Communicable Diseases Refresher PDF

REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS COMMUNICABLE DISEASES ADAPTIVE / ACQUIRED Active Immunity (GINAWA) –– take...

REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS COMMUNICABLE DISEASES ADAPTIVE / ACQUIRED Active Immunity (GINAWA) –– takes its time to produce antibodies but long lasting. ⇒ Caused by infectious agent that is spread from person to ○ When exposure to a disease organism person triggers the immune system to produce antibodies to that disease COMMUNICABLE NON-COMMUNICABLE ○ Could be through: Natural: exposure to a disease Ebola virus Diabetes Artificial (given preexposure): HIV Hypertension vaccines Measles Liver cirrhosis Live attenuated –– live but LO DIabetes insipidus STDs weakened virus Inactivated –– killed virus Toxoids CONTAGIOUS INFECTIOUS Passive Immunity (IPINASA) –– immediately ⇒ Easily transmissible ⇒ not easily transmissible protected but short-lived. Airborne and Blood-borne ○ When a person is given antibodies to a droplet infection (HIV, hep. disease rather than producing them through transmission B), food borne, water borne, STDS his or her own immune system ○ Could be through: DEFINITION OF TERMS within the body. IL Infection –– invasion and growth of microorganism Pathogenicity –– ability of a microorganism to cause disease. Natural: transplacental or perinatal transmission (IgG), breastfeeding (IgA), Artificial (given post exposure): immunoglobulins, anti-toxin (best time frame: 24-72 hours) R Virulence –– ability of a pathogen to damage its host. ○ Gaano siya kabilis nakakahawa or STAGES OF DISEASE nakakadamage or nakakamatay INCUBATION - Initial entry of a pathogen IMMUNITY - Period of the first exposure to the pathogen to the R ⇒ Body’s protection against diseases, especially infectious period of the first appearance of the signs and diseases symptoms. Antigen –– substance (toxins, bacteria, or viruses) - Asymptomatic that prompts your body to trigger an immune response against it PRODROMAL / CATARRHAL A Antibody –– Y-shaped proteins that the body - Generalized signs and symptoms (non-specific) produces when it detects antigens; proteins to ○ Fever neutralize or destroy pathogens ○ Coughs and colds ○ Headache TYPES OF DEFENSE BARRIERS ACUTE / ILLNESS C - Specific signs and symptoms 1. Anatomical: skin, mucous membranes - Pathognomonic (hallmark) signs and symptoms 2. Physiologic: fever, pH, saliva, tears - Either could die or recover 3. Phagocytic: WBC (neutrophils, macrophage) 4. Inflammatory: tissue damage → vascular fluid CONVALESCENCE / RECOVERY leak→ proteins → antibacterial activity - Sign and symptoms subside or disappear TYPES CHAIN OF INFECTION INNATE / NATURAL INFECTIOUS AGENTS –– microorganism capable of causing - Inherent disease or illness. Bacteria Fungi Parasites  REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS Prions (target brain cells) –– spread through AIRBORNE unsterilized equipment and meat - Droplet nuclei (small, finer particles of 5 mm or ○ Example: Creutzfeldt Jakob Disease smaller in size). RESERVOIRS –– place in which infectious agents live, grow, VEHICLE ROUTE and reproduce. - Inanimate objects or non living things capable of People transmitting a pathogen Water - Example: Food ○ Food ○ Water PORTALS OF EXIT –– ways in which infectious agents leaves ○ Blood LO the reservoir. ○ Fomites Blood Secretions VECTOR BORNE Excretions - Living organisms capable of transmitting a pathogen Skin - Example: ○ Aedes aegypti → Chikungunya virus → MODES OF TRANSMISSION –– ways in which the infectious Dengue agent is spread from the reservoir to the susceptible host. ○ Plasmodium falciparum → Anopheles → Physical Malaria Contact droplets ○ Culex Mosquito → Flavivirus → Japanese Airborne PORTALS OF ENTRY –– ways in which the infectious agent enters the susceptible host. Mucous membrane Respiratory system IL INFECTION CONTROL encephalitis STANDARD PRECAUTION - Used for all patient care R Digestive system Broken skin 1. Hand hygiene a. Before touching a patient SUSCEPTIBLE HOST –– individuals may have traits that b. Before clean or aseptic procedure affect their susceptibility and severity of disease. c. After body fluid exposure risk R Immune deficiency d. After touching a patient Diabetes e. After touching patient surroundings Burns 2. Use of PPE Surgery a. Sequence of donning: gown → mask → eye Age shield → gloves A b. Sequence of removing: gloves → eye shield MAIN ROUTES OF TRANSMISSION → gown → mask DIRECT CONTACT 3. Respiratory hygiene / cough etiquette - Direct body contact with the tissues or fluids of an 4. Sharps safety infected individual. 5. Safe injection practices - Physical transfer and entry of microorganism 6. Sterile instruments and devices C - Examples: 7. Clean and disinfected environmental surfaces ○ Skin-to-skin ○ Kissing DISEASES ○ Sexual intercourse ○ Droplet DIPHTHERIA DROPLET ⇒ Acute toxin mediated disease → the toxins releases the s/sx - Relatively large and travel only short distances (up to of the disease 6 feet or 2 meters). Causative agent: Corynebacterium diphtheria or Klebbs-loffer INDIRECT CONTACT Mode of transmission: droplet, especially secretions - Contact between a person and a contaminated object from mucous membranes of the nose and (fomites).  REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS nasopharynx and from skin and other lesions; milk Oral hygiene serve as a vehicle ○ Use orahex (bactidol) Incubation period: 2- 5 days ○ Avoid use of toothbrush and commercial alcoholic mouthwashes RISK FACTORS Drug of choice: erythromycin (20, 000 - 100, 000 Ages 5 and below units IM once only) Substandard living condition Nutrition: Immunocompromised ○ NGT Incomplete immunization or vaccination ○ Soft diet TYPES Prevention LO RESPIRATORY Active immunization: DPT immunization - Most common Passive immunization: anti-toxin Clinical Manifestation PERTUSSIS Sore throat ⇒ “Whooping cough” Fever Causative agent: Dysphagia ○ Bordetella pertussis Bull neck appearance ○ Bordet-gengou bacillus Pathognomonic Sign: pseudomembrane ○ Pertussis bacillus ○ DO NOT SCRAPE Mode of transmission: droplet, especially from As it may cause aspiration → IL airway obstruction (most common cause of death of diphtheria) → suffocation It is vascular Uphold droplet precautions as it is highly infectious laryngeal and bronchial secretions Incubation period: 7- 10 days, less than 21 days RISK FACTOR Aged 5 and below R CLINICAL MANIFESTATION LARYNGEAL - Stages: 6 week disease Clinical Manifestation: gradually increasing hoarseness, cough, stridor Catarrhal or Prodromal Stage (7-14 days) –– MOST INFECTIOUS phase R NASAL Mild fever - Mildest form Headache Clinical Manifestation: Clear nasal discharge but Colds eventually becomes blood stained Persistent cough CUTANEOUS A Paroxysmal Stage (Spasmodic or whooping stage; 14-28 Clinical Manifestation: Skin ulcers commonly in the days) legs Paroxysmal cough Anorexia due to lack of appetite COMPLICATION Fatigue Myocarditis Vomiting C Whooping cough (involuntary): deep inhalation DIAGNOSTIC followed by series of cascading sharp coughs Nose throat swab; swab from the skin lesions Moloney’s test Convalescent Stage (21 days; could be beyond 2 weeks) Schick’s test Less cough and vomiting MANAGEMENT DIAGNOSTIC Isolate the child until two negative nose and throat Bordet-gengou agar test culture are taken within 24 hours apart Medications: MANAGEMENT ○ Antibiotic: erythromycin and penicillin Medication: ○ Antipyretic: paracetamol ○ Drug of choice: erythromycin or penicillin Bed rest is necessary (except for nasal diphtheria) (20,000 - 100, 000 units)  REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS ○ Antipyretics Medications: Isolation and complete bed rest ○ Drugs to control muscle spasm: diazepam For paroxysmal stage: ○ Antibiotics: penicillin G ○ Avoid dust pollutants ○ Antipyretics: paracetamol ○ Oxygenation Tetanus vaccination ○ Calm environment Isolation Promote effective coughing Protect the child for any stimuli, so place child in dark Proper positioning room Increase OFI Protect from falling, record convulsion episodes Provide physiotherapy IV for nutrition if inability to swallow Oxygenation. Possible tracheostomy LO Prevention Active immunization: DPT vaccine (6th, 10th, 14th Prevention weeks) Active immunization: ○ Booster: 2 years and 4-5 years ○ DPT immunization ○ Patient should be segregated until after 3 ○ Tetanus toxoid (artificial active) immunization weeks from the appearance of paroxysmal among pregnant women cough Passive immunization: Passive immunization: Immunoglobulin (Gamma ○ Tetanus immunoglobulin globulin) If allergic to immunoglobulin, still give it to the patient through TETANUS ⇒ “Lockjaw” Causative agent: Clostridium tetani (bacteria; IL anaerobic spore-forming heat-resistant and lives in soil or intestine) releases: ○ Tetanolysin –– localized Time interval fractionated doses. ○ Anti-toxin (anti-tetanus serum; ATS) should be given 24 hours Protection Benefits R ○ Tetanospasmin –– painful muscle TT1 As early as None None contractions; one of the most potent toxins. possible during Mode of transmission: indirect contact (soil, pregnancy or from manure, unsterilized medical equipment, penetrating 15 years of age eye injuries, puncture wound) TT2 At least 4 weeks 80% 3 years R Incubation period: varies from 3 days to 1 month, later mother falling between 7-14 days protection CLINICAL MANIFESTATIONS TT3 At least 6 months 95% 5 years Convulsion is the first warning symptom among later mother protection A children Restlessness and irritability TT4 At least 1 year 99% 10 years Sore throat with dysphagia is the early warning sign later mother among adults protection Muscular stiffness progresses Trismus: tight jaw, inability to open mouth C TT5 At least 1 year 100% Lifetime ○ 75% of the cases of tetanus exhibit this. later mother Stiff arms and legs, then whole body protection Risus sardonicus: facial muscle spasm; devil’s grin Opisthotonus: backward arching of the back as a POLIOMYELITIS result of dominance of extensor muscles of the spine, ⇒ “Infantile paralysis” head draws back Causative agent: Legio debilitans (poliovirus) ○ Man is the only reservoir DIAGNOSTIC ○ Target: motor neurons → paralysis No diagnostic test Mode of transmission: oro-fecal Rely on history taking and physical exam Incubation period: 5-14 days MANAGEMENT Aggressive wound care  REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS RISK FACTOR Mode of transmission: airborne Aged 5 and below Incubation period: 10 days – fever; 14 days – rashes appear CLINICAL MANIFESTATIONS - Progressive but NOT all would progress RISK FACTOR Aged 5 and below ABORTIVE POLIOMYELITIS –– nonspecific s/sx Colds CLINICAL MANIFESTATIONS Coughs Coryza = COLDS Fever ○ Occur before rash appearance Headache Fever LO Vomiting ○ Highest just before the appearance of rash Barking cough NON-PARALYTIC POLIO –– meningitis-like s/sx Conjunctivitis = sore eyes Stiffness of neck, back, and limbs Photophobia Nauseous and vomiting Enlarged posterior cervical lymph nodes Increase protein in CSF Pathognomonic sign: Koplik’s spot (seen in the buccal mucosa) PARALYTIC POLIO –– iron lung machine ○ Whitish spots with a reddish base Spinal: limb paralysis ○ Appear on the day before rash Chest, diaphragm, bladder and bowel paralysis may Rashes (maculopapular): FACEDOWN progression also occur. BULBAR POLIO –– life-threatening Swallowing problem and regurgitation Aspiration may occur encephalitis IL DIAGNOSTIC ○ Appear first on the face, neck, then downwards ○ Pruritus RT PCR serum IgM antibody R DIAGNOSTIC MANAGEMENT CSF analysis or lumbar tap - Symptomatic management Isolate the child until 5 days after the rash MANAGEMENT appearance. R - Symptomatic management: Bed rest Rehabilitation exercises such ROM Eye care with warm saline solution Change positioning every 2 hours. ○ At Home: Clean tap water Proper body alignment Medication: ○ Place child on firm mattress ○ Antipyretics ○ Use footboard to prevent foot drop Increase oral fluid intake A Application of heat and cold to relax muscles Mouth care for Koplik’s spots Suction secretions as needed. IMCI protocol: vitamin A treatment to prevent Assess gag reflex for nutrition ophthalmic complications (blindness) and respiratory For incontinence, skin care; catheterization if ordered. complications (pneumonia) ○ D C Prevention Active immunization: OPV (6th, 10th, 14th weeks), Prevention IPV (14th week) vaccination (trivalent poliovirus Disinfection of soiled articles vaccine) Active immunization: MMR vaccine ○ Sabin: OPV Attenuated; orally Passive immunization: Immunoglobulin ○ Salk: IPV Killed virus; injection Passive immunization: gamma globulin MUMPS Causative agent: Paramyxovirus MEASLES ○ Target: CSF ⇒ “Rubeola” Period of communicability: one to six days before Causative agent: RNA containing paramyxovirus the first symptoms appear until swelling disappears Period of communicability: 4 days before the Mode of transmission: droplet appearance of rash to 5 days after rash appearance Incubation period: 16-18 days  REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS Complication: Sterility MANAGEMENT Prevention CLINICAL MANIFESTATION Avoid pregnancy for three months after MMR vaccine Prodromal Phase Active immunization: MMR vaccine Coryza = Colds Passive immunization: immunoglobulins Low grade fever Vomiting, headache, malaise CHICKENPOX Causative agent: Varicella zoster virus Acute Phase Mode of transmission: airborne Mastoiditis –– tender swelling behind the ears Incubation period: 2-3 weeks commonly 13-17 days Dysphagia Period of communicability: from as early as 1 to 2 LO Parotitis –– swollen salivary glands (unilateral or days before the rashes appear until the lesions bilateral) have crusted. Orchitis Mastitis CLINICAL SIGNS Prodromal Phase DIAGNOSTIC Mild fever RT PCR Malaise Headache MANAGEMENT - Symptomatic management Acute Phase Isolate until the swelling disappears Bed rest Encourage soft foods and fluids Apply heat or cold compress for swelling IL Orchitis: support scrotum, use cold compress for 20 minutes Vesiculopustular rashes (centrifugal appearance–– start on the trunk then spread peripherally) Pruritus DIAGNOSTIC RT PCR R GERMAN MEASLES MANAGEMENT ⇒ “Rubella;” 3 day measles; teratogenic - symptomatic Causative agent: Rubella virus or RNA containing Medication togavirus ○ DOC: Acyclovir R Mode of transmission: droplet Orally to reduce the number of Incubation period: 12-23 days lesions Communicable period: 7 days before and 7 days Topically to reduce the pruritus after rash appearance ○ Antihistamine ○ NEVER GIVE ASPIRIN to children as this is A CLINICAL SIGNS a viral infection and may lead to the Prodromal Phase development of Reye’s syndrome → brain Mild fever swelling and liver failure. Malaise Isolate the patient until the lesions have crusted. Headache Cool sponge bath with baking soda, oatmeal or colloid Anorexia Calamine lotion for pruritus C Colds Sore throat Prevention Active immunization: chickenpox vaccine Acute Phase ○ 12-15 months; 4-6 years old Pathognomonic sign: Forscheimer spots (red Passive immunization: immunoglobulin pinpoint patches on the oral cavity) Faint maculopapular rashes: fade upon pressure; FACEDOWN progression. NICE TO KNOW Shingles is the reactivation of chickenpox infection caused DIAGNOSTIC by herpes zoster virus → CNS complication, kidney. Rubella IgM by enzyme immunoassay (EIA) Rubella titer ○ Normal 1:10  REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS HEPATITIS B ○ 5 mm or more: significant in HIV patients; ⇒ Serum hepatitis; Sexually transmitted infection high risk individuals (immunocompromised, Causative agent: Hepatitis B virus healthcare workers, overcrowded, persons Mode of transmission: blood and body fluids (cum, deprived with liberty, institutionalized pre-cum, vaginal secretions); transplacental; vaginal facilities) delivery ○ 10 mm or more – significant in normal Incubation period: average 90 days individuals ○ Takes 48-72 hours to read the results CLINICAL MANIFESTATIONS Direct sputum smear microscopy –– confirmatory test Can be asymptomatic ○ Early morning sputum: 3-5 mL → oral care Right sided abdominal pain afterwards. LO Jaundice Anorexia For extrapulmonary TB, biopsy or body fluids. Nausea and vomiting ○ Spine: Pott’s disease Joint and muscle pain Xpert MTB/RIF: Nucleic acid amplification test that Steatorrhea uses disposable cartridge; RAPID TEST within 2 Dark-colored urine hours → results Low grade fever ○ Sputum (1ml) is mixed with a reagent → GeneXpert machine COMPLICATION Liver fibrosis –– thickening and scarring of the liver DIAGNOSTIC Hepatitis B surface agglutination (HBSAg) test IL Liver cirrhosis –– severe scarring of the liver Liver cancer –– chronic hepatitis B is the most common cause of liver cancer Notation T XPERT MTB/RIF Mycobacterium Interpretation tuberculosis (MTB) detected, rifampicin resistance not detected. R RR MTB detected, rifampicin resistance ○ Positive or reactive means INFECTED detected. Anti-HBs or HBsAB (Hepatitis B surface antibody) ○ Positive or reactive means PROTECTED TI MTB detected, rifampicin resistance indeterminate. MANAGEMENT R - Symptomatic management N MTB not detected. Bed rest to reduce metabolic demands of the liver Hand washing I Invalid, no result, error. Safe sex Screen blood for transfusion CLINICAL SIGNS A Usually asymptomatic Prevention Low grade afternoon fever Active immunization: hepatitis B vaccine (0, 1st Productive cough month, 6 months) Easy fatigability Passive immunization: hepatitis B immunoglobulin Hemoptysis (severe case) C Night sweat TUBERCULOSIS Anorexia Causative agent: Mycobacterium tuberculosis; Weight loss Koch’s bacillus Mode of transmission: airborne LATENT TB INFECTION ACTIVE TB INFECTION Incubation period: 2-8 weeks Has no symptom Has symptom DIAGNOSTIC Does not feel sick Usually feels sick Chest x-ray to determine the activity of TB infection Tuberculin / Mantoux test to identify the exposure to Cannot spread TB bacteria May spread TB bacteria to TB bacteria to others other ○ 0-4 mm induration: not significant Usually has a skin or blood Usually has a skin test or  REFRESHER: COMMUNICABLE DISEASES LECTURER: PROFESSOR JAIDEE ROJAS Convalescent Stage test indicating TB infections blood test indicating TB infection Stable vital signs Has a normal chest x-ray; May have abnormal chest WHO CLASSIFICATION OF DENGUE negative sputum smear x-ray; positive sputum smear Needs treatment to prevent Needs treatment to prevent GRADE I: NON SPECIFIC / FLU-LIKE SYMPTOMS TB diseases (Isoniazid, TB diseases Herman’s sign = dengue rashes rifampicin) (+) tourniquet test / Rumpel-Leede test ○ 10 or more petechiae in 1 inch square MANAGEMENT LO GRADE II: GRADE I + SPONTANEOUS BLEEDING Medication: TB DOTS (Direct Observed Treatment Short Course) → increase compliance GRADE III: GRADE II + BEGINNING CIRCULATORY FAILURE (HYPO, TACHY, TACHY) MEDICATION SIDE EFFECTS GRADE IV: GRADE III + DENGUE SHOCK SYNDROME Rifampicin Red orange body fluid discoloration; (INTERNAL ORGAN FAILURE) hepatotoxic Isoniazid Peripheral neuropathy → vitamin B6 DIAGNOSTIC (pyridoxine) RT PCR Pyrazinamide Ethambutol Hyperuricemia → increase OFI IL Optic neuritis; blurring of vision Avoid giving to patient under 6 years old Platelet count: < 150, 000 → (+) Dengue (correlate with s/sx) Dengue duo test: NS1 Antigen + IgG/IgM antibody Test MANAGEMENT R Streptomycin Ototoxic; nephrotoxic - Symptomatic management Medication: DENGUE ○ Anti-inflammatory ○ Antipyretic Causative agent: Dengue virus 1, 2, 3, and 4, and ○ Analgesic Chikungunya virus R ○ AVOID aspirin to reduce the bleeding Mode of transmission: vector borne; bite of female episodes infected mosquito (Aedes aegypti) characterized by Replacement of fluids––most important treatment black and white stripes ○ NSS ○ Daytime biting Low flying Stagnant clear ○ LR –– IV fluid of choice water Urban Blood transfusion: RBC and platelet A Incubation period: 5-7 days Diet: ○ Low fat, fiber CLINICAL MANIFESTATIONS ○ Avoid dark colored foods Febrile / Invasive Stage Sudden high fever Prevention C Abdominal pain Eliminate vectors. Environmental control –– primary Headache prevention approach Vomiting Avoid too many hanging clothes inside the house Sore eyes Residual spraying with insecticide (e.g. Baygon) Epistaxis Daytime fumigation Body malaise Use of mosquito repellants (e.g. OFF lotion Wear long sleeves, pants, and socks Toxic / Hemorrhagic Stage Severe abdominal pain Internal bleeding (usually GI bleed) Unstable vital signs: Hypotension Shock → death may occur