antibiotics as prescribed

BOTULISM
 EA : Clostridium botulinum
 Canned-good bacillus
 Sausage bacillus
 MOT:
 Entry of Botulinum Toxin (BOTOX) via:
 ingestion of endospores from contaminated food products
(Food-borne), often home canned- or smoked-foods
 through open wounds

BOTULISM
 Most severe form of food poisoning often resulting in death
 Botulinum toxin (a neurotoxin) inhibits release of Acetylcholine at the

NMJ, thereby preventing muscle contraction
 most potent toxin known to man (more toxic than venom of
cobra)
 Spore can withstand boiling for several hours

BOTULISM
 Cardinal signs of Botulism:
 acute symmetrical cranial nerve impairment
 ptosis
 diplopia
 dysarthria
 descending weakness and/or flaccid muscle paralysis
 dyspnea from respiratory muscle paralysis
 rarely causes diarrhea and fever

 highly fatal if left untreated
BOTULISM
 types:
 Food-borne / Classical botulism
 Wound / Cutaneous botulism
 Infant botulism
BOTULISM
 FOOD-BORNE / CLASSICAL BOTULISM
 results from ingestion of inadequately cooked contaminated food
 canned goods
 sausage
 preserved foods
BOTULISM
 WOUND / CUTANEOUS BOTULISM
 manifests with skin ulcers
 INFANT BOTULISM
 also known as Hypotonic (Floppy) Infant Syndrome
 common among infants who ingest or place objects in their mouth
with dust or soil contaminated with the toxin

BOTULISM
 Botulinum toxin (BOTOX) is often used for:
 therapeutic purposes such as in treating muscle twitches
 aesthetic purposes such as treating wrinkles

BOTULISM
 Tx/Nursing management:
 Immediate treatment with an anti-toxin
 Intubation
 Supportive care with particular attention to respiratory and

nutritional needs
 Gastric lavage
 Do not give foods with honey to infants
 honey is known to contain C. botulinum

BOTULISM
BOTULISM
BOTULISM
BOTULISM
TYPHOID FEVER
 Enteric Fever
 EA : Salmonella typhi
 MOT :
 Ingestion of contaminated water or food products (Fecal-oral)
 Foodborne (usually from shellfish)
 Waterborne
 Vector borne (Flies)
 Placenta
TYPHOID FEVER
 RES : Human excreta
 S. typhi primarily infects the Peyer’s patches of the small intestines
 Long incubation of 10-20 days with the onset of Remittent “Step-

ladder” or “Saw-tooth” fever
 Flu-like symptoms
 Patient seems to be staring blankly (Coma vigil); Delirium

TYPHOID FEVER
 Teeth and lips accumulate dirty brown collection of dried mucus and
bacteria (Sordes)
 Rose spots may be seen in the skin
 (+) immunity after attack; however, a small percentage of patients will

become chronic carriers in which the bacteria remain in the gall
bladder thereby contaminating fecal matter
 Tx : Antibiotic therapy
TYPHOID FEVER
 Diagnostic tools:
 Typhidot test
 Widal test
STAPHYLOCOCCAL
FOOD POISONING
 EA : Staphylococcus aureus
 MOT:
 Ingestion of staphylococcal Enterotoxin (Food-borne)
STAPHYLOCOCCAL
FOOD POISONING
 Enterotoxin stimulates the vomiting center of the brain
 abrupt onset with intense vomiting, with a rapid convalescence
 Risk is high when food handlers with skin infections contaminate foods
left at room temperature
 Tx : Fluid and electrolyte replacement

BACILLUS CEREUS
FOOD POISONING
 associated with reheating fried rice
 EA : Bacillus cereus
 MOT :
 Ingestion of spores from contaminated food products (Food-
borne)
BACILLUS CEREUS
FOOD POISONING
 types:
 Emetic type
 Occurs after 1-6 hours
 Causes intense nausea and vomiting
 Diarrheal type
 Occurs after 8-16 hours
 Causes profuse diarrhea
 Both are self-limiting

BACILLUS CEREUS
FOOD POISONING
 Tx:
 Fluid and electrolytes replacement; Supportive treatment
 Anti-microbial therapy.
CHOLERA (EL TOR)
 severe gastrointestinal disease characterized by vomiting and severe
watery diarrhea with rapid dehydration and shock
 EA :Vibrio cholerae
 secretes cholera enterotoxin called Choleragen
 MOT:
 Food-borne
 fecal-oral route
 ingestion of food or water with stool or vomitus of patient
 Mechanical transmission by flies

CHOLERA (EL TOR)
 S/Sx :
 Severe diarrhea
 “Rice-water” stool with peculiar fishy odor
 Pathognomonic sign
 causes fluid loss amounting to 1 to 30 liters per day

CHOLERA (EL TOR)
 S/Sx :
 Severe diarrhea
 resulting to:
 Sunken eyes with poor skin turgor
 Oliguria or anuria
 Skin is cold, the fingers and toes are wrinkled,

assuming the characteristic Washer-woman’s hand
 Rapid severe dehydration leading to circulatory

collapse to DEATH
CHOLERA (EL TOR)
 S/Sx :
 (–) Tenesmus (painful straining); Defecation becomes continuous
 Loss of voice or aphonia
 Vomiting and abdominal cramps
 VS changes:
 Weak pulses
 Rapid Respiratory rate
 Low Blood pressure

SALMONELLOSIS
 Infective Food Poisoning
 Salmonella Gastro-enteritis
 Acute Entero-colitis
 EA : Salmonella enteritidis
 MOT :
 Ingestion of contaminated water or food products (Water- and
Food-borne)
 especially from improper handling of eggs and poultry
SALMONELLOSIS
 S/Sx :
 short incubation of 1-2 days with the sudden onset fever,
headache, and diarrhea.

CLOSTRIDIUM PERFRINGENS
FOOD POISONING
 EA : Clostridium perfringens (Welch’s Bacillus)
 MOT :
 Acquired from ingesting food contaminated with soil or feces
(Food-borne)
 Abrupt onset with profuse diarrhea

ESCHERICHIA COLI GASTROENTERITIS
 EA : Escherichia coli
 MOT:
 Fecal-oral / Ingestion of contaminated food and water (Water-
and Food-borne)
 Direct contact
 Types:
 Enterotoxigenic E. coli (ETEC)
 Enterohemorrhagic E. coli (EHEC)
 Enteropathogenic E. coli (EPEC)
 Enteroinvasive E. coli (EIEC)

 ENTEROTOXIGENIC E. COLI
 primary cause of Traveler’s diarrhea in developing countries
 produces watery diarrhea similar to cholera

 ENTEROHEMORRHAGIC E. COLI
 causes:
 Hemorrhagic Colitis
 Hemolytic Uremic Syndrome
 Blood in urine leading to kidney failure
 produces an exotoxin called Verotoxin
 cause of several outbreaks; most famous is the serotype O157:H7
 primary reservoir: Cattle (undercooked meats)

 ENETROPATHOGENIC E. COLI
 Childhood diarrhea
 Nursery outbreak
 ENTEROINVASIVE E. COLI
 Dysentery-like diarrhea
CAMPYLOBACTER ENTERITIS
 Leading cause of food-borne disease in the U.S.
 EA : Campylobacter jejuni
 MOT :
 Transmission via ingestion of contaminated food products, water,
and most especially raw unpasteurized milk
 Direct contact with infected animals
 Indirect contact via Fomites – cutting boards; especially after

handling raw poultry
 Skin invasion
 S/Sx :
 Ranging from asymptomatic to severe diarrhea, N/V, fever,
malaise and abdominal pain.
BACILLARY DYSENTERY or SHIGELLOSIS
 EA : Shigella sp.
 dysenteriae
 flexneri
 boydii
 sonnei
 MOT :
 Fecal-oral / Ingestion of water or food products contaminated
with Shiga Toxin

 Foodborne
 Waterborne
 Vector borne (Flies)
 Contact with feces or vomitus of infected people

 short incubation of with the sudden onset of abdominal pain, and

fever
 (+) Tenesmus / painful straining, even without the passage of feces

 leading to Rectal Prolapse
 phases of infection:
 Enterotoxin phase / Watery Diarrhea phase
 Day 1 – 2
 Invasive phase / Bloody diarrhea phase

 Day 2 – 5
 Bloody-mucoid diarrhea
 as many as 20 bowel movements a day
 May be fatal due to dehydration
 Tx : Supportive treatment and Antibiotic therapy

PSEUDOMEMBRANOUS COLITIS
 Antibiotic-Associated Diarrhea
 EA : Clostridium difficile
 a normal flora of the intestinal tract
 MOT : non-communicable
 S/Sx : Watery or bloody diarrhea, abdominal cramps, fever.

 Occurs when a patient receives oral antibiotics that kill off susceptible
members of the gastrointestinal flora
 Since C. Difficile is resistant to most antibiotics, it increases in number

and causes an infection when normal flora are destroyed
 Tx:
 Stop anti-microbial therapy unless necessary
 Do NOT give GIT regulators/anti-diarrheal medications
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PSEUDOMEMBRANE
BACTERIAL GASTRITIS and ULCERS
 EA :Helicobacter pylori
 the only bacteria known to grown in the highly acidic stomach
environment
 Acidophilic
 MOT:
 Usually unknown
 but presumed via ingestion, either:
 oral-oral
 fecal-oral route
 S/Sx:
 GASTRIC ULCER
 Upper abdominal pain with nausea or heartburn;
 Pain right after eating
 DUODENAL ULCER
 Gnawing, burning, aching pain below the breastbone, an
empty feeling, and hunger;

 Pain on an empty stomach (2 to 3 hours after eating)
 Tx : Antibiotic therapy (H. pylori eradication treatment).

LEPTOSPIROSIS or
WEIL’S DISEASE
 Hemorrhagic jaundice
 Mud fever
 EA : Leptospira interrogans et. al.

LEPTOSPIROSIS or
WEIL’S DISEASE
 MOT:
 Ingestion of water and food products infected with urine
 Contact with infected urine through the mucous membranes

 swimming in contaminated pools of water
 wading in contaminated pools of water
 Bites by infected animals

LEPTOSPIROSIS or
WEIL’S DISEASE
 Infection carried by animals whose excreta contaminate water or
food which is ingested or inoculated through the skin or mucous
membrane
 stages:
1. Septicemic stage
2. Immune or Toxic stage
3. Convalescent stage
LEPTOSPIROSIS or
WEIL’S DISEASE
1. SEPTICEMIC STAGE
 flu-like symptoms
 high remittent fever
 muscle pain usually at the calf area

LEPTOSPIROSIS or
WEIL’S DISEASE
2. IMMUNE or TOXIC STAGE
 characterized by IgM production
 stage with a high mortality rate
 lasts for 4 to 30 days
 types:
 Anicteric type
 Icteric type
LEPTOSPIROSIS or
WEIL’S DISEASE
 Anicteric type
 Without jaundice
 Conjunctival infection/inflammation; iridocyclitis
 Signs of meningeal irritation

LEPTOSPIROSIS or
WEIL’S DISEASE
LEPTOSPIROSIS or
WEIL’S DISEASE
 Icteric type
 With jaundice
 presence of jaundice is a bad prognostic sign
 Hepatic and renal manifestations

 Hepatomegaly
 Hemorrhage
 Oliguria or anuria
 Shock, coma, CHF

LEPTOSPIROSIS or
WEIL’S DISEASE
3. CONVALESCENT STAGE
 Tx : Antibiotic Therapy (Penicillin)
 Isolate patient
 Proper disposal of urine
 Eradicate rodents
LEPTOSPIROSIS or
WEIL’S DISEASE
SKIN & MUCOUS MEMBRANE
STAPHYLOCOCCAL SKIN INFECTIONS
 EA : Staphylococcus aureus
 MOT: Skin to skin contact
 S/Sx : Localized, painful inflammatory reaction that has a central

suppuration and heals quickly when pus is drained.
 Involve abscess formation found in:

 Folliculitis
 Carbuncles
 Sty
 Furuncles
 Impetigo
 honey crusted lesions formed after a pustule/pus-filled
lesion ruptures
 common cause of outbreaks in hospital nurseries
 Involve abscess formation found in:

 Scalded skin syndrome
 Perioral erythema (reddening around the mouth), which is
usually the first sign then eventually becomes generalized

within 2 days
↓
blister formation
↓
rupture of blisters
↓
peeling of skin revealing raw areas (Nikolsky’s sign)
 Tx:
 Incision and Drainage (I & D)
 Anti-microbial therapy
STY
FOLLICULITIS
FURUNCLE
FURUNCLE
CARBUNCLE
CARBUNCLE
CARBUNCLE
SCALDED SKIN SYNDROME
IMPETIGO
IMPETIGO
IMPETIGO
IMPETIGO
INCISION AND DRAINAGE
ERYSIPELAS /
ST. ANTHONY’S FIRE
 EA : Streptococcus pyogenes (Group A Streptococcus)
 MOT: Skin to skin contact

ERYSIPELAS /
 S/Sx:
 massive brawny edema and a rapidly advancing margin.
 superficial blistering and eroded areas covered by pus or crusts
 may attack:
 Subcutaneous tissue (Cellulitis)
 Muscle (Myositis)
 Muscle covering (Necrotizing fasciitis)

 surgical removal is required
ERYSIPELAS /
 Tx : Antimicrobial therapy
ERYSIPELAS /
ERYSIPELAS /
ERYSIPELAS /
LYME DISEASE or
LYME BORRELIOSIS
 EA : Borrelia burgdorferi
 MOT: Bite of a deer tick

LYME DISEASE or
LYME BORRELIOSIS
 Most common vector-borne disease in the U.S.
 S/Sx:
 “Target-lesions”
 pathognomonic sign, at early stages
 large red spot with a central clearing
 Neurologic, musculoskeletal, and cardiac abnormalities at later

stages
LYME DISEASE or
LYME BORRELIOSIS
LYME DISEASE or
LYME BORRELIOSIS
LYME DISEASE or
LYME BORRELIOSIS
LYME DISEASE or
LYME BORRELIOSIS
LYME DISEASE or
LYME BORRELIOSIS
LYME DISEASE or
LYME BORRELIOSIS
LYME DISEASE or
LYME BORRELIOSIS
LYME DISEASE or
LYME BORRELIOSIS
LEPROSY or
HANSEN’S DISEASE
 EA : Mycobacterium leprae
 Hansen’s bacillus
LEPROSY or
HANSEN’S DISEASE
 MOT:
 Direct contact to skin or mucous membrane
 Indirect contact through fomites
 Vectors
 contrary to popular belief, leprosy is NOT highly contagious and

actually has low infectivity
LEPROSY or
HANSEN’S DISEASE
 types:
 Lepromatous leprosy
 Tuberculoid leprosy
 Borderline leprosy
LEPROSY or
HANSEN’S DISEASE
 LEPROMATOUS LEPROSY
 most severe type and most infectious
 leads to falling or hair and atrophy of the skin

LEPROSY or
HANSEN’S DISEASE
 gives rise to nodular lesions (Leproma)
 if present in the face, it gives rise to the so-called Leonine
Facies
LEPROSY or
HANSEN’S DISEASE
 gives rise to nodular lesions (Leproma)
 ulceration of nodules and necrosis produce the classical
mutilating lesions of adult leprosy

 there is:
 atrophy of the skin and muscles
 eventual melting of small bones, primarily of the
hands and feet causing natural amputation

 ulceration of the mucous membrane of the nose
LEPROSY or
HANSEN’S DISEASE
 TUBERCULOID LEPROSY
 non-contagious type
 affects the peripheral nerves (anesthesia) and sometimes the

surrounding skin
 characterized by a definite tendency towards healing

LEPROSY or
HANSEN’S DISEASE
 BORDERLINE LEPROSY
 has the characteristics of both lepromatous and tuberculoid leprosy
 Tx : Dapsone and Rifampicin

LEPROSY or
HANSEN’S DISEASE
 If admitted to the hospital:
 isolation
 medical asepsis
 Moral support
LEPROSY or
HANSEN’S DISEASE
LEPROSY or
HANSEN’S DISEASE
LEPROSY or
HANSEN’S DISEASE
LEPROSY or
HANSEN’S DISEASE
LEPROSY or
HANSEN’S DISEASE
LEPROSY or
HANSEN’S DISEASE
LEPROSY or
HANSEN’S DISEASE
LEPROSY or
HANSEN’S DISEASE
ACNE VULGARIS
 EA : Propionibacterium acnes
 normal flora of the skin
 MOT : non communicable (buti na lang…)

ACNE VULGARIS
 Most common skin disease
 occurs often at puberty, though onset may be delayed into the third or
fourth decades
ACNE VULGARIS
 dried sebum
 flaked skin
 bacteria
↓
collect and clog in skin pores
↓
Comedo / Comedone
↓
blocks sebum from flowing from the hair follicles up through the pores
ACNE VULGARIS
 If blockage is complete – Whitehead
 If blockage is incomplete – Blackhead
 Blocked sebum make it suitable for the P. acnes to grow
 Cosmetics frequently aggravate the condition
 Diet – including the consumption of chocolates – has been

demonstrated to have no significant effect on the disease
ACNE VULGARIS
 Tx:
 Anti-microbial therapy
 Benzoyl peroxide
 loosens clogged follicles
 Isotretinoin
 prevents sebum formation
ACNE VULGARIS
ACNE VULGARIS
ACNE VULGARIS
ACNE VULGARIS
ACNE VULGARIS
ACNE VULGARIS
CHLAMYDIAL CONJUNCTIVITIS
 Inclusion conjunctivitis
 Swimming pool conjunctivitis
 EA : Chlamydia trachomatis
 MOT:
 Direct contact of conjunctiva from:
 Infected vaginal cavity (during delivery of course)
 Unchlorinated swimming pools

 tends to resolve spontaneously unlike Gonorrheal Ophthalmia

Neonatorum (discussed later)
 may lead to TRACHOMA

 considered as the greatest single infectious cause of blindness
in the world today
 MOT (of Trachoma):

 Direct contact
 Indirect contact (Sharing of personal objects)
 Mechanical vectors (Flies)

 may lead to TRACHOMA

 starts out as conjunctivitis but eventually leads to permanent
scarring of cornea
 scars abrade the cornea leading to blindness
 “Turning-in” of eyelashes may further cause corneal

scarring
 Proper handwashing
 Avoid sharing of personal belongings if infection is suspected
 Proper sanitary practices
 House screening
NEURO-MUSCULAR &
BLOOD DISEASES
BACTERIAL MENINGITIS
 EA:
 Escherichia coli
 MC: among neonates and infants
 Haemophilus influenza
 MC: among children (5 months to 5 years old)
 Streptococcus Pneumoniae
 MC: among adults
 Neisseria meningitides
 Meningococcal meningitis
 MOT :
 Inhalation of respiratory droplets (Droplet / Airborne)
 May rise from underlying causes such as:

 Otitis media
 Mastoiditis
 Upper respiratory tract infection
 Head injury/Skull fracture

 S/Sx
 High fever and flu-like symptoms
 Tachypnea
 Respiratory arrhythmia
 Hemorrhagic rash (for Meningococcal meningitis)
 Nausea and vomiting*

 S/Sx
 ↑ Intracranial pressure (ICP)
 blurring of vision / visual disturbances
 altered sensorium
 *projectile vomiting
 headache
 bulging of anterior fontanel (among infants, of course!)
 convulsions
 S/Sx
 Meningeal irritation
 Nuchal rigidity
 rigidity / resistance of the neck on flexion

 S/Sx
 (+) Kernig’s sign
 resistance to full
extension of leg at
knee when hip is
flexed
 S/Sx
 (+) Brudzinski’s sign
 flexion of both hips
and knees when

back is passively
flexed
 S/Sx
 Opisthotonus position
 Hyperextension of the back and neck muscles

 Prev: Immunization
 HiB for H. influenza
 Pneumovaccine for S. pneumoniae
 Tx:
 Antibiotic therapy
 Osmotic diuretic (Mannitol)
 Anti-convulsants
MENINGOCOCCEMIA
 EA : Neisseria meningitidis
 MOT :
 Droplet or Airborne
 Direct contact
MENINGOCOCCEMIA
 S/Sx of Meningococcemia
 High fever and flu-like symptoms
 Hemorrhagic rash
 Disseminated intravascular coagulation (DIC)

MENINGOCOCCEMIA
 S/Sx of Meningococcemia
 Adrenal medullary hemorrhage
+ Meningococcemia
= Waterhouse-Friderichsen Syndrome
(Fulminant Meningococcemia)
 Death is within ten to twelve hours due to Shock

MENINGOCOCCEMIA
 Tx:
 Antibiotic therapy (Penicillin)
 Rifampicin (preventive/prophylactic treatment)

MENINGOCOCCEMIA
MENINGOCOCCEMIA
MENINGOCOCCEMIA
MENINGOCOCCEMIA
MENINGOCOCCEMIA
TETANUS or LOCKJAW
 EA : Clostridium tetani
TETANUS or LOCKJAW
 MOT :
 Acquired from any type of skin trauma; contact with soil
contaminated with feces

 wounds or burns
 Using infected instruments during certain procedures (common

in rural areas) such as:
 cutting of umbilical cord
 dental extraction
 ear piercing
 circumcision (buti na lang…)
 cleaning ear canal with dirty or rusty hairpin

TETANUS or LOCKJAW
 an infectious disease with prominent systemic neuromuscular effects
manifested by generalized spasmodic contractions of the skeletal
muscles
 Toxins involved:
 Tetanospasmin
 a neurotoxin
 Tetanolysin
 a hemolysin
TETANUS or LOCKJAW
 TETANOSPASMIN (a neurotoxin)
 responsible for muscular spasms
 Trismus (Lock-jaw)
 Risus sardonicus (Sardonic grin)

 pathognomonic sign
 Opisthotonus position
TETANUS or LOCKJAW
 TETANOSPASMIN
 Trismus / Lock-jaw  Masticator m. spasm
 Trigeminal nerve damage
 Neck an facial muscle
rigidity
 Risus sardonicus /
Sardonic grin  Facial m. spasm
 Facial nerve damage
 Opisthotonus position
 Neck and back m. spasm
TETANUS or LOCKJAW
 TETANOLYSIN (a hemolysin)
 responsible for headaches and irritability
 prolonged infection eventually leads to:

 laryngeal spasms
 death due to:
 hypoxia
 respiratory failure
TETANUS or LOCKJAW
 Prevention:
 DPT
 Tetanus toxoid
 Tx:
 Anti-microbial therapy (Penicillin)
 Anti-tetanus serum (ATS)
 Muscle relaxants
TETANUS or LOCKJAW
TETANUS or LOCKJAW
TETANUS or LOCKJAW
TETANUS or LOCKJAW
TETANUS or LOCKJAW
TETANUS or LOCKJAW
TETANUS or LOCKJAW
PLAGUE
 Black Death
 EA: Yersinia pestis (Plague bacillus)
 MOT:
 Rodent flea bites
 Considered as the deadliest bug alive
PLAGUE
 primarily infects rodents and transferred via flea bite
 darkened, bruised, foul-smelling skin (Black Death) because of cell

necrosis
 Types:
 Bubonic Plague
 Pneumonic Plague
 Septicemic Plague
PLAGUE
 BUBONIC PLAGUE
 Involves in the formation of Buboes
 painful lymphadenopathy, commonly with enlarged nodes
 lymph nodes may be filled with pus

PLAGUE
 PNEUMONIC PLAGUE
 infection of the lungs by Y. pestis
 involves in the formation of blood-tinged to bright-red foamy

sputum
 highly contagious
 considered as the worst pandemic in history wherein it killed

1/3 of Europe’s population and some 75 million people
worldwide in 1347-1351
PLAGUE
 SEPTICEMIC PLAGUE
 Most severe
 it may cause death even before symptoms appear
PLAGUE
PLAGUE
PLAGUE
PLAGUE
PLAGUE
PLAGUE
PLAGUE
PLAGUE
GAS GANGRENE / CLOSTRIDIAL
MYONECROSIS
 EA : Clostridium perfringens (Welch’s Bacillus)
 MOT :
 Acquired from any type of skin wound involving contact with
dirt
 Non-communicable (with other humans)

MYONECROSIS
 sudden onset of pain and edema in area of wound contamination
 Gas in the tissue by x-ray or palpation
 foul smelling discharge/gas from the wound, rapidly progressing

necrosis (due to ischemia), fever, toxemia, and shock to death.
MYONECROSIS
 Tx:
 Early surgery (amputation)
 Anti-toxin
MYONECROSIS
MYONECROSIS
MYONECROSIS
MYONECROSIS
MYONECROSIS
MYONECROSIS
MYONECROSIS
TOXIC SHOCK SYNDROME
 EA : Staphylococcal aureus
 secretes an exotoxin called Toxic Shock Syndrome Toxin
(TSST)
 POE : Skin and vaginal cavity
 often observed in wounds and in young women from the use of

tampons (buti na lang…)
 S/Sx :
 abrupt onset of high fever, vomiting, diarrhea, myalgias, skin
rash, and vaginal discharge

 deep red rash on palms and soles that later desquamates
 eventually hypotension and shock
 Tx :
 Removing the tampon immediately
 IV fluid replacement therapy
 Antimicrobial therapy
GENITO-URINARY TRACT
Bacterial GUT Diseases:
 All info concerning the patient is considered confidential
 no discussion concerning the patient and laboratory reports
 Instruct patient that their partner/s should also be tested and/or

treated
 Avoid sexual contact until treatment is complete
 Report ALL cases of gonorrhea to the rural health office

 report all cases of gonorrhea in children to child abuse
authorities (DSWD)
Bacterial GUT Diseases:
 Sex education emphasizing the reservoir and modes of transmission
 Proper handwashing
 Instruct patient to wash the genitalia daily with soap and water
 Practicing safe sex:

 abstinence
 be faithful
 condom
GONORRHEA
 Gonococal urethritis
 Morning drop
 Clap
 Flores Blancas
 Gleet
 “Tulo”
 EA : Neisseria gonorrhea (Gonococcus)

GONORRHEA
 MOT :
 Direct contact
 Skin or Mucous membrane to mucous membrane
 Sexual contact (vaginal, oral, or rectal)
 During birth, contact with infected vaginal secretions
 Indirect contact through fomites

GONORRHEA
 Infection involving the mucosal surface of the GUT, rectum, and/or
pharynx (papaano?...)
GONORRHEA
 Males
 Purulent urethral discharge (Gleet)
 Painful urination (Dysuria)
 Pelvic pain
 Fever
GONORRHEA
 Females
 Usually asymptomatic
 but can also cause dysuria
 Purulent vaginal discharge
 can cause Pelvic Inflammatory Disease (PID)

 abdominal tenderness, if it spreads towards the fallopian
tubes (Salphingitis)
 common cause of:
 ectopic pregnancy
 infertility
GONORRHEA
 can cause DISSEMINATED GONOCOCCAL INFECTION
 results from a hematogenous spread from the initial site of
infection
GONORRHEA
 can cause DISSEMINATED GONOCOCCAL INFECTION
 involves:
 Skin and Joints (Dermatitis-arthritis syndrome)
 most common
 if only joints are affected
 Septic arthritis/Gonococcal arthritis
 Meninges
 Endocardium and myocardium
 Liver
GONORRHEA
 in neonates it can cause GONORRHEAL OPHTHALMIA
NEONATORUM
 occurs when newborn passes through an infected vaginal cavity
 can lead to loss of vision or blindness
 *Chlamydial conjunctivitis tends to resolve spontaneously unlike

Gonorrheal Ophthalmia Neonatorum
GONORRHEA
 in neonates it can cause GONORRHEAL OPHTHALMIA
NEONATORUM
 CREDE’S PROPHYLAXIS on both eyes during cord care
 Silver nitrate
 no longer used because:
 Chlamydia usually accompanies Gonorrheal
infection
 Chlamydia is resistant to Silver nitrate
 Erythromycin or Tetracycline ophthalmic solution/ointment

 Sensitive to both Gonorrhea and Chlamydia
GONORRHEA
 Tx: Antibiotics
GONORRHEA
GONORRHEA
GONORRHEA
GONORRHEA
GONORRHEA
GONORRHEA
GONORRHEA
GONORRHEA
GONORRHEA
CHLAMYDIAL URETHRITIS and CERVICITIS
 EA : Chlamydia trachomatis
 MOT:
 Direct contact
 Sexual contact (vaginal, oral, or rectal)
 During birth, contact with infected vaginal secretions
 Indirect contact
 Transplacental
 Most common sexually transmitted bacterial disease

 it is even more common than gonorrhea
 signs and symptoms are exactly alike with gonorrheal urethritis

URINARY TRACT INFECTION
 EA:
 Escherichia coli (MC)
 Staphylococcus saprophyticus
 Pseudomonas aeruginosa (Nosocomial UTI)
 MOT : Can be acquired sexually but mostly acquired through

patient’s own flora
 Factors that augment the development of UTI:
 Female
 UTI is about 50 times more common among females than
males
 due to:
 shorter urethra
 have more receptors for bacterial adhesins
 proximity of the urethral opening to the vagina and

anus
 Factors that augment the development of UTI:
 Reduced frequency of urination
 Uncircumcised males
 Use of diaphragms and spermicidal creams

 alters vaginal flora
 though females may develop UTI easily, they are often asymptomatic
 if symptoms occur, the patient may experience:

 Dysuria and Flank pain
 Sensation of a full bladder even after urination (“balisawsaw”)
 Cloudy urine
 types of UTI:
 Urethritis (urethra)
 Cystitis (urinary bladder)
 Ureteritis (ureters)
 Pyelonephritis (kidneys)
SOFT CHANCRE / CHANCROID
 EA : Haemophilus ducreyi
 MOT : Sexual contact
 S/Sx :
 Painful genital ulcers (soft chancre) with lymphadenopathy
(Bubo)
 affects mostly males:
 who have poor personal hygiene
 who are uncircumcised
SYPHILIS
 EA : Treponema pallidum
 MOT:
 Direct contact
 Indirect contact
 Blood transfusion
 Transplacentally, from mother to fetus

SYPHILIS
 Stages of untreated syphilis:
1. Incubation Period
2. Primary Syphilis
3. Secondary Syphilis
4. Latent Syphilis
5. Tertiary / Late Syphilis

SYPHILIS
1. INCUBATION PERIOD (10 to 90 days)
 Subclinical
2. PRIMARY SYPHILIS (1 to 6 weeks)

 Most infectious stage
 Hard Chancre (painless lesion/ulcer)

 (remember: Soft Chancre → painful)
 Enlargement of the regional lymph node (Bubo)

SYPHILIS
3. SECONDARY SYPHILIS (10 to 90 days)
 Flu-like symptoms
SYPHILIS
 five common lesions:
 Dermatitis
 generalized maculo-papular rash
 Mucous patches
 white-yellow, covered in exudates that reveals a
glistening surface when removed
 formation of Condyloma Lata
 fused, weeping papules on the moist areas of the

skin and mucous membranes
SYPHILIS
 five common lesions:
 Alopecia
 Iritis
 Joint and Bone Pain

SYPHILIS
4. LATENT SYPHILIS
 Symptoms tend to recede even without treatment
 but the patient is NOT cured

SYPHILIS
5. TERTIARY / LATE SYPHILIS
 Clinical destructive stage after latent period
 destructive but non-infectious stage
 may occur 10 to 30 years after exposure
 appearance of Gummas
 lumps found commonly at the legs, upper trunk, face, and
scalp
SYPHILIS
5. TERTIARY / LATE SYPHILIS
 mainly affects the:
 Cardiovascular system (Cardiovascular syphilis)
 CNS (Neurosyphilis)
 Skeletal system
SYPHILIS
 Diagnostic tools:
 Venereal Disease Research Laboratory (VDRL)
 Rapid Plasma Reagin (RPR)
 Tx : Antibiotic Therapy (Penicillin)

SYPHILIS
 Stress the importance of completing treatment even after the
symptoms subside
 Instruct patient that their partners should also be tested and/or

treated
SYPHILIS
 JARISCH – HERXHEIMER REACTION
 May occur in patients under treatment with syphilis
 Occurs due to the:

 massive destruction of spirochetes by penicillin
 release of toxic products of the spirochetes

SYPHILIS
 symptoms include:
 Aggravation of syphilitic signs and symptoms
 Flu-like symptoms
 Myalgia
 Malaise
SYPHILIS
 usually begins within the first 24 hours and subsides
spontaneously within the next 24 hours of penicillin treatment
 treatment should NOT be discontinued unless symptoms become

severe or life threatening
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS
SYPHILIS

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COMMON BACTERIAL

 must avoid exertion when defecating

 to decrease workload of the heart

 Encourage patient to drink fruit juices rich in vitamin C

 Airborne and Contact transmission precaution

 Cover mouth when sneezing or coughing preferably with a

 Advise patient to stop smoking

 Administer antibiotics as ordered

 EA : Mycobacterium tuberculosis (Koch’s Bacilli)

 Prolonged direct contact (controversial)

 Ingestion of sputum (common among children)

 Primary Complex in children is NOT contagious

 Fever usually in the late afternoon

 Weight loss, anorexia

 Fine crepitant rales over the apical areas

 Hemoptysis (coughing up blood)

 often considered as pathognomonic sign by other

 most common type of meningitis in the Philippines

 Bones especially the spine/vertebra

 results in gradual wasting of the body

 must be taken with Vitamin B6

 but these 2 drugs should never be given alone

 Good compliance to medications renders the patient NOT contagious

 early neonatal period

 before entering primary school

4. Elderly persons who have healed dormant lesions living in

6. Persons who have significant reaction to tuberculin test

 Always check sputum for blood

 Maintain respiratory isolation until patient:

 stress importance of:

 continuing to take medications for the prescribed

 these are the highest priority in nursing

 Handwashing after sneezing and coughing

 Cover mouth when sneezing or coughing preferably

 High CHON, CHO, Caloric, and Vit. C diet

 small frequent meals

 Be alert for side effects of anti-TB drugs

 100 days cough

 PRODROMAL / CATARRHAL STAGE

 cough becomes irritating, hacking, nocturnal, and becoming more

 most communicable stage

usually 5-10 coughs in one expiration

high-pitched crowing sound (“whoop”) and usually followed by

 child becomes cyanotic during coughing fits, and eyes appear to

 Can lead to:

 Bleeding of the eyes and brain

 Prevention : Immunization (DPT)

 Tx : Antibiotic therapy (Erythromycin)

 isolation and medical asepsis

 patient should not be left alone during coughing fits;

 child should be kept as quiet as possible

 Primary Atypical Pneumonia

 found in water of air-conditioners

 can cause some epidemics in hotels, business districts,

 Direct and Indirect contact with respiratory secretions

 Tachycardia and tachypnea

 Acute chest pain with DOB

 Direct and Indirect contact with respiratory secretions

 progresses in the formation of Pseudomembrane