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- 1. gventula.RN DISEASE HOST ETIOLOGY S/SX DIAGNOSIS TREATMENT PREVENTION NOTES DENGUE “Break Bone Fever” * GRADE 1 - nonspeci symptoms + tourniquet test * GRADE 2 - Grade 1 + bleeding * GRADE 3 - Grade 2 + circu failure * GRADE 4 - Grade 3 + shock Female Aedes aegypti - arboviruses (transmitted by anthropods) - white markings - day biting; low flying Dengue Fever Virus - RNA Virus ________________ - mosquito bites - infected blood prod - organ donation - vertical transmission A. Febrile Stage - high fever; abdo pain; headache - rash at 2nd day or later - biphasic fever - petechiae (+) tourniquet test B. Critical/Hemorrhage - low fever; severe abdo pain; melena; hematemesis; vomiting - narrow pulse pressure - unstable BP (-) tourniquet test C. Recovery - watch for circ overload - reported symptoms - physical exam _________________ CHANGES: 1. Low WBC 2. Low Platelet 3. Metabolic Acidosis - hemoconcentration or rising Hct - hypoalbuminemia - ascites Symptom relief: - paracetamol - antipyretic - fluid replacement (3L per day) - BT (usually whole blood or PRBC) - oresol (75mL/kg for 4 to 6 hours) - LOOP diuretic * NO ASPIRIN * STOP IV DURING RECOVERY – prevent circu overload * DORSAL RECUMBENT if with shock - low fat; low fiber; non-irritating FOUR S by DOH 1. Search and Destroy 2. Self Protection 3. Seek consultation 4. Say no to fogging DHF - Fever - Hemorrhagic episode - platelet <100,000 - increased vascular permeability DSS - DHF symptoms plus shock INCUBATION: 6 to 7 days COMMUNICABILITY Within first week June to November MALARIA Female Anopheles - clear, flowing, shaded streams - brown; night biting SPOROZOITE MEROZOITE - invades RBC - symptoms begin PLASMODIUM Falciparum- common Malariae Vivax Ovale Knowle Attacks hepatocytes at the LIVER ________________ - BT - shared needle - vertical trans Chills Hepatomegaly Anemia Sweating Elevated Temperature + malaise and spleenomegaly + may cause JAUNDICE due to RBC death A. CLINICAL METHOD - signs and symptoms B. MICROSCOPIC METHOD - blood smear (GOLD STANDARD) CHLOROQUINE for prophylaxis (2 weeks) MEFLOQUINE if pregnant * ARTEMISININ COMBINATION THERAPY (ACT) WITH VACCINE RTS,S OR MOSQUIRIX A. Treatment of Mosquito Nets B. House Spraying C. On Stream Seeding D. On Stream Clearing 9PM to 3AM ZOOPROPHYLAXIS INCUBATION 10 – 14 days
- 2. gventula.RN FILARIAS - under helminthiasis or worm infection Culex or Anopheles WUCHERERIA BANCROFTI BRUGIA MALAYI BRUGIA TIMORI ________________ Young and adult worm (10 years lifespan) stay at lymph nodes and vessels Micofilariae at blood A. ASYMPTOMATIC - microfilariae at blood B. ACUTE - LYMPHADENITIS (inflam of lymph nodes) - LYMPHANGITIS (inflame of lymph vessels) C. CHRONIC - HYDROCELE - LYMPHEDEMA - ELEPHANTIASIS NOCTURNAL BLOOD EXAM (Finger Prick) - Gold Standard - taken at night after 8:00PM IMMUNOCHROMA TOGRAPHIC TEST (ICT) - for rapid assessment DIETHYL CARBAMAZINE CITRATE (DEC) or HETRAZAN - 6mg/kg once a year Hygiene (clean twice a day with soap and water Give antibiotic or antifungal Surgery Sanitation Insecticide Same PPE for mosquito Health Education Repellants INFECTIVE STAGE: - Larvae entering the body DIAGNOSTIC STAGE - presence of sheathed microfilariae in the blood SCHISTOSOMIAS - “Bilhariasis” - “Snail Fever” ONCOMELANIA QUADRASI Usually taken from contaminated water Schistosoma: - JAPONICUM - MANSONI (both are GI) - HAEMATOBIUM (usually at bladder and ureter) INFECTIVE: - CERCARIAE (fork tailed) - dies after 48 hours MIRACIDIUM SWIMMER’S ITCH Diarrhea Bloody Stool Enlarged abdomen Spleenomegaly Weakness Anemia Inflamed liver CIRCUMOVAL PRECIPITIN TEST - or identification of egg through microscopy KATO – KATZ STOOL EXAM PRAZIQUANTEL (BILTRICIDE) - 1 tab twice a day for three months Treat breeding sites with MOLLUSCICIDES May wipe foot with 70% alcohol after wading from water Always dry REMOVE BREEDING SITES OF SNAILS INCUBATION 4 – 6 weeks
- 3. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES LEPROSY - “Hansen’s Disease” - leading cause of permanent physical disability - affects peripheral nerves, eyes, skin, mucosa of URT - MILDLY CONTAGIOUS “LEONINE FACIES” “GLOVE AND STOCKING” RA 4073 MYCOBACTERIUM LEPRAE - acid fast, rod shape MYCOBACTERIUM LEPROMATOSIS Airborne inhalation Skin to skin contact EARLY - change in skin color - loss of sensation - decrease sweating - thickened and paiful nerves - muscle weakness or paralysis - painful, red eyes - nasal obstruct or bleeding - ulcers do not heal LATE * MADAROSIS - loss of eyebrows * LAGOPHTHALMOS - inability to close eye - clawing of fingers - contractures - sinking nose bridge - gynecomastia - chronic ulcer PHYSICAL EXAM + HISTORY OF CONTACT - presence of skin lesions and loss of sensory - can either be single or multiple; hypopigmented or reddish or copper - SENSORY LOSS is important to distinguish 2. (+) SLIT SKIN SMEAR (SSS) - optional - only if in doubt PAUCIBACILLARY 1. RIFAMPICIN - 600mg/month - 450mg if 10-14 yo 2. DAPSONE - 100mg per day - 50mg if 10-14 yo * 6 BLISTER PACKS IN 9 MONTHS MULTIBACILLARY + DAPSONE - 100mg daily - 50mg daily * 12 BLISTER PACKS IN 19 MONTHS If age below ten, HALF DOSAGE If treatment is complete, CURED even if with s/sx NON – INFECTIOUS after 1 week of treatment 12 years below are susceptible BCG VACCINATION PERSONAL HYGIENE AVOID CONTACT INCUBATION: 5 – 2 years RIDLEY-JOPLING CLASSIFICATION 1. MULTIBACILLARY - more than 5 lesions - lepromatous and borderline - INFECTIOUS (-) LEPROMIN TEST - slow peripheral nerve involvement 2. PAUCIBACILLARY - less than 5 - tuberculoid and indeterminate - NON – INFECTIOUS (+) LEPROMIN TEST – good sign - rapid peripheral involvement POSITIVE if: 10mm or more in 48H or 5mm after 21 days
- 4. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES DIPHTERIA - infection of the tonsils, throat, nose, larynx, or a wound marked by patches of grayish membrane 1. GRAVIS 2. MITIS 3. INTERMIDIUS CORYNEBACTERIUM DIPTHERIA (Klebs – Loeffer Bacillus) - toxin producing - gram positive - aerobic HUMAN TO HUMAN TRANSMISSION - through coughing or sneezing (droplet) - direct contact - MILK can serve as a vehicle GREYISH PSEUDOMEMBRANE FOUL SMELLING NASAL DISCHARGES “BULL NECK” BRASSY OR BARKING COUGH “CROUP” LABORATORY ISOLATION OF BACTERIA through gram staining or throat culture SCHICK TEST - susceptibility - 0.1ml of diphtheria toxin, ID (+) red and swollen - indicate non- immunity MOLONEY TEST - hypersensitivity to DPT - masamang reaction Drink vitamin C juice Inhalation of O2 Prevent exertion Hydration Tracheostomy Have patient isolated Eat soft food Rest for two weeks Ice collar Antibiotic, antitoxin PENICILLIN ERYTHRO - both for 14 days ANTITOXIN DPT VACCINE PASTEURIZE MILK INCUBATION: 2 to 5 days COMMUNICABILITY: Until absence of bacilli in secretion or lesion - 2 to 4 weeks INFANTS BORN TO MOTHERS WITH DIPHTHERIA ARE IMMUNE UNTIL 6TH MONTH PERTUSSIS “WHOOPING COUGH” “100 DAY COUGH” - an airborne disease - highly contagious - direct contact is a possible transmission BORDETELLA PERTUSSIS Others: - Hemophilus pertussis - Bordet Gengou - Initial: common cold; runny nose; fever; cough (CATARRHAL STAGE) - weeks of cough fits - high pitch whoop sounds in between cough fits - cyanosis; distended vein - may last up to 10 weeks - may vomit, break ribs (PAROXYSMAL STAGE) - reduced coughing - reduced vomiting -whoops may persist (CONVALESCENT STAGE) If less than one year, no cough; apnea NASOPHAYNGEAL SWAB - taken at the back of the nose and throat - culture during the first 3 weeks only; Polymerase Chain Reaction after 3 weeks. Antibiotic: Erythro; Clarithro: Azithro (Macrolides) If treated with antibiotic, no longer infectious after five days. ISOLATE during time of communicability DPT VACCINE INCUBATION: 7 to 10 days but not >21 days COMMUNICABILITY: Start of symptoms until three weeks into the coughing fits SUSCEPTIBILITY: Mostly seen in children; peaks at age 7; highest in infants < 6mos ONE ATTACK CONFERS DEFINITE AND PROLONGED IMMUNITY although second attack is possible
- 5. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES TETANUS “LOCKJAW” or “TRISMUS” - characterized by muscle spasms - usually starts at the jaw and moves to other parts “RISUS SARDONICUS” - sarcastic smile - pathog CLOSTRIDIUM TETANI - anaerobic - spore forming - toxin producing - commonly found in soil, saliva, dust, and manure - enters body through puncture TETANOSPASMIN - this causes the spasm - inhibits GABA and glycin TRISMUS OPISTHOTONUS - arching of the back BASED ON SYMPTOMS NO BLOOD TEST FOR TETANUS (SAD) The bacteria is hard to isolate; may also be found in people without tetanus SPATULA TEST - touch posterior tongue (+) biting down (-) gag reflex Mild: - TETANUS IMMUNOGLOBULIN (TIG) aka tetanus antibodies or tetanus antitoxin - METRONIDAZOLE - DIAZEPAM Severe: Admit at ICU - TIG - trachea with mech - magnesium (for seizure) - diazepam (relaxant) DPT TT If mother is vaccinated, infant will have passive immunity Post exposure prophy: Give TT with or without tetanus immunoglobin INCUBATION: 3 to 21 days - the farther, the longer * in infants, appears 4 to 14 days after birth; average of 7 days 10% infected dies; bye bitch In infants, cause is due to unhealed umbilical stump; especially when cut with unsterile instrument Full recovery after 4 to 6 weeks HIGH CALORIE DIET to help compensate (3500 to 4000) NGT POLIOMYELITIS “INFANTILE PARALYSIS” “HEINE-MEDIN DISEASE” Poliovirus (Legio debilitans) - PV1 BRUNHILDE (most common) - PV2 LANSING - PV3 LEON Immunity to one strain does not provide protection against the other two. Transmitted through fecal-oral and oral- oral route Normal people: asymptomatic NON-PARALYTIC PARALYTIC POLIO - virus enters CNS; replicates at anterior horn cells (motor neurons) of spinal cord causing ACUTE FLACCID PARALYSIS *SPINAL: paralysis on one or both lower extrem * BULBAR POLIO - attacks motor neurons of the brain stem causing DOB; dysphagia SIGNS AND SYMPTOMS Culture from stool sample or throat swab CSF: increased WBC; increased protein - detection of virus from CSF confirms paralytic polio NO CURE, BABY. I’M SORRY Relief of symptoms: Antibiotics; analgesics; exercise; nutritious diet; OT; PT; ventilators DO NOT GIVE MORPHINE: May depress breathing INCUBATION: 3 to 35 days COMMUNICABILITY: 7 to 10 days before and after appearance of symptoms; but can still be transmitted while virus is in the saliva or feces VEM (Ventral-Efferent-Motor) DAS (Dorsal-Afferent-Sensory) PANDY’S SIGN (elevated protein) -turns Pandy’s solution from clear to turbid HOYNE’S SIGN (head lag) AMOSS’ SIGN (tripod)
- 6. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES MEASLES/RUBIOLA - highly communicable; fever, rash, URT symptoms KOPLIK’S SPOTS - pathog - temporary and rarely seen - usually resolves after about three weeks - one of the leading cause of death among children Measles Virus (Morbilli paramyxoviridae) - airborne, through cough and colds - contact with saliva and nasal secretion - can be contagious in the air or in the surface for up to TWO HOURS Man is the only reservoir - initial: 4D (4 day) fever, 3C (cough, coryza, conjunctivitis) -KOPLIK’S SPOTS , or greyish pecks in inner cheeks (2-3 days after onset of symptoms) - red flat rashes (maculopapular) (morbilliform rash) starts at the face (back of ear) and spreads (4-5 days after onset of symptoms) Day 6: Kopliks regress Day 7-8: Intense rash Day 10: resolution HISTORY OF FEVER FOR ATLEAST THREE DAYS; WITH ATLEAST ONE OF THE 3C’s KOPLIK’S SPOT IS ALSO A DIAGNOSIS NO SPECIFIC TREATMENT, BABY. Patient recovers through rest and supportive treatment. Give VITAMIN A to prevent blindness (WHO) Give ZINC for better outcome HYDRATE; GOOD NUTRITION; ANTIBIOTIC FOR EYE AND EAR INFECTION VACCINATION ISOLATION DISINFECTION _______________ Protect patient’s eyes to strong lights Keep in rooms free from drafts to prevent pneumonia INCUBATION: 10 – 12 days after exposure COMUNICABILITY: 4 days before and after start of rash Cause of death is due to complications Passive immunity to babies born from mothers who had measles for the FIRST MONTH OF LIFE ONLY. PERMANENT ACQUIRED IMMUNITY after the attack MUMPS “Endemic Parotitis” - a viral disease; swelling of one or both parotid glands Mumps virus - paramyxoviridae - rubulavirus - PARAMYXOVIRUS Transmitted via droplet, direct contact. Man is the only reservoir Fever; headache; malaise; loss of appetite; painful swelling infront of ear, jaw and neck Parotid swelling persist for about one week Testicular inflammation (ORCHITIS) BY SYMPTOM (PAROTID SWELLING) - can be confirmed through virus isolation from parotid duct SUPPORTIVE - apply ice or heat at neck of testicle - acetaminophen - warm gargles; soft, bland or liquid food (not sweet, not sour); extra fluid ISOLATE For orchitis, support testicles. Give 300 – 400mg cortisone, then 100mg every 6 hours. BED REST. DAILY BATH. MOUTH WASH Prophylaxis with vaccine. It is useless if the patient has active mumps disease. ALWAYS DISINFECT PPE DO NOT ENTER SCHOOL PLEASE INCUBATION: 12 – 26 days; usually 18 COMMUNICABILITY: 7 days before symptoms; 8 days after (Wiki) 48H before swelling (Sir July) After first attack, immune for life. Tho reinfection may still occur DO NOT GIVE ASPIRIN TO CHILDREN. MAY CAUSE REYE’S SYNDROME GENERAL RULE: NO MEDICATION FOR CHILDREN PWEDE KA MABAOG BES. OKI LANG. PANGIT NAMAN LAHI MO.
- 7. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES VARICELLA “Chickenpox” VARICELLA ZOSTER VIRUS (Human Herpesvirus) Humans are the only source of infection - airborne disease through cough and sneeze - direct or indirect Skin rash: small, itchy, blisters which scabs. Starts at chest, back, and face then all over the world. Maculopapular first, then vesicular, then scab. Ganon. Improving. Fever, tiredness, headache. ITCHINESS THROUGH PRESENTING SYMPTOMS SUPPORTIVE - stay at home - cut nails; or wear mittens or gloves; calamine lotion for itchiness; - good hygiene with warm water - paracetamol; NOT ASPIRIN, MAKULIT? - ACYCLOVIR, start within 24H of rash onset - antihistamine EXCLUDE FROM SCHOOL FOR 1 WEEK AFTER VESICLES If >15yo, report to check possibility of SMALLPOX ISOLATE DISINFECT INCUBATION: 2 – 3 weeks; 13 to 17 days common COMMUNICABILITY: Not more than one day before eruption of first rash up to 5 days after LAST CROP. Usually lasts 5 to 7 days. AN ATTACK CONFERS LONG TERM IMMUNITY Not common in infancy. SHINGLES “HERPES ZOSTER” - due to the reactivation of the varicella zoster virus POSTHERPETIC NEURALGIA - usual after effect - nerve pain due to nerve damage; - 90 days - heals within 2 to 4 weeks Painful skin rash with blisters in LOCALIZED area in a single wide stripe either on the left or right side of body or face Tingling sensation 2 to 4 days before rash. BURNING PAIN - headache, fever, malaise - hyperesthesia - paresthesia (tingling) DERMATONAL RASH THROUGH PRESENTING SYMPTOMS ACYCLOVIR, start within 24H of rash onset ANALGESIC ANTI- INFLAMMATORY VACCINATE DISINFECT Exposure of people to the virus from blisters may cause chickenpox. WITH VACCINE COMMUNICABILITY: Not more than one day before eruption of first rash up to 5 days after LAST CROP. SHINGLES IN CHILDREN IS PAINLESS ZOSTER SINE HERPETE describes the person with shingles but without rash
- 8. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES RUBELLA “German Measles” “3-day Measles” - mild, most won’t even know they are infected FORCHHEIMER’S SIGN – small, red papules on the area of soft palate RUBELLA VIRUS (Rubi togaviridae) Transmitted through the air, droplet. Replicates in nasopharynx and lymph nodes. TERATOGENIC - capable of crossing placenta, stop cells or destroy them ONLY HUMANS ARE INFECTED. Similar to flu Primary symptom: APPEARANCE OF RASH (EXANTHEM) - starts at two weeks after exposure; starts at face and spread centrifugally to trunk and extremities. - usually fades at day 3 - itchy, not as bright as measles (pink or light red) -LEAVES NO STAINING OR AFTERMARKS SWOLLEN LYMPH NODES - posterior lymphadenopathy; persists for up to a week; JOINT PAIN IN ADULT Fever rarely rises above 38c (low grade); CONJUNCTIVITIS LABORATORY WORKS: Finding the virus at blood, throat or urine; presence of antibodies + presence of the rash SUPPORTIVE BED REST; ACETAMINOPHEN; ANTIHISTAMINE; STARCH BATH VACCINATION DISINFECTION ISOLATION DROPLET PRECAUTION COMMUNICABILITY: The week before and after the appearance of rashes. ONCE RECOVERED, IMMUNE FOR LIFE. THE OLDER THE PERSON, THE MORE SEVERE THE SYMPTOMS INCUBATION: 2 to 3 weeks after exposure CONGENITAL RUBELLA SYNDROME - caused by intrauterine infection THE MAIN REASON FOR THE RUBELLA VACCINE Causes prematurity, low birth weight; neonatal thrombocytopenia; anemia; hepatitits MOST RISKY AT FIRST TRIMESTER Mother with rubella at first trimester may have a miscarriage or stillborn. If baby survives, it will have heart defects (PDA is common), blindness, deafness; microcephaly; mental retardation; bone alterations; liver and spleen damage BLUE BERRY MUFFIN - skin manifestation INCLUDED IN THE TORCH COMPLEX: TOXOPLASMOSIS Other infections RUBELLA CYTOMEGALOVIRUS HERPES SIMPLEX Others may include: chickenpox, Chlamydia; coxsackievirus; HIV; syphilis; zika fever SUPPORTIVE MANAGEMENT ONLY.
- 9. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES GONORRHEA “GC” “DRIP” “CLAP” - most common cause of PELVIC INFLAMMATORY DISEASE Ectopic pregnancy or infertility may be a complication due to PID (pelvic inflammatory disease; uterus, fallo, ovary) NEISSERIA GONORRHOEAE - fragile; does not survive long outside the body - KILLED BY DRYING; SUNLIGHT; UVL - Killed by ordinary disinfectant Spread through sexual contact: ORAL, ANAL, VAGINAL Vertical transmission May be asymptomatic BURNING URINATION PUS DISCHARGES (most common in men) LOWER ABDOMINAL PAIN PAIN DURING SEX Infection of throat, eye, nose ENDOMETRIOSIS SALPINGITIS GRAM STAINING of cervical smear and urethral smear DIPLOCOCCI will be seen IN JECTABLE CEFTRIAXONE with either azithromycin or doxycycline CDC and WHO recommends Ceftrio and Azithro CDC’s ABC DOH 4C CDC recommends to avoid contact atleast one week after final day of treatment CREDE’S PROPHYLAXIS (tetracycline, erythromycin, silver nitrate) - given within 1 hour after birth 50% of women are asymptomatic INCUBATION: 2 to 14 days Symptoms appear at 4th to 6th day PREVIOUS INFECTION DOES NOT CONFER IMMUNITY MSM have higher risk OPHTHALMIA NEONATORUM - infection of baby’s eye CHLAMYDIA - most common STI “The Silent Epidemic” TRACHOMA - roughing of the inner surface of the eyelids - may cause blindness Same complications as Gonorrhea CHLAMYDIA TRACHOMATIS Spread through sexual contact: ORAL, ANAL, VAGINAL Vertical transmission Personal contact; flies, contaminated towel Maybe asymptomatic especially when CERVIX is infected Vaginal bleeding; abdominal pain; painful sex; fever; painful urination; urinary urgency Inflammation of urethra; penile discharge; testicular pain and swelling; fever May cause epididymitis causing sterility SWAB from site of infection AZITHROMYCIN DOXYCYCLINE CREDE’S PROPHYLAXIS Advise not to have sex for seven days or until symptom free SCREENING IS RECOMMENDED TO WOMEN BELOW 25 WHO ARE SEXUALLY ACTIVE. INCUBATION: 2 to 3 weeks
- 10. gventula.RN DISEASE AGENT S/SX DIAGNOSIS TREATMENT PREVENTION SIDE NOTES SYPHILIS “Sy” “Bad blood” “The Pox” “The Great Immitator” - chronic, infectious which begins in mucus membrane and becomes sytemic TREPONEMA PALLIDUM - passes trough mucosa and placenta - spiral shape, highly mobile, gram nega - dies quickly outside the body Transmitted through sex, vertical transmission, kissing near a lesion, blood products PRIMARY (3 to 90 days) - appearance of CHANCRE either cervix, penis or rectum - macule, papule, ulcer - firm, painless, non-itchy SECONDARY (4 to 10 wks) - rash on palms, soles - fever, malaise, sore throat, ALOPECIA - warts LATENT - it is asymptomatic - contagious only via transplacenta TERTIARY (3 to 15 years) - formation of gummas, tumor-like balls of inflame - can infect liver, brain, bones, heart BLOOD TEST DARK FIELD ILLUMINATION TEST KALM TEST BENZYLPENICILLIN DOXYCYCLINE TETRACYCLINE (cause discoloration of teeth) JARISCH- HERXHEIMER REACTION - potential side effect of rupturing syphilis bacteria - starts within one hour up to 24 hours: Fever, hypotension, musculoskeletal pain, tachycardia - NOT LIFE THREATENING SAME SAME CONGENITAL SYPHILIS - asymptomatic, but develops symptoms after several years: enlargement of liver and spleen, rash, fever, lung inflammation