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  • 1. COMMUNICABLEDISEASEINCUBATIONPERIODCAUSATIVE AGENT MODE OFTRANSMISSIONPORTAL OF ENTRYAND EXITTREATMENTSCentral Nervous SystemBacterialTetanus(Lock jaw)3 days to 3 weeks inadult3 to 30 days innewbornClostridium Tetani ThroughpuncturedwoundsUmbilical stumpof the newbornDental extractionBabies deliver tomother withouttetanus toxoid.Unrecognizedwounds (cleaningof the ears withsharp materials.ENTRY: when clostridiumtetani enters the body itcauses local infection andextensive tissue destructionand local multiplication ofmicroorganism morefrequently when the woundwas healed.EXIT: which an infectiousagent leaves the reservoir.May be continuous such aswith respiratory droplet ordependent on the body fluidexiting the body underunusual circumstances1)SPECIFIC- w/in 72 hours after puncturedwound patient should receiveATS,TAT-T.T 5cc IM given on standardprecaution-pen G Na2)NON-SPECIFIC- oxygen inhalation- NGT feeding-tracheostomy- adequate fluid, electrolyte andcaloric intake- good nursing careMeningitis(Cerebrospinal fever)1 – 10 days Neisseria meningitidis Respiratory dropletsthroughnasopharyngealmucosaDirect invasionthrough otitis mediaSkull fracture andpenetrating woundENTRY:- nasal secretions- buccal secretionsEXIT:- direct contact- droplet spray- droplet nucleiIV antibiotics – ampicillin,cephalosporin (ceftriaxone),aminoglycosidesDigitalis glycosides(digoxin) – for arrhythmiasManitol – to dec. cerebraledemaAnticonvulsant or sedatives– to reduce restlessness andconvulsionsAcetaminophen – forheadache and feverViralEncephalitis(Brain Fever)Typically 5 to 15days but may ranges4-21 days.Arboviruses -Transmitted to human bythe bite of an infectedmosquito.--Mosquito becomesinfected by biting aninfected bird.ENTRY:Skin mucosa or membraneEXIT:Respiratory tract(nose or mouth)Promote comfort to theclientMonitor intake andoutput.Convulsion must becontrolled.
  • 2. Nose and throatsecretions should besanitary disposed off.TSB or alcohol spongemay be given iftemperature isexcessively high.Oral care should bedone strictly.Poliomyelitis( InfantileParalysis/Heine MedinDisease)7-21 days forparalytic casePolio Virus3 strains:1.) Leon2.) Lansing3.) BrunhildeDirect Contact –through feces,oropharyngealPerson to personthrough healthycarrierIndirectly throughfood and waterENTRY:Oropharyngeal MucosaIntestinal MucosaEXIT:Fecal/ OralSUPPORTIVE MEASURES:Analgesics forheadacheAntibiotics to preventinfectionRabies(Hydrophobia/ Lyssa)1 week – 7 ½months in dogs10 days – 15years in humanA bullet-shapedfilterable virus calledRhabdovirusThe most common modeof rabies virustransmission is through thebite and virus-containingsaliva of an infected host.ENTRY: through openwounds and mucousmembrane such as eyes, nose,and mouth contaminated withsaliva containing the virus.EXIT: salivary glandssecretionImmediate and thoroughcleaning of the wound withsoap, followed by ethanolor aqueous iodine.Postexposure prophylaxis(PEP) if required:administration of rabiesimmunoglobulin in case ofsevere exposurePEP to be applied as soonas possible – vaccines witha potency at least 2.5 IU persingle immunizingintramuscular doseImmunize all dogs and catsowned by an individual orby the community andreduce the size of theownerless dog populationby reproduction control,reduction of the carryingcapacity of the environment
  • 3. and law inforcement whenneededImmunize any person withproven or probableexposure to rabies andadminister rabiesimmunoglobulin in case ofsevere exposureHumans at high risk (e.g.laboratory personnel,professions at high risk)must receive pre-exposureimmunization: 3 injectionsof an intramuscular dose ondays 0, 7, and 28.Circulatory SystemViralDengue Fever(Breakbonefever/HemorrhagicFever,InfectiousThrombocytopeniaPurpura)3-14 days commonly7-10 days-Flavivirus 1,2,3,4 ;afamily of Rogaridae- Arboviruses group b-Aedes aegypti, A.albopictusBite of an infectedmosquito principallythe Aedes Aegypti.Aedes Albopictusmainly contribute tothe transmission ofthe dengue virus inrural areas.Other contributorymosquitoesa.Aedes Polynensisb.ScutellarisENTRY:- Deposited in theskin by the vector.EXIT:- An infected personis bitten by amosquito; this is theportal of exit. Themosquito now hasthe dengue virus inits system and afterabout a week theinfected mosquito iscapable of spreadingthe virus to anotherpersonAnalgesics drugs rather thanAspirin.Intravenous InfusionBlood TransfusionOxygen TherapySedativesMalaria  P. falciparum: 12Days P. vivax and P.ovale: 14 Days P. malariae: 30DaysA. Protozoa of genusPlasmodia4 Species of Protozoa:1. Plasmodiumfalciparum(MalignantTertain)1. Mechanically throughbite of an infectedfemale Anophalesmosquito2. Parenterally throughblood transmission3. Through sharedcontaminated needlesENTRY: The infected cellswill be circulated in the bodythrough the blood stream orblood.EXIT: Skin through femaleAnophales mosquito bite. Anti malarial drugs: Choloroquine (all speciesexcept P. malariae) Quinine as for resistant of P.falciparum Primaquine for relapses ofP. vivax and ovale
  • 4. 2. Plasmodium vivax(Benign Tertain)3. Plasmodiummalariae (Quartan)4. Plasmodium ovaleB. The primary vectorof malaria is thefemale Anophelesmosquito.4. Through placentaltransmission Erythrocyte exchangetransfusion for rapidproduction of high levels ofparasites in the blood.Filariasis(Elephantiasis)8 to 16 months Wuchereria aAs& lymphvessels of thelegs, arms, vulva& breasts.Brugia malayi-withmanifestation ofswelling ofextremities, belowknees & belowelbows.Brugia timori-affects genitals.Loa loa-another filarialparasite inhumanstransmitted bydeer fly1. Person to person bymosquito bites2. Persons havingcirculatingmicrofilariae areoutwardly health buttransmit the infectionto others throughmosquito bites3. Persons with chronicfilarial swellings4. In India, 99.4% ofcases caused byWuchereria bancrofti,Brugia amalayiENTRY: Skin by mosquitobite1. Invermectin,albendazole ordiethylcarbamazine(DEC)Treatment act by:a. Eliminating thelarvaeb. Impairing the adultworms ability toreproduce &c. Actually killing theadult wormIntegumentary SystemMeasles(Rubeolla/Morbili)Usually 10 to 12days.Longest is 20 daysand shortest is 8days.Filtrable Virus whichbelongs to the genusMorbilivirus of thefamilyparamyxoviridae.Through directcontact withdroplets spreadthrough coughingor sneezing.Indirectly througharticles or fomitesfreshlyENTRY:-Respiratory tract-DropletsEXIT:-Respiratory secretions-Genitourinary-TransplacentalAnti-viral Drugs(Isoprinosine)Antibiotics if there’s acomplication.Supportive TherapyOxygen inhalation
  • 5. contaminatedwith Respiratorysecretions orinfected patients.IV FluidsGerman Measles(Rubella/Three-dayMeasles)Usually 14-21 days(from exposure to theappearance of therashes)Rubella virus(Family: TogaviradaeGenus: Rubivirus)•Direct contact withnasopharyngeal secretions•Indirect contact•Transplacentaltransmission in congenitalrubella•Contact in pharyngealsecretions and urine frominfants with congenitalrubellaENTRY: Respiratory tractEXIT: Respiratory tracta. Treatment is essentialsymptomatic.Chicken Pox 10-21 days or may beprolonged afterpassive immunizationagainst chicken poxVaricella 1. Direct contact with apatient who sheds thevirus from thevesicles2. Indirect contact,through linens orfomites3. Airborne, or spreadby aerosolizeddroplets from thenasopharynx of illindividualsPortal of EXIT: sneezingPortal of ENTRY: newlyinfected mouth1. Oral cyclovir 800 mg3x a day for 5 days2. Oral antihistamine3. Calamine lotion4. Salicylates5. Antipyretics6. AntihistamineHerpes zoster(Shingles/AcutePosterior Ganglionitis)Varicella-zoster Unknown, but isbelieved to be 13 to 17daysDirect contact,specifically throughdroplet infection andairborne spreadIndirect contactsuch as article freshlysoiled by secretionsand discharges from aninfected personENTRY-nasopharyngeal space andthe conjunctivaSymptomaticAntiviral drugsAnalgesics to controlpainAnti-inflammatoryLeprosy(Hansen’sdisease/Hansenosis)Mycobacteriumleprae5 ½ months to 8 years RespiratorydropletsInoculationthrough the skinbreak andmucousmembranesEXIT - skin and the nasalmucosaENTRY - skin and the upperrespiratory tracta therapyRehabilitation,recreational andoccupational therapyMultiple drug therapy(MDT)
  • 6. - Combinations ofrifampicin 600mggiven once amonth, a 50mgdaily for a 12month duration anda 100mg daily for aleprosy- For a leprosy, giverifampicin 600mgonce a month, aonce daily;duration oftreatment 6 months- Rifampicin is themost important anti– leprosy drugScabies Usually between 2 to6 weeks; can be aslittle as 1 to 4 days inpeople that have beensensitized by priorexposureSarcoptes scabiei Skin-to-skincontact withpersons carryingthe scabies miteLess often,scabies can betransmitted bysharing of clothesand beddingENTRY: SkinEXIT: Skin(Limited entirely to the skin)Examine the whole familybefore undertakingtreatmentBenzyl benzoate emulsion(Burroughs, Welcome) –cleaner to use and has morerapid effectKwella ointmentRespiratory SystemBacterialDiphtheria(Boulogne Sore Throat)Usually 2 to 5 days,occasionally longerCornybacteriumdiphtheriae(Klebs-Loeffler bacillus)Contact with a patient orcarrier or with articlessoiled with discharges ofinfected persons. Milk hasserved as a vehicleENTRY:Spread person to person viarespiratory droplets or skincontactEXIT:Respiratory droplets;aerosolized secretions ofinfected individualsAntitoxin - it neutralizescirculating diphtheria toxinand reduces the progressionof the disease.Antibiotics – such aspenicillin or erythromycin.Inserting a breathing tube(intubation)HospitalizationBed restIntravenous fluidsTracheotomyIsolation to avoid contagion
  • 7. Pertussis(Whooping Cough)The incubationperiod of Pertussis iscommonly 7–10days, with a range of4–21 days, and rarelymay be as long as42days.Bordetella pertussis 1. Transmission mostcommonly occurs by therespiratory route throughcontact with respiratorydroplets, or by contactwith airborne droplets ofrespiratory secretions.2. Transmission occursless frequently by contactwith freshly contaminatedarticles of an infectedperson.ENTRY:Respiratory tractEXIT:Respiratory tract1.Antibiotic effective againstpertussis (such as azithromycin,erythromycin or trimethoprim -sulfamethoxazole) should beadministered to all closecontacts of persons withPertussis, regardless of age andvaccination status.PneumoniaTypes of pneumonia:Community-acquiredpneumoniaHospital-acquiredpneumoniaHealth Care-AssociatedpneumoniaAspirationpneumoniaAtypicalPneumonia1-3 days StreptococcuspneumoniaRespiratory droplets fromthe nose or mouth of aninfected personRespiratory Tract -penicillin-ceftriaxone-antipseudomonalfluoroquinolones-antihistaminesOthers:-Hydration-Oxygen inhalation-Chest physiotherapy-nasal decongenstantsViralBird’s FluAvian Influenza3 daysranges of 2-4 daysA bird-adapted strain ofH5N1, called HPAI A(H5N1) for "highlypathogenic avianinfluenza virus of type Aof subtype H5N1", is thecausative agent of H5N1flu, commonly known as"avian influenza" or"bird flu".People mainly becomeinfected with avianinfluenza through closecontact with infected birdsand poultry (live or dead)or theirdroppings. Human-to-human transmission isinefficient.ENTRY:Faeco-oral route (amongsthuman or birds)Upper respiratory tractamong humansEXIT:Feces, saliva and nasalsecretions of infected birdsDifferent types of avian flu virusmay cause different symptoms.Therefore, treatment may vary.In general, treatment with theantiviral medication oseltamivir(Tamiflu) or zanamivir(Relenza) may make the diseaseless severe if you start taking themedicine within 48 hours afteryour symptoms start.
  • 8. Main upper respiratory tractamong humansOseltamivir may also beprescribed for persons who livein the same house as thosediagnosed with avian flu.The virus that causes humanavian flu appears to be resistantto the antiviral medicinesamantadine and rimantadine.Therefore these medicationsshould not be used if an H5N1outbreak occurs.People with severe infectionmay need to be placed on abreathing machine. Expertsrecommend that personsdiagnosed with avian flu be putin isolation.Doctors recommend that peopleget an influenza (flu) shot toreduce the chance of an avian fluvirus mixing with a human fluvirus, which would create a newvirus that may easily spread.The U.S. Food and DrugAdministration have approved avaccine to protect humans fromthe avian flu. Experts say thevaccine could be used if thecurrent H5N1 virus startsspreading between people.Influenza(Commonly known asFlu)1-4 days(average: 2 days)Influenza virus Direct transmission(when an infectedperson sneezes mucusdirectly into the eyes,nose or mouth of anotherperson)EXIT:Mucous secretionsENTRY: Respiratory System(mouth or nose)Flu Shot (annually)Bed RestFluidsAcetaminophen(Tylenol), or Ibuprofencan relieve head andmuscle aches. Aspirin
  • 9. Airborne route (whensomeone inhales theaerosols produced by aninfected personcoughing, sneezing orspitting)Hand-to-eye, hand-to-nose, or hand-to-mouthtransmission, either fromcontaminated surfaces orfrom direct personalcontact such as a hand-shake.should be avoided forchildren because it cancause Reyes SyndromeAntiviral drugs:Relenza and TamifluSARS (Severe acuterespiratory syndrome)OTHER NAME: SARScoronavirusSARS is usuallyfrom 2-7 days, butup to 10 days. A3-5 day incubationperiod is mostcommon Coronavirus The mode oftransmission is stillbelieved to be by dropletspread through closeperson to person contact.These droplets travel adistance of about 3 feetfrom the mouth or noseof an infected personduring talking, coughingor sneezing.SARS is spread by closeperson-to-personcontact. Close contactincludes having livedwith or cared for anindividual with SARSor having had directcontact with the bodyfluids or respiratorysecretions of anindividual infected withSARS.ENTRY: The portal of entry isthought to beinhalation or contactwith mucousmembranes and/orconjunctiva.EXIT: Respiratory route:Respiratory dropletSARS Treatment Generally speaking,treatment for SARSfocuses on providing reliefof symptoms andcomplications while thepatients body fights theSARS virus. Since there iscurrently no cure that cankill the virus, treatmentmay requirehospitalization forintensive supportive care,including providingpatients with IV fluids,medications, and breathingsupport.An Overview of TreatingSARS About 2 to 10 days afterthe SARS virus has
  • 10. Examples of closecontact:KissingHuggingSharing drinkingor eating utensilsDirectly touchinga SARS patientTalking to aSARS patientwithin three feetinfected a person, theperson may begindeveloping SARSsymptoms. There iscurrently no treatment thatcan kill the SARS virus.Therefore, treatment forSARS is focused onproviding relief ofsymptoms andcomplications as the bodyfights the SARS virus.Supportive CareSARS treatment requireshospitalization for intensivesupportive care. This supportivecare can include:Intravenous (IV) fluidsMedications, includingantibiotics, steroids, and/orantiviralsBreathing support from aventilatorPrevention of secondaryinfectionsGood nursing care.Gastrointestinal SystemTyphoid fever Salmonellae typhi Average 10–14-day Through the ingestion offood or drinkcontaminated by the faecesor urine of infected people.EXIT:>Respiratory secretion> Feces>Lesion, exudatesFluids and electrolytes may begiven through a vein(intravenously)Appropriate antibiotics are givento kill the bacteria
  • 11. 5 basic methods oftransmission:Flies.-Feces.-Food.-Fingers-Fornication.ENTRY:> Respiratory tract>Alimentary tract>Skin, genital membranesBroken skinBotulismThere are three forms ofbotulism :Classical botulismIntestinal botulismWound botulism- Classical botulismoccurs within 12–36hours (sometimesseveral days) aftereating contaminatedfood. The incubationperiod for infantbotulism is unknowndue to difficulty indetermining theprecise time ofingestion. Shorterincubation periodsare associated withmore severe diseaseand higher case-fatality ratesClostridium botulinuminfection (Group AdiseaseClassical botulism isacquired by ingestion ofinadequately cooked foodor processed orrefrigerated foods in whichtoxin has formed,particularly canned andalkaline foods.-wound botulism are dueto ground-in soil or gravel-Infant botulism arisesfrom ingestion of sporesrather than pre-formedtoxin. Sources of sporesinclude foods such ashoney and dust.Portal of Exit• Released throughMOUTH(vomiting), ANUS(feces) andsometimes eventhrough ourSWEAT.Portal of Entry:1. Mucus Membranes2. Skin3. ParentarelaIt is only food borne,airborne (ONLY when youinhale the toxin –bioterrorism) and infectiousin open wounds.-Trivalent botulinum antitoxin(types A, B, E) administered assoon as possible.Antitoxin is not used in infantbotulism due to the risk ofanaphylaxis. Antibiotics do notaffect the course of the disease.For wound botulism, inaddition to antitoxin the woundshould be debrided or drained,and appropriate antibioticprophylaxis against otherpotential infections should beadministered.Ascariasis(Roundworm Infection)The lifecycle requiresfour to eight weeks tocomplete. Ascariseggs areunsegmented whenpassed and require aperiod of two or threeweeks outside thehost to develop to theinfective stage.Mature femaleworms have beenestimated to producean average of 200000 eggs per day.(Ascaris lumbricoides) 1. Ascaris lumbricoidesis transmitted throughcontaminated fingersput into the mouth.2. Ingestion of food anddrinks contaminatedwith embryonatedeggs can transmitAscariasis.ENTRY:Ingestion ofcontaminated wateror with eating rawvegetables,especially if “nighsoil” is used as thefertilizer.Soil contaminatedwith human excretaContaminated food,water, and otherobject.Ingested tointestine1. Albendazole ormebendazole-15 cc as asingle dose.2. Piperazine citrate- 75mg/kgtwice daily, orally3. Pyrantel pamoate- 1mg/kgas a single dose, orally.
  • 12. EXIT:After 10 days, in thepulmonarycapillaries andalveoli, the larvamigrates to thebronchioles, tracheaand epiglottis.GITPenetrates the wallof the intestine(duodenum)Carried to thebloodstreamSome are carried tothe biliary tract.Amoebiasis(Amoebic Dysentery)The incubationperiod in severeinfection is threedays.In subacute andchronic form it lastsfor several months.In average cases theincubation periodvaries from three tofour weeksEntamoeba Histolytica1. Trophozoites/vegetative form Trophozoites arefacultativeparasites thatmay invade thetissues or may befound in theparasitizedtissues and liquidcolonic contents.2. Cyst Cyst is passedout with formedor semi-formedstools and areresistant toenvironmentalconditions. infective stage inthe cycle of E.1. The disease can bepassed from oneperson to anotherthrough fecal-oraltransmission.2. The disease can betransmitted throughdirect contact, throughsexual contact byorogenital, oroanal,and proctogenitalsexual activity.3. Through indirectcontact, the diseasecan infect humans byingestion of foodespecially uncookedleafy vegetables orfoods contaminatedwith fecal materialscontaining E.histolytica cysts.ENTRY:Oral RouteEXIT:Fecal Route1. Metronidazole (Flagyl)800mg TID X 5 days2. Tetracyline 250 mg every 6hours3. Ampicillin, quinolonessulfadiazine4. Streptomycin SO4,Chloramphenicol5. Lost fluid and electrolytesshould be replaced
  • 13. histolyticaDysentery, Bacillary(Shigellosis)-is an infectious diseaseof the intestinal tractcaused by bacteria ofthe genusShigella,whichiscommonlyafood-bornediseaseIt has a 1-4 dayincubation period andcan vary from 12hours to 6 days.-It is a contagiousinfection, occurs inepidemics and occursmore frequently inthe summer and fall.Shigella bacteria1. Shigelladysenteriae2. Shigellaflexneri3. Shigellasonnei:4. Shigella boydiifecal material of apatient/carrier-indirectly throughcontaminated food andwater.-Hand-to mouth transfer ofcontaminated material-via personal contact withsick persons and carriers- Transmission can alsooccurFrom person to personthrough certain types ofsexual contact (e.g., oral-anal contact).ENTRY:- Gastrointestinal-tractmucous membranesEXIT:- fecesNursing Management:-Observe isolationand enteric precaution-Provide health educationand instruct patient to-Boil water for drinking oruse purified water-Avoidwashingfoodfromopendrumorpail-Cover leftover food-Wash hands after defecationsand before eating-Avoid ground vegetables(lettuce, carrots, and the like-Treatment includes replacementof fluids and salts, low-residuediet and medications (ifindicated).-Increase fluid intake.-Use of a heating pad or hot-water bottle on the abdomenmay relieve pain-Hospitalization of persons(especially small children withdehydration) who are seriouslyill. Hospital care will includeisolation and intravenous fluidsupplements
  • 14. Medical Management:- Antibiotics may beprescribed. The currentantibiotics of choice are.Triimethoprim-sulfamethoxazole, ciprofloxacinand norfloxacin.-Antibiotics are indicated whenthe patient is very young, whenthe disease is very severe orwhen the spread of infection toother people is likely.-The severity of symptoms andthe length of time the stoolcontains Shigella can be reducedwith antibiotics.-Dont use paregoricpreparations or other anti-diarrhea drugs unless they areprescribed. Antispasmodics suchas tincture of belladonna arehelpful when cramps are severe.Drugs that inhibit intestinalperistalsis e.g. paregoric, mayameliorate symptoms butprolong fever, diarrhea andexcretion of Shigella in feces.Cholera One (1) – Five (5)days after ingestionof bacteria.Vibrio cholerae Indirect contact,transmitted by eithercontaminated food orwater.ENTRY:Indirect contact, transmittedby either contaminated foodor water.EXIT:Mouth, ingestion ofcontaminated food and water.Anus, feces affectswaterways, ground andOral Rehydration TherapyAntibiotics: Doxycycline,cotrimoxazole, erythromycin,tetracycline, chloramphenicol,and furazolidone.Electrolyte Replacements:Potassium Levels
  • 15. drinking water.Leptospirosis(Well’sDisease/CanicolaFever/HemorrhagicJaundice/ MudFever/Swine HerdDisease)The incubationperiod varies fromsix to fifteen days (6-15 days)A spirochete of thegenus Leptospira(Leptospirainterrogans)1. Leptospirosis istransmittedthrough ingestionor contact withthe skin ormucousmembranes of theinfected urine orcarcasses ofeither wild ordomestic animals.2. The disease canbe transmittedthrough themucousmembranes of theeyes, nose andmouth, andthrough thebreaks in theskin.3. Leptospira entersthe blood to causedamage, andthereafter in thekidneys, the liverand theconjunctivae.4. Leptospirosis canalso betransmitted by thesemen of infectedanimals.5. Leptospirosis iscommon amongwaters portenthusiasts incertain areas asprolongedimmersion inwater is known topromote the entryENTRY:Contact withcontaminated waterand soilEntry throughmouth and eyes.Broken skinEXIT:After the organismgains entrance intothe body, itmultiplies in thebloods, invades theliver that can resultto the presence ofjaundice.In kidneys, thepresence oforganism causesinflammation of thenephrons andtubular necrosis,resulting in renalfailure.Leptospira mayaffect the muscle,resulting in pain andsometimes edema.It also invades theeye, resulting inconjunctivitis.MEDICAL:A. Suppressing thecausative agentsB. Fighting possiblecomplications-Aetiotropic drugs-penicillin, doxycycline,ampicillin, amoxicillin.For prophylaxis,doxycycline 100 mgPO every 12 hours forone week-Peritoneal dialysis-Administration of fluidand electrolytes andblood as indicatedNURSING:A. Isolate the patientB. Urine should be exposedproperlyC. Darken the patient’s roomto decrease eye irritation.D. Observe meticulous skincare to ease pruritus.E. Keep client under closesurveillance.F. Keep homes cleanG. Eradicate cats and rodentsH. Provide health education onthe modes of transmissionI. Encourage to increase oralintake.
  • 16. of bacteria.6. Occupations atrisk includeveterinarians,slaughter houseworkers, farmersand sewerworker.7. Human to humantransmission israre.Schistosomiasis or(Bilharzia disease)Incubation period istypically 14–84days for acuteschistosomiasisFive species oftrematodes:1. Schistosomamansoni,2. S. japonicum3. S.haematobium4. S. intercalatum5. S. mekongiOccurs in freshwaterwhen intermediate snailhosts release infectiveforms of the parasite.People are infected bycontact with water whereinfected snails live.ENTRYpenetration of intact skin bycercariae stageEXITThe host exit by penetratingthe gut or bladder wall andbeing passed with host faecesor urine.-Drug treatment is the onlyway to reduce diseasesymptoms and improve thesituation of the patients. Drugsavailable are:-praziquantel: effective in asingle dose against all species-oxamniquine: effective in asingle dose, but only against S.mansoniHookworm Disease(Anyclostomiasis /Miner’s Disease /Egyptian Chlorosis)- a soil transmittedhelminthes infection- It is a parasiticroundworm thatburrows through theskin, moves through thebloodstream to thelungs, and finallymoves into theintestinal tract.2 - 8 weeks- Hookworm ovaappear in the stoolabout 4-6 weeks afterlarvae penetrate theskin.- Necatoramericanus- Ancylostomaduodenale- Ancylostomaceylanicum- Ancylostomabraziliense- Necator can only betransmitted throughpenetration of the skinwhereas Anclyostoma canbe transmittedpercutaneously, orally andprobably transplacental.- Accomplished directlythrough the skin of foot(ground itch).- Walking barefoot overcontaminated soil.- Through ingestion ofcontaminated drinkingENTRY:- skin- mucous membrane- bloodEXIT:- fecesNursing Management:- Personal hygiene should bemaintained.- Diet should be high in calories,high protein, vitamins andminerals.- Proper handling and disposalof patient excretions.- Health teaching for the clientabout the importance of goodhygiene, drinking of purified orwell-boiled drinking water.
  • 17. water or food.- Do not walk barefoot on thesoil or sand.- Do not touch the soil or sandwith your bare hands.- Improvement in sanitationmeasures, proper excretadisposalMedical Management:- Cure the infestation; treat thecomplications of anemia, and toimprove nutrition.- Parasite-killing medications(Mebendazole, Albendazole)- Pyrantel Pamoate - orally, 1 - 3days- Iron supplement - to correctanemiaRed Tide(Parasitic shellfishpoisoning)30 minutes to severalhours after ingestionDinoflagellates  Ingestion of rawof inadequatecooked seafoodusually bivalvemollusks duringred tide seasonENTRY: Oral Respiratory dropletsEXIT:vomitusNo definite treatmentInduce vomitingDrink pure coconutmilk- weakens the toxiceffectSodium bicarbonatesolution(25 grams in ½glass of water)Mumps/ Infectious DiseasesMumps(Epidemic Parotitis)From 12-26 days,usually 18 daysMumps virus, a memberof the familyParamyxomviridae spread by directcontact with aperson who hasthe disease by contact withthe articles inhis/her immediateENTRY: Respiratory tractEXIT: NasopharyngealsecretionsProphylactic:activeimmunization of patientagainst mumpsActive treatment: casesbefore the age of pubertyrequires little attentionAfter the age of puberty:
  • 18. environmentwhich havebecome freshlysoiled withsecretion fromnasopharynx-should remain in bed restuntil all fever and swellinghave been absent for at least4 days because of the dangerof glandular complicationsIn males:-scrotum should be supportedby a properly fittedsuspensory, pillow, or asling between the thighs tominimize danger of orchitis-Sedatives to relieve pain iforchitis occursImmediate oral dose ofCortisoneSoft or liquid diet astolerated. Sour food or fruitjuices are disliked becauseof the burning or stingingsensation they elicit.Sexually Transmitted DiseasesVaginal InfectionBacterial Vaginosis(Non-specific Vaginitis)There is noincubation period forbacterial vaginosis.The bacterium thatcauses it is alwayspresent in the vaginain small amounts.Gardnerella vaginalis Sexual contact to MultiplepartnersENTRY:GenitalsEXIT:Genitals1. Metronidazole2. ClindamycinCandidiasis(Moniliasis, yeastinfection )Typically 7 to 10daysCandida albicans Sexual contact ENTRY: mucous membraneEXIT: mucous membrane- Miconazole nitratevaginally- Other antifungal drugsTrichomoniasis alsocalled "trich"If symptoms appear,it usually takes from3 to 28 days for themto develop.Trichomonas vaginalis  Spread throughsexual contact Transmission canoccur even if aperson does nothave symptomsof infection. Women contracttrichomoniasisfrom infectedPORTAL OF ENTRY: Urethra and vaginaPORTAL OF EXIT: vagina ,vulva,urethra Antibiotics -Metronidazole 500mg2-3 times a day for 7-10days. It is important thatboth partners aretreated at the same timebecause an infectedman, even a man whohas never had
  • 19. male or femalepartners whilemen usuallycontract it onlyfrom femalepartners Using condomsand/or dentaldams providesome protection.Their use isstronglyencouraged, butis not 100%safe. Trichomoniasiscan also surviveon infectedobjects likesheets, towels,and underwearand could betransmitted bysharing them.symptoms or whosesymptoms havestopped, can continueto infect a femalepartner until he hasbeen treated. Should avoid sex untilthey and their sexpartners havecompleted thetreatment.Infection of the External GenitaliaGenital Herpes(Herpes Genitalis)6-8 daysIn some cases, it canbe as short as 1 day-26 days.HSV-1 (Herpessimplex virus1)HSV-2(Herpessimplex virus2)Direct contactSexual intercourse Oral sex Anal sex Vaginal sexENTRY:Skin (genital area)EXIT:Skin (genital area)Genital herpes cannot be cured.However, some drugs that canshorten outbreaks and makethem less severe or even stopthem from happening. These are:acyclovir,valacyclovirfamciclovir.Genital Warts(Condylomaacuminatum or venerealwarts)6 weeks – 3 monthsHuman papillomavirus(HPV)-Sexually transmitted-direct skin-to-skin contactduring oral, genital, oranal sex with an infectedpartner.ENTRY:SkinEXIT:Skin-Topical agents includepodofillox or podophyllin,which have serious side effectsand are contraindicated duringpregnancy.-Cryotherapy destroys genitalwarts by freezing them withliquid nitrogen.-Electrocautery removes genitalwarts on the penis, vulva, oraround the anus by burning them
  • 20. with a low-voltage electrifiedprobe.-Laser Treatment-Photodynamic Therapy-Cantharidin effective againstsome warts those are resistant toother treatments.Urogenital InfectionsClamydiaa( Silent Epidemic)1-3weeks ChlamydiaTrachomatisThe transmission ofchlamydia occurs duringvaginal, anal, or oral sex.Transmission can alsooccur from an infectedmother to her baby duringvaginal childbirth.ENTRY:Enters the body throughabrasions or lacerationsand infects cells of theconjunctiva or cellslining various mucousmembranes-Culture of tissue from:Female endocervix andurethraMale urethraTest for antibodies toChlamydiaPolymerase chain reaction(PCR) or Ligase Chainreaction (LCR)Antibiotics:tetracyclinerthyromicinazithromycin-Avoid having any sexualactivity during chlamydiatreatment.-Tell your sexual partners sothat they can receivetreatment for chlamydia,too.-See your doctor if yoursymptoms do not disappearwithin one to two weeksafter finishing the medicine.-See your doctor withinthree to four months forchlamydia testing,especially if your sexpartner was not treated or ifyou have a new sex partner.Gonnorhea(The clap)2 – 5 daysRange: 2 – 14 daysNeisseria gonorrhoeae Contact with exudates(inflammatory fluid -a.pus) from infected personusually as a result ofsexual activity throughEXIT: GenitourinaryENTRY: Mucousmembranes of genitalia1. Injectable ceftriaxone- Typically give incombination with:either azithromycin or doxycycline.
  • 21. vaginal, oral, or anal sex. 2. QuinolonesSyphilis(Great imitator)The averageincubation period ofis 21 daysThe causative agentspirochete bacteriumTreponema palladium1. Contact with openlesion of infectedperson: common modeof infection is venerealinfection by sexualcontact and kissing(Atentiona! theinfection in thesecondary stage reachthe mucous of themouth).2. Exposure to infectedblood by:-using bloodcontaminated syringesand needles forinoculation ofmedicines or takingblood sample or byintravenous drugabuse.-blood transfusionwithout precaution.Professional exposureof medical andparamedical andlaboratory workers tinfected blood.3. Congenital Infection"inutero infection":transplacental infectionfrom the 4th month ofpregnancy to the end ofdelivery.4. Contaminatedarticles andfomites::towels,clothing, drinking, cupsENTRY: the organism entrytransmissible by kissing neara lesion, as well as oral,vaginal, and anal sex.EXIT: the organisms exit inexudates of skin and mucousmembrane lesions, bloodand body fluids.Primary and secondarysyphilis: penicillin Gbenzathine, intramuscular singledose.Doxycycline is use if the patientis allergy to penicillin.
  • 22. and others arepotentiallyinfectious but their roleis minor.Period of Infectivity:Untreated cases areinfectious during theprimary and secondarystages of disease ofvaried period, usually2-4 years.Pelvic InflammatoryDisease (PID)This varies. It can bemonths, even yearsafter the infection ofan STD.Sexually transmitteddiseases bacteria such aschlamydia andgonorrhea.Transmitted throughsexual contact and otherbodily secretions.Exit: GenitourinaryEntrance: Mucousmembranes of genitalia1. Antibiotic therapy2. Treat the person includingthe partners to prevent thespread of infection.3. Pain medication and IVfluids if needed.Humanimmunodeficiencyvirusinfection / acquiredimmunodeficiencysyndrome(HIV/AIDS)Humanimmunodeficiencyvirus (HIV)Retrovirus (Lentivirus)“SlowViruses”The period betweeninfection and theappearance of AIDS cantake from 7 to 12 years.HIV infection can lastfrom about three years toover 20 years (onaverage, about eightyears).1. Sexual transmission. Itcan happen when there iscontact with infectedsexual secretions (rectal,genital or oral mucousmembranes). This canhappen while havingunprotected sex, includingvaginal, oral and anal sexor sharing sex toys withsomeone infected withHIV.2. Blood Transfusion andsharing of infectedsyringes and needlesamong Intravenous drugusers. The risk oftransmitting HIV throughblood transfusion isnowadays extremely lowin developed countries,thanks to meticulousscreening and precautions.Among drug users, sharingand reusing syringesEntry:Needle Sticksa. Although unintentionalneedle sticks are usuallylimited to health-careworkers, anyone can getinjured with a sharp,contaminated object.B.If you are consideringgetting a tattoo or piercing,or another voluntary needlestick, consider theenvironment first, as needlesticks can be deadly ifcontaminated wars drug users whoshare dirty needles aresharing a portal of entry forblood borne pathogens. Onceused, the dirty needle cantransmit disease through theskin directly into thebloodstream.2. Gestational PortalsA fetus is directly connectedto its mother by umbilicalTreatments Modalities:1. Reverse Transcriptaseinhibitors-They Inhibit theenzyme called reversetranscriptase, which is needed to“copy” information for the virusto replicate. These drugs area.Zedovudine(ZDV)- Retrivirb.Zalcitabine- Havidc.Stavudine- Zeritd. Lamivudine- Epivire.Nevirapine-2. Protease Transcriptaseinhibiting the enzyme a neededfor the assembly of viralparticles. These drugs are.a. a- ab. a- ac. Indinavir- a.Nursing Management:1. An Education. TheHealth Care workermust:
  • 23. contaminated with HIV-infected blood isextremely hazardous.3. Vertical or perinataltransmission (from apregnant woman to thefetus during pregnancy,child delivery, orbreastfeeding.There are Several waysof receiving infectedblood.1.Blood Transfusion2. Sharing of unsterilizedsyringes and needles usedfor intravenous injections.3. Transmission duringpregnancy.a.) may betransplacental.B.)There is greater riskof transmission when theMother has developedadvanced AIDS.4. Organ donation.5. Accidental exposure inhospitals or clinics.HIV is transmitted by1.three main routes:sexual contact,2.exposure to infectedbody fluids or tissues,3. From mother to childduring pregnancy,delivery, or breastfeeding(known as verticaltransmission..arteries that facilitatetransmission of the mothersblood and nutrients to baby.3. Open WoundsOpen wounds, includingsuperficial and deep cuts,should be covered with anadhesive bandage or cleandressing at all times.Uncovered wounds arevulnerable portals of entryfor potential contact withblood-borne pathogens.4. Mucous MembranesMucous membranes line thesoft tissues of your mouth,eyes, nose, and lining of thereproductive organs andanus. Designed to absorbliquids and contain moisture,these membranes are easilypermeable upon contact witha blood borne pathogen.HIV, a blood bornepathogen, is transmittedthrough mucous membranesduring unprotectedintercourse due to thepotential for contact withblood and body fluids.a. Give practical adviceb. Inform the client ofthe disease process andthe mode oftransmission.c. Emphasize the“AIDS” awarenessprogram.d. Avoid judgmentaland moralisticmessages.E. Be consistent andconcise in givinginstructions, especiallythose for propermanagement.f. Use positivestatement: andG. encourage client totrace or identifyprevious contacts forproper management.2. Practice universal/standard precaution.a. There is a need fora thorough medicalhand washing afterevery contact witheach patient andafter removing thegown and gloves,and before leavingthe room of anAIDS suspect orknown AIDSpatient.b. Use of Universalbarriers or personalprotectiveequipment( PPE)3. Preventiona. Care should be taken to
  • 24. .avoid accidental pricksfrom sharp instrumentscontaminated withpotentially infectiousmaterials from an AIDSpatient.b. Gloves should be wornwhen handling bloodspecimens and otherbody secretions, as wellas surfaces, materialsand objects exposed tothem.