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All information and pictures presented in this slideshow were meant for EDUCATIONAL purposes only. 1Nurses.com does not claim any liability from the use of this slide and does not guarantee any action that might result from the use of this material. 1Nurses.com does not claim any ownership for the images and articles presented in this report. All articles and Images are the respective Copyright of the respective owners.

COMMUNICABLE DISEASE Is any disease that can be transmitted directly or indirectly from one person to another

COMMUNICABLE DISEASE

Is any disease that can be transmitted directly or indirectly from one person to another

INFECTION Is a condition caused by the entry and multiplication of pathogenic microorganisms within the host body. It is also an invasion of an organisms (bacteria, helminths, fungi, parasite, ricketsia and prion)

INFECTION

Is a condition caused by the entry and multiplication of pathogenic microorganisms within the host body.

It is also an invasion of an organisms (bacteria, helminths, fungi, parasite, ricketsia and prion)

FACTORS AFFECTING RISK OF INFECTION AGE HEREDITY LEVEL OF STRESS NUTRITIONAL STATUS CURRENT MEDICAL THERAPY PRE-EXISTING DISEASE IMMUNIZATION STATUS

AGE

HEREDITY

LEVEL OF STRESS

NUTRITIONAL STATUS

CURRENT MEDICAL THERAPY

PRE-EXISTING DISEASE

IMMUNIZATION STATUS

IMMUNITY THE QUALITY OF BEING INSUSCEPTIBLE TO OR UNAFFECTED BY A PARTICULAR DISEASE.

THE QUALITY OF BEING INSUSCEPTIBLE TO OR UNAFFECTED BY A PARTICULAR DISEASE.

TYPES OF IMMUNITY INNATE = within the HOST Immune System ACQUIRED = inoculation and disease Active Passive

INNATE = within the HOST Immune System

ACQUIRED = inoculation and disease Active Passive

IMMUNE SYSTEM PROTECTION AGAINST ANTIGEN OR DISEASES BY A SYSTEM OF ANTIBODY PRODUCTION ANTIBODY PRODUCED BY LYMPHOCYTES IN RESPONSE TO ANTIGEN. ANTIGEN TRIGGERING AGENT OF THE IMMUNE SYSTEM

IMMUNE SYSTEM PROTECTION AGAINST ANTIGEN OR DISEASES BY A SYSTEM OF ANTIBODY PRODUCTION

ANTIBODY PRODUCED BY LYMPHOCYTES IN RESPONSE TO ANTIGEN.

ANTIGEN TRIGGERING AGENT OF THE IMMUNE SYSTEM

IMMUNOGLOBULINS IgG MOST PREVALENT ANTIBODY 80%, PRODUCE LATER IN THE IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS THE PLACENTA IgA FOUND IN COLOSTRUM , TEARS, SALIVA, SWEAT IgM PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL IMMUNIZATION IgE ALLERGIC REACTION IgD UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B CELLS

IgG MOST PREVALENT ANTIBODY 80%, PRODUCE LATER IN THE IMMUNE RESPONSE, ONLY Ig THAT CAN CROSS THE PLACENTA

IgA FOUND IN COLOSTRUM , TEARS, SALIVA, SWEAT

IgM PRINCIPAL ANTIBODY OF BLOOD, QUICKLY PRODUCED IN RESPONSE TO AN ANTIGEN, RESPONDS TO ARTIFICIAL IMMUNIZATION

IgE ALLERGIC REACTION

IgD UNKNOWN, ANTIGEN RECEPTOR, FOUND IN THE SURFACE OF B CELLS

IMMUNIZATION A PROCESS BY WHICH RESISTANCE TO AN INFECTIOUS DISEASE IS INDUCED OR AUGMENTED. ACTIVE AND PASSIVE IMMUNIZATION

A PROCESS BY WHICH RESISTANCE TO AN INFECTIOUS DISEASE IS INDUCED OR AUGMENTED.

ACTIVE AND PASSIVE IMMUNIZATION

EPI Hepa b 3 shots, 0-1-6 mo, im, 0.5 ml, vas. lateralis Bcg 1 at birth, id, 0.05 ml, right arm Bcg 2 at 6 y/o, id, 0.1 ml, left arm Dpt 3 shots, 6 weeks old, 4 weeks interval im, 0.5 ml, vas. lateralis Opv 3x, same with dpt, oral gtts, 2-3 months Measles 1x, 9 mo, sq, 0.5 ml, right arm

Hepa b 3 shots, 0-1-6 mo, im, 0.5 ml, vas. lateralis

Bcg 1 at birth, id, 0.05 ml, right arm

Bcg 2 at 6 y/o, id, 0.1 ml, left arm

Dpt 3 shots, 6 weeks old, 4 weeks interval im, 0.5 ml, vas. lateralis

Opv 3x, same with dpt, oral gtts, 2-3 months

Measles 1x, 9 mo, sq, 0.5 ml, right arm

Active Immunity ANTIBODIES ARE PRODUCED BY THE BODY IN RESPONSE TO INFECTION. ANTIGEN IS INTRODUCED, LONG DURATION EXAMPLE: NATURAL ACTIVE = DISEASE ARTIFICIAL ACTIVE = VACCINES

ANTIBODIES ARE PRODUCED BY THE BODY IN RESPONSE TO INFECTION. ANTIGEN IS INTRODUCED, LONG DURATION

EXAMPLE:

NATURAL ACTIVE = DISEASE

ARTIFICIAL ACTIVE = VACCINES

ARTIFICIAL ACTIVE ANTIGENS (VACCINES OR TOXOIDS) ARE ADMINISTERED TO STIMULATE ANTIBODY PRODUCTION. REINFORCED BY BOOSTER DOSE TO INCREASE IMMUNITY. KILLED VACCINES PERTUSSIS VACCINE, TYPHOID VACCINE LIVE VACCINES ATTENUATED, WEAKENED SABIN, MEASLES TOXOID INACTIVATED BACTERIAL TOXIN-TETANUS, DIPHTHERIA

ANTIGENS (VACCINES OR TOXOIDS) ARE ADMINISTERED TO STIMULATE ANTIBODY PRODUCTION. REINFORCED BY BOOSTER DOSE TO INCREASE IMMUNITY.

KILLED VACCINES PERTUSSIS VACCINE, TYPHOID VACCINE

LIVE VACCINES ATTENUATED, WEAKENED SABIN, MEASLES

TOXOID INACTIVATED BACTERIAL TOXIN-TETANUS, DIPHTHERIA

Artificial Active

Artificial Active

Artificial Active

PASSIVE IMMUNITY ANTIBODIES ARE PRODUCED BY ANOTHER SOURCE. ANTIBODIES ARE INTRODUCED, SHORT DURATION Example: NATURAL PASSIVE = MOTHER ARTIFICIAL PASSIVE = GLOBULINS

ANTIBODIES ARE PRODUCED BY ANOTHER SOURCE. ANTIBODIES ARE INTRODUCED, SHORT DURATION

Example:

NATURAL PASSIVE = MOTHER

ARTIFICIAL PASSIVE = GLOBULINS

ARTIFICIAL PASSIVE IMMUNE SERUM (ANTIBODY) FROM ANIMAL OR HUMAN IS INJECTED. PROVIDE IMMEDIATE PROTECTION (DIPHTHERIA ANTITOXIN, TETANUS ANTITOXIN) SKIN-TESTING IS A MUST.

IMMUNE SERUM (ANTIBODY) FROM ANIMAL OR HUMAN IS INJECTED. PROVIDE IMMEDIATE PROTECTION (DIPHTHERIA ANTITOXIN, TETANUS ANTITOXIN) SKIN-TESTING IS A MUST.

CONDITIONS BEFORE AN INFECTION DEVELOPS Sufficient number of microorganisms Virulence of microorganisms Resistance of the of the host Immunity of the host Cycle of infection must be completed

Sufficient number of microorganisms

Virulence of microorganisms

Resistance of the of the host

Immunity of the host

Cycle of infection must be completed

THE INFECTION PROCESS CYCLE Agent (bacteria or virus) Reservoir (fomites or living things) Portal of Exit Mode of Transmission (direct or indirect) Portal of Entry The Host

Agent (bacteria or virus)

Reservoir (fomites or living things)

Portal of Exit

Mode of Transmission (direct or indirect)

Portal of Entry

The Host

STAGES OF AN INFECTIOUS PROCESS INCUBATION PERIOD PRODROMAL PERIOD ILLNESS PERIOD (PATHOGNOMONIC SIGN) CONVALESCENT PERIOD

INCUBATION PERIOD

PRODROMAL PERIOD

ILLNESS PERIOD (PATHOGNOMONIC SIGN)

CONVALESCENT PERIOD

Terminologies ETIOLOGY EPIDEMIOLOGY INCIDENCE PREVALENCE ENDEMIC EPIDEMIC PANDEMIC SPORADIC

ETIOLOGY

EPIDEMIOLOGY

INCIDENCE

PREVALENCE

ENDEMIC

EPIDEMIC

PANDEMIC

SPORADIC

FUNDAMENTALS OF STANDARD PRECAUTION HANDWASHING GLOVES MASKS, GOGGLES, FACE SHIELDS AIR FILTERS GOWNNS ISOLATION STRICT ISOLATION CONTACT ISOLATION RESPIRATORY ISOLATION TUBERCULOSIS ISOLATION ENTERIC PRECAUTION DRAINAGE/SECRETION PRECAUTION BLOOD/BODY FLUIDS PRECAUTION

HANDWASHING

GLOVES

MASKS, GOGGLES, FACE SHIELDS

AIR FILTERS

GOWNNS

ISOLATION

STRICT ISOLATION

CONTACT ISOLATION

RESPIRATORY ISOLATION

TUBERCULOSIS ISOLATION

ENTERIC PRECAUTION

DRAINAGE/SECRETION PRECAUTION

BLOOD/BODY FLUIDS PRECAUTION

ISOLATION It is necessary when a person is known or suspected to be infected with pathogens that can be transmitted by direct or indirect contact. The principle behind isolation technique is to create a physical barrier that prevents the transfer of infectious agents. To do this you have to know how the organisms are transmitted.

It is necessary when a person is known or suspected to be infected with pathogens that can be transmitted by direct or indirect contact.

The principle behind isolation technique is to create a physical barrier that prevents the transfer of infectious agents. To do this you have to know how the organisms are transmitted.

Transmission-Based Precautions Airborne Droplets Contact

Airborne

Droplets

Contact

AIRBORNE PRIVATE ROOM NEGATIVE AIR PRESSURE VENTILATION SAFEGUARDS air from room is not recirculated to other areas DOOR SHOULD BE KEPT CLOSED BARRIER TO SMALL PARTICLES masks HEPA high efficiency particulate air COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT

PRIVATE ROOM

NEGATIVE AIR PRESSURE

VENTILATION SAFEGUARDS air from room is not recirculated to other areas

DOOR SHOULD BE KEPT CLOSED

BARRIER TO SMALL PARTICLES masks HEPA high efficiency particulate air

COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT

DROPLET PRIVATE ROOM WEAR MASK IF WORKING WITHIN 3 FEET WEAR MASKS UPON ENTRY INTO THE ROOM COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT

PRIVATE ROOM

WEAR MASK IF WORKING WITHIN 3 FEET

WEAR MASKS UPON ENTRY INTO THE ROOM

COVER MOUTH OF PATIENT WITH MASK DURING TRANSPORT

CONTACT PRIVATE ROOM WEAR GLOVES GLOVES ARE REMOVED BEFORE EXITING FROM THE ROOM HANDS ARE WASHED THOROUGHLY NOTHING IS TOUCHED BEFORE EXITING THE ROOM GOWN IS WORN WHEN ENTERING THE ROOM REMOVE GOWN CAUTIOUSLY BEFORE LEAVING THE ROOM PATIENT CARE ITEMS SHOULD BE RESTRICTED TO SINGLE PATIENT

PRIVATE ROOM

WEAR GLOVES

GLOVES ARE REMOVED BEFORE EXITING FROM THE ROOM

HANDS ARE WASHED THOROUGHLY

NOTHING IS TOUCHED BEFORE EXITING THE ROOM

GOWN IS WORN WHEN ENTERING THE ROOM

REMOVE GOWN CAUTIOUSLY BEFORE LEAVING THE ROOM

PATIENT CARE ITEMS SHOULD BE RESTRICTED TO SINGLE PATIENT

OTHER TYPE OF ISOLATION AFB ISOLATION STRICT ISOLATION RESPIRATORY ISOLATION WOUND AND SKIN ISOLATION ENTERIC ISOLATION PROTECTIVE OR REVERSE ISOLATION

AFB ISOLATION

STRICT ISOLATION

RESPIRATORY ISOLATION

WOUND AND SKIN ISOLATION

ENTERIC ISOLATION

PROTECTIVE OR REVERSE ISOLATION

AFB ISOLATION VISITORS REPORT TO NURSES’ STATION BEFORE ENTERING ROOM MASKS ARE TO BE WORN IN THE PATIENT’S ROOM GOWNS ARE INDICATED TO PREVENT CLOTHING CONTAMINATION GLOVES ARE INDICATED FOR BODY FLUIDS AND NON-INTACTSKIN HANDWASHING-after touching the patient or potentially contaminated articles and after removing gloves articles should be discarded, cleaned or sent for decontamination and reprocessing room is to remain closed patient is to wear mask during transport

VISITORS REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

MASKS ARE TO BE WORN IN THE PATIENT’S ROOM

GOWNS ARE INDICATED TO PREVENT CLOTHING CONTAMINATION

GLOVES ARE INDICATED FOR BODY FLUIDS AND NON-INTACTSKIN

HANDWASHING-after touching the patient or potentially contaminated articles and after removing gloves

articles should be discarded, cleaned or sent for decontamination and reprocessing

room is to remain closed

patient is to wear mask during transport

STRICT ISOLATION VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM PRIVATE ROOM-necessary, door must be kept closed GOWNS-must be worn by all persons entering the room MASKS- must be worn by all persons entering the room HANDS-must be washed on entering and leaving room GLOVES-must be worn by all persons entering the room ARTICLES-must be discarded, or wrapped before being sent to CENTRAL SUPPLY for disinfection or sterilization

VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

PRIVATE ROOM-necessary, door must be kept closed

GOWNS-must be worn by all persons entering the room

MASKS- must be worn by all persons entering the room

HANDS-must be washed on entering and leaving room

GLOVES-must be worn by all persons entering the room

ARTICLES-must be discarded, or wrapped before being sent to CENTRAL SUPPLY for disinfection or sterilization

RESPIRATORY ISOLATION VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM PRIVATE ROOM-necessary, door must be kept closed GOWNS-gowns not necessary MASKS- must be worn by all persons entering the room if susceptible disease HANDS-must be washed on entering and leaving room GLOVES-not necessary ARTICLES-those contaminated with secretions must be disinfected CAUTION-all persons susceptible to the specific disease should be excluded from the area, susceptibles must wear masks

VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

PRIVATE ROOM-necessary, door must be kept closed

GOWNS-gowns not necessary

MASKS- must be worn by all persons entering the room if susceptible disease

HANDS-must be washed on entering and leaving room

GLOVES-not necessary

ARTICLES-those contaminated with secretions must be disinfected

CAUTION-all persons susceptible to the specific disease should be excluded from the area, susceptibles must wear masks

WOUND AND SKIN PRECAUTIONS VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM PRIVATE ROOM-desirable GOWNS-must be worn by all persons having direct contact with the patient MASKS- during dressing changes HANDS-must be washed on entering and leaving room GLOVES-must be worn by all persons having direct contact with infected area ARTICLES-instruments, dressing, linens

VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

PRIVATE ROOM-desirable

GOWNS-must be worn by all persons having direct contact with the patient

MASKS- during dressing changes

HANDS-must be washed on entering and leaving room

GLOVES-must be worn by all persons having direct contact with infected area

ARTICLES-instruments, dressing, linens

ENTERIC PRECAUTIONS VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM PRIVATE ROOM-necessary FOR CHILDREN ONLY GOWNS- must be worn by all persons having direct contact with the patient MASKS- not necessary HANDS-must be washed on entering and leaving room GLOVES-must be worn by all persons having direct contact with patient or articles contaminated with fecal material ARTICLES-special precautions necessary for articles contaminated with urine and feces, must be disinfected or discarded

VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

PRIVATE ROOM-necessary FOR CHILDREN ONLY

GOWNS- must be worn by all persons having direct contact with the patient

MASKS- not necessary

HANDS-must be washed on entering and leaving room

GLOVES-must be worn by all persons having direct contact with patient or articles contaminated with fecal material

ARTICLES-special precautions necessary for articles contaminated with urine and feces, must be disinfected or discarded

PROTECTIVE ISOLATION VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM PRIVATE ROOM-necessary, door must be kept closed GOWNS- must be worn by all persons entering room MASKS- - must be worn by all persons entering room HANDS-must be washed on entering and leaving room GLOVES-must be worn by all persons having direct contact with patient

VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

PRIVATE ROOM-necessary, door must be kept closed

GOWNS- must be worn by all persons entering room

MASKS- - must be worn by all persons entering room

HANDS-must be washed on entering and leaving room

GLOVES-must be worn by all persons having direct contact with patient

DIAGNOSTIC TOOLS COLLECTION OF SPECIMEN PRINCIPLES TYPES OF SPECIMEN COLLECTION BLOOD URINE STOOL SPUTUM WOUNDS THROAT

COLLECTION OF SPECIMEN

PRINCIPLES

TYPES OF SPECIMEN COLLECTION

BLOOD

URINE

STOOL

SPUTUM

WOUNDS

THROAT

LABORATORY TESTS MICROSCOPY CULTURE ANTIBIOTIC SUSCEPTIBILITY TESTING WHITE BLOOD CELL COUNT IMMUNOLOGIC TEST

MICROSCOPY

CULTURE

ANTIBIOTIC SUSCEPTIBILITY TESTING

WHITE BLOOD CELL COUNT

IMMUNOLOGIC TEST

DISORDERS CNS DISEASES GIT DISEASES RESPIRATORY DISEASE BLOOD BORNE DISEASES ERUPTIVE FEVER DISEASES CONTACT DISEASE SEXUALLY TRANSMITTED DISEASES TORCHS HIV AND AIDS HEPATITIS

CNS DISEASES

GIT DISEASES

RESPIRATORY DISEASE

BLOOD BORNE DISEASES

ERUPTIVE FEVER DISEASES

CONTACT DISEASE

SEXUALLY TRANSMITTED DISEASES

TORCHS

HIV AND AIDS

HEPATITIS

CNS

Tetanus Clostridium tetani MOT = wound setting IP = 3 -21 days IMMUNITY Active = TT Passive = TAT and TIG Natural = active none, passive (+)

Clostridium tetani

MOT = wound setting

IP = 3 -21 days

IMMUNITY

Active = TT

Passive = TAT and TIG

Natural = active none, passive (+)

Tetanus Wound Infection FATAL INFECTION OF THE CNS TOXIN-NEUROTOXIN

Wound Infection

FATAL INFECTION OF THE CNS

TOXIN-NEUROTOXIN

PATHOPHYSIOLOGY: SETTING OF WOUND ---- ENTRANCE OF C.T. ---- RELEASES TETANUS TOXIN ---- TETANOSPASMIN (CNS), TETANOLYSIN (BLOOD) ---- ABSORBED BY MOTOR NERVE ENDINGS ---- SYNAPSE (CONNECTION BETWEEN NEURONS) ---- MYONEURAL JUNCTION ---- ACETYLCHOLINE DISTURBANCE IN THE TRANSMISSION OF NERVE IMPULSE

SETTING OF WOUND ---- ENTRANCE OF C.T. ---- RELEASES TETANUS TOXIN ---- TETANOSPASMIN (CNS), TETANOLYSIN (BLOOD) ---- ABSORBED BY MOTOR NERVE ENDINGS ---- SYNAPSE (CONNECTION BETWEEN NEURONS) ---- MYONEURAL JUNCTION ---- ACETYLCHOLINE DISTURBANCE IN THE TRANSMISSION OF NERVE IMPULSE

Trismus – lock jaw Risus sardonicus - maskface Risorius - grinsmile Dx wound and blood extraction (non specific)

Trismus – lock jaw

Risus sardonicus - maskface

Risorius - grinsmile

Dx wound and blood extraction (non specific)

Immunization DPT (0.5 ml IM) 1 – 1 ½ months old 2 - after 4 weeks 3 – after 4 weeks 1 st booster – 18 mos 2 nd booster – 4-6 yo subsequent booster – every 10 yrs thereafter TT (0.5 ml IM) TT1 - 6 months within preg TT2 - one month after TT1 TT3 to TT5 - every succeeding preg or every year TAT (horse) and TIG (human)

DPT (0.5 ml IM) 1 – 1 ½ months old 2 - after 4 weeks 3 – after 4 weeks

1 st booster – 18 mos

2 nd booster – 4-6 yo

subsequent booster – every 10 yrs thereafter

TT (0.5 ml IM) TT1 - 6 months within preg TT2 - one month after TT1 TT3 to TT5 - every succeeding preg or every year

TAT (horse) and TIG (human)

3 types of patients w/ skin wounds post exposure prophylaxis (+) immunization as a child w/ boosters but last shot > 10 yrs – give TT 2. (-) immunization - TT + TIG/TAT 3. (+) tetanus – TIG/TAT + TT + Abx + wound cleansing + supportive therapy

(+) immunization as a child w/ boosters but last shot > 10 yrs – give TT

2. (-) immunization - TT + TIG/TAT

3. (+) tetanus – TIG/TAT + TT + Abx + wound cleansing + supportive therapy

Management 1. Anticonvulsant, muscle relaxants, antibiotics, wound cleansing and debridement, hyperbaric chamber 2. Active-DPT and tetanus toxoid 3. Passive-TIG and TAT, placental immunity

1. Anticonvulsant, muscle relaxants,

antibiotics, wound cleansing and debridement, hyperbaric chamber

2. Active-DPT and tetanus toxoid

3. Passive-TIG and TAT, placental immunity

Rabies/Lyssa (Zoonotic) Rhabdovirus/filterable virus MOT = Bite from warm blooded animals Canine (human) and sylvatic (animals) IP = 10 days to several years IMMUNITY Active = rabies vaccine Passive = HRIG, ERIG Natural = active none, passive none

Rhabdovirus/filterable virus

MOT = Bite from warm blooded animals

Canine (human) and sylvatic (animals)

IP = 10 days to several years

IMMUNITY

Active = rabies vaccine

Passive = HRIG, ERIG

Natural = active none, passive none

Rabies/Lyssa (Zoonotic) Hydrophobia (fear of choking) Aerophobia (laryngospasm) Bite from warm blooded animals Encephalitis/meningitis/respiratory paralysis

Hydrophobia (fear of choking)

Aerophobia (laryngospasm)

Bite from warm blooded animals

Encephalitis/meningitis/respiratory paralysis

Category of bites I – intact skin (lick) II – mucosal, non bleeding wounds, abrasions III – bleeding bites and above neck, stray dogs, laceration, multiple bites

I – intact skin (lick)

II – mucosal, non bleeding wounds, abrasions

III – bleeding bites and above neck, stray dogs, laceration, multiple bites

Rabies/Lyssa (Zoonotic) Observe dog for maniachal s/sx Active-rabies vaccine Passive-rabies immunoglobulin Dx History taking Quarantine the dog Staining of brain tissue (dog) (+) Negri bodies

Observe dog for maniachal s/sx

Active-rabies vaccine

Passive-rabies immunoglobulin

Dx

History taking

Quarantine the dog

Staining of brain tissue (dog) (+) Negri bodies

AFTER THE BITE WASH WITH SOAP AND WATER GIVE ANTIBIOTICS AND ANTITETANUS OBSERVE DOG FOR 14 DAYS, IF IT DIES CONSULT DOCTOR IF DOG SHOWS SUGGESTIVE OF RABIES, KILL THE DOG IMMEDIATELY AND BRING HEAD FOR LAB EXAM (+) NEGRI BODIES SUBMIT FOR IMMUNIZATION WHILE WAITING FOR RESULTS IF DOG IS NOT AVAILABLE FOR OBSERVATION SUBMIT FOR IMMUNIZATION

WASH WITH SOAP AND WATER

GIVE ANTIBIOTICS AND ANTITETANUS

OBSERVE DOG FOR 14 DAYS, IF IT DIES CONSULT DOCTOR

IF DOG SHOWS SUGGESTIVE OF RABIES, KILL THE DOG IMMEDIATELY AND BRING HEAD FOR LAB EXAM (+) NEGRI BODIES SUBMIT FOR IMMUNIZATION WHILE WAITING FOR RESULTS

IF DOG IS NOT AVAILABLE FOR OBSERVATION SUBMIT FOR IMMUNIZATION

Immunization Rabies vaccine (5 shots) IM (2 ml deltoid) 0, 3, 7, 14, 28 days ID (0.1 ml deltoid) 0, 3, 7 days (0.1 ml deltoid 2 shots) 30, 90 days (0.1 ml deltoid single shot) Rabies immunoglobulin (HRIG and ERIG) IM (0.2 x kg) single shot wound 40% deltoid 60%

Rabies vaccine (5 shots) IM (2 ml deltoid) 0, 3, 7, 14, 28 days ID (0.1 ml deltoid) 0, 3, 7 days (0.1 ml deltoid 2 shots) 30, 90 days (0.1 ml deltoid single shot)

Rabies immunoglobulin (HRIG and ERIG) IM (0.2 x kg) single shot wound 40% deltoid 60%

4 STAGES 1. prodrome - fever, headache, paresthesia, 2. encephalitic – excessive motor activity, hypersensitivity to bright light, loud noise, hypersalivation, dilated pupils 3. brainstem dysfunction – dysphagia, hydrophobia, apnea 4. death/recovery

1. prodrome - fever, headache, paresthesia,

2. encephalitic – excessive motor activity, hypersensitivity to bright light, loud noise, hypersalivation, dilated pupils

3. brainstem dysfunction – dysphagia, hydrophobia, apnea

4. death/recovery

RESPONSIBLE PET OWNERSHIP HAVE PET IMMUNIZED AT 3 MONTHS AND EVERY YEAR AFTER NEVER ALLOW PETS TO ROAM IN THE STREET LEASHED YOUR DOG YOUR PET ACTION IS YOUR RESPONSIBILITY

HAVE PET IMMUNIZED AT 3 MONTHS AND EVERY YEAR AFTER

NEVER ALLOW PETS TO ROAM IN THE STREET

LEASHED YOUR DOG

YOUR PET ACTION IS YOUR RESPONSIBILITY

Poliomyelitis Infantile Paralysis Polio virus, Legio debilitans Legio brunhilde (fatal) Legio lansing Legio leon MOT = Fecal oral route (common) and droplets IP = 7-12 days IMMUNITY Active = OPV Passive = none Natural = active (+), passive none

Polio virus, Legio debilitans

Legio brunhilde (fatal)

Legio lansing

Legio leon

MOT = Fecal oral route (common) and droplets

IP = 7-12 days

IMMUNITY

Active = OPV

Passive = none

Natural = active (+), passive none

Poliomyelitis Infantile Paralysis Assymetrical paralysis Hayne’s sign - head drop Poker’s sign - opisthotonus Landry’s sign - ascending paralysis Pandy’s Test – increased in CSF CHON

Assymetrical paralysis

Hayne’s sign - head drop

Poker’s sign - opisthotonus

Landry’s sign - ascending paralysis

Pandy’s Test – increased in CSF CHON

Poliomyelitis Infantile Paralysis I – abortive or inapparent II – meningitis (non-paralytic) III – paralytic (anterior horn of spinal cord) IV – bulbar (encephalitis)

I – abortive or inapparent

II – meningitis (non-paralytic)

III – paralytic (anterior horn of spinal cord)

IV – bulbar (encephalitis)

Meningitis Menigococcemia Neisseria meningitides (bacteria) MOT = droplets IP = 1-2 days IMMUNITY = xxx

Neisseria meningitides (bacteria)

MOT = droplets

IP = 1-2 days

IMMUNITY = xxx

Meningitis Menigococcemia Immunocompetent are susceptible Petechiae (volar/palm of hands) EARLY Opisthotonus MENIGEAL IRRITATION Brudzinski MENINGEAL IRRITATION Kernigs MENINGEAL IRRITATION Increased ICP BRAIN Seizure BRAIN

Immunocompetent are susceptible

Petechiae (volar/palm of hands) EARLY

Opisthotonus MENIGEAL IRRITATION

Brudzinski MENINGEAL IRRITATION

Kernigs MENINGEAL IRRITATION

Increased ICP BRAIN

Seizure BRAIN

Menigococcemia S/sx: Meningococcemia – spiking fever, chills, arthralgia, petechial rash Fulminant Meningococcemia (Waterhouse Friderichsen) – septic shock; hypotension, tachycardia, enlarging petecchial rash, adrenal insufficiency Meningitis – most common; nuchal rigidity, brudzinski, kernigs, Photophobia, confusion

S/sx:

Meningococcemia – spiking fever, chills, arthralgia, petechial rash

Fulminant Meningococcemia (Waterhouse Friderichsen) – septic shock; hypotension, tachycardia, enlarging petecchial rash, adrenal insufficiency

Meningitis – most common; nuchal rigidity, brudzinski, kernigs, Photophobia, confusion

Menigococcemia Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and blood culture Mgmt: antibiotics (Pen G, ceftriaxone), steroids, anticonvulsants, Rifampin for close contacts of meningococcemia

Dx: CT/ MRI, CSF analysis, CSF gram stain, CSF and blood culture

Mgmt: antibiotics (Pen G, ceftriaxone), steroids, anticonvulsants, Rifampin for close contacts of meningococcemia

Encephalitis Arbo virus (arthropod borne virus) MOT = bite from mosquito (St. Louise) IP = xxx IMMUNITY = xxx

Arbo virus (arthropod borne virus)

MOT = bite from mosquito (St. Louise)

IP = xxx

IMMUNITY = xxx

Encephalitis S/sx: fever, abdominal pain, sore throat, respiratory symptoms, headache, meningeal signs, photophobia, Seizure (lacrosse), SIADH w/ hypoNa (St Louis) Dx: CSF analysis r/o other CNS disease, CT scan, MRI Mgmt: nonspecific; control seizures

S/sx: fever, abdominal pain, sore throat, respiratory symptoms, headache, meningeal signs, photophobia, Seizure (lacrosse), SIADH w/ hypoNa (St Louis)

Dx: CSF analysis

r/o other CNS disease, CT scan, MRI

Mgmt: nonspecific; control seizures

Leprosy Mycobacterium Leprae, Hansen’s Bacillus MOT = (unknown) may be due to prolonged skin-skin contact (common) or droplets IP = years to decades IMMUNITY Active = BCG Passive = none Natural = none

Mycobacterium Leprae, Hansen’s Bacillus

MOT = (unknown)

may be due to prolonged skin-skin contact (common)

or droplets

IP = years to decades

IMMUNITY

Active = BCG

Passive = none

Natural = none

Leprosy EARLY Skin lesion and paresthesia LATE Lagopthalmos Madarosis Gynecomastia Saddle Nose Contractures

EARLY

Skin lesion and paresthesia

LATE

Lagopthalmos

Madarosis

Gynecomastia

Saddle Nose

Contractures

Leprosy

Leprosy Dx: Lepromin Test – ID injection Slit Skin Smear Dapsone-Lamprene-Rifampicin Dapsone-don’t give to anemic Lamprene-dry skin, hyperpigmentation (lasting) Rifampicin-renal and liver toxicity

Dx:

Lepromin Test – ID injection

Slit Skin Smear

Dapsone-Lamprene-Rifampicin

Dapsone-don’t give to anemic

Lamprene-dry skin, hyperpigmentation (lasting)

Rifampicin-renal and liver toxicity

Leprosy MDT-RA 4073 (home meds) Paucibacillary - 6-9 months 1. Dapsone 2. Rifampicin Multibacillary- 12-24 months 1. Dapsone – mainstay; hemolysis, agranulocytosis 2. Clofazimine – reddish skin pimentation, intestinal toxicity 3. Rifampicin – bactericidal; renal and liver toxicity

MDT-RA 4073 (home meds)

Paucibacillary - 6-9 months 1. Dapsone

2. Rifampicin

Multibacillary- 12-24 months

1. Dapsone – mainstay; hemolysis, agranulocytosis

2. Clofazimine – reddish skin pimentation, intestinal toxicity

3. Rifampicin – bactericidal; renal and liver toxicity

Leprosy MDT- two or more drugs RA 4073 (home meds) Paucibacillary.- 6-9 months Multibacillary.- 12-24 months Tuberculoid – high resistant, less severe (+LT) Lepromatous – most severe, low resistant (-LT)

MDT- two or more drugs

RA 4073 (home meds)

Paucibacillary.- 6-9 months

Multibacillary.- 12-24 months

Tuberculoid – high resistant, less severe (+LT)

Lepromatous – most severe, low resistant (-LT)

Leprosy Non - communicable After 1 week of medication Considered cured After completing the course of treatment

Non - communicable

After 1 week of medication

Considered cured

After completing the course of treatment

Red Tide Poisoning Pyromidium Bahamense Exotoxin Dinoflagellates Plankton Algae MOT = Ingestion of contaminated bi-valve shellfish IP = within 30 minutes IMMUNITY = xxx

Pyromidium Bahamense

Exotoxin

Dinoflagellates

Plankton

Algae

MOT = Ingestion of contaminated bi-valve shellfish

IP = within 30 minutes

IMMUNITY = xxx

Red Tide Poisoning Dx gastric siphoning EARLY Circumoral numbness nausea and vomiting LATE Bulbar paralysis and metabolic acidosis Mgmt: emesis/gastric lavage + activated charcoal, supportive

Dx gastric siphoning

EARLY

Circumoral numbness

nausea and vomiting

LATE

Bulbar paralysis and metabolic acidosis

Mgmt: emesis/gastric lavage + activated charcoal, supportive

CLINICAL MANIFESTATIONS: NUMBNESS OF THE FACE ESPECIALLY AROUND THE MOUTH VOMITING, DIZZINESS, HEADACHE TINGLING SENSATION, WEAKNESS RAPID PULSE, DIFFICULTY OF SPEECH (ATAXIA), DYSPHAGIA, RESPI PARALYSIS, DEATH.

NUMBNESS OF THE FACE ESPECIALLY AROUND THE MOUTH

VOMITING, DIZZINESS, HEADACHE

TINGLING SENSATION, WEAKNESS

RAPID PULSE, DIFFICULTY OF SPEECH (ATAXIA), DYSPHAGIA, RESPI PARALYSIS, DEATH.

MANAGEMENT AND CONTROL MEASURES: NO DEFINITE MEDICATIONS INDUCE VOMITING (EARLY INTERVENTION) DRINKING PURE COCONUT MILK (WEAKENS TOXIC EFFECT) DON’T GIVE DURING LATE STAGE IT MAY WORSEN THE CONDITION. NaHCO3 SOLUTION (25 GRAMS IN ½ GLASS OF WATER) RESPIRATORY SUPPORT AVOID USING VINEGAR IN COOKING SHELLFISH AFFECTED BY RED TIDE (15X virulence) TOXIN OF RED TIDE IS NOT TOTALLY DESTROYED IN COOKING. AVOID TAHONG, TALABA, HALAAN, KABIYA, ABANIKO. WHEN RED TIDE IS ON THE RISE.

NO DEFINITE MEDICATIONS

INDUCE VOMITING (EARLY INTERVENTION)

DRINKING PURE COCONUT MILK (WEAKENS TOXIC EFFECT) DON’T GIVE DURING LATE STAGE IT MAY WORSEN THE CONDITION.

NaHCO3 SOLUTION (25 GRAMS IN ½ GLASS OF WATER)

RESPIRATORY SUPPORT

AVOID USING VINEGAR IN COOKING SHELLFISH AFFECTED BY RED TIDE (15X virulence)

TOXIN OF RED TIDE IS NOT TOTALLY DESTROYED IN COOKING.

AVOID TAHONG, TALABA, HALAAN, KABIYA, ABANIKO. WHEN RED TIDE IS ON THE RISE.

Botulism Clostridium Botulinum (bacteria) Endotoxin MOT canned foods Ingestion of contaminated foods) IP = 12-36H canned food, 4-14 days wound IMMUNITY Active = xxx Paiive = botulinum antitoxin Natural = xxx

Clostridium Botulinum (bacteria)

Endotoxin

MOT

canned foods

Ingestion of contaminated foods)

IP = 12-36H canned food, 4-14 days wound

IMMUNITY

Active = xxx

Paiive = botulinum antitoxin

Natural = xxx

Botulism Dx = gastric siphoning EARLY VISUAL DIFFICULTY, DYSPHAGIA, DRY MOUTH LATE VOMITING, CONSTIPATION/DIARRHEA DESCENDING SYMMETRICAL FLACCID BULBAR PARALYSIS

Dx = gastric siphoning

EARLY

VISUAL DIFFICULTY, DYSPHAGIA, DRY MOUTH

LATE

VOMITING, CONSTIPATION/DIARRHEA

DESCENDING SYMMETRICAL FLACCID

BULBAR PARALYSIS

GIT

Amoebiasis Entamoeba Hystolitica –protozoan (parasite) MOT = 5 F’s, fecal oral route IP = 2-4 weeks IMMUNITY = xxx

Entamoeba Hystolitica –protozoan (parasite)

MOT = 5 F’s, fecal oral route

IP = 2-4 weeks

IMMUNITY = xxx

Amoebiasis Dx microscopic stool exam or rectal secretions (tetra nucleated cyst and trophozoites) Diarrhea and constipation (non dysenteric) Blood streaked, diarrhea and watery mucoid, abd’l cramps (dysenteric) Extra amoebiasis-penile, vagina, spleen, liver, anal, lungs and meninges Metronidazole (Flagyl)

Dx microscopic stool exam or rectal secretions

(tetra nucleated cyst and trophozoites)

Diarrhea and constipation (non dysenteric)

Blood streaked, diarrhea and watery mucoid, abd’l cramps (dysenteric)

Extra amoebiasis-penile, vagina, spleen, liver, anal, lungs and meninges

Metronidazole (Flagyl)

Bacillary Dysentery Shigellosis Shiga bacillus (bacteria) s. dysenterae (fatal) s. flexneri (common in the Philippines) s. boydii s. sonnei MOT = same with amoebiasis IP = 1-7 days IMMUNITY = xxx

Shiga bacillus (bacteria)

s. dysenterae (fatal)

s. flexneri (common in the Philippines)

s. boydii

s. sonnei

MOT = same with amoebiasis

IP = 1-7 days

IMMUNITY = xxx

Bacillary Dysentery Shigellosis Dx stool exam Watery mucoid, bloody with pus feces Tenesmus = rectal prolapse Chloramphenicol, Tetracycline

Dx stool exam

Watery mucoid, bloody with pus feces

Tenesmus = rectal prolapse

Chloramphenicol, Tetracycline

Cholera, El Tor Vibrio Coma (inaba, ogawa, hikojima) Vibrio Cholerae Vibrio El Tor (bacteria) MOT = same with amoebiasis IP = few hours to 5 days IMMUNITY Active = cholera vaccine Passive = none Natural = none

Vibrio Coma (inaba, ogawa, hikojima)

Vibrio Cholerae

Vibrio El Tor (bacteria)

MOT = same with amoebiasis

IP = few hours to 5 days

IMMUNITY

Active = cholera vaccine

Passive = none

Natural = none

Cholera, El Tor Dx stool exam Rice watery stool with fishy odor Washerwoman’s appearance Severe dehydration Chloramphenicol

Dx stool exam

Rice watery stool with fishy odor

Washerwoman’s appearance

Severe dehydration

Chloramphenicol

Typhoid Fever Salmonella typhosa (bacteria) MOT = same with amoebiasis (5 F’s) IP = 1-3 weeks IMMUNITY Active = vaccine Passive = xxx Natural = lifetime immunity

Salmonella typhosa (bacteria)

MOT = same with amoebiasis (5 F’s)

IP = 1-3 weeks

IMMUNITY

Active = vaccine

Passive = xxx

Natural = lifetime immunity

Pathophysiology Oral ingestion Bloodstream Reticuloendothelial system (lymph node, spleen, liver) Bloodstream Gallbladder Peyer’s patches of SI necrosis and ulceration

Oral ingestion

Bloodstream

Reticuloendothelial system (lymph node, spleen, liver)

Bloodstream

Gallbladder

Peyer’s patches of SI

necrosis and ulceration

Typhoid Fever 1st week step ladder (BLOOD) 2nd week rose spot and fastidial typhoid pyschosis (URINE & STOOL) 3rd week (complications) intestinal bleeding, perforation, peritonitis, encephalitis, 4th week (lysis) decreasing S?SX 5th week (convalescent)

1st week step ladder (BLOOD)

2nd week rose spot and fastidial

typhoid pyschosis (URINE & STOOL)

3rd week (complications) intestinal bleeding,

perforation, peritonitis, encephalitis,

4th week (lysis) decreasing S?SX

5th week (convalescent)

Typhoid Fever Blood (typhi dot) 1st week after Stool and urine 2nd week after Chloramphenicol

Blood (typhi dot) 1st week after

Stool and urine 2nd week after

Chloramphenicol

Typhoid Fever Rose spot (abdominal rashes) Step ladder fever to fastidial (peak of fever) typhoid psychosis Peyer’s patches of small intestine May stay in the gallbladder (hiding area)

Rose spot (abdominal rashes)

Step ladder fever to fastidial (peak of fever) typhoid psychosis

Peyer’s patches of small intestine

May stay in the gallbladder (hiding area)

Hookworm (Roundworm) Necator Americanus, Ancylostoma Duodenale Skin entry (sole of the feet to blood steam then into the lungs then ascends to the pharynx where it is swallowed and attached into the intestinal mucosa and subsists on the blood of the host) Anemia, abd’l cramps, abd’l distention, perforation to peritinotis to septicemia

Necator Americanus, Ancylostoma Duodenale

Skin entry (sole of the feet to blood steam then into the lungs then ascends to the pharynx where it is swallowed and attached into the intestinal mucosa and subsists on the blood of the host)

Anemia, abd’l cramps, abd’l distention, perforation to peritinotis to septicemia

Hookworm (Roundworm) IP few weeks to months Dx microscopic exam (stool exam) Pyrantel Pamoate and Mebendazole Note: don’t give drug without (+) stool exam members of the family must be examined and treated also.

IP few weeks to months

Dx microscopic exam (stool exam)

Pyrantel Pamoate and Mebendazole

Note: don’t give drug without (+) stool exam members of the family must be examined and treated also.

Hookworm (Roundworm) Nursing Consideration FOLLOW-UP EXAMINATION OF THE STOOL 2 WEEKS AFTER THERAPY NUTRITION COUNSELING AND IRON SUPPLEMENTS FAMILY MEMBERS AND CLOSE CONTACTS SHOULD BE EXAMINED AND TREATED FOR PARASITES EDUCATE PUBLIC ABOUT DANGERS OF CONTAMINATED SOIL IMPORTANCE OF WEARING SHOES DEWORMING

Nursing Consideration

FOLLOW-UP EXAMINATION OF THE STOOL 2 WEEKS AFTER THERAPY

NUTRITION COUNSELING AND IRON SUPPLEMENTS

FAMILY MEMBERS AND CLOSE CONTACTS SHOULD BE EXAMINED AND TREATED FOR PARASITES

EDUCATE PUBLIC ABOUT DANGERS OF CONTAMINATED SOIL

IMPORTANCE OF WEARING SHOES

DEWORMING

Ascariasis (Roundworm) Ascaris Lumbricoides MOT ingestion of food contaminated by ascaris lumbricoides GIT to LUNGS and other ORGANS

Ascaris Lumbricoides

MOT ingestion of food contaminated by ascaris lumbricoides GIT to LUNGS and other ORGANS

MOT: ingestion of food contaminated by ascaris eggs larvae in large intestine penetrate wall towards lung where larvae grow and coughed up intestine larvae mature and passed out in feces

MOT: ingestion of food contaminated by ascaris eggs larvae in large intestine penetrate wall towards lung where larvae grow and coughed up intestine larvae mature and passed out in feces

Ascariasis (Roundworm) Coughing, wheezing and hemoptysis IP same with hookworm Drug: same with hookworm Dx same with hookworm

Coughing, wheezing and hemoptysis

IP same with hookworm

Drug: same with hookworm

Dx same with hookworm

Tapeworm Taenia Saginata (cattle) Taenia Solium (pigs) MOT fecal oral route (ingestion of food contaminated by the agent) Dx: Stool Exam S/Sx diarrhea, abdominal discomfort, anemia

Taenia Saginata (cattle)

Taenia Solium (pigs)

MOT fecal oral route (ingestion of food contaminated by the agent)

Dx: Stool Exam

S/Sx diarrhea, abdominal discomfort, anemia

Pinworm Enterobiasis (nocturnal animation/alive) Vermicularis Enterobius MOT fecal oral route S/sx Itchiness at the anal area (eggs of the agent causes the itchiness) Dx tape test at night time (agents release their eggs during night time)

Enterobiasis (nocturnal animation/alive)

Vermicularis Enterobius

MOT fecal oral route

S/sx Itchiness at the anal area (eggs of the agent causes the itchiness)

Dx tape test at night time (agents release their eggs during night time)

Thread worm – storgyloidiasis Whip worm – trichoniasis voracious eating abdominal pain weight loss Flat worm - paragonimiasis

Thread worm – storgyloidiasis

Whip worm – trichoniasis voracious eating abdominal pain weight loss

Flat worm - paragonimiasis

QUIZ 1. hookworm a. taenia s. 2. ascariasis b. vermicularis enterobius 3. pinworm c. ascaris lumbricoides 4. tapeworm d. necator americanus

1. hookworm a. taenia s.

2. ascariasis b. vermicularis enterobius

3. pinworm c. ascaris lumbricoides

4. tapeworm d. necator americanus

5. Common s/sx of worm infestation? 6. single most important nursing consideration prior to DEWORMING? 7. MOT of hookworm infestation? 8. distinct s/sx of PINWORM infestation? 9. WHIPWORM infestation s/sx? 10. LUNG FLUKE infestation?

5. Common s/sx of worm infestation?

6. single most important nursing consideration prior to DEWORMING?

7. MOT of hookworm infestation?

8. distinct s/sx of PINWORM infestation?

9. WHIPWORM infestation s/sx?

10. LUNG FLUKE infestation?

Schistosomias, Snail Fever, Takayama Blood fluke Schistosoma japonicum S. hematobium S. mansoni MOT skin entry (cercaria) travel in to the blood stream where they will infiltrate the liver, from liver to intestines

Blood fluke

Schistosoma japonicum

S. hematobium

S. mansoni

MOT skin entry (cercaria) travel in to the blood stream where they will infiltrate the liver, from liver to intestines

Schistosomias, Snail Fever, Takayama Cycle: Egg-larvae (miracidium)-intermediary host (oncomelania quadrasi-tiny snail)-cercaria Itchiness at the site RUQ pain (hepatomegaly) Intestine infiltration-abd’l cramps, diarrhea with blood Praziquantel Dx COPT (stool exam)

Cycle: Egg-larvae (miracidium)-intermediary host (oncomelania quadrasi-tiny snail)-cercaria

Itchiness at the site

RUQ pain (hepatomegaly)

Intestine infiltration-abd’l cramps, diarrhea with blood

Praziquantel

Dx COPT (stool exam)

Schistosomiasis KEY POINTS! Egg– miracidium– snail– cercaria- human Itchiness – liver – intestines Praziquantel COPT PREVENTION Samar and Leyte

Egg– miracidium– snail– cercaria- human

Itchiness – liver – intestines

Praziquantel

COPT

PREVENTION

Samar and Leyte

Mumps Mumps virus/filtrable virus MOT = droplets and airborne HIGHLY CONTAGIOUS IP 12-16 days IMMUNITY Active = MMR Passive = mumps Ig Natural = active =lifetime

Mumps virus/filtrable virus

MOT = droplets and airborne

HIGHLY CONTAGIOUS

IP 12-16 days

IMMUNITY

Active = MMR

Passive = mumps Ig

Natural = active =lifetime

Mumps Unilateral or bilateral parotitis Ice collar Stimulating foods cause severe pain Bilateral orchitis and oophoritis Active spermatogenesis Sterility Steroids Supporter

Unilateral or bilateral parotitis

Ice collar

Stimulating foods cause severe pain

Bilateral orchitis and oophoritis

Active spermatogenesis

Sterility

Steroids

Supporter

Respiratory System

Diphtheria Corynebacterium diphtheriae Klebsloeffler’s bacillus (bacteria) MOT = droplets and airborne HIGHLY CONTAGIOUS IP 2-5 days IMMUNITY Active = DPT Passive = DAT Natural = xxx

Corynebacterium diphtheriae

Klebsloeffler’s bacillus (bacteria)

MOT = droplets and airborne

HIGHLY CONTAGIOUS

IP 2-5 days

IMMUNITY

Active = DPT

Passive = DAT

Natural = xxx

Diphtheria Dx = throat swab, MOLONEY, SCHICK Pseudomembrane, Bullneck Penicillin or erythromycin Resp Acidosis with hypoxemia Cx: myocarditis, septicemia

Dx = throat swab, MOLONEY, SCHICK

Pseudomembrane, Bullneck

Penicillin or erythromycin

Resp Acidosis with hypoxemia

Cx: myocarditis, septicemia

Diphtheria Nursing Considerations: OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS PSEUDOMEMBRANOUS MAY LEAD TO RESP. OBSTRUCTION ISOLATION UNTIL 2 NEGATIVE CULTURE AT 24 HOUR INTERVAL F&E RESUSCITATION PARENTS OR SIBLINGS WHO HAVE NEVER IMMUNIZED SHOULD RECEIVE A DOSE OF DIPH. ANTI-TOXIN ATTENTION TO NASOPHARYNGEAL DISCHARGE ANTIBIOTICS-PENICILLIN, ERYTHROMYCIN IF ALLERGIC TO PENICILLIN

Nursing Considerations:

OBSERVE CNS, CARDIAC AND KIDNEY COMPLICATIONS

PSEUDOMEMBRANOUS MAY LEAD TO RESP. OBSTRUCTION

ISOLATION UNTIL 2 NEGATIVE CULTURE AT 24 HOUR INTERVAL

F&E RESUSCITATION

PARENTS OR SIBLINGS WHO HAVE NEVER IMMUNIZED SHOULD RECEIVE A DOSE OF DIPH. ANTI-TOXIN

ATTENTION TO NASOPHARYNGEAL DISCHARGE

ANTIBIOTICS-PENICILLIN, ERYTHROMYCIN IF ALLERGIC TO PENICILLIN

S/sx: sore throat, fever, “Bull-neck” (Pseudomembrane- gray exudate, foul breath, massive swelling of tonsils and uvula, thick speech, cervical lymphadenopathy, swelling of submandibular and anterior neck), obstruction of respiratory tract Dx: Schick test - susceptibility to diphtheria toxin Moloney - sensitivity to diphtheria toxoid Throat swab (K tellurite and Loeffler’s coagulated blood serum) Mgmt: Diphtheria antitoxin (Skin test), Penicillin,erythromycin, rifampicin, clindamycin

S/sx: sore throat, fever, “Bull-neck” (Pseudomembrane- gray exudate, foul breath, massive swelling of tonsils and uvula, thick speech, cervical lymphadenopathy, swelling of submandibular and anterior neck), obstruction of respiratory tract

Dx: Schick test - susceptibility to diphtheria toxin

Moloney - sensitivity to diphtheria toxoid

Throat swab (K tellurite and Loeffler’s coagulated blood serum)

Mgmt: Diphtheria antitoxin (Skin test), Penicillin,erythromycin, rifampicin, clindamycin

Diphtheria KEY POINTS! Highly contagious Pseudomembrane and bullneck Immunization best intervention PREVENTION Obstruction and myocarditis Isolation technique

Highly contagious

Pseudomembrane and bullneck

Immunization best intervention PREVENTION

Obstruction and myocarditis

Isolation technique

Whooping Cough, Pertussis Bordetella pertussis (bacteria) B. parapertussis B. bronchiseptica Hemophilus bacillus MOT = droplets and airborne HIGHLY CONTAGIOUS IP 3-21 days IMMUNITY Active = DPT Passive = xxx Natural = xxx

Bordetella pertussis (bacteria)

B. parapertussis

B. bronchiseptica

Hemophilus bacillus

MOT = droplets and airborne

HIGHLY CONTAGIOUS

IP 3-21 days

IMMUNITY

Active = DPT

Passive = xxx

Natural = xxx

Whooping Cough, Pertussis Manifestations: CATARRHAL (HIGHLY CONTAGIOUS) 1-2 WEEKS, CORYZA, SNEEZING, DRY COUGH, FEVER, ANOREXIA PAROXYSMAL 4-6 WEEKS, SEVERE VIOLENT COUGHING ATTACKS IN CLUSTERS, THAT ENDS IN WHOOP (NOISY SPASM OF INSPIRATION) RESULTING TO CYANOSIS, VOMITING, EXHAUSTION.

Manifestations:

CATARRHAL (HIGHLY CONTAGIOUS)

1-2 WEEKS, CORYZA, SNEEZING, DRY COUGH, FEVER, ANOREXIA

PAROXYSMAL

4-6 WEEKS, SEVERE VIOLENT COUGHING ATTACKS IN CLUSTERS, THAT ENDS IN WHOOP (NOISY SPASM OF INSPIRATION) RESULTING TO CYANOSIS, VOMITING, EXHAUSTION.

Whooping Cough, Pertussis Ferrous iodide to liquefy thicky secretions Erythromycin or Ampicillin Bordet gengao (agar for culture) Catarrhal stage (highly contagious) Clusters of cough that ends with a whoop Prostration

Ferrous iodide to liquefy thicky secretions

Erythromycin or Ampicillin

Bordet gengao (agar for culture)

Catarrhal stage (highly contagious)

Clusters of cough that ends with a whoop

Prostration

PERTUSSIS key points! Highly contagious Thick secretions Cluster of cough Extreme exhaustion HYPOXIA PREVENTION is still the BEST intervention IMMUNIZATION

Highly contagious

Thick secretions

Cluster of cough

Extreme exhaustion

HYPOXIA

PREVENTION is still the BEST intervention

IMMUNIZATION

PTB, Koch’s Pulmonary Mycobacterium tubercle Tubercle bacillus (bacteria) MOT: Airborne/droplets INCUBATION-DEPENDS ON HOST RESISTANCE RISK FACTORS: DECREASED BODY RESISTANCE MALNUTRITION, POVERTY, OVERCROWDING, STEROID THERAPY, CHEMOTHERAPY

Mycobacterium tubercle

Tubercle bacillus (bacteria)

MOT: Airborne/droplets

INCUBATION-DEPENDS ON HOST RESISTANCE

RISK FACTORS: DECREASED BODY RESISTANCE MALNUTRITION, POVERTY, OVERCROWDING, STEROID THERAPY, CHEMOTHERAPY

PTB Pathogenesis: Transmission into the lungs Immune response macrophage (bacilli) creating a lesion Tubercle formation scar or spot Dissemination EPTB

Pathogenesis:

Transmission into the lungs

Immune response macrophage (bacilli) creating a lesion

Tubercle formation scar or spot

Dissemination

EPTB

PTB, Koch’s Pulmonary Manifestation: EARLY WEIGHT LOSS, LISTLESSNESS, VAGUE CHEST PAIN, PLEURISY, ANOREXIA, FEVER, NIGHT SWEATS LATE PULMONARY HEMORRHAGE, EXPECTORATION OF PURULENT SPUTUM, DYSPNEA, HEMOPTYSIS (CAVITARY SPREAD)

Manifestation:

EARLY WEIGHT LOSS, LISTLESSNESS, VAGUE CHEST PAIN, PLEURISY, ANOREXIA, FEVER, NIGHT SWEATS

LATE PULMONARY HEMORRHAGE, EXPECTORATION OF PURULENT SPUTUM, DYSPNEA, HEMOPTYSIS (CAVITARY SPREAD)

PTB Dx: PPD-exposure 0-4 mm (negative) 5 mm variable > 10 mm (positive) Chest xray-cavitary lesion Sputum-confirmatory

Dx:

PPD-exposure

0-4 mm (negative)

5 mm variable

> 10 mm (positive)

Chest xray-cavitary lesion

Sputum-confirmatory

PTB MDT r-orange urine i-neuritis and hepatitis p-hyperuricemia e-impairment of vision s-8th cranial nerve damage

MDT

r-orange urine

i-neuritis and hepatitis

p-hyperuricemia

e-impairment of vision

s-8th cranial nerve damage

PTB CGFNS and NCLEX Usual Dose RIE – 9 months to 12 months 2-4 weeks non infectious Drug Resistant Tuberculosis RIE+ (2 nd line drug) STREPTOMYCIN PYRAZINAMIDE CAPREOMYCIN PARA-AMINOSALICYLIC ACID CYCLOSERINE

CGFNS and NCLEX

Usual Dose RIE – 9 months to 12 months 2-4 weeks non infectious

Drug Resistant Tuberculosis RIE+ (2 nd line drug) STREPTOMYCIN PYRAZINAMIDE CAPREOMYCIN PARA-AMINOSALICYLIC ACID CYCLOSERINE

PTB 2 weeks after medications – non communicable 3 successive negative sputum-non communicable rifampicin-prophylactic

2 weeks after medications – non communicable

3 successive negative sputum-non communicable

rifampicin-prophylactic

PTB category I (new PTB (+) sputum) category II (relapsed) category III (PTB case (-) sputum) short course – 6-9 months long course – 9-12 months DOTS- direct observe treatment short course Case finding Home meds (members of the family) Referrals Follow-up

category I (new PTB (+) sputum)

category II (relapsed)

category III (PTB case (-) sputum)

short course – 6-9 months

long course – 9-12 months

DOTS- direct observe treatment short course

Case finding

Home meds (members of the family)

Referrals

Follow-up

TREATMENT: CATEGORY 1 NEW PTB, (+) SPUTUM GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS CATEGORY 2 PREVIOUSLY TREATED WITH RELAPSES GIVE RIPES 1ST 2 MONTHS, REPS 1 MONTH, MAINTENANCE RIE 5 MONTHS CATEGORY 3 NEW PTB (-) SPUTUM FOR 3X GIVE RIP 2 MONTHS, MAINTENACE RI 2 MONTHS

TREATMENT:

CATEGORY 1 NEW PTB, (+) SPUTUM GIVE RIPE 2 MONTHS, MAINTENANCE OF RI 4 MONTHS

CATEGORY 2 PREVIOUSLY TREATED WITH RELAPSES GIVE RIPES 1ST 2 MONTHS, REPS 1 MONTH, MAINTENANCE RIE 5 MONTHS

CATEGORY 3 NEW PTB (-) SPUTUM FOR 3X GIVE RIP 2 MONTHS, MAINTENACE RI 2 MONTHS

Pneumonia Typical Community Acquired Streptococcus pneumoniae Hospital Acquired Staphylococcus aureus, Pseudomonas aeruginosa Elderly Hemophilus influenzae type B

Typical

Community Acquired

Streptococcus pneumoniae

Hospital Acquired

Staphylococcus aureus, Pseudomonas aeruginosa

Elderly

Hemophilus influenzae type B

Pneumonia Atypical Pneumocystis carinii (fungal) Aspergillosis (fungal) Azole, SARS

Atypical

Pneumocystis carinii (fungal)

Aspergillosis (fungal) Azole,

SARS

Pneumonia s/sx chest pain, fever with chills, Dx: C&S and XRAY Productive cough pneumococcal – purulent, rusty sputum staphylococcal – yellow, blood streaked klebsiella species – red, gelatinous sputum mycoplasmal – non productive, mucoid sputum ABG Pulse Oximetry

s/sx chest pain, fever with chills,

Dx:

C&S and XRAY

Productive cough pneumococcal – purulent, rusty sputum staphylococcal – yellow, blood streaked klebsiella species – red, gelatinous sputum mycoplasmal – non productive, mucoid sputum

ABG

Pulse Oximetry

Pneumonia CARI-health teachings Watchout for complications Respiratory distress In 24 hours death will occur RESPIRATORY SUPPORT!

CARI-health teachings

Watchout for complications

Respiratory distress

In 24 hours death will occur RESPIRATORY SUPPORT!

Pneumonia Cx: pleural effusion Empyema consolidation Diminished Lung Sound: egophony CHANGE IN VOICE bronchophony CLARITY OF VOICE whispered pectoriloquy AUSCULTATE

Cx:

pleural effusion

Empyema

consolidation Diminished Lung Sound: egophony CHANGE IN VOICE bronchophony CLARITY OF VOICE whispered pectoriloquy AUSCULTATE

Severe Acute Respiratory Syndrome Coronavirus Severe acute respiratory syndrome IP: 2-7 days MOT: respiratory droplet/person to person contact Risk Factors: History of recent travel to China Hong Kong Taiwan Close contact w/ ill persons with a hx of recent travel to such areas Health workers

Coronavirus

Severe acute respiratory syndrome

IP: 2-7 days

MOT: respiratory droplet/person to person contact

Risk Factors:

History of recent travel to

China

Hong Kong

Taiwan

Close contact

w/ ill persons

with a hx of recent travel to such areas

Health workers

SARS Dx: sputum C&S CLINICAL MANIFESTATIONS: FEVER-38 C AND ABOVE CONTINUOUS FOR 7-10 DAYS CHILLS HEADACHE, GENERAL FEELING OF DISCOMFORT, BODY ACHES, DRY PRODUCTIVE COUGH WITH HYPOXEMIA (RESP. ACIDOSIS) DYSPNEA RELATED TO LOSS OF AERATING SURFACE

Dx: sputum C&S CLINICAL

MANIFESTATIONS:

FEVER-38 C AND ABOVE CONTINUOUS FOR 7-10 DAYS

CHILLS HEADACHE, GENERAL FEELING OF DISCOMFORT, BODY ACHES, DRY PRODUCTIVE COUGH WITH HYPOXEMIA (RESP. ACIDOSIS)

DYSPNEA RELATED TO LOSS OF AERATING SURFACE

SARS NURSING CONSIDERATIONS: NO SPECIFIC TREATMENT ANTIVIRAL AGENT-OSELTAMIVIR OR RIBAVIRIN CLOSE SUPERVISION/OBSERVATION PROPHYLACTIC ANTIBIOTIC AVOID INFECTED AREAS IDENTIFIED BY WHO (HONGKONG, GUANDONG, SHANXI, CHINA, HANOI, VIETNAM, TORONTO, CANADA, SINGAPORE)

NURSING CONSIDERATIONS:

NO SPECIFIC TREATMENT

ANTIVIRAL AGENT-OSELTAMIVIR OR RIBAVIRIN

CLOSE SUPERVISION/OBSERVATION

PROPHYLACTIC ANTIBIOTIC

AVOID INFECTED AREAS IDENTIFIED BY WHO (HONGKONG, GUANDONG, SHANXI, CHINA, HANOI, VIETNAM, TORONTO, CANADA, SINGAPORE)

SARS NURSING CONSIDERATIONS: SEEK IMMEDIATE MEDICAL ATTENTION IF YOU SUSPECT SARS WEAR FACE MASK N95, BRA MASK (HONGKONG), DON’T GO TO WORK OR SCHOOL OBSERVE PERSONAL HYGIENE HANDWASHING (5 MINUTES) BUILD UP BODY RESISTANCE (PROPER DIET) DIET (HIGH IN CHON, CHO, VIT C, D , E , A, MINERAL ZINC (INCREASE BODY RESISTANCE)

NURSING CONSIDERATIONS:

SEEK IMMEDIATE MEDICAL ATTENTION IF YOU SUSPECT SARS

WEAR FACE MASK N95, BRA MASK (HONGKONG),

DON’T GO TO WORK OR SCHOOL

OBSERVE PERSONAL HYGIENE

HANDWASHING (5 MINUTES)

BUILD UP BODY RESISTANCE (PROPER DIET)

DIET (HIGH IN CHON, CHO, VIT C, D , E , A, MINERAL ZINC (INCREASE BODY RESISTANCE)

BLOOD BORNE DISEASES

Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease Acute Febrile Disease CAUSATIVE AGENT-FILTRABLE VIRUS DENGUE VIRUS TYPE 1,2,3,4, CHIKUNGUNYA VIRUS MOT (Mode of Transmission) bite from: Aedes aegypti Aedes albopictus Culex fatigans IP (Incubation Period) 1 week

Acute Febrile Disease

CAUSATIVE AGENT-FILTRABLE VIRUS

DENGUE VIRUS TYPE 1,2,3,4,

CHIKUNGUNYA VIRUS

MOT (Mode of Transmission) bite from:

Aedes aegypti

Aedes albopictus

Culex fatigans

IP (Incubation Period) 1 week

Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease Hyperpyrexia without focal of infection TRIAD: fever, rashes and muscle pain Bleeding to hypovolemic shock ASA (Aspirin) is contraindicated Watchout for bleeding PLATELET is being attack

Hyperpyrexia without focal of infection

TRIAD: fever, rashes and muscle pain

Bleeding to hypovolemic shock

ASA (Aspirin) is contraindicated

Watchout for bleeding

PLATELET is being attack

Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease Dx: ACUTE FEBRILE ILLNESS WITH NO IDENTIFIABLE FOCUS OF INFECTION Internal and external sign of bleeding Torniquet Test or Rumpel Lead Test Platelet count PT (Prothrombin Time) APTT (Activated Partial Thromboplastin Time) Bleeding time Coagulation time

Dx:

ACUTE FEBRILE ILLNESS WITH NO IDENTIFIABLE FOCUS OF INFECTION

Internal and external sign of bleeding

Torniquet Test or Rumpel Lead Test

Platelet count

PT (Prothrombin Time)

APTT (Activated Partial Thromboplastin Time)

Bleeding time

Coagulation time

TRIAD (FEVER, RASH, SEVERE HEADACHE/BACKACHE/MYALGIA) 1ST STAGE, FIRST 4 DAYS HIGH FEVER, ABDOMINAL PAIN, HEADACHE, FLUSHING, VOMITING, EPISTAXIS 2ND STAGE, 4-7 DAYS TOXIC OR HEMORRHAGIC STAGE LOWERING OF BODY TEMP., SEVERE ABDOMINAL PAIN, VOMITING, GIT BLEEDING-HEMATEMESIS, MELENA, NARROW BP, SHOCK 3RD STAGE, 7-10 DAYS CONVALESCENT OR RECOVERY STAGE SIGN OF PLASMA LEAKAGE PLEURAL EFFUSION, ASCITES, HYPOPROTEINEMIA HERMAN’S SIGN

TRIAD (FEVER, RASH, SEVERE HEADACHE/BACKACHE/MYALGIA)

1ST STAGE, FIRST 4 DAYS HIGH FEVER, ABDOMINAL PAIN, HEADACHE, FLUSHING, VOMITING, EPISTAXIS

2ND STAGE, 4-7 DAYS TOXIC OR HEMORRHAGIC STAGE LOWERING OF BODY TEMP., SEVERE ABDOMINAL PAIN, VOMITING, GIT BLEEDING-HEMATEMESIS, MELENA, NARROW BP, SHOCK

3RD STAGE, 7-10 DAYS

CONVALESCENT OR RECOVERY STAGE SIGN OF PLASMA LEAKAGE PLEURAL EFFUSION, ASCITES, HYPOPROTEINEMIA HERMAN’S SIGN

GRADE 1 (+) TORNIQUET TEST, NO BLEEDING GRADE 2 SPONTANEOUS BLEEDING, (+) GRADE 1 GRADE 3 CIRCULATORY FAILURE,,DECREASED BP, RAPID WEAK PULSE, NARROWING OF PULSE PRESSURE, COLD CLAMMY SKIN, RESTLESSNESS GRADE 4 PROFOUND SHOCK, UNDETECTABLE BP AND PULSE

GRADE 1 (+) TORNIQUET TEST, NO BLEEDING

GRADE 2 SPONTANEOUS BLEEDING, (+) GRADE 1

GRADE 3 CIRCULATORY FAILURE,,DECREASED BP, RAPID WEAK PULSE, NARROWING OF PULSE PRESSURE, COLD CLAMMY SKIN, RESTLESSNESS

GRADE 4 PROFOUND SHOCK, UNDETECTABLE BP AND PULSE

Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease Nursing Considerations ANY CONDITION ASSOCIATED WITH BLEEDING IS ENOUGH CAUSE FOR ALARM FOR FEVER DON’T GIVE ASA RAPID REPLACEMENTS OF FLUIDS IS THE MOST IMPORTANT TREATMENT GIVE ORESOL/HYDRITE VIT C TO PROMOTE CAPILLARY INTEGRITY

Nursing Considerations

ANY CONDITION ASSOCIATED WITH BLEEDING IS ENOUGH CAUSE FOR ALARM

FOR FEVER DON’T GIVE ASA

RAPID REPLACEMENTS OF FLUIDS IS THE MOST IMPORTANT TREATMENT

GIVE ORESOL/HYDRITE

VIT C TO PROMOTE CAPILLARY INTEGRITY

Dengue Fever, H-Fever, Dandy Fever, Breakbone Disease Nursing Considerations BLOOD TRANSFUSION IV CRYSTALLOIDS (PLAIN LRS, PLAIN 0.9 NSS) DEXTRAN (COLLOIDS) PLATELETS FRESH FROZEN PLASMA CRYOPRECIPITATE WHOLE BLOOD NO KNOWN IMMUNIZATION (VACCINE CURRENTLY UNDERWAY)

Nursing Considerations

BLOOD TRANSFUSION

IV CRYSTALLOIDS (PLAIN LRS, PLAIN 0.9 NSS)

DEXTRAN (COLLOIDS)

PLATELETS

FRESH FROZEN PLASMA

CRYOPRECIPITATE

WHOLE BLOOD

NO KNOWN IMMUNIZATION (VACCINE CURRENTLY UNDERWAY)

Dengue KEY POINTS Day biting aedes aegypti, stagnant Fever with no focal of infection Bleeding is imminent when fever subsides Fluid replacement BT platelets

Day biting aedes aegypti, stagnant

Fever with no focal of infection

Bleeding is imminent when fever subsides

Fluid replacement

BT

platelets

Malaria, King of Tropical Disease Protozoan plasmodium plasmodium ovale - dormant (liver) plasmodium vivax - benign plasmodium malariae - mild but resistant plasmodium falciparum - malignant (cerebral malaria) P. VIVAX AND OVALE MAY HAVE RECCURENCE OF SYMPTOMS tertian-febrile paroxysm q24H-48H quartan-febrile paroxysm q48H-72H

Protozoan plasmodium

plasmodium ovale - dormant (liver)

plasmodium vivax - benign

plasmodium malariae - mild but resistant

plasmodium falciparum - malignant (cerebral malaria)

P. VIVAX AND OVALE MAY HAVE RECCURENCE OF SYMPTOMS

tertian-febrile paroxysm q24H-48H

quartan-febrile paroxysm q48H-72H

Malaria, King of Tropical Disease MOT Bite from infected anopheles mosquito or minimus flavire (night biting) Blood Transfusion Sexual cycle sporogony (mosquito) gametes is the infective stage Asexual cycle schizogony (human) IP (Incubation Period) 5-6 days

MOT

Bite from infected anopheles mosquito or minimus flavire (night biting)

Blood Transfusion

Sexual cycle

sporogony (mosquito)

gametes is the infective stage

Asexual cycle

schizogony (human)

IP (Incubation Period) 5-6 days

Malaria, King of Tropical Disease Nursing Considerations Dx: blood extraction (extract blood at the height of fever) Fever, chills, profuse sweating-convulsion Anemia and fluid and electrolytes imbalance, hepatomegaly, splenomegaly, rigor, headache and diarrhea. Chloroquine and Primaquine drug of choice Chloroquine for pregnant women For resistant plasmodium-use chemo drug RBC is being attack

Nursing Considerations

Dx:

blood extraction (extract blood at the height of fever)

Fever, chills, profuse sweating-convulsion

Anemia and fluid and electrolytes imbalance, hepatomegaly, splenomegaly, rigor, headache and diarrhea.

Chloroquine and Primaquine drug of choice

Chloroquine for pregnant women

For resistant plasmodium-use chemo drug

RBC is being attack

Malaria, King of Tropical Disease Nursing Considerations IV FLUIDS AND ELECTROLYTES Blackwater Fever – hemolysis and hemoglobinuria Sickle Cell Trait – provides natural resistance DECREASE FLUIDS IN CEREBRAL EDEMA ASSISTED VENTILATION IN PULMONARY EDEMA DIALYSIS IN RENAL FAILURE BT IN ANEMIA

Nursing Considerations

IV FLUIDS AND ELECTROLYTES

Blackwater Fever – hemolysis and hemoglobinuria

Sickle Cell Trait – provides natural resistance

DECREASE FLUIDS IN CEREBRAL EDEMA

ASSISTED VENTILATION IN PULMONARY EDEMA

DIALYSIS IN RENAL FAILURE

BT IN ANEMIA

Malaria, King of Tropical Disease TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW PREVENTIVE MEASURES- (CHEMOPROPHYLAXIS CHLOROQUINE MAY BE TAKEN 1 WEEK BEFORE ENTERING ENDEMIC AREA) SOAKING OF MOSQUITO NET IN AN INSECTICIDE SOLUTION BIO PONDS FOR FISH ON STREAM CLEARING (TO EXPOSE THE BREEDING STREAM TO SUNLIGHT) VECTORS PEAK BITING AT NIGHT 9PM-3AM PLANTING OF NEEM TREE (REPELLENT EFFECT) ZOOPROPHYLAXIS (DEVIATE MOSQUITO BITES FROM MAN TO ANIMALS) INFECTED MOTHER CAN STILL CONTINUE BREAST FEEDING

TRAVELERS TO MALARIA ENDEMIC area SHOULD FOLLOW PREVENTIVE MEASURES- (CHEMOPROPHYLAXIS CHLOROQUINE MAY BE TAKEN 1 WEEK BEFORE ENTERING ENDEMIC AREA)

SOAKING OF MOSQUITO NET IN AN INSECTICIDE SOLUTION

BIO PONDS FOR FISH

ON STREAM CLEARING (TO EXPOSE THE BREEDING STREAM TO SUNLIGHT)

VECTORS PEAK BITING AT NIGHT 9PM-3AM

PLANTING OF NEEM TREE (REPELLENT EFFECT)

ZOOPROPHYLAXIS (DEVIATE MOSQUITO BITES FROM MAN TO ANIMALS)

INFECTED MOTHER CAN STILL CONTINUE BREAST FEEDING

MALARIA key points Night biting anopheles, running water Falciparum – fatal Ovale and vivax – exacerbate Sporogony – sexual – mosquito Schizogony – asexual – human Chloroquine Seizure, fluid and elec loss Rbc and liver

Night biting anopheles, running water

Falciparum – fatal

Ovale and vivax – exacerbate

Sporogony – sexual – mosquito

Schizogony – asexual – human

Chloroquine

Seizure, fluid and elec loss

Rbc and liver

Filariasis, Elephantiasis, Human Lymphatic Filariasis CAUSATIVE AGENT-NEMATODE PARASITE MICROFILARIAE OR FILARIAL WORMS WUCHERERIA BRONCOFTI BRUGIA MALAYI BRUGIA TIMORI MOT Bite from aedes poecilius (night biting) Invade the lymph vessel, obstructing the lymphatic channel-leads to edema and may infiltrate the reproductive organs. IP 8-16 months

CAUSATIVE AGENT-NEMATODE PARASITE

MICROFILARIAE OR FILARIAL WORMS

WUCHERERIA BRONCOFTI

BRUGIA MALAYI

BRUGIA TIMORI

MOT

Bite from aedes poecilius (night biting)

Invade the lymph vessel, obstructing the lymphatic channel-leads to edema and may infiltrate the reproductive organs.

IP 8-16 months

CLINICAL MANIFESTATIONS: ASYMPTOMATIC STAGE (+) MICROFILARIAE IN THE BLOOD NO CLINICAL S/SX ACUTE STAGE LYMPHADENITIS (LYMPH NODES) LYMPHANGITIS (LYMPH VESSELS) GENETALIA-FUNICULITIS, EPIDYDIMITIS, ORCHITIS CHRONIC STAGE HYDROCOELE LYMPHEDEMA (UPPER AND LOWER EXTREMITIES) ELEPHANTIASIS

CLINICAL MANIFESTATIONS:

ASYMPTOMATIC STAGE

(+) MICROFILARIAE IN THE BLOOD

NO CLINICAL S/SX

ACUTE STAGE

LYMPHADENITIS (LYMPH NODES)

LYMPHANGITIS (LYMPH VESSELS)

GENETALIA-FUNICULITIS, EPIDYDIMITIS, ORCHITIS

CHRONIC STAGE

HYDROCOELE

LYMPHEDEMA (UPPER AND LOWER EXTREMITIES)

ELEPHANTIASIS

Filariasis, Elephantiasis, Human Lymphatic Filariasis

Filariasis, Elephantiasis, Human Lymphatic Filariasis INCIDENCE-REGION 5,8,11 AND CARAGA, MARINDUQUE, SARANGGANI Drug: Diethyl Carbamazine Citrate or Hetrazan 6mg/KgBW one dose every year Dx: NBE nocturnal blood exam (night) ICT immunochromatographic test (day)

INCIDENCE-REGION 5,8,11 AND CARAGA, MARINDUQUE, SARANGGANI

Drug: Diethyl Carbamazine Citrate or Hetrazan 6mg/KgBW one dose every year

Dx:

NBE nocturnal blood exam (night)

ICT immunochromatographic test (day)

Nursing Considerations MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE DOSE PER YEAR. ENVIRONMENTAL SANITATION PERSONAL HYGIENE MOSQUITO NETS LONG SLEEVES, LONG PANTS AND SOCKS INSECT REPELLENT SCREENING OF HOUSES HEALTH EDUCATION

MASS TREATMENT-DOSE IS 6mg/KBW, SINGLE DOSE PER YEAR.

ENVIRONMENTAL SANITATION

PERSONAL HYGIENE

MOSQUITO NETS

LONG SLEEVES, LONG PANTS AND SOCKS

INSECT REPELLENT

SCREENING OF HOUSES

HEALTH EDUCATION

Filariasis KEY POINTS Night biting aedes poecilius, plants Chronic, lymphedema HETRAZAN ICT and NBE Lymphatic vessel obstruction

Night biting aedes poecilius, plants

Chronic, lymphedema

HETRAZAN

ICT and NBE

Lymphatic vessel obstruction

Leptospirosis, Weil’s Disease (Zoonotic) Spirochete-leptospira interrogans IP 5-6 days MOT (Mode of Transmission) Skin penetration = flood INGESTION OF CONTAMINATED FOOD SKIN, MUCUS MEMBRANE, ABRADED SKIN, CONJUNCTIVA INHALATION AFTER PENETRATION LEPTOSPIRES ENTER THE BLOOD STREAM AND ARE CARRIED TO ALL PARTS OF THE BODY INCLUDING Liver, kidneys and CSF

Spirochete-leptospira interrogans

IP 5-6 days

MOT (Mode of Transmission)

Skin penetration = flood

INGESTION OF CONTAMINATED FOOD

SKIN, MUCUS MEMBRANE, ABRADED SKIN, CONJUNCTIVA

INHALATION

AFTER PENETRATION LEPTOSPIRES ENTER THE BLOOD STREAM AND ARE CARRIED TO ALL PARTS OF THE BODY INCLUDING

Liver, kidneys and CSF

Leptospirosis, Weil’s Disease (Zoonotic) Dx: CULTURE OF MICROORGANISMS BLOOD AND CSF EXAMINATION (FIRST WEEK) URINE EXAM- AFTER 10 DAYS MICROSCOPIC AGGLUTINATION TEST (MAT) A RISE IN ANTIBODY TITER

Dx:

CULTURE OF MICROORGANISMS

BLOOD AND CSF EXAMINATION (FIRST WEEK)

URINE EXAM- AFTER 10 DAYS

MICROSCOPIC AGGLUTINATION TEST (MAT) A RISE IN ANTIBODY TITER

CLINICAL MANIFESTATIONS EARLY = fever and headache LEPTOSPIREMIC PHASE = vasculitis HEPATITIS, JAUNDICE, SKIN HEMORRHAGE, FEVER, CHILLS, RENAL FAILURE, MENINGITIS WITH MENTAL STATUS CHANGE, MUSCULAR PAIN, NAUSEA AND VOMITING, COUGH AND CHEST PAIN IMMUNE PHASE APPEARANCE OF CIRCULATING IgM

EARLY = fever and headache

LEPTOSPIREMIC PHASE = vasculitis

HEPATITIS, JAUNDICE, SKIN HEMORRHAGE, FEVER, CHILLS, RENAL FAILURE, MENINGITIS WITH MENTAL STATUS CHANGE, MUSCULAR PAIN, NAUSEA AND VOMITING, COUGH AND CHEST PAIN

IMMUNE PHASE

APPEARANCE OF CIRCULATING IgM

NURSING CONSIDERATIONS PENICILLIN OR DOXYCYCLINE (IMMEDIATELY) ERYTHROMYCIN IF ALLERGIC TO PENICILLIN FLUID AND ELECTROLYTE BALANCE ENSURE ADEQUATE RENAL PERFUSION TO PREVENT ARF IF AZOTEMIA IS SEVERE OR PROLONGED (CONSIDER DIALYSIS) DISEASE IS USUALLY SHORT LIVED AND MILD BUT SEVERE INFECTION CAN DAMAGE KIDNEYS, LIVER, CNS AND RESPIRATORY SYSTEM MOST SERIOUS FORM IS CALLED WEIL’S DISEASE PRIMARILY A DISEASE OF DOMESTICATED AND WILD ANIMALS

PENICILLIN OR DOXYCYCLINE (IMMEDIATELY)

ERYTHROMYCIN IF ALLERGIC TO PENICILLIN

FLUID AND ELECTROLYTE BALANCE

ENSURE ADEQUATE RENAL PERFUSION TO PREVENT ARF

IF AZOTEMIA IS SEVERE OR PROLONGED (CONSIDER DIALYSIS)

DISEASE IS USUALLY SHORT LIVED AND MILD BUT SEVERE INFECTION CAN DAMAGE KIDNEYS, LIVER, CNS AND RESPIRATORY SYSTEM

MOST SERIOUS FORM IS CALLED WEIL’S DISEASE

PRIMARILY A DISEASE OF DOMESTICATED AND WILD ANIMALS

PREVENTION AND CONTROL AVOIDANCE OF EXPOSURE TO URINE AND TISSUES FROM INFECTED ANIMALS (FLOOD) RODENT CONTROL VACCINATION OF ANIMALS HYGIENIC CONDITIONS IN SLAUGHTERHOUSES, FARM YARD BUILDINGS AND BATHING POOLS USE OF PROTECTIVE CLOTHING AND BOOTS CHEMOPROPHYLAXIS (DOXYCYCLINE 200 mg PO ONCE A WEEK SUPPORTIVE MANAGEMENT ALL PATIENT SUSPECTED TO HAVE LEPTO, MILD OR SEVERE SHOULD BE ADMITTED

AVOIDANCE OF EXPOSURE TO URINE AND TISSUES FROM INFECTED ANIMALS (FLOOD)

RODENT CONTROL

VACCINATION OF ANIMALS

HYGIENIC CONDITIONS IN SLAUGHTERHOUSES, FARM YARD BUILDINGS AND BATHING POOLS

USE OF PROTECTIVE CLOTHING AND BOOTS

CHEMOPROPHYLAXIS (DOXYCYCLINE 200 mg PO ONCE A WEEK

SUPPORTIVE MANAGEMENT

ALL PATIENT SUSPECTED TO HAVE LEPTO, MILD OR SEVERE SHOULD BE ADMITTED

LEPTOSPIROSIS key points Spirochette, rat, urine and feces Skin penetration, ingestion Fever and headache Liver, kidneys and CSF Doxycycline

Spirochette, rat, urine and feces

Skin penetration, ingestion

Fever and headache

Liver, kidneys and CSF

Doxycycline

ERUPTIVE FEVER

Measles, Rubeola, 7 Day Fever, Hard Red Measle Paramyxo virus MOT = droplets and airborne PC 4 days before and 5 days after rash HIGHLY CONTAGIOUS IP 7-14 days IMMUNITY Active = measles vaccine, MMR Passive = measles Ig Natural = lifetime

Paramyxo virus

MOT = droplets and airborne

PC 4 days before and 5 days after rash

HIGHLY CONTAGIOUS

IP 7-14 days

IMMUNITY

Active = measles vaccine, MMR

Passive = measles Ig

Natural = lifetime

Measles, Rubeola, 7 Day Fever, Hard Red Measle Rashes: Maculopapular Cephalocaudal With desquamation Pruritus

Rashes:

Maculopapular

Cephalocaudal

With desquamation

Pruritus

Measles, Rubeola, 7 Day Fever, Hard Red Measle Rashes: maculopapaular, cephalocaudal (hairline and behind the ears to trunk and limbs), confluent, desquamation, pruritus

Rashes: maculopapaular, cephalocaudal (hairline and behind the ears to trunk and limbs), confluent, desquamation, pruritus

PS koplik’s spot Characteristic: stimsons, photophobia (typical complaint) Fever: high fever CX pneumonia, meningitis

PS koplik’s spot

Characteristic: stimsons, photophobia (typical complaint)

Fever: high fever

CX pneumonia, meningitis

German Measles, Rubella, Rotheln Disease, 3 Day Measles RNA rubella virus MOT = droplets and airborne PC 5 days before and 5 days after rash HIGHLY CONTAGIOUS IP = 10-21 days IMMUNITY Active = MMR Passive = rubella Ig Natural = lifetime

RNA rubella virus

MOT = droplets and airborne

PC 5 days before and 5 days after rash

HIGHLY CONTAGIOUS

IP = 10-21 days

IMMUNITY

Active = MMR

Passive = rubella Ig

Natural = lifetime

German Measles, Rubella, Rotheln Disease, 3 Day Measles Rashes: Maculopapular Diffuse No desquamation

Rashes:

Maculopapular

Diffuse

No desquamation

German Measles, Rubella, Rotheln Disease, 3 Day Measles Rashes: Maculopapular, Diffuse/not confluent, No desquamation, spreads from the face downwards

Rashes: Maculopapular, Diffuse/not confluent, No desquamation, spreads from the face downwards

PS forschheimer’s Characteristic: cervical lymphadenopathy Fever: low grade fever CX rare CX to pregnant women: 1st tri-congenital anomalies 2nd tri-abortion 3rd tri-pre mature delivery

PS forschheimer’s

Characteristic: cervical lymphadenopathy

Fever: low grade fever

CX rare

CX to pregnant women:

1st tri-congenital anomalies

2nd tri-abortion

3rd tri-pre mature delivery

Chicken Pox, Varicella Herpes Zoster Virus Varicella Zoster Virus MOT = droplets and airborne PC one day before rash and 6 days after first crop of vesicles HIGHLY CONTAGIOUS IP 14-21 days IMMUNITY Active = varicella vaccine Passive = xxx Natural = lifetime

Herpes Zoster Virus

Varicella Zoster Virus

MOT = droplets and airborne

PC one day before rash and 6 days after first crop of vesicles

HIGHLY CONTAGIOUS

IP 14-21 days

IMMUNITY

Active = varicella vaccine

Passive = xxx

Natural = lifetime

Chicken Pox, Varicella Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk and spreads to entire body Leaves a pitted scar (pockmark)

Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk and spreads to entire body

Leaves a pitted scar (pockmark)

Chicken Pox, Varicella Dx = Tzanck smear (scraping of ulcer for staining) Rashes: Maculopapulovesicular (covered areas) Centrifugal Leaves a pitted scar (pockmark) CX furunculosis, erysipelas, meningoencephalitis Dormant: remain at the dorsal root ganglion and may recur as shingles

Dx = Tzanck smear (scraping of ulcer for staining)

Rashes:

Maculopapulovesicular (covered areas)

Centrifugal

Leaves a pitted scar (pockmark)

CX furunculosis, erysipelas, meningoencephalitis

Dormant: remain at the dorsal root ganglion and may recur as shingles

Small Pox, Variola Pox virus MOT = droplets and airborne PC until all crust disappear HIGHLY CONTAGIOUS IP 1-3 weeks ERADICATED BIOLOGIC WEAPON

Pox virus

MOT = droplets and airborne

PC until all crust disappear

HIGHLY CONTAGIOUS

IP 1-3 weeks

ERADICATED

BIOLOGIC WEAPON

Small Pox, Variola Rashes Maculopapulovesiculopustular Centripetal CX same with chicken pox Differential Dx Paul’s test - instilling of vesicular fluid of small pox into the cornea if keratitis develops its small pox

Rashes

Maculopapulovesiculopustular

Centripetal

CX same with chicken pox

Differential Dx

Paul’s test - instilling of vesicular fluid of small pox into the cornea if keratitis develops its small pox

CONTACT

Pediculosis Blood sucking lice Pediculus humanus p. capitis-scalp p. palpebrarum-eyelids and eyelashes p. pubis-pubic hair p. corporis-body Drugs: Lindane (Kwell) topical Permethrin (Nix) topical CX impetigo to AGN, RHD, SLE MOT skin contact

Blood sucking lice

Pediculus humanus

p. capitis-scalp

p. palpebrarum-eyelids and eyelashes

p. pubis-pubic hair

p. corporis-body

Drugs: Lindane (Kwell) topical

Permethrin (Nix) topical

CX impetigo to AGN, RHD, SLE

MOT skin contact

Scabies Sarcoptes scabie Pruritus (excreta of mites) Mites come-out from burrows to mate at night Drugs: Permethrin (Nix) cream Sulfur soap Linens: wash with hot water MOT skin contact

Sarcoptes scabie

Pruritus (excreta of mites)

Mites come-out from burrows to mate at night

Drugs: Permethrin (Nix) cream

Sulfur soap

Linens: wash with hot water

MOT skin contact

Conjunctivitis Children Viral-hygiene and rest Bacterial-yellow, green or white pus, photophobia-antibiotic eyedrops or ointment Chlamydial –cough, history of maternal infection-antibiotic Herpetic-pain, photophobia, skin lesions-antiviral agents Allergic-itching, watery discharge-antihistamine S/Sx From mild pruritus to severe drainage, burning, hyperemia and chemosis (edema) Pink eye-infectious conjunctivitis MOT direct contact with eye secretions

Children

Viral-hygiene and rest

Bacterial-yellow, green or white pus, photophobia-antibiotic eyedrops or ointment

Chlamydial –cough, history of maternal infection-antibiotic

Herpetic-pain, photophobia, skin lesions-antiviral agents

Allergic-itching, watery discharge-antihistamine

S/Sx

From mild pruritus to severe drainage, burning, hyperemia and chemosis (edema)

Pink eye-infectious conjunctivitis

MOT direct contact with eye secretions

STD

Gonorrhea (bacteria) Neisseria gonorrheae (gram positive) IP 3 -7 days Asymptomatic in women Mucopurulent discharge Painful urination DX: gram stain of cervical secretions Drugs: single dose only Ceftriaxone (Rocephin) 125 mg IM Ofloxacin (Floxin) 400 mg orally CX: PID, ectopic pregnancy and infertility Ophthalmia neonatorum and sepsis (infant) vaginal birth

Neisseria gonorrheae (gram positive)

IP 3 -7 days

Asymptomatic in women

Mucopurulent discharge

Painful urination

DX:

gram stain of cervical secretions

Drugs: single dose only

Ceftriaxone (Rocephin) 125 mg IM

Ofloxacin (Floxin) 400 mg orally

CX:

PID, ectopic pregnancy and infertility

Ophthalmia neonatorum and sepsis (infant) vaginal birth

Syphilis (bacteria) Treponema pallidum (spirochete) IP 10-90 days Painless, clean chancre DX: Non specific VDRL Confirmed by-antitreponemal antibody tests Dark-field examination of lesion

Treponema pallidum (spirochete)

IP 10-90 days

Painless, clean chancre

DX:

Non specific VDRL

Confirmed by-antitreponemal antibody tests

Dark-field examination of lesion

Primary – painless chancre Secondary – generalized rash Tertiary - gumma

Syphilis (bacteria) Primary-chancre-most infectious Secondary-generalized macular papular rash including palms and soles (condylomata lata) Tertiary-neurosyphilis-permanent damage (insanity) (gumma) Drugs: Primary and secondary Pen G Tertiary IV Pen G

Primary-chancre-most infectious

Secondary-generalized macular papular rash including palms and soles (condylomata lata)

Tertiary-neurosyphilis-permanent damage (insanity) (gumma)

Drugs:

Primary and secondary

Pen G

Tertiary

IV Pen G

Chlamydia (bacteria) Chlamydia trachomatis IP 2-10 days Maybe asymptomatic Gray white discharge Burning and itchiness at the urethral opening DX: Antigen detection test on cervical smear Urinalysis

Chlamydia trachomatis

IP 2-10 days

Maybe asymptomatic

Gray white discharge

Burning and itchiness at the urethral opening

DX:

Antigen detection test on cervical smear

Urinalysis

Chlamydia (bacteria)

Chlamydia (bacteria) Drugs: Azithromycin (Zithromax) 1 g orally one dose Erythromycin and Ofloxacin CX: PID Ectopic pregnancy Fetus transmittal (vaginal birth)

Drugs:

Azithromycin (Zithromax) 1 g orally one dose

Erythromycin and Ofloxacin

CX:

PID

Ectopic pregnancy

Fetus transmittal (vaginal birth)

Herpes Genitalis (virus) HSV 2 Painful sexual intercourse Painful lesion (cervix, vagina, perineum, glans penis) DX: Viral culture Pap smear (shows cellular changes) Tzanck smear (scraping of ulcer for staining) Drugs: Anti viral-acyclovir (zovirax) CX: Meningitis Neonatal infection (vaginal birth)

HSV 2

Painful sexual intercourse

Painful lesion (cervix, vagina, perineum, glans penis)

DX:

Viral culture

Pap smear (shows cellular changes)

Tzanck smear (scraping of ulcer for staining)

Drugs:

Anti viral-acyclovir (zovirax)

CX:

Meningitis

Neonatal infection (vaginal birth)

Genital Warts, Condyloma Acuminatum (virus) HPV type 6 & 11, papilloma virus Single or multiple soft, fleshy painless growth of the vulva, vagina, cervix, urethra, or anal area Vaginal bleeding, discharge, odor and dyspareunia DX: Pap smear-shows cellular changes (koilocytosis) Acetic acid swabbing (will whiten lesion) Management: Laser treatment is more effective CX: Neoplasia Neonatal laryngeal papillomatosis (vaginal birth)

HPV type 6 & 11, papilloma virus

Single or multiple soft, fleshy painless growth of the vulva, vagina, cervix, urethra, or anal area

Vaginal bleeding, discharge, odor and dyspareunia

DX:

Pap smear-shows cellular changes (koilocytosis)

Acetic acid swabbing (will whiten lesion)

Management:

Laser treatment is more effective

CX:

Neoplasia

Neonatal laryngeal papillomatosis (vaginal birth)

Genital Warts, Condyloma Acuminatum (virus) Mgmt: Laser treatment is more effective CX: Neoplasia Neonatal laryngeal papillomatosis (vaginal birth)

Mgmt:

Laser treatment is more effective

CX:

Neoplasia

Neonatal laryngeal papillomatosis (vaginal birth)

Candidiasis, Moniliasis Yeast or fungus Cheesy white discharge Extreme itchiness DX: KOH (wet smear indicate positive result) Drugs: Monistat Diflucan CX: Oral thrush to baby (vaginal birth)

Yeast or fungus

Cheesy white discharge

Extreme itchiness

DX:

KOH (wet smear indicate positive result)

Drugs:

Monistat

Diflucan

CX:

Oral thrush to baby (vaginal birth)

Trichomoniasis Parasite Trichomona vaginalis Yellow gray frothy vaginal discharge Foul smelling Drugs: Metronidazole (Flagyl) CX: PROM

Parasite

Trichomona vaginalis

Yellow gray frothy vaginal discharge

Foul smelling

Drugs: Metronidazole (Flagyl)

CX: PROM

Prevention A abstinence B be faithful C condom D do it yourself “ One stick one hole” Both partners must be treated

A abstinence

B be faithful

C condom

D do it yourself

“ One stick one hole”

Both partners must be treated

TORCHS T toxoplasmosis O others Papilloma virus - STD Gonorrhea - STD Varicella zoster – chicken pox Hepa B HIV Measles Mumps R rubella C cytomegalovirus – hemolytic anemia, hydro/microcephalus H herpes genitalis - STD S syphilis - STD

TORCHS

T toxoplasmosis

O others Papilloma virus - STD Gonorrhea - STD Varicella zoster – chicken pox Hepa B HIV Measles Mumps

R rubella

C cytomegalovirus – hemolytic anemia, hydro/microcephalus

H herpes genitalis - STD

S syphilis - STD

HIV

HIV and AIDS Retrovirus (HIV1 & HIV2) Attacks and kills CD4+ lymphocytes (T-helper) Capable of replicating the lymphocytes undetected by the immune system Immunity declines and opportunistic microbes sets in

Retrovirus (HIV1 & HIV2)

Attacks and kills CD4+ lymphocytes (T-helper)

Capable of replicating the lymphocytes undetected by the immune system

Immunity declines and opportunistic microbes sets in

HIGH RISK GROUP Homosexual or bisexual Intravenous drug users BT recipients before 1985 Sexual contact with HIV+ Babies of mothers who are HIV+

Homosexual or bisexual

Intravenous drug users

BT recipients before 1985

Sexual contact with HIV+

Babies of mothers who are HIV+

MOT Sexual intercourse (oral, vaginal and anal) Exposure to contaminated blood, semen, breast milk and other body fluids placenta

Sexual intercourse (oral, vaginal and anal)

Exposure to contaminated blood, semen, breast milk and other body fluids

placenta

HIV TEST Elisa Western Blot Rapid hiv test Suds hiv-1 Results are obtained in less than 10 minutes Color indicator similar to pregnancy test Positive result needs a confirmatory test

Elisa

Western Blot

Rapid hiv test

Suds hiv-1

Results are obtained in less than 10 minutes

Color indicator similar to pregnancy test

Positive result needs a confirmatory test

How to Diagnose HIV+ 2 consecutive positive ELISA and 1 positive Western Blot Test AIDS+ HIV+ CD4+ count below 500/ml Exhibits one or more of the ff: (next slide) Full blown AIDS CD4 is less than 200/ml

HIV+ 2 consecutive positive ELISA and 1 positive Western Blot Test

AIDS+ HIV+ CD4+ count below 500/ml Exhibits one or more of the ff: (next slide)

Full blown AIDS CD4 is less than 200/ml

Exhibits one or more of the ff: Extreme fatigue Intermittent fever Night sweats Chills Lymphadenopathy Enlarged spleen Anorexia Weight loss Severe diarrhea Apathy and depression PTB Kaposis sarcoma Pneumocystis carinii AIDS dementia

Exhibits one or more of the ff:

Extreme fatigue

Intermittent fever

Night sweats

Chills

Lymphadenopathy

Enlarged spleen

Anorexia

Weight loss

Severe diarrhea

Apathy and depression

PTB

Kaposis sarcoma

Pneumocystis carinii

AIDS dementia

HIV CLASSIFICATION CATEGORY 1 – CD4+ 500 OR MORE CATEGORY 2 – CD4+ 200-499 CATEGORY 3 – CD4+ LESS THAN 200

CATEGORY 1 – CD4+ 500 OR MORE

CATEGORY 2 – CD4+ 200-499

CATEGORY 3 – CD4+ LESS THAN 200

Management Prevention of spread (safe sex) Universal precautions Health Education Symptomatic intervention No known cure Prevent CD4 reduction

Prevention of spread (safe sex)

Universal precautions

Health Education

Symptomatic intervention

No known cure

Prevent CD4 reduction

DRUGS 1. Nucleoside Reverse Transcriptase Inhibitors NRTI’s INTERFERES WITH DNA CHAIN Zidovudine (AZT) SE – NEUROPATHY AND RASH

1. Nucleoside Reverse Transcriptase Inhibitors NRTI’s

INTERFERES WITH DNA CHAIN

Zidovudine (AZT)

SE – NEUROPATHY AND RASH

DRUGS 2. Non-nucleoside Reverse Transcriptase Inhibitors NNRTI’s - BINDS TO REVERSE TRANSCRIPTASE AND BLOCKS RNA AND DNA REPLICATION Ritonavir (Norvir) SE – RASH, HEPATOTOXICITY, BONE MARROW DEPRESSION

2. Non-nucleoside Reverse Transcriptase Inhibitors NNRTI’s

- BINDS TO REVERSE TRANSCRIPTASE AND BLOCKS RNA AND DNA REPLICATION

Ritonavir (Norvir)

SE – RASH, HEPATOTOXICITY, BONE MARROW DEPRESSION

DRUGS 3. Protease Inhibitors PI BLOCK VIRUS ABILITY TO BREAK DOWN LARGER PROTEIN MOLECULES Indinavir (Crixivan) SE – HEPATOTOXICITY, NV, ABDOMINAL PAIN, RENAL CALCULI

3. Protease Inhibitors PI

BLOCK VIRUS ABILITY TO BREAK DOWN LARGER PROTEIN MOLECULES

Indinavir (Crixivan)

SE – HEPATOTOXICITY, NV, ABDOMINAL PAIN, RENAL CALCULI

Hepatitis

Types of Hepatitis Hepa A – fecal oral route Hepa B – body fluids Hepa C – non A non B, BT, body fluids Hepa D – hypodermic, body fluids Hepa E – fecal oral route, fatal and common among pregnant women Hepa G – body fluids (HIV)

Hepa A – fecal oral route

Hepa B – body fluids

Hepa C – non A non B, BT, body fluids

Hepa D – hypodermic, body fluids

Hepa E – fecal oral route, fatal and common among pregnant women

Hepa G – body fluids (HIV)

Hepatitis A Hepa A virus Infectious hepa Fecal oral route Short incubation (3-5 weeks) Poor sanitation Worldwide distribution Spread from person-person Food handlers, contaminated water Mortality 1%, with full recovery Enteric precautions Active Immunity (Havrix) Passive Immunity (HAIg) (+) ANTI HAV – INFECTED (+) Igm ANTI HAV – RECENT INFECTION (ANTIBODY)

Hepatitis A

Hepa A virus

Infectious hepa

Fecal oral route

Short incubation (3-5 weeks)

Poor sanitation

Worldwide distribution

Spread from person-person

Food handlers, contaminated water

Mortality 1%, with full recovery

Enteric precautions

Active Immunity (Havrix)

Passive Immunity (HAIg)

(+) ANTI HAV – INFECTED

(+) Igm ANTI HAV – RECENT INFECTION (ANTIBODY)

Hepatitis B Hepa B virus Serum hepa Blood recipients, hemodialysis, IV drug users, sexually active homosexual, tattoing and health care workers (high risk) Blood and other body fluids route Long incubation (2-5 months) Worldwide distribution Main cause of liver cirrhosis and liver cancer (+) HBsAg indicates acute, chronic and carrier Active Immunity (hevac-B) Passive Immunity (HBIg) 85% full recovery, 15% lifetime carrier

Hepatitis B

Hepa B virus

Serum hepa

Blood recipients, hemodialysis, IV drug users, sexually active homosexual, tattoing and health care workers (high risk)

Blood and other body fluids route

Long incubation (2-5 months)

Worldwide distribution

Main cause of liver cirrhosis and liver cancer

(+) HBsAg indicates acute, chronic and carrier

Active Immunity (hevac-B)

Passive Immunity (HBIg)

85% full recovery, 15% lifetime carrier

DX Elevated AST or SGPT (specific) and ALT or SGOT Increased IgM during acute phase HBsAg (+) or REACTIVE = INFECTED maybe acute, chronic or carrier HBeAg (+) = highly infectious HBcAg found only in the liver cells Anti-HBc (+) = acute infection Anti-HBe (+) = reduced infectiousness Anti-HBs (+) = with antibodies (FROM vaccine or disease) Blood Chem. Analysis (to monitor progression) Liver biopsy (to detect progression to CA)

DX

Elevated AST or SGPT (specific) and ALT or SGOT

Increased IgM during acute phase

HBsAg (+) or REACTIVE = INFECTED maybe acute, chronic or carrier

HBeAg (+) = highly infectious

HBcAg found only in the liver cells

Anti-HBc (+) = acute infection

Anti-HBe (+) = reduced infectiousness

Anti-HBs (+) = with antibodies (FROM vaccine or disease)

Blood Chem. Analysis (to monitor progression)

Liver biopsy (to detect progression to CA)

Manifestations: Stage I pre-icteric for 1-21 days Anorexia, nausea and vomiting, LBM, weight loss RUQ pain, fatty food intolerance, fever, chills and headache Satge II icteric for 2-6 weeks Jaundice, pruritus, weight gain, ascites, dark-tea colored urine (urobilirubin) ADEK deficiency Stage III pre coma NH3 level increases with decreasing LOC Flapping tremors or asterixis Stage IV recovery

Manifestations:

Stage I pre-icteric for 1-21 days Anorexia, nausea and vomiting, LBM, weight loss RUQ pain, fatty food intolerance, fever, chills and headache

Satge II icteric for 2-6 weeks Jaundice, pruritus, weight gain, ascites, dark-tea colored urine (urobilirubin) ADEK deficiency

Stage III pre coma NH3 level increases with decreasing LOC Flapping tremors or asterixis

Stage IV recovery

jaundice

Manifestations CHO – fatigue CHON – toxicity (latent phase) Fats – bile, fat intolerance, ADEK Bilirubin – jaundice, kernicterus (children) Deamination – NH3 increases Synthesis CHON – immunocompetent Cirrhosis and Cancer - complications

CHO – fatigue

CHON – toxicity (latent phase)

Fats – bile, fat intolerance, ADEK

Bilirubin – jaundice, kernicterus (children)

Deamination – NH3 increases

Synthesis CHON – immunocompetent

Cirrhosis and Cancer - complications

Management: Rest Diet: - high CHON 75-100 g/day - high CHO – energy - low fat - high calorie 2,500-3,000 cal/day - increase vit A, E if there is steatorrhea Bile sequestrants – to reduce pruritus Cholestryamine (Questran) Avoid hepatotoxic drugs Acetaminophen, Sedatives, ASA Give Antiviral and Interferon

Management:

Rest

Diet: - high CHON 75-100 g/day - high CHO – energy - low fat - high calorie 2,500-3,000 cal/day - increase vit A, E if there is steatorrhea

Bile sequestrants – to reduce pruritus Cholestryamine (Questran)

Avoid hepatotoxic drugs Acetaminophen, Sedatives, ASA

Give Antiviral and Interferon

Other diseases

Lyme disease Named for the Connecticut town, 1975 Appears in summer or early fall Spirochete, Borrelia burgdorferi Carried by “deer ticks” Pahogenesis: Tick injects spirochete-laden saliva into the blood stream or deposits fecal matter on the skin disseminate to other skin sites or travel into the blood stream and lymphatic system

Named for the Connecticut town, 1975

Appears in summer or early fall

Spirochete, Borrelia burgdorferi

Carried by “deer ticks”

Pahogenesis:

Tick injects spirochete-laden saliva into the blood stream or deposits fecal matter on the skin

disseminate to other skin sites or travel into the blood stream and lymphatic system

s/sx: may take years to fully develop *Skin lesion “erythema chronicum migrans” Early localized (Stage 1) = lesion with bright red outer rim with white center, itchy, may sting or burn; fatigue, headache, chills, fever, sore throat and muscle joint pain Early disseminated (Stage 2) = meningitis, extreme neck flexion and cranial nerve palsy, cardiac symptoms, brief attacks of arthritis Late (Stage 3) = Chronic arthritis, Behavioral changes, depression and psychosis Cardiac, neurologic, arthritis (complications)

s/sx: may take years to fully develop

*Skin lesion “erythema chronicum migrans”

Early localized (Stage 1) = lesion with bright red outer rim with white center, itchy, may sting or burn; fatigue, headache, chills, fever, sore throat and muscle joint pain

Early disseminated (Stage 2) = meningitis, extreme neck flexion and cranial nerve palsy, cardiac symptoms, brief attacks of arthritis

Late (Stage 3) = Chronic arthritis, Behavioral changes, depression and psychosis

Cardiac, neurologic, arthritis (complications)

Lyme disease Dx: – biopsy, antibody titer, ELISA, Western Blot Mgmt: symptomatic 14-28 day oral tetracycline or doxycycline Children – oral Penicillin Late stage: IV or IM antibiotics Vaccine – Immulyme, Lymerix

Dx: – biopsy, antibody titer, ELISA, Western Blot

Mgmt:

symptomatic

14-28 day oral tetracycline or doxycycline

Children – oral Penicillin

Late stage: IV or IM antibiotics

Vaccine – Immulyme, Lymerix

Toxoplasmosis ZOONOTIC Toxoplasma gondii, parasite Affects birds, mammals ie cats Infected person may carry the organism for life (reactivation is possible) Pathogenesis: ingestion of cyst from uncooked meat / fecal oral route from infected cats (feces) Quickly multiply in the GIT Distributed to CNS, lymphatic tissue, skeletal muscle, myocardium, retina and placenta

Toxoplasma gondii, parasite

Affects birds, mammals ie cats

Infected person may carry the organism for life (reactivation is possible)

Pathogenesis:

ingestion of cyst from uncooked meat / fecal oral route from infected cats (feces)

Quickly multiply in the GIT

Distributed to CNS, lymphatic tissue, skeletal muscle, myocardium, retina and placenta

S/sx: Toxoplasmosis Malaise, fever, myalgia, headache, fatigue, sore throat, lymphadenopathy Fulminant = vomiting, cough and dyspnea, hyperpyrexia, delirium and seizures, encephalopathy, meningitis Infants = hydrocephalus and microcephalus, seizure, jaundice later strabismus, blindness, epilepsy, mental retardation

S/sx: Toxoplasmosis

Malaise, fever, myalgia, headache, fatigue, sore throat, lymphadenopathy

Fulminant = vomiting, cough and dyspnea, hyperpyrexia, delirium and seizures, encephalopathy, meningitis

Infants = hydrocephalus and microcephalus, seizure, jaundice later strabismus, blindness, epilepsy, mental retardation

Toxoplasmosis Dx: serology, CT scan Mgmt: 4-6 weeks of sulfonamide and pyrimethamine (take folic acid to counteract drug’s adverse effects)

Dx: serology, CT scan

Mgmt:

4-6 weeks of sulfonamide and pyrimethamine (take folic acid to counteract drug’s adverse effects)

TORCHS T toxoplasmosis O others Papilloma virus - STD Gonorrhea - STD Varicella zoster – chicken pox Hepa B HIV Measles Mumps R rubella C cytomegalovirus – hemolytic anemia, hydro/microcephalus H herpes genitalis - STD S syphilis - STD

TORCHS

T toxoplasmosis

O others Papilloma virus - STD Gonorrhea - STD Varicella zoster – chicken pox Hepa B HIV Measles Mumps

R rubella

C cytomegalovirus – hemolytic anemia, hydro/microcephalus

H herpes genitalis - STD

S syphilis - STD

Ebola ZOONOTIC Filoviruses, 1960 Unknown reservoir Viral replication takes place in almost all organs 90% mortality, recovery is often prolonged BIOLOGICAL WEAPON IP: 3-9 days MOT: direct contact w/ blood, vomitus, urine, stool, semen probably aerosol transfer during later stages

Filoviruses, 1960

Unknown reservoir

Viral replication takes place in almost all organs

90% mortality, recovery is often prolonged

BIOLOGICAL WEAPON

IP: 3-9 days

MOT: direct contact w/ blood, vomitus, urine, stool, semen

probably aerosol transfer during later stages

Ebola S/sx: frontal and temporal headache, malaise, myalgia, nausea, vomiting, fever, conjunctivitis, watery diarrhea (3 rd day), lethargy, nonpruritic maculpapular rash, desaquammation, hemorrhagic manifestations (5 th day) Dx: history Symptomatic intervention Report suspected EBOLA case Health workers = advised to wear cap, goggles, mask, gown, gloves and shoe covers

Ebola

S/sx: frontal and temporal headache, malaise, myalgia, nausea, vomiting, fever, conjunctivitis, watery diarrhea (3 rd day), lethargy, nonpruritic maculpapular rash, desaquammation, hemorrhagic manifestations (5 th day)

Dx: history

Symptomatic intervention

Report suspected EBOLA case

Health workers = advised to wear cap, goggles, mask, gown, gloves and shoe covers

Bird Flu ZOONOTIC Avian influenza, virus Occur naturally among birds (intestines) but some types very contagious among birds Influenza A (H5N1) virus– deadly to birds and has caused human illness and death in Asia Person to person transmission rare

Avian influenza, virus

Occur naturally among birds (intestines)

but some types very contagious among birds

Influenza A (H5N1) virus– deadly to birds and has caused human illness and death in Asia

Person to person transmission rare

Bird Flu MOT: saliva, nasal secretions, and feces direct contact with infected waterfowl or other infected poultry contact with surfaces (such as dirt or cages) or materials (such as water or feed) contaminated with virus

MOT:

saliva, nasal secretions, and feces

direct contact with infected waterfowl or other infected poultry

contact with surfaces (such as dirt or cages) or materials (such as water or feed) contaminated with virus

Bird Flu S/sx: Influenza-like symptoms Fever, Cough, sore throat, muscle aches, eye infections, Pneumonia Mgmt: * resistant to amantadine and rimantadine – comon influenza drugs * oseltamavir and zanamavir - under study

Bird Flu

S/sx: Influenza-like symptoms

Fever, Cough, sore throat,

muscle aches, eye infections,

Pneumonia

Mgmt:

* resistant to amantadine and rimantadine – comon influenza drugs

* oseltamavir and zanamavir - under study

Foot and Mouth Disease ZOONOTIC Aphthovirus Hosts - cattle, buffaloes, sheep, goats, swine IP: 2-4 days MOT: contact w/ infected animals Ingestion of unprocessed milk or dairy products from infected animals Humans act as transmitter to animals Harbor virus in respiratory tract for 1-2 days Contaminated boots, clothing, vehicles Spread to susceptible animals

Aphthovirus

Hosts - cattle, buffaloes,

sheep, goats, swine

IP: 2-4 days

MOT: contact w/ infected animals

Ingestion of unprocessed milk or dairy products from infected animals

Humans act as transmitter to animals

Harbor virus in respiratory tract for 1-2 days

Contaminated boots, clothing, vehicles

Spread to susceptible animals

Foot and Mouth Disease s/sx: Very rarely develop mild clinical signs malaise, fever, vomiting, red ulcerative lesions of oral tissues, vesicular lesions skin Dx: Virus isolation or antibody identification required for diagnosis Mgmt: supportive care

Foot and Mouth Disease

s/sx: Very rarely develop mild clinical signs

malaise, fever, vomiting, red ulcerative lesions of oral tissues, vesicular lesions skin

Dx: Virus isolation or antibody identification required for diagnosis

Mgmt: supportive care

Infectious Mononucleosis 3 hallmarks fever sore throat swollen cervical lymph nodes (+) heterophil antibodies No major complications Self limiting “ Kissing Disease” Incubation period is 10-50 days

3 hallmarks fever sore throat swollen cervical lymph nodes

(+) heterophil antibodies

No major complications

Self limiting

“ Kissing Disease”

Incubation period is 10-50 days

EBV Caused by EBV epstein-barr virus Or cytomegalovirus Lodges in the salivary glands Spread via oropharyngeal route Kissing (intimate) Contagious before symptoms start until fever subsides

Caused by EBV epstein-barr virus

Or cytomegalovirus

Lodges in the salivary glands

Spread via oropharyngeal route

Kissing (intimate)

Contagious before symptoms start until fever subsides

EBV Virus invades the B cells of lymphoid tissue As the B cells die virus is released in the blood Causing fever and other symptoms Antiviral antibodies in the blood fights the virus They disappear in the blood and lodges in to the salivary glands

Virus invades the B cells of lymphoid tissue

As the B cells die virus is released in the blood

Causing fever and other symptoms

Antiviral antibodies in the blood fights the virus

They disappear in the blood and lodges in to the salivary glands

EBV Diagnostic WBC count abnormally high (+) heterophil antibodies Indirect immunoflourescent (+) EBV (specific)

Diagnostic WBC count abnormally high (+) heterophil antibodies Indirect immunoflourescent (+) EBV (specific)

EBV Management Symptomatic ASA Steroids

Management

Symptomatic

ASA

Steroids

Gas Gangrene Clostridium perfringens welchii novyi Deep wound (bronzed or blackened wound) Necrosis of muscle tissue Pain and Anemia

Clostridium perfringens welchii novyi

Deep wound (bronzed or blackened wound)

Necrosis of muscle tissue

Pain and Anemia

Gas Gangrene CS Incision and Drainage Debridement Hyperbaric oxygenation Amputation SEPSIS

CS

Incision and Drainage

Debridement

Hyperbaric oxygenation

Amputation

SEPSIS

Anthrax (Zoonotic) Bacillus anthracis (gram negative) Cattle, sheep, goat and pig Biological weapons

Bacillus anthracis (gram negative)

Cattle, sheep, goat and pig

Biological weapons

Anthrax Inhalation- URTI-fever-3-5 days-lower infection (alveoli)-metabolic acidosis-hypoxia GIT- ingestion of contaminated carcasses-severe gastroenteritis-bloody stools-perforation-peritoniitis-septicemia Skin- most common-direct/indirect-itchiness-papule-vesicle-depressed black eschars-painless-septicemia-death

Anthrax

Inhalation- URTI-fever-3-5 days-lower infection (alveoli)-metabolic acidosis-hypoxia

GIT- ingestion of contaminated carcasses-severe gastroenteritis-bloody stools-perforation-peritoniitis-septicemia

Skin- most common-direct/indirect-itchiness-papule-vesicle-depressed black eschars-painless-septicemia-death

Lyme Disease Named for the Connecticut town, 1975 Appears in summer or early fall Skin lesion “ erythema chronicum migrans ” Cardiac, neurologic, arthritis (complications)

Named for the Connecticut town, 1975

Appears in summer or early fall

Skin lesion “ erythema chronicum migrans ”

Cardiac, neurologic, arthritis (complications)

Lyme Disease Caused by spirochete borrelia burgdorferi Carried by “deer ticks” Tick injects spirochete-laden saliva into the blood stream or deposits fecal matter on the skin Spirochetes disseminate to other skin sites or travel into the blood stream and lymphatic system

Caused by spirochete borrelia burgdorferi

Carried by “deer ticks”

Tick injects spirochete-laden saliva into the blood stream or deposits fecal matter on the skin

Spirochetes disseminate to other skin sites or travel into the blood stream and lymphatic system

Lyme Disease Signs and symptoms may take years to fully develop Stage 1 = site, red lesion, it may itch, sting or burn lesion has white center, bright red outer rim rash is accompanied with fatigue, headache, chills, fever, sore throat and muscle joint pain severe headache may suugest meningeal irritation

Signs and symptoms may take years to fully develop

Stage 1 = site, red lesion, it may itch, sting or burn lesion has white center, bright red outer rim rash is accompanied with fatigue, headache, chills, fever, sore throat and muscle joint pain severe headache may suugest meningeal irritation

Lyme Disease Stage 2 = meningitis and cranial nerve palsy also cardiac symptoms may appear extreme neck flexion Stage 3 = Chronic arthritis Note: may change the behavior, depression and psychosis

Stage 2 = meningitis and cranial nerve palsy also cardiac symptoms may appear extreme neck flexion

Stage 3 = Chronic arthritis

Note: may change the behavior, depression and psychosis

Lyme Disease Diagnostic antibody titer ELISA Western Blot IgM AST WBC ESR

Diagnostic antibody titer ELISA Western Blot IgM AST WBC ESR

Lyme Disease Management 14-28 day oral tetracycline or doxycycline Children – oral Penicillin Late stage: IV or IM antibiotics symptomatic

Management

14-28 day oral tetracycline or doxycycline

Children – oral Penicillin

Late stage: IV or IM antibiotics

symptomatic

Toxoplasmosis (Zoonotic) Toxoplasma gondii Affecting birds and mammals Transmitted to humans by ingestion of uncooked meat and fecal oral route from infected cats (feces) Quickly multiply in the GIT Disseminate to the CNS, lymphatic tissue, skeletal muscle, myocardium, retina and placenta

Toxoplasma gondii

Affecting birds and mammals

Transmitted to humans by ingestion of uncooked meat and fecal oral route from infected cats (feces)

Quickly multiply in the GIT

Disseminate to the CNS, lymphatic tissue, skeletal muscle, myocardium, retina and placenta

Toxoplasmosis Malaise, fever, myalgia, headache, fatigue and sore throat Fulminant = vomiting, cough and dyspnea, hyperpyrexia, delirium and seizures Infants = hydrocephalus and microcephalus, seizure, jaundice later strabismus, blindness, epilepsy, mental retardation Infected person may carry the organism for life (reactivation is possible)

Malaise, fever, myalgia, headache, fatigue and sore throat

Fulminant = vomiting, cough and dyspnea, hyperpyrexia, delirium and seizures

Infants = hydrocephalus and microcephalus, seizure, jaundice later strabismus, blindness, epilepsy, mental retardation

Infected person may carry the organism for life (reactivation is possible)

Toxoplasmosis Management 4-6 weeks of sulfonamide and pyrimethamine (take folic acid to counteract drug’s adverse effects)

Management

4-6 weeks of sulfonamide and pyrimethamine (take folic acid to counteract drug’s adverse effects)

Ebola and Marburg Viruses (Zoonotic) Filoviruses, 1960 Biological weapons Extreme virulence Reservoir not yet confirmed Exposure to unrecognized host Insect bites Asia and Africa (animals)

Filoviruses, 1960

Biological weapons

Extreme virulence

Reservoir not yet confirmed

Exposure to unrecognized host

Insect bites

Asia and Africa (animals)

Ebola MOT not known Diagnosis = febrile and hemorrhagic fever from Asia and Africa (travellers) Health workers = advised to wear cap, goggles, mask, gown, gloves and shoe covers

MOT not known

Diagnosis = febrile and hemorrhagic fever from Asia and Africa (travellers)

Health workers = advised to wear cap, goggles, mask, gown, gloves and shoe covers

Ebola Rapid onset of symptoms profound hemorrhage organ failure and shock 90% mortality, recovery is often prolonged No known antiviral drugs Symptomatic intervention Report suspected EBOLA case

Rapid onset of symptoms profound hemorrhage organ failure and shock

90% mortality, recovery is often prolonged

No known antiviral drugs

Symptomatic intervention

Report suspected EBOLA case

Bird Flu (Zoonotic) Avian influenza Infection caused by avian (bird) influenza (flu) viruses. Occur naturally among birds Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Avian influenza

Infection caused by avian (bird) influenza (flu) viruses.

Occur naturally among birds

Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them

However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Bird Flu MOT = saliva, nasal secretions, and feces direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.

MOT = saliva, nasal secretions, and feces

direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.

Bird Flu Low and high extremes of virulence The “low pathogenic” form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production) The highly pathogenic form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100% often within 48 hours.

Low and high extremes of virulence

The “low pathogenic” form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production)

The highly pathogenic form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100% often within 48 hours.

Bird Flu Human infection with avian influenza viruses There are many different subtypes of type A influenza viruses. These subtypes differ because of changes in certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 known HA subtypes and 9 known NA subtypes of influenza A viruses. Many different combinations of HA and NA proteins are possible. Each combination represents a different subtype. All known subtypes of influenza A viruses can be found in birds.

Human infection with avian influenza viruses

There are many different subtypes of type A influenza viruses. These subtypes differ because of changes in certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 known HA subtypes and 9 known NA subtypes of influenza A viruses. Many different combinations of HA and NA proteins are possible. Each combination represents a different subtype. All known subtypes of influenza A viruses can be found in birds.

Bird Flu Usually, “avian influenza virus” refers to influenza A viruses found chiefly in birds Infections with these viruses can occur in humans The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997 Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds The spread of avian influenza viruses from one ill person to another has been reported very rarely, and transmission has not been observed to continue beyond one person.

Usually, “avian influenza virus” refers to influenza A viruses found chiefly in birds

Infections with these viruses can occur in humans

The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans

However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997

Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds

The spread of avian influenza viruses from one ill person to another has been reported very rarely, and transmission has not been observed to continue beyond one person.

Bird Flu “ Human influenza virus” usually refers to those subtypes that spread widely among humans. There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans. It is likely that some genetic parts of current human influenza A viruses came from birds originally. Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans.

“ Human influenza virus” usually refers to those subtypes that spread widely among humans.

There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans.

It is likely that some genetic parts of current human influenza A viruses came from birds originally.

Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans.

Bird Flu During an outbreak of avian influenza among poultry, there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds.

During an outbreak of avian influenza among poultry, there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds.

Bird Flu Influenza-like symptoms Fever Cough sore throat muscle aches eye infections Pneumonia severe respiratory diseases

Influenza-like symptoms

Fever

Cough

sore throat

muscle aches

eye infections

Pneumonia

severe respiratory diseases

Bird Flu Avian Influenza A (H5N1) Avian influenza A (H5N1) in Asia and Europe Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them.

Avian Influenza A (H5N1)

Avian influenza A (H5N1) in Asia and Europe

Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them.

Bird Flu Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control. Since late June 2004, however, new outbreaks of influenza H5N1 among poultry were reported by several countries in Asia (Cambodia, China [Tibet], Indonesia, Kazakhstan, Malaysia, Mongolia, Russia [Siberia], Thailand, and Vietnam). It is believed that these outbreaks are ongoing. Influenza H5N1 infection also has been reported among poultry in Turkey and Romania and among wild migratory birds in Croatia.

Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control. Since late June 2004, however, new outbreaks of influenza H5N1 among poultry were reported by several countries in Asia (Cambodia, China [Tibet], Indonesia, Kazakhstan, Malaysia, Mongolia, Russia [Siberia], Thailand, and Vietnam). It is believed that these outbreaks are ongoing. Influenza H5N1 infection also has been reported among poultry in Turkey and Romania and among wild migratory birds in Croatia.

Bird Flu Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, and Vietnam. For the most current information about avian influenza and cumulative case numbers

Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, and Vietnam. For the most current information about avian influenza and cumulative case numbers

Bird Flu Human health risks during the H5N1 outbreak H5N1 virus does not usually infect people, but more than 130 human cases have been reported by the World Health Organization since January 2004. Most of these cases have occurred as a result of people having direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 have occurred.

Human health risks during the H5N1 outbreak

H5N1 virus does not usually infect people, but more than 130 human cases have been reported by the World Health Organization since January 2004. Most of these cases have occurred as a result of people having direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 have occurred.

Bird Flu No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.

No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.

Bird Flu Treatment and vaccination for H5N1 virus in humans The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies still need to be done to demonstrate their effectiveness.

Treatment and vaccination for H5N1 virus in humans

The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies still need to be done to demonstrate their effectiveness.

Bird Flu Treatment and vaccination for H5N1 virus in humans There currently is no commercially available vaccine to protect humans against H5N1 virus that is being seen in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way.

Treatment and vaccination for H5N1 virus in humans

There currently is no commercially available vaccine to protect humans against H5N1 virus that is being seen in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way.

Foot and Mouth Disease (Zoonotic) Picornaviridae, genus Aphthovirus One of the most contagious animal diseases, with important economic losses Low mortality rate in adult animals, but often high mortality in young due to myocarditis

Picornaviridae, genus Aphthovirus

One of the most contagious animal diseases, with important economic losses

Low mortality rate in adult animals, but often high mortality in young due to myocarditis

Foot and Mouth Disease Hosts Bovidae (cattle, zebus, domestic buffaloes, yaks), sheep, goats, swine, all wild ruminants and suidae. Camelidae (camels, dromedaries, llamas, vicunas) have low susceptibility

Hosts

Bovidae (cattle, zebus, domestic buffaloes, yaks), sheep, goats, swine, all wild ruminants and suidae. Camelidae (camels, dromedaries, llamas, vicunas) have low susceptibility

Foot and Mouth Disease Transmission Direct or indirect contact (droplets) Animate vectors (humans, etc.) Inanimate vectors (vehicles, implements) Airborne, especially temperate zones (up to 60 km overland and 300 km by sea)

Transmission

Direct or indirect contact (droplets)

Animate vectors (humans, etc.)

Inanimate vectors (vehicles, implements)

Airborne, especially temperate zones (up to 60 km overland and 300 km by sea)

Foot and Mouth Disease Sources of virus Incubating and clinically affected animals Breath, saliva, faeces, and urine; milk and semen (up to 4 days before clinical signs) Meat and by-products in which pH has remained above 6.0 Carriers: particularly cattle and water buffalo; convalescent animals and exposed vaccinates (virus persists in the oropharynx for up to 30 months in cattle or longer in buffalo, 9 months in sheep). African Cape buffalo are the major maintenance host of SAT serotypes

Sources of virus

Incubating and clinically affected animals

Breath, saliva, faeces, and urine; milk and semen (up to 4 days before clinical signs)

Meat and by-products in which pH has remained above 6.0

Carriers: particularly cattle and water buffalo; convalescent animals and exposed vaccinates (virus persists in the oropharynx for up to 30 months in cattle or longer in buffalo, 9 months in sheep). African Cape buffalo are the major maintenance host of SAT serotypes

Foot and Mouth Disease Occurrence FMD is endemic in parts of Asia, Africa, the Middle East and South America (sporadic outbreaks in free areas) Incubation Period 2-14 days

Occurrence

FMD is endemic in parts of Asia, Africa, the Middle East and South America (sporadic outbreaks in free areas)

Incubation Period

2-14 days

Foot and Mouth Disease PREVENTION AND CONTROL Sanitary prophylaxis Protection of free zones by border animal movement control and surveillance Slaughter of infected, recovered, and FMD-susceptible contact animals Disinfection of premises and all infected material (implements, cars, clothes, etc.) Destruction of cadavers, litter, and susceptible animal products in the infected area Quarantine measures ( Code Chapter 2.1.1.)

PREVENTION AND CONTROL

Sanitary prophylaxis

Protection of free zones by border animal movement control and surveillance

Slaughter of infected, recovered, and FMD-susceptible contact animals

Disinfection of premises and all infected material (implements, cars, clothes, etc.)

Destruction of cadavers, litter, and susceptible animal products in the infected area

Quarantine measures ( Code Chapter 2.1.1.)

Foot and Mouth Disease PREVENTION AND CONTROL Medical prophylaxis Inactivated virus vaccine containing an adjuvant. Immunity: 6 months after two initial vaccinations, 1-month apart, depending on the antigenic relationship between vaccine and outbreak strains

PREVENTION AND CONTROL

Medical prophylaxis

Inactivated virus vaccine containing an adjuvant. Immunity: 6 months after two initial vaccinations, 1-month apart, depending on the antigenic relationship between vaccine and outbreak strains

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