Communicable virus

6. CHICKEN GUINEA:

It is a rare form of viral infection caused by

an alpha virus that is spread by the
mosquitoes of genus aedes i.e Aedes
Aegypti , Aedes Albopictus.
 MODE OF TRANSMISSION:

The virus is spread to human by two

species of mosquito of the genus
Aedes: Aedes Albopictus and Aedes
Aegypti.
Animals reservoirs of the virus
include monkeys, birds, cattle, and
rodents.
 INCUBATION:
1-12 days.
CLINICAL MANIFESTATIONS:
Sudden onset with high fever , joint pain and
rash.
Headache.
Fatigue
Digestive complaints
Conjunctivitis.
 TREATMENT:
There is no vaccine to prevent or to treat
chikungunya virus.
Complete bed rest and advice to drink
plenty of fluids.
Advice paracetamol to reduce fever and
pain.
Do not take Aspirin and NSAIDS until
dengue can be ruled out to reduce the risk
of bleeding .
Prevention from mosquitoes bites for the
first week.
a.During the first week of infection,
chikungunya virus can be found in the
blood and passed from an infected person
to a mosquito through mosquito bites.
b.An infected mosquito can then spread
the virus to other people.
 7. INFLUENZA:
Influenza is an acute infection of the
respiratory tract. It is caused by influenza
viruses.
ETIOLOGICAL FACTORS:
1.Agent: Three immunological types of
influenza viruses are known, namely types
A,B and C. Type A causes the most severe
type of infection. Type C tends to be the
mildest.
2. Sources of infection:
a.Cases.
b.Subclinical cases.
3.Infective period: A case can communicate
the infection to others upto 7 days from the
beginning of the disease.
4. Age and sex: All ages and both sexes are
susceptible.
5. Immunity: An attack of influenza gives
temporary immunity for about 8 to 12
months.
MODE OF TRANSMISSION:
Direct contact.
Droplet infection.
Handling or using articles recently
contaminated.
CLINICAL MANIFESTATIONS:
Cold.
Fever persists for about 3 days.
Headache.
Shivering.
Sore throat.
Sneezing.
Nasal block.
Bodyache
Cough.
Weakness.
COMPLICATIONS:
Pneumonia
Bronchitis
Ear infections
CONTROL AND PREVENTION:
1.Report the influenza cases to state health
authorities.
2. Isolate the patient as soon as possible.
3.Instruct the patient to take rest.
4. Advice to take plenty of fluids.
5.Administer analgesics to relieve pain.
6.Administer antibiotic to control infection.
7.Give health education to patient and community
about the disease.
8.Separate the patient articles from other members.
9.Killed influenza vaccines are widely used for
protection against influenza but they are not
completely protective.
10. 2 doses of 1 ml each spaced at an interval of
about 10 days are recommended, To be effective
the first dose must be given before the onset of an
epidemic.
 8.MUMPS:
Mumps is an acute infectious
disease caused by a virus.It is
characterized by swelling and
tenderness of one or both of the
parotid glands.
Infections are common in winter
but sporadic cases occurs
throughout the year.
ETIOLOGICAL FACTORS:
1.Agent : The causative agent is a paramyxo virus.
2.Sources of infection:
a.patients suffering from mumps.
b.Subclinical cases about 60% of cases remain
subclinical.
3. Period of infectivity days before the onset of
symptoms and until the swelling of parotid glands
has subsided.
4. Age and Sex: 5 to 15 years. Both sexes are
affected.
5. Mode of Spread: Mumps spread through saliva
and respiratory droplets.
6. Immunity: Usually life long after infection. But
second attack may occur.
MANAGEMENT:Isolate the patient
until swelling subsides.
Bed rest.
Give mumps Vaccination.
Use immunoglobulins.
Provide symptomatic treatment to
the client.
Disinfect the articles used by the patient.
Local application of heat to salivary gland .
Provide liquid or soft diet.
Restrict the food containing acid because it
cause irritation to the throat.
Restrict the oily and fatty foods as they tend to
aggravate mumps symptoms.
PREVENTION:
Mumps is know preventable disease.
A live vaccine has been prepared against
mumps.
A single dose of the vaccine is given
subcutaneous.
Immunity persists for atleast 8 years.
 9. ENCEPHALITIS:
Encephalitis is an acute illness of the
parenchyma of the brain or the spinal cord.
It is caused by enteroviruses such as echovirus ,
coxsackie virus, poliovirus, paramyxovirus and
varicella zoster and herpes simplex type1 virus.
 PATHOGENESIS:
Virus enter to the CNS invade brain tissue

Inflammatory response takes place and extended

cerebral cortex, the white matter and meninges.
Cause degeneration of the neurons

Local necrotizing haemorrhage that becomes

generalized and cause prominent edema.
 CLINICAL MANIFESTATIONS:

Fever
Headache
Nausea
Seizures
Stiff neck
Altered level of consciousness.
Agitated
Restlessness or lethargic and drowsy.
 DIAGNOSTIC EVALUATION:

CSF examination to find out causative

agent, protein level (it is slight
increased) and glucose (it is normal).
CT Scan ,EEG, MRI, PET, PCR done.
 MANAGEMENT:
Acyclovir (zovirax) and vidarabine ( vira
A) .
Antiseizure drugs (dilantin) are used to control
convulsion.
Promotive care – mosquito control should be
practiced including cleaning rain gutters,
removing old tyres and removing collected water
as they give space for mosquito breeding.
 NURSING MANAGEMENT:

Monitor LOC including orientation,

memory, and attention.
Monitor vital signs on regular basis as
patient have fever.
Monitor for convulsion provide low bed
with padded side rails.
Observe for ICP like hypertension ,
bradycardia, respiratory changes and
vomiting.
Administer prescribed medicines and
maintain fluid balance.
 11. POLIOMYELITIS:
Poliomyelitis is a viral infection . It is
primarily an infectious disease of the
human alimentary tract but may affect the
brain, spinal cord and nerves resulting in
paralysis.
The extend of paralysis depend upon the
damage done to the nerve cells by the virus.
 ETIOLOGICAL FACTORS:

Agent: The causative agent is polio virus which

has 3 sero types designated as type1, type2, and
type3. Type 1 is responsible for all major
epidemics.
Sources of infection:
a.Feces: The virus is found in feces of cases for
few weeks and upto 3 months in young children.
b.Pharyngeal secretions: During the first 5 days
the virus is found in the secretion of the throat.
Age : The majority of cases contact polio
between 1 and 2 years.
Environmental conditions: Polio occurs in
higher frequency in areas with over
crowding and poor sanitation .It occurs
mostly in rainy season (july to sept).
Period of infectivity: The cases are most
infectious 7 to 10 days before and after onset of
symptoms.
Immunity: The adult population is largely
immune but the disease can also affect non-
immune persons.(infants are protected upto
about 6 months of age because of maternal
antibodies).
MODE OF TRANSMISSION:
Fecal – oral route.
Droplet infection.
 CLINICAL MANIFESTATION:
Fever
Headache
Diarrhea
 Vomiting and drowsiness
Warning signs are pain
Stiffness of neck and back.
Paralysis of the affected limb.
Diagnosis can be confirmed by serological
testing for polio viral antibodies.
 PREVENTION:
Bed rest.
Give health education to the community people regarding
the prevention and control of disease.
Improve environmental sanitations.
Community health education in matters of personal
hygiene.
Active immunization of all infants and children according
to the national immunization schedule.
Report all the cases to health workers.
Government conducting pulse polio
immunization days every year until
poliomyelitis is eradicated.
Parents should be educated about infants
immunization and encouraged to take part
in PPI.
Provide knowledge to parents about pulse
polio immunization.
Do not give hot milk and hot fluids to child
atleast for half of an hour after immunization.
Breast milk can be given to child.
Polio vaccine should not be given to any child
suffering from dysentery , diarrhoea, vomiting
and fever.
Child should be immunized with injectable polio
medicine also.
VARIOUS DISEASE
CAUSED BY
BACTERIA:
 1. DIPTHERIA

Diphtheria is an acute infectious disease

caused by the exotoxin of diphtheria bacilli
(corynebacterium diptheriae). The disease
affects mostly the throat , tonsils, larynx or
nose .
 ETIOLOGICAL FACTORS:

1. Agent :Diptheria bacilli.

2. Sources of infection: It may be patient, carrier,
most carriers are between 5 and 8 years of age.
3.Infective material : Nose and throat secretions.
4. Infectivity : it vary from 14 to 28 days from the
onset of disease.
5. Age : children 2 to 5 years.
MODE OF TRANSMISSION:
Droplet infection .
Fomites or contaminated articles.
INCUBATION:
2 to 5 days.
 CLINICAL MANIFESTATIONS :

1. Sore throat.

2. Difficulty in swallowing.
3. Formation of a greyish –yellow
membrane over tonsils and throat.
4. Fever
5. Toxemia
6. Marked edema of the neck
7. Obstructive “croup”
8. Stridor
9. Eventually asphyxia.
 TREATMENT:

1. Diphtheria antitoxin which must be given

immediately ranging from 10000 to 80000 units
according to the severity of the case.
2. Antibiotics (penicillin or erythromycin) help to
eliminate the infection and prevent production of
further toxin.
3. Bed rest is essential.
4. Tracheostomy may be needed if there is respiratory
obstruction.
 
 2. WHOOPING COUGH ( PERTUSIS)

A highly infectious disease of the respiratory

tract caused by the whooping.
Cough bacilli ( bordetella pertusis).
The disease is characterized by severe
attacks of an irritating cough which becomes
paroxysmal producing the typical whoop
which gives the disease of children.
 ETIOLOGICAL FACTORS:

1. Agent : Causative agent is bordetella pertusis.

2. Source of infection: Nose and throat secretions.
3. Infective period: A week after exposure to about
3 weeks after the onset of the paroxysmal stage.
4. Age: Infants and toddlers below the age of 5
years. However , all ages may be affected if there
is no previous immunity.
5. Immunity: one attack of pertusis gives solid
immunity.
MODE OF TRANSMISSION:
Spread directly by droplet infection or
indirectly by articles soiled with discharges
from infected cases.
INCUBATION PERIOD:
7 to 14 days.
 CLINICAL MANIFESTATIONS:

1. Slight fever
2. Cold
3. Running nose
4. Irritating cough which gradually becomes
paroxysmal within 1-2 weeks.
5. The illness may be exacerbated by inter-
current virus infections.
 CONTROL OF PERTUSSIS

1. Isolate the patient .

2. Report the cases of diphtheria to health
worker.
3. Disinfect the patients article properly .
4. Disinfect and safe disposal of discharges
from nose and throat.
5. Erythromycin may help to shorten the
duration of illness but only if given during
the first 5 days of illness.
6.The child should be immunized according to
the national immunization schedule.
 3. TETANUS:

Tetanus is an acute disease induced by the

exotoxin of “clostridium tetani”.
It is a disease of nervous system caused by the
spores of a soil bacterium.
The disease is clinically characterized by
muscular rigidity which affects mainly the
masseters, the abdominal muscles and the erectors
of the spine and painful muscular spasms which
occurs at intervals.
 ETIOLOGICAL FACTORS:

1. Agent : The causative agent is “clostridium

tetani”.
2. Source of infection: The spores are widely
distributed in the environment , soil, street dust,
horse and cow dung.
3. Immunity : Immunization against tetanus should
be performed.
MODE OF TRANSMISSION:
Most patient acquires tetanus as a result of
injuries, these getting contaminated with
tetanus spores.
Tetanus may also occurs after injections and
vaccination.
Tetanus may result from surgery: The
spores being introduced by instruments ,
catgut, dressings, and various powders such
as talcum and sulphonamide. This is called
post-operative tetanus.
INCUBATION PERIOD:
3 to 21 days.
 CLINICAL MANIFESTATIONS:

1.Muscle stiffness around the site of the wound.

2.Rigidity of face and neck muscles, it is called
“lockjaw”.
3.Muscular spasms.
4.Asphyxia.
5.Fever.
6.Photophobia.
 PREVENTION:

1. Active immunization:
2. Tetanus is best prevented by active
immunization with tetanus toxoid.
3. Two doses of 0.5 ml each of tetanus toxoid
at an interval of 6 weeks given IM followed
by booster doses every 10 years.
4.Infants and children are best immunized by
giving them DPT vaccine according to the
National immunization Schedule.
5.Active immunization of the mothers during
pregnancy will protect the infant against
neonatal tetanus.
 .

Passive immunization:
Temporary protection for a wounded patient can
be provided by an injection of human tetanus
immunoglobulin.
Human immunoglobulin is the best prophylactic
use.
Anti- tetanus serum should be given in a dose of
1500 IU, injected SC with suitable precautions.
 MANAGEMENT:

 1. Keep patent airway of patient to prevent

cardiopulmonary complications.
2.Sedative and muscle relaxants are used to
control convulsions , keep muscles relaxed,
diazepam.
3.Keep record of vital signs, intake/ output
chart.
4. Avoid fall, injury, maintain safety.
5. Keep the patient in a dark and absolutely
quite room as little stimulation can trigger
convulsions.
6.Take care of bladder, bowel, avoid bed sore.
7.Give health education to relatives to prevent
tetanus in future.
8.Administer muscle relaxant to the patient .
9.Administer mild sedation and assisted
ventilation in intensive care units.
 4. TYPHOID FEVER ( ENTERIC FEVER)

Typhoid fever is an acute communicable disease

caused by “Salmonella Typhi”.
The disease is marked by prolonged fever, toxic
symptoms and constitutional disturbances.
The term “Enteric Fever” includes both typhoid
and paratyphoid fevers.
 ETIOLOGICAL FACTORS:
Agent: Salmonella typhi .
Sources of infection: Patients or Carriers of
typhoid fever . Carriers are important in
transmission because they spread the disease for
several years and go undetected.
Infective material: Feces and urine of infected
persons.
Infective period: As long as the bacilli are present in
feces and urine.
Age: The disease affects all age groups but
commonly between 10 to 30 years.
Immunity: An attack of typhoid fever gives a
fairly lasting immunity. Second attack may also
occur.
Poor sanitation: Lack Sanitation of a safe water
are involved in transmission.
Unhygienic habits:
A.Open air defecation.
B.Urination
C.Low standards of food hygiene.
D.Illeteracy
E.Health ignorance are responsible for the
epidemic of typhoid fever in India.
 CLINICAL MANIFESTATIONS:

1. Fever (103degree F)

2. Abdominal pain
3. Severe diarrhea
4. Fever develops rash ( rose spots) in belly and
chest.
PHASES:
1st phase:
The patient’s temperature rises gradually to 40
degree C and the general condition becomes
very poor with bouts of sweating, no appetite,
coughing and headache.
2nd Phase:
In 2nd -3rd weeks of disease symptoms of
intestinal infection are manifested and the fever
remains very high and pulse becomes weak and
rapid.
MODE OF TRANSMISSION:
Fecal – oral and urinal routes.
INCUBATION PERIOD:
7 to 28 days.
 
 CONTROL OF TYPHOID FEVER:

Notification: Typhoid is notifiable disease. The

number of cases and deaths are to be reported
daily and weekly.
Isolation: Isolate the patient as soon as the
diagnose or disease is verified to protect others.
Treatment :Administer chloramphenicol to
patient.
Disposal of feces and urine: the proper sanitary
disposal of human excreta , such as water seal
type of latrines.
Disinfection of clothing , linen and fomites:
fomites maybe disinfected by boiling them in
water for 15 minutes and finally washing them
with water and soda.
Immunization of contacts with typhoid vaccine:
Anti- typhoid vaccine (monovalent or bivalent)
is given subcutaneously in 2 doses of 0.6ml each
for adults at an interval of 4 to 6 weeks.
 
 6.GASTROENTERITIS:

Inflammation of the lining of the stomach and

intestine.
ETIOLOGY:
1.Psychological causes:
a.Fear
b.Anger
c.Emotional upset.
 2. Allergic reactions to certain foods.
 3. Excessive use of alchohol.
 ETIOLOGY:
1.Psychological causes:
a.Fear
b.Anger
c.Emotional upset.
 2. Allergic reactions to certain foods.
 3. Excessive use of alchohol.
Food poisoning is an acute gastroenteritis caused by the
ingestion of food or drink contaminated with either living
bacteria or their toxins or chemical substances.
 TYPES OF POISONING:
Non-bacterial: Caused by ingestion of chemical
poisons such as arsenic.
Bacterial: Caused by ingestion of living bacteria or
their toxins. The following types of bacterial food
poisoning are well-known.
Salmonella food poisoning.
Staphylococcal food poisoning.
Botulism.
 
 CLINICAL MANIFESTATION:
• 1.Nausea
2.Vomiting
3.Itching
4.Abdominal cramps
5.Diarrhea
6.Dehydration
7.Fever
8.Headache
9.Weakness.
 PREVENTION AND CONTROL:
1. Ensure proper food sanitation including personal
hygiene.
2. Refrigeration: Foods not eaten should kept in cold
storage. “ Cook and eat the same day is golden rule”.
3. Canned foods: All canned food should be
discarded if there is evidence of decomposition.
4. Foods must be protected against flies, rats, mice
and dust.
5. Food handlers: They should be free from infected
wounds, boils, diarrhea, dysentery, and throat
infections.
 7. CHOLERA:
A cholera is an acute infectious disease caused
by cholera vibrios (vibrio cholera) .
A typical cases of cholera are characterized by
repeated purging and vomiting leading to rapid
dehydration often resulting in death.
 
 ETIOLOGICAL FACTORS:
Agent: Cholera is caused by two kinds of vibrios.
Classical cholera vibrios.
Vibrios
Sources of infection: Either a case or carrier of
cholera. The cases range from mild to severe.
Infective material: Stools and vomits of the patient
are infective.
Environmental conditions: Cholera affects mainly
low socioeconomic groups with poor personal and
environmental hygiene.
Age: Cholera affects all ages.
Immunity: The immunity conferred by an attack
lasts a few months only.
MODE OF TRANSMISSION:
By ingestion of contaminated water, food or drink.
INCUBATION PERIOD:
Few hours to 5 days (usually 1-20 days).
 
 CLINICAL MANIFESTATION:
1.Watery stools
2.Vomiting
3.Dehydration
4. Acidosis
5.Hypokalemia
6.Intense thirst
7.Cramps in legs and abdomen
8.Sunken eyes
9.Hollow cheeks.
10.Sub- normal temperature.
11.Washerman’s hands and feet.
12.Low blood pressure.
13.Suppression of urine.
14.Coma.
15.Sometimes, death may occur in severe cases.
 
 CONTROL OF CHOLERA:
1.Verification of the diagnosis: It is important to
confirm the outbreak of cholera as quickly as
possible by identifying vibrio cholera in the stools
of the patient.
2.Notification: Cholera is a notifiable disease
locally , nationally and internationally. The number
of cases and deaths are to be reported daily and
weekly till the area is declared free of cholera.
3.Case finding: Cholera is greatly facilitated by the
early detection of cases and to initiate treatment
before patients go into shock.
4.Oral rehydration: The solution of ORS
should be freshly prepared and used within 24
hours.It should be dissolved in 1litres of
drinking water.
5.Antimicrobial treatment: Tetracycline is
the antibiotic of choice. The adult dose of
tetracycline is 500mg every 6 hours for 3 days.
Septron has also been recommended.
6.Disinfection:
A. Stool and vomit: Mix stool and vomit with 5% Lysol for
2 hrs, then dispose it properly.
B. Clothes: These should be soaked in 2% Lysol or cresol
solution for 30 min and then washed with soap and water.
C. Room disinfection: The floor and walls upto a height of 3
feet should be treated with 5% cresol or Lysol.
D. Hands: Hands may be dipped in 1 % of Lysol and washed
afterwards with soap and water.
E. Feeding and cooking Vessels: These may be disinfected
by boiling them in water for 15 min and finally washing
them with water and soda.
7. Sanitation Measures.
8. Vaccination.
9. Chemoprophylaxis:
Tetracyclines are the drugs of choice for
chemoprophylaxis 500mg bd for 3 days.
10. Health education:
 8. MENINGOCOCCAL MENINGITIS:

Meningococcal meningitis is a bacterial

infection of the membranes covering the
brain and the spinal cord.
 ETIOLOGY:
The most common causes of meningitis are
viral infections that usually get better without
treatment.
Meningitis also can be caused by
Chemical irritation
Drug allergies.
Fungi
Parasites.
Tumors
 Most viral meningitis is due to entero viruses,
which are viruses that also can cause intestinal
illness.
It can caused by herpes viruses, the same virus
that can cause cold sores and genital herpes.
Viruses that cause mumps and HIV can cause
aseptic meningitis.
Recently , West Nile virus spread by mosquito
bites, has become a cause of viral meningitis in
most of the US.
 CLINICAL MANIFESTATION:

Bacterial meningitis is an emergency. Symptoms

usually appear on quickly and may include:
Fever and chills.
Mental status changes.
Nausea and vomiting
Sensitivity to light.
Severe headache
Stiff neck (meningismus)
Agitation
Bulging fontanelles in babies
Decreased alertness
Poor feeding or irritability in children.
Rapid breathing.
Unusual posture , with the head and neck arched
backwards ( opisthotonos).
 SIGNS:
Fast heart rate
Fever
 Mental status change
 Stiff neck.
DIAGNOSTIC EVALUATIONS;
A lumber puncture.
Blood culture.
Chest x-ray.
CT scan of the head.
WBC count.
 MANAGEMENT:
Antibiotics should be started as soon as
possible. Ceftriazone is of the most commonly
used antibiotics for meningococcal meningitis.
Penicillin in high doses is almost always
effective .
Steroids also advice.
Chloramphenicol may be used when
patient have allergic to penicillin.
People in close contact with someone who
has meningococcal meningitis should be
given antibiotics to prevent infection
 COMLICATION:

Brain damage.
Formation of fluid between in skull and
brain
Hearing loss
Hydrocephalus
Seizures.
 9. TUBERCULOSIS:

Pulmonary tuberculosis (TB) is a contagious

bacterial infection that mainly involves the
lungs, but may spread to other organs.
It is caused by the Mycobacterium tuberculosis ,
a pathogen of tuberculosis also written as M.
Tuberculosis or tubercle bacillus.
Pulmonary tuberculosis is marked by the
formation of granuloma in infected lung tissues
and cell-mediated hypersensitivity, that also
causes inflammation and fibrocavitary
destruction in the lungs, produces chronic
respiratory symptoms, and reduces the quality of
life.
 CAUSES AND RISKS FACTORS:

It is caused by Mycobacterium

tuberculosis.
This bacterium is typically attacks the
lungs but also attack other parts of the body
such as the kidney, spine, and brain.
 RISKS:

Close contact with someone who has active

tuberculosis.
Immunocompromised Status: HIV
infection, cancer, transplanted organs and
prolonged high dose corticosteroid therapy.
Substance abuse: Alchoholism and IV drug
abuse.
Pre existing medical condition: DM, Chronic
renal failure, Silicosis, Leukemia or Hodgkin’s
disease.
Malnutrition.
Living in overcrowded place.
 TRANSMISSION:

TB is spread through air from one person

to another through droplet nuclei.
E.g: coughing, sneezing, singing, laughing,
or talking and remain suspended in the air
for many hours.
 CLINICAL MANIFESTATIONS:
 Cough that lasts 3 weeks or longer.
Mucoid or mucopurulent sputum
Pain in the chest.
Breathing difficulty
Wheezing.
Coughing up blood or sputum
Unexplained weight loss.
Fever.
Chills
 Night sweats
Weakness or fatigue.
Loss of appetite.
Clubbing of the fingers or toes
Enlarged or tender lymph nodes in the neck or other
areas.
Fluid around lung.
Unsusual breath sound (crackles).
TB infection sometimes spread in bloodstreams and
lymphatic system to cause infection in other parts of
body. E.g. Lymph glands, Gut and abdomen, Bones and
Joints, heart, kidney and bladder, brain, skin.
TB infection sometimes spread in bloodstreams
and lymphatic system to cause infection in other
parts of body. E.g. Lymph glands, Gut and
abdomen, Bones and Joints, heart, kidney and
bladder, brain, skin.
Spread to many parts of the body .This is called
military TB and can affect many organs
including lungs, bones, liver and eyes and skin.
 DIAGNOSTIC EVALUATION:

A complete history and physical examination.

Tuberculin skin test.
Chest X- ray.
Sputum testing.
Quantiferon – TB Gold test.
 MEDICAL MANAGEMENT:

Pulmonary TB is treated primarily with chemotherapeutic

agents for 6 to 12 months.
First line drugs:
Isoniazid is the most potent bactericidal drug.It has good
penetration of tuberculous lesions and is excreted by the
kidneys.
Rifampicin is a potent mycobacterial RNA polymerase
inhibitor . It has good tissue penetration and gives an
orange discoloration to body fluids. It is metabolised by
the liver and excreted in urine and bile.
Pyrazinamide is bacteriostatic against semi-
dormant , intracellular mycobacteria and is
excreted by the kidneys.
Ethambutol gradually inhibits mycobacterial
growth and is excreted in urine and faeces.
Second line drugs:
It is used when there is resistance and
intolerance and include: amikacin, capreomycin,
cycloserine, macrolids and quinolones.
 NURSING MANAGEMENT:

Assess the lungs sounds, respiratory rate and

effort, use of accessory muscles. Diminished
lungs sounds indicate possible poor air
movement and impaired gas exchange.
Observe skin and mucous membranes for
cyanosis.
Administer supplemental oxygen if needed.
Teach the patient about relaxation excercises.
Encourage patient to cough and deep breathe
every hour.
Administer expectorants as ordered.
Perform chest physiotherapy and postural
drainage.
Encourage patient to cough and deep breathe every
hour.
Administer expectorants as ordered.
Perform chest physiotherapy and postural drainage.
Teach the patient how to avoid spreading the disease by
sneezing, or coughing, into doubly ply tissues instead of
their bare hands, washing their hands after this and
disposing of the tissue into a closed plastic bag.
Put a mask on the patient during transportation to
other departments.
Explain the importance of a nutritious diet,
monitoring weight , administer vitamin supplements
and small frequent meals.
Teach the patient about the importance of taking all
prescribed medications because the bacteria that
causes TB grows slowly and requires along time to
be eliminated.
 10. PLAGUE:

Plague disease is a severe illness that can

result in pneumonia, swollen glands, blood
infection, and death.
It is caused by bacteria named Yersinia
pestis.
Rodents, such as rats, spread the disease to
humans.
 RISK FACTORS:

Living in a rural areas and especially in areas

where plague is common.
Having contacts with sick animals, small
rodents, or other possible hosts.
Participating in wilderness
activities( camping, hiking, sleeping on the
ground, hunting).
Exposure to flea bites.
Exposure to naturally occurring plagues in the
community.
Employment as a veterinarian.
Outdoor activity during the summer months.
 TYPES OF PLAGUE:

Pneumonic plague: An infection of the lungs. It

occur by breathing in the plague bacteria. It usually
takes 1-4 days until illness starts.
Bubonic Plague: An infection of the lymph
nodes. Bubonic plague is the most common
naturally – occurring form of plague and is caused
by the bite of an infected flea. A sore usually forms
at the site of the bite.
Septicemic Plague: Septicemic (blood) Plague is
a blood infection with plague bacteria.
It can result from fleabites, touching plague-
infected materials with broken skin, or spread of
infection from the lung or bubo.
Once plague bacteria are in the blood stream
,severe illness and death can follow quickly.
 CLINICAL MANIFESTATION:

Fever and chills

Headace and body aches
Sore throat.
Weakness and general feeling of illness.
Abdominal pain
Nausea and vomiting.
Constipation , diarrhea and black or tarry stools.
Stomach pains
Cough
Stiff neck
Heart irregularities , low BP
Confusion, seizures.
 DIAGNOSTIC EVALUATION:

History and physical examination

Blood culture.
Culture of lymph node aspirate
Culture of sputum
Chest x-ray.
 MANAGEMENT:

People with plague need immediate treatment.

Isolate the patient not to infect others.
All forms of plague can be treated with antibiotics
such as streptomycin,gentamicin, chloramphenicol,
doxycycline, tetracycline and fluroquinolones are
used to treat plague.
Oxygen and IV fluids and respiratory support
usually are also needed.
Eliminate the sources of food and nesting
places for rodents around homes, work
place, and recreation areas remove brush
rock piles junk cluttered firewood .
General sanitation and house living
condition should be improved to control
the rodents.
 11. LEPTOPSPIROSIS

Leptospirosis (weil disease) is a bacterial

disease that affects human and animals .
It is caused by bacteria of the genus
Leptospira.
 CAUSES AND RISK FACTOR:

The leptospira bacteria can be found in fresh water

that has been contaminated by animal urine. The
infection occurs in warmer climates.
It is not spread from one person to person, except
in very rare cases. It occasionally spreads through
sexual intercourse, breast milk , or from a mother
to her unborn child.
 RISK FACTORS:

Occupational exposure: farmers, slaughter house

workes, veterinarians , rice field workers.
Recreational activities: fresh water swimming,
canoeing and trail biking in warm areas.
Household exposure; pet dogs, domesticated
livestock, rainwater catchment systems, and
infected rodents.
 CLINICAL MANIFESTATIONS:

Symptoms can take 2 to 26 days to develop and include:

Dry cough
Fever
Headache
Muscle pain
Nausea, vomiting, and diarrhea.
Shaking chills
Abdominal pain
Conjunctivitis
Enlarged lymph glands
Enlarged spleen or liver.
Joint aches.
Muscle rigidity
Muscle tenderness.
Skin rash
Sore throat.
 DIAGNOSTIC EVALUATIONS:

The blood is tested for antibodies to the

bacteria.
Complete blood count.
Creatinine kinase.
LFT: increase serum bilirubin, transminases.
 COMPLICATION:
GI haemorrhage
Myocarditis
Hypotension.
Liver failure.
Acute kidney injury.
 MANAGEMENT:
1.Antibiotic treatment:
First line of drug is oral doxycycline starting
within 48 hours of illness.
Oral amoxicillin , ampicillin, and doxycycline are
effective in mild to moderate infections.
Intravenous penicillin G for severely ill patients.
Third generation cephalosporins
( ceftriazone, cefotaxime)
2.Other treatment:
Supportive treatment of the hypotension,
haemorrhage, acute kidney injury, and liver
failure.
Vit.K should be administered for
hypoprothrombinaemia.
VECTOR BORNE
DISEASE:
 MALARIA:
Malaria is a mosquito- borne febrile disease caused by
the malarial parasites (plasmodium). It is transmitted
to man by infected female anopheles mosquitoes.

Malaria is clinically characterized by:

Fever which comes on chills and leaves with sweating.
Enlargement of the spleen.
Secondary anaemia. The disease has a tendency to
relapse
 ETIOLOGICAL FACTORS:

Agent: there are species of malarial parasite which

cause disease in man. These are
P.Vivax
P. Falciparum
P. Quartan
P. Ovale.
Source of infection:
A person who harbours the sexual forms of
parasites.
MODE OF TRANSMISSION:
Bite of infected , female anopheles mosquito.
INCUBATION:
P.Vivax- 14 days.
P.falciparum-12 days.
 CLINICAL MANIFESTATION:

Cold stage: upto 1 hrs.

Headache
Shivering
Fever rising rapidly
Cold skin
Hot stage: (upto 5 hours)
Very hot feeling
Severe headache
Skin flushed
Fever starts falling
Sweating stage:
Profuse sweating
Temperature normal.
 MANAGEMENT:

Early detection of fever cases in the community

by house to house visits by the health workers
once in every 15 days.
Early administration of chloroquin.
The collection of blood films from fever cases.
The laboratory examination of all blood films
collected from fever cases for malaria parasite.
Anti adult measures. E.g. insecticide spraying.
Anti- larval measures, e.g. larvicidaloperations.
Protection against mosquito bites.
In unconscious patient maintain a clear airway.
Change position every 2 hours.
A careful record of fluid should be checked
frequently.
 YELLOW FEVER:

Yellow fever is enzootic viral disease caused

by an arbovirus.
 It affects mainly monkeys and other
vertebrates in tropical America and Africa
and is transmitted to man by certain
mosquitoes.
 ETIOLOGICAL FACTORS:

Agent: The causative agent is Flavi virus fibricus.

Reservoir of infection: Monkeys and forest
mosquitoes.
Period of communicability:
Man: Blood of patient is infective during the first
3 to 4 days of illness.
Mosquitoes: After an extrinsic incubation period
of 8 to 12 days the mosquito becomes infective.
Age and sex: All ages and both sexes are
susceptible to yellow fever in the absence of
immunity.
Occupation: Persons whose occupation
brings them in contact with forests where
yellow fever is endemic are exposed to risk
of infection.
Immunity: one attack of yellow –fever gives
lifelong immunity.
INCUBATION PERIOD:
3 to 6 days.
 CLINICAL MANIFESTATION:

Black vomit
Epistaxis
Melena
Anuria
Shock
Agitation
Albuminuria
Severe jaundice
Rigor
Headache
Pain in back and limbs.
 
CONTROL OF YELLOW FEVER:
Jungle yellow fever:
It continues to be an uncontrollable disease.
Vaccination of humans with 17 D vaccine is
the only control measure.
Urban yellow fever:
Rapid immunization of the populations at
risk is the most effective control strategy for
yellow fever.
Vector control: Personal protection against
contact with insects is of major importance in
integrated vector control.
Surveillance:It should be constituted in
countries where the disease is endemic, for the
early detection of the presence of the virus in
human population or in animals that may
contribute to its dissemination.