Schistosomiasis

Bilharziasis / Snail fever

Definition

 Schistosomiasis is a slow, progressive disease caused by blood flukes of class Trematoda.

Etiologic Agent

The cause of the disease are three blood flukes of genus Schistosoma
 Schistosoma japonica
 Infects the intestinal tract (Katayama disease) / The only type that is endemic in the Philippines
 Schistosoma mansoni
 Affects the intestinal tract / Common in some parts of Africa
 Schistosoma haematobium
 Affects the urinary tract / Can be found in some parts of the Middle East, like Iraq and Iran
Incubation Period
 The incubation period is at least two months
Mode of Transmission
 Through ingestion of contaminated water / Through the skin pores
 Intermediary host, a tiny snail called Oncomelania qundrasi
Source of Infection
 Feces of infected individuals
 Manure of infected animals (that can be hosts of the organism) such as dogs, pigs carabaos,
cows, monkeys, and wild rats
Pathogenesis/Pathology
 The larvae (cercaria) penetrates the skin or mucous membrane and eventually works their way to the
liver's venous portal circulation.
 They mature in one to three months in the portal vessels.
 The mature worms live in copula in the portal vessels and migrate to some parts of the body.
 The female cercaria lay eggs in the blood vessels surrounding the large intestine or bladder laceration
in the mucosa occur and the eggs escape into the lumen of the intestine and are excreted with the
feces
 The eggs secrete proteolytic enzymes that help them migrate to the bladder and intestines to be shed.
 The enzymes also cause an eosinophilic inflammatory reaction when eggs get trapped in tissues or
embolize to the liver, spleen, lungs, or the brain.
 Some of the eggs are carried by the portal
circulation and filtered in the liver where small
lesions or granulomas form.
 These granulomas resolve and are replaced by
fibrous tissue
 Likewise, the ulcerations in the intestines are
healed and scar formation occurs
 As the disease progresses, the liver enlarges due
to increasing fibrosis.
 The flow of blood is interrupted in the
intrahepatic portion, and results in portal
hypertension.
 Fluid accumulates in the patient's abdomen,
causing it to bulge
Diagnostic Procedures
 Fecalysis or direct stool exam
 Kato Katz technique or Richie technique (finding ova and cysts during stool examination)
 Liver and rectal biopsy
 Enzyme-linked immunosorbent assay (ELISA)
 Cercumoval precipetin test (COPT) is the confirmatory diagnostic test
 Antibody detection can be useful to indicate schistosome infection in people who have traveled to
areas where schistosomiasis is common and the eggs cannot be demonstrated in fecal or urine
specimens.
Clinical Manifestations
 Many individuals do not experience symptoms; if symptoms do appear, it usually take 4 to 6 weeks
from the time of infection to manifest. The signs and symptoms of the disease depend on the site of
infection.
 12 hours after infection, a pruritic rash develops at the site of the entrance of the microorganism,
known as "swimmer's itch
 Around 2-10 weeks later, low-grade fever, myalgia, and cough occur
 Weeks or months after the initial infection, acute schistosomiasis (Katayama fever) occurs as a
systemic reaction against the migrating schistosomulae as they pass through the bloodstream through
the lungs and on to the liver.
 Abdominal discomfort due to hepatomegaly, splenomegaly, and lymphadenopathy is observed.
 Bloody-mucoid, "dysentery-like" stools occur on and off tor weeks. The patient become icteric and
jaundiced.
 The abdomen becomes distended due to the inflamed liver, which is a result Schistosoma eggs
accumulating in that organ.
 After some years the patient becomes weak with marked muscle wasting and a pale complexion.
 If the parasite reaches the brain, the victim experiences severe headache, dizziness and
convulsions.
 Many infections are mildly symptomatic, with anemia and malnutrition being common in endemic
areas.

Complications
 Liver cirrhosis, portal hypertension
 Genitourinary disease/ hydronephrosis with possible kidney failure
 Cerebral granulomatous disease develops. The presence of eggs in the spinal cord can led to
transverse myelitis with flaccid paraplegia
Modalities of Treatment
 Treatment is effective only when given early in the course of the disease
 Praziquantel tablet / Fuadin injection

Prevention and Control

 Interrupt the life cycle of the worms and protect people from infection.
 Submit samples stool examination
 Reduce the snail population
 Diminish infection rate by:
 Carry out health education on the disease process, mode of transmission, and prevention.
 Leptospirosis
(Weil’s disease / Canicola fever / Hemorrhagic jaundice /
Mud fever / Swine herd disease)
Definition

 It is a zoonotic infectious disease that originates from both domestic and wild animals.
Etiologic Agent

 Leptospira interrogans
Incubation Period
 Varies from 6-15 days
Mode of Transmission
 Ingestion or direct contact of the skin and mucous membranes with the urine of infected animals
Source of Infection
 Contaminated food and water
 urine of infected wildlife and domestic animals, especially rodents

Period of communicability
 Leptospira can be found in the urine between 10 – 20 days after onset

 Risk Factors
 Leptospirosis is an occupational hazard to people who engage in outdoor activities especially in tropical
climates.
 The disease has also been associated with swimming, wading and rafting in contaminated lakes and rivers.
Clinical Manifestations
1. The degree of illness in leptospirosis varies from asymptomatic to severe or fatal
 Initial phase
 Second phase
2. Three septic stages can be recognize
 Septic stage
 Immune or toxic stage
 Convalescence
Management

 Penicillin G Na / Tetracycline
 Peritoneal dialysis
 Administration of fluid and electrolyte and blood as indicated
Prevention and Control
 Prophylaxis with doxycycline for those who are at risk
 Sanitation in homes, workplaces, and farms
 Proper drainage system and control of rodents
 Vaccination of animals (cattle, dogs, cats, and pigs)
 Treatment of infected people and pets
 Effective information dissemination campaign
 Avoid swimming or wading in flood waters
 Use rubber boots in flooded areas, specially if wounds and other skin problems on the foot or legs
are present
 Wash feet thoroughly with soap and water after wading through flooded areas
 Instruct the patient and significant others to watch for signs and symptoms of leptospirosis
such as:
 fever, pain at the muscles of the legs, and headache
 periorbital and intraocular pain
 yellowish discoloration; first of the sclera, then the skin,
 tea-colored urine
 Cough vomiting sometimes associated with diarrhea.
Nursing Management
 Isolate the patient, and his/her urine must be disposed of properly.
 Keep the patient under close surveillance
 Investigate contacts and source of infection
 For home care, clean dirty places and pools. Remove stagnant water if possible.
 Eradicate rats and other disease-carrying rodents.
 GONORRHEA
(Clap, Flores blancas, Gleet)
Definition

 Gonorrhea is a sexually transmitted bacterial disease involving the mucosal lining of the
genitourinary tract, cervix, rectum, pharynx, or membranes of the eyes, and conjunctiva.
Infectious Agent

 Neisseria gonorrheae / gonococcus

Incubation Period
 3 - 21 days (average three to five days)
Mode of Transmission
 By contact with exudates from the mucous membranes of infected persons as result of
sexual activity
 May occur in utero upon rupture of membranes in infants delivered by cesarean section
 Direct contact with contaminated vaginal secretions of the mother during delivery
 It may be acquired through sexual contact (orogenital, anogenital) between partners of the
opposite sex as well as those of the same sex.

Risk Factors Affecting Gonococcal Infection

 Younger individuals
 People with multiple partners
 Clients who had previous gonorrhea infection
 Individuals who have other STDs, specifically those with HIVIAIDS
Period of Communicability
 The infected person may remain communicable as long as the organisms are present in
secretions and discharges

Pathology
 After infection, gonococci adhere to the urethral epithelium.
 Penetration of the mucosa usually elicits an acute inflammatory response consisting mainly of
polymorphonuclear leukocytes in the submucosa.
 Inflammatory edema of the gland ducts or plugs of debris obstruct drainage, forming
microabscesses that may coalesce into larger ones.
 The infection spreads along mucosal surfaces, and may involve the fallopian tubes and the
endometrium, and eventually enter the peritoneal cavity of women
 Scarring from abscess formation, or from tubal involvement, may lead to strictures and sterility.
 Epididymitis and possible sterility may occur in men
Clinical Manifestations
 Females
 Burning sensation and frequent urination associated with itching at the perineal area
 Redness and swelling of the genitals with yellowish purulent vaginal discharge
 Urethritis or cervicitis may occur a few days after exposure
 Endometritis, salphingitis, or pelvic peritonitis are symptoms of uterine invasion which may lead to
infertility. Early signs of pelvic infection are fever, nausea and vomiting and abdominal
pain/tenderness
 Vaginal bleeding between periods, such as after vaginal intercourse
 Pregnant women with gonorrhea may infect the eyes of their babies during the passage through
the birth canal.
 In Males
 Dysuria with purulent discharge from the urethra 2 to 7 days after exposure
 Rectal infection is common among homosexuals:
 Inflammation of the urethra can cause strictures, which can prevent passage of urine
 Prostatitis, pelvic pain, and fever may be present
 Gonorrhea can also infect other parts of the body such as:
 Eyes - Infection is manifested by pain, photophobia or sensitivity to light. The affected eye/s
usually have pus - like discharges
 Throat - sore throat, swollen lymph nodes in the neck
 Joints – joint pain accompanied by swelling, redness, and warmth
 Rectum - itchiness around the rectum later followed by discharge / blood is present in the stools
and can be mistaken for internal hemorrhoids.
Diagnostic Procedures
 For females:
 Culture of the specimen taken from the cervix and anal canal (inoculation of specimen on Thayer-
Martin medium is made. The medium contains an antibiotic that inhibits the growth of other
microorganisms)
 For males:
 Gram-staining of urethral discharge

Complications
 Infertility in women
 Epididymitis
 Arthritis
 Conjunctivitis
 Meningitis and endocarditis
 Ophthalmia neonatorum if untreated will end in blindness.
Treatment Modalities
 Due to emerging strains of drug-resistant N. gonorrhoeae, the CDC recommends that
uncomplicated gonorrhea be treated only with:
 Antibiotic ceftriaxone, given in combination with either azithromycin or doxycycline
 For pregnant women - ceftriaxone plus erythromycin
 Penicillin G if sensitive to ceftriaxone and azithromycin.
 CDC 2015 guidelines recommend 10-14 days parenteral therapy tor gonococcal meningitis and 4
weeks treatment for gonococcal endocarditis
 Babies born to mothers with gonorrhea should receive an eye prophylaxis ( Crede’s prophylaxis )
soon after birth to prevent ophthalmia neonatorum. If an eye infection develops can be treated
with antibotics
Prevention and Control
 Sex education - mode of transmission and the source of infection
 Case finding and contact tracing
 Treatment for partners is essential

Nursing Management
 All information is considered confidential.
 Infants born to mothers positive of gonorrhea should be given 1 % silver nitrate eye prophylaxis on
both eyes at the time of birth
 Isolation of the patient until he/she recovers from the disease
 Syphilis
Lues venereal / Morbus gallicus
 Definition
 Syphilis is a chronic, infectious, sexually transmitted disease that usually begins in the mucous membranes
and quickly becomes systemic.
Etiologic Agent

 Treponema pallidum.
Incubation Period
 10 to 90 days; the average is three weeks
Mode of Transmission
 Direct transmission / Indirect contact
 Vertical transmission through the placenta of a syphilitic mother
 Accidental exposure of a caretaker carelessly handling contaminated diapers soiled by a baby
with congenital syphilis

Sources of Infection
 Discharge from obvious or concealed lesions of the skin or mucous membranes
 Semen, blood, tears, and urine of an infected person
 Mucous discharges from the nose, eyes, genital tract, or bowel
 Surface lesions can contain high counts of the spirochetes
Period of Communicability
 The period of communicability is varíable and indetinite.
Clinical Manifestations
 Primary syphilis
 Secondary syphilis
 Latent syphilis
 Tertiary syphilis
 Neurosyphilitic symptoms include:
 Meningeal syphilis
 Meningovascular syphilis
 General paresis
 Tabes dorsalis
 Cardiovascular syphilis
 Gummas.

 Late stage syphilis

CONGENITAL SYPHILIS
 Once the treponema enters the fetal circulation, dissemination to all the tissues occur at once.
They multiply and infect many organs of the fetus.
 The fetus may be overwhelmed by the infection and die. The uterus may expel the body, resulting
in either miscarriage or stillbirth, depending on the stage of pregnancy

If treponemal infection does not prove fatal, congenital syphilis may still cause
significant alteration in fetal development at various stages in both intra and
extrauterine life
Clinical Manifestations
 Early congenital syphilis
 Lesions of the skin and mucous membranes
 Liver and Spleen
 Late congenital syphilis
 Interstitial keratitis is the most common late lesion associated with late congenital syphilis.
Complications
 Severe damage to several organs and the nervous system
 Heart disease and brain damage
 Severe illness or death in newborns

Diagnostic Procedures
 Darkfield illumination test is most effective if moist lesions are present
 Fluorescent treponemal antibody absorption test uses exudates from lesions
 Venereal Disease Research Laboratory (VDRL) slide test and rapid plasma reagent test
 CSF analysis
 Treatment Modalities
 Penicillin G benzathine 2.4 million units
 Nonpregnant patients who are allergic to penicillin may be treated with oral tetracycline or
doxycycline for 15 days for early syphilis and for 30 days for late infections. Tetracycline is
contraindicated for pregnant women
 Abstain from sexual contact until the syphilis completely healed. Partners must also be treated and
must complete treatment as well.

Prevention and Control

 Introduce proper sex education
 Report cases to the Department of Health.
 Require sex workers to undergo regular checkups
 Case finding
Nursing Management
 Emphasize to the client on the importance of completing the treatment even after symptoms
subside.
 Instruct clients to inform their partners that they should be tested, and if necessary treated.
 Practice universal precautions
 Encourage the patient to undergo VDRL testing after 3, 6, 12, and 24 months to detect possible
relapse.
 Report all cases of syphilis to local public health authorities. Refer the patient and his / her sexual
partner tor HIV testing
 In secondary syphilis, keep the lesions dry as much as possible. If they are draining dispose of the
contaminated materials properly.
 In cardiovascular syphilis, check for signs of decreased cardíac output (decreased urine output,
hypoxia, and decreased sensorium) and pulmonary congestion.
 In neurosyphilis, regularly check the patient's level of consciousness, mood, and coherence. Watch
for signs of ataxia
Health Tips
 All pregnant women should be tested for syphilis at their first prenatal visit. It is advisable for this
group to be tested for syphilis at least once during their pregnancy. A client should receive
immediate treatment if the test comes out positive
 A person should get tested regularly for syphilis if he or she is sexually active and:
 Is a man who has sex with other men
 one who is living with HIV
 have partner/s who tested positive for syphilis.
 An infected baby may be born without signs or symptoms of disease. However, if not assessed
and treated immediately, the baby may develop serious problems within a few weeks. Untreated
infants can have health problems such as cataracts, deafness seizures, and may die.
 HERPES SIMPLEX
Definition
 Herpes simplex is a viral infection caused by the herpes simplex virus (HSV). Oral herpes
involves the face or mouth. It may result in small blisters that occur in groups, often called
cold sores or fever blisters In other cases, the patient may just have a sore throat. Herpes
simplex is related to the viruses that cause infectious mononucleosis (Epstein-Barr virus),
chickenpox, and shingles.
Etiologic Agent
 Herpes simplex virus (HSV)
 Type 1 virus
 The type I virus can cause cold sores that usually affects infant and children.
 The sores are characterized by tiny, clear fluid-filled blisters.The sore most commonly
appears on the lips, mouth, nose, chin, or cheeks shortly after exposure. This may also
develop on wounds
 Patients may barely notice the symptoms or need medical attention for pain relief.
 The disease can be transmitted by kissing or sharing kitchen utensils and towels.
 Patients usually catch the infection from family members or friends who carry the virus
 The sores of primary infection appear 2-20 days after contact with an infected person and
usually last for 7-10 days
 
Pathogenesis
 The skin may itch or become very sensitive before the blister appears.
 The blister may break as a result of injury, allowing the fluid inside to ooze and form a crust
 The crust eventually falls off, revealing slightly red healing skin. However, the virus remains in the
body, where they move to the nerve cells before entering a resting state,
 The infection may reappear in either the same location or in a nearby site. The infection may recur
every few weeks, or less frequently.
 Recurrent infections tend to be milder than the primary infection. It can be triggered by a variety of
factors including fever, sun exposure, and the menstrual period. For many the recurrence is
unpredictable and has no recognizable cause.
 Type 2 virus (Genital herpes)
 Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus
(HSV)
 Sexual contact is the primary mode of transmission. After the initial infection, the virus lies
dormant in the patient's body and can reactivate several times a year
 Genital herpes can cause pain, itching, and sores in the genital area. Vesicular and pustular
lesions with painful erythematous ulcers around the genitals may also be present
 The virus affects about 20% of sexually active individuals.
 The virus can also be spread by autointection (touching an unaffected part of the body after
touching the herpes lesion)
 There is no cure for genital herpes, but medications can ease symptoms and reduce the risk of
infecting others
 More than 80% of women affected HSV2 manifest cervical and urethal involvement
 A person with genital herpes can be contagious even if he/she does not have visible sores, and
the disease can recur within 12 months.
Signs and Symptoms
 Flu-like signs and symptoms with swollen lymph nodes in the groin, headache, muscle ache, and fever.
 Manifestations include minor rash or itching, painful sores, fever, muscular pain and burning sensation
on urination.
 Pain, itching, and tenderness may occur in the genital area until the infection clears.
 Small red bumps or tiny white blisters may appear a few days to weeks after infection.
 Ulcers may form when blisters rupture, ooze or bleed. These lesions may make it painful to urinate
 Scabs may form when the skin crusts over and form scabs as the ulcers heal.
 Sores appear where the infection entered the body. The patient can spread the disease by touching a
sore and then rubbing or scratching unaffected parts of the body, including the eyes.
 Men and women can develop sores on the:
 buttocks, thighs, and anus / mouth and the pharynx / and urethra. 
Women can also develop sores in or on the:
 vaginal area, external genitals and cervix
Men can also develop sores in or on the:
 penis and scrotum

Treatment Modalities
 Initial treatment
 Antiviral drugs. Drug therapy is not a cure, but it can make living with the condition easier.
 There are three major drugs commonly used to treat genital herpes (7-10 days treatment)
 acyclovir (Zovirax) / famciclovir (Famvit) / valacyclovir (Valtrix)
 Intermittent treatment
 The same drugs are taken for two to five in cases recurrence of
the disease.
 Suppressive treatment
 If the infection recurs often, an antiviral drug is taken every day.
 For patients who suffer more than six outbreaks a year, suppressive therapy can reduce the number of
outbreaks by 70% to 80%.
 Personal hygiene is very essential to halt or minimize the spread of herpes.

 Prevention
 Avoid having sex during a herpes outbreak.
 Use protection like condoms and dental dams during sex to help decrease the risk of acquiring herpes.
 Avoid contact with another person's mouth or genitals.
Thank you!