INFECTIOUS DISEASESAirborne Diseases

OUTBREAK

Main Characters:

General Plot:

Synopsis:

Trace the Pathogenesis of the disease which served as the main theme of the movie.

What strategies were employed to control the epidemic.

Suggest ways and means on how a highly contagious disease be prevented from being contacted by people in your family or community.

MEASLES, RUBEOLA, 7 DAY FEVER, HARD RED MEASLES

• 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

• Rashes:•Maculopapular• Cephalocaudal•With 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

3C’S OF MEASLES

• Cough• Coryza• conjuctivitis

DIAGNOSTIC TEST

• Nose and throat swabbing• u/a• Blood chemistry• Confirmatory test is complement fixation on or

hemagglutination inhibition tests

PHARMACOLOGY

• Sulfadiazine – bacteriostatic

• Guaifenesin – sympromatic management of cough

• Cephalexin – treatment of skin and skin infection, pneumonia and otitis media

• Paracetamol – anti pyretic

GERMAN MEASLES, RUBELLA, ROTHELIN 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

• Rashes:• Maculopapular• Diffuse• No desquamation

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

•  

• PS Forscheimer’s spot

• Diagnostic Test- Rubella Hemaglutination- ELISA- IgM- TORCH Test

PHARMACOLOGY

• MMR

• Ibuprofen

• Acataminophen

• Aspirin

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

• Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk and spreads to entire body• Leaves a pitted scar (pockmark)• PS Maculo Papular rashes

• 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

DIPHTHERIA• Corynebacterium diphtheriae• Klebsloeffler’s bacillus (bacteria)• MOT = droplets and airborne• HIGHLY CONTAGIOUS

• IP 2-5 days• IMMUNITY• Active = DPT• Passive = DAT• Natural = xxx

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

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

DIPHTHERIA KEY POINTS!

• Highly contagious• Pseudomembrane and bullneck• Immunization best intervention PREVENTION• Obstruction and myocarditis• Isolation technique

MENINGITISMeningitis is an inflammatory process of the leptomeninges and CSF

CLASSIFICATION

• 1. acute pyogenic (bacterial) meningitis

• 2.acute aseptic (viral) meningitis

• 3.acute focal suppurative infection (brain abscess,subdural and extradural empyema)

• 4.chronic bacterial infection (tuberculosis).

ACUTE PYOGENIC BACTERIAL MENINGITIS

• Most important• Can be fatal if untreated• Organisms: E.coli ---------- neonates Streptococci B ---------- neonantes H. influenzae-------------adolescents Neisseria meningitidis------------- young adults Streptococcus pneumonia--------- elderly

CLINICAL SIGNS

• Signs of infection (fever,malaise,rigor….)• Signs of meningeal irritation: 1.headache 2.neck stiffness 3.photophobia 4.irritabilityC.S.F by lumbar puncture shows : a.cloudy purulent csf b.abundant neutrophils > 90,000/mm3 c.high protein level and d.reduced glucose level.

COMPLICATIONS

• Antibiotic treatment------ full recovery

• Delayed or untreated cases--- can be fatal

• Healing by fibrosis cause obliteration of subarachenoid space--- HYDROCEPHALUS

• Brain abscess

• Septic shock and skin rashes, why ?

SKIN RASHES

• Is due to small skin bleed• All parts of the body are affeced• The rashes do not fade under pressure• Pathogenesis:

a. Septicemia

b. wide spread endothelial damage

c. activation of coagulation

d. thrombosis and platelets aggregation

e. reduction of platelets (cosumption )

f. BLEEDING 1.skin rashes

2.adrenal hemorrhage

Arenal hemorrhage is called Waterhouse-Friderichsen Syndrome.It cause acute adrenal insufficiency and is uaually fatal

ACUTE ASEPTIC (VIRAL ) MENINGITIS

• Can follow any viral infection• Less danger • CSF shows : 1.lymphocytes 2. mild increase in protein 3. normal glucose level Viral meningitis is usually self-limiting and treated

symptomatically.

BRAIN ABSCESS

• Causes : 1. complication of bacterial meningitis 2. bacterial endocarditis 3. pulmonary sepsis : peumonia……etc 4. other sepsis

Brain abscess cause a space occupying lesion in the brain

MENINGITIS MENIGOCOCCEMIA

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

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

• 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

• 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

VECTORBORNE

DENGUE HEMORRHAGIC FEVER

Philippine Hemorrhagic Fever was first reported in 1953. In 1958, hemorrhagic became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever.

IINTRODUCTION:

What is Dengue Hemorrhagic Fever?

• A severe mosquito transmitted viral illness endemic in the tropics.

• It is characterized by increased vascular permeability, hypovolemia and abnormal blood clotting mechanisms.

Occurrence:

Dengue occurrence is sporadic throughout the year.

Epidemic usually occurs during the rainy seasons June – November.

Peak months are September and October.

DHF are observed most exclusively among children of the indigenous population under 15 years of age.

Occurrence is greatest in the areas of high Aedis Aegypti prevalence.

• The DOH reported 70,204 dengue cases for week ending September 10, 2011. This was over 24,000 cases less or 25.87% lower than for the same period last year. In addition, the number of cases in July and August (the peak months for dengue) was 52% lower than last year. A total of 396 deaths were reported for this year, which is lower than last year’s number of 620.

Reservoir / Source of Infection:

• Some source is a vector mosquito, the Aedes Aegypti or the common household mosquito

• The infected person

Mode of Transmission:

Mosquito bite (Aedis Aegypti)

Incubation Period: Probably 6 days to one week

Period of Communicability:

Presumed to be on the 1st week of illness – when virus is still present in the blood

Susceptibility and resistance:

All persons are susceptible. Both sexes are equally affected. The age groups predominantly affected are the preschool age and school age. Adults and infants are not exempted. Peak age affected 5-9 years. Susceptibility is universal. Acquired immunity may be temporary but usually permanent.

Diagnostic Test:

1.) Tourniquet Test (Rumpel Leads Tests)• Inflate the blood pressure cuff on the upper

arm to a point midway between the systolic and diastolic pressure for 5 minutes

• Release cuff and make an imaginary 2.5 cm square or 1 inch just below the cuff, at the antecubital fossa

• Count the number of petechiae inside the box

• A test is (+) when 2 or more petechiae per 2.5 cm square or 1 inch square are observed

2.) A con firmed diagnosis is established by culture of the virus, polymerase-chain-reaction (PCR) tests, or serologic assays.

Clinical Manifestations (Public Health Nursing in the Philippines, 2007):An acute febrile infection of sudden onset with 3 stages:

• 1st-4th day (febrile or invasive stage)

-high fever, abdominal pain and headache; later flushing which may be accompanied by vomiting, conjunctiva infection and epistaxis.

• 4th-7th day (toxic or hemorrhagic stage)

-lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from gastrointestinal tract in the form of hematemesis or melena. Unstable blood pressure, narrow pulse pressure and shock. Death may occur. Tourniquet test which may be positive may become negative due to low or vasomotor collapse.

• 7th-10th day (convalescent or recovery stage)

-generalized flushing with intervening areas of blanching, appetite regained and blood pressure already stable.

• Dengue shock syndrome is defined as dengue hemorrhagic fever plus:

*Weak rapid pulse, *Narrow pulse pressure (less than 20 mm Hg) or, *Cold, clammy skin and restlessness

Grading of Dengue Fever:

The severity of DHF is categorized into four grades:

• grade I, without overt bleeding but positive for tourniquet test

• grade II, with clinical bleeding diathesis such as petechiae, epistaxis and hematemesis

• grade III, circulatory failure manifested by a rapid and weak pulse with narrowing pulse pressure (20 mmHg) or hypotension, with the presence of cold clammy skin and restlessness; and

• Grade IV, profound shock in which pulse and blood pressure are not detectable. It is note-worthy that patients who are in threatened shock or shock stage, also known as dengue shock syndrome, usually remain conscious.

* Grade III and IV are considered to be Dengue Shock Syndrome

MALARIA

• 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

• 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

• 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• 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

• 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

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

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

• 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

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

• 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)

• Egg– miracidium– snail– cercaria- human• Itchiness – liver – intestines• Praziquantel• COPT• PREVENTION• Samar and Leyte