Communicable Diseases: SLRC Comprehensive Review

COMMUNICABLE DISEASE AND PUBLIC HEALTH NURSING TOPIC 1: COMMUNICABLE DISEASES SLRC COMPREHENSIVE REVIEW | (OCTOBER 17, 2022) Lecturer: Michael Bryan Flores Reference Lecture: None...

COMMUNICABLE DISEASE AND PUBLIC HEALTH NURSING TOPIC 1: COMMUNICABLE DISEASES SLRC COMPREHENSIVE REVIEW | (OCTOBER 17, 2022) Lecturer: Michael Bryan Flores Reference Lecture: None to Person between Infection Control (Object) Non-Communicable What is a disease? ○ More common in the hospital setting ○ Detectable alteration in normal tissue function. Infectious VS Contagious Communicable ○ Abnormal condition Diseases ○ Manifestation of signs and symptoms All communicable disease are infectious Types All communicable/infectious diseases are contagious. (There is transmission + Communicable pathogen) ○ Involves infectious agent and All infectious diseases are communicable transmission (There is transmission + pathogen) ○ Infection Not all communicable/infectious diseases Successful inoculation, implantation are contagious. Some are transmitted and replication of an organism in through fomites tissue where it is not commonly Both do not cause disease unless the found pathogen causes s/x (due to immunity and Infectious DSE vaccines) Infection + sign and symptoms Contagion does NOT always lead to & immune response contagious disease NOT all infection can lead to Infection does NOT always lead to Infectious DSE infectious disease ○ Contagion Not all infectious diseases are contagious, There is contact, exposure, that can but all contagious diseases are infectious. lead to transmission of disease Contagious DSE Contagion + successful contact + exposure that leads to signs and symptoms/immune response NOT all Contagion can lead to Contagious DSE ○ Contagious VS Infectious Contagious Infectious Transmitted Person to Person through Person with Element  COMMUNICABLE DISEASE AND PUBLIC HEALTH NURSING TOPIC 1: COMMUNICABLE DISEASES SLRC COMPREHENSIVE REVIEW | (OCTOBER 17, 2022) Lecturer: Michael Bryan Flores Reference Lecture: None to Person between Infection Control (Object) Non-Communicable What is a disease? ○ More common in the hospital setting ○ Detectable alteration in normal tissue function. Infectious VS Contagious Communicable ○ Abnormal condition Diseases ○ Manifestation of signs and symptoms All communicable disease are infectious Types All communicable/infectious diseases are contagious. (There is transmission + Communicable pathogen) ○ Involves infectious agent and All infectious diseases are communicable transmission (There is transmission + pathogen) ○ Infection Not all communicable/infectious diseases Successful inoculation, implantation are contagious. Some are transmitted and replication of an organism in through fomites tissue where it is not commonly Both do not cause disease unless the found infectious pathogen causes s/x (due to immunity and Infectious DSE ✗ all infection → disease vaccines) Infection + sign and symptoms Contagion does NOT always lead to & immune response contagious disease NOT all infection can lead to Infection does NOT always lead to Infectious DSE infectious disease ○ Contagion Not all infectious diseases are contagious, There is contact, exposure, that can but all contagious diseases are infectious. lead to transmission of disease contagious Contagious DSE ✗ all contagion ≠ diseases Contagion + successful contact + exposure that leads to signs and symptoms/immune response NOT all Contagion can lead to Contagious DSE ○ Contagious VS Infectious Contagious Infectious Transmitted Person to Person through Person with Element  Stages of Infectious Diseases Types of Infection Stages According to Involvement Incubation Local infection - specific to certain part of Prodromal the body Stage of Illness Systemic infection - Multi-system Convalescent Stage involvement Incubation Period exposure → 1st sign According to Severity From the exposure/contact (causative Acute - sudden, short time < 14 days ; < 6 months agent) to the appearance of the first sign Chronic - slowly, long time (months to ○ All organisms have incubation period years) > 14 days ; > 6 months Duration of incubation ≠ fatality/severity and infectivity of disease Acute Chronic Duration of incubation period = virulence of the disease (inversely proportional) Infection 14 days sa○ Shorter incubation period = more Disease 6months virulence (potency/power of organism to cause a disease and manifest s/sx) According to Source sa Shorter ○ incubation = less communicable. *Longer incubation can be more Healthcare Associated Infection (HAI’s) ✗ present @ admission communicable since the person can be a ○ Nosocomial Infection ✗ rlt diagnosed infxn carrier and does not manifest s/s Acquired during the client’s stay in the healthcare facility first sign path gnomonic → Prodromal Period ◦ sign The infection was NOT present at the time of admission, and NOT A.k.a Catarrhal period related to diagnosis admission Appearance of first sign to appearance of Appears 48-72 hours after classical / pathognomonic sign admission, can manifest even after ○ Classical sign: general signs discharge ○ Pathognomonic sign: specific sign Ex: pneumonia (pneumococcal *Not all diseases have pathognomonic sign infection) ○ Iatrogenic Infection Stage of Illness Related to the procedures performed to the client Manifestation of ALL signs and symptoms Example: Full-blown disease UTI r/t catheterization Surgical site infection Convalescent Stage Ventilator acquired pneumonia, central line related infection Recovery stage Community-acquired Infection ○ Local transmission in the community Endogenous Infection ○ Internal Infection  ○ Ex: Creutzfeldt Jakob disease/ Summary Transmissible Spongiform Encephalopathy (TSE)/ Mad Cow’s Involvement Local Disease Systemic Abnormal misfolding of the normal Severity Acute prions from the neurons → Infection Chronic → immune response → cell lysis → death of prions → formation of Source Healthcare Associated sponges → Spongiform ○ Nosocomial Encephalopathy ○ Iatrogenic unknown cause Community-acquired *Bovine Spongiform Encephalopathy - in Endogenous animals Exogenous *Transmissible Spongiform Encephalopathy - Opportunistic in humans aka Ceutzfeldt Jakob ○ Ex: Clostridium difficile Common in elderly Infectious diarrheal disease Concepts related to Infection associated to antibiotics Broad antibiotics → eliminates good Epidemiology bacteria → proliferation of abnormal flora Involves the study of patterns and Exogenous Infection occurences of the disease ○ External All diseases have epidemiology ○ From the environment Provides the backbone of disease ○ From cross-contamination prevention ○ Ex: Creutzfeldt Jakob disease/ ○ Proven responses of pandemic Transmissible Spongiform occurences in the past help us in the Encephalopathy (TSE)/ Mad Cow’s current pandemic Disease Ex: 1918 Spanish flu pandemic (Flu virus Ingestion of abnormal prions from H1N1) → serve as guideline for COVID-19 meat or unpasteurized milk → pandemic protocol Involves the study of Bovine Spongiform Encephalopathy patterns and occurrences of the disease or Mad Cow’s Disease Agent: Influenza H1N1 Opportunistic Infection ○ Occurs when immune defense is very Components of occurrences of Epidemiology weak ○ Caused by proliferation of normal flora of Time the skin and normal bacteria/fungi in the Person GI Place ○ Common in AIDS HIV is a disease Patterns of Disease ○ AIDS (Syndrome) is the immuneless state, thus, not a disease EndemiC A syndrome - an immune less state ○ Constant, Consistent, and Continuous of body occurrence of disease ○ Example: Dengue and Leptospirosis during rainy season, Malaria to Palawan and Mindoro,  Filariasis in Sorsogon Goal: 3ft; smaller droplet surfaces (lysol) nuclei; N95 Antiseptics can be used as Aerosol - pressure or force that can disinfectants by disinfectants cannot be suspend the droplet to become be used for antiseptics airborne (Mechanical Ventilator, Sterilization - destroy or eliminate all forms nebulizer) of microbial life ○ Methods: Steam Sterilization - use of moist Portal of Entry heat to destroy the microorganisms by denaturing the enzyme or protein All organs of the body layer of the pathogen therefore destroying the structural layer of the Susceptible Host pathogen (autoclave) Autoclave for at least 30 Factors affecting susceptibility of the host: minutes ○ Age ○ Sex ○ Lifestyle  Ethylene Oxide Sterilization - use of oral med administration, colorless gas with a concentration of managing NGT, personal 450 -1,200 mg/L hygiene, nsg tasks) Disadvantage: Lengthy time Surgical / Sterile - to render an (exposure of 1-6 hours) area free of microorganisms Radiation - UV rays, alpha, beta, (ex: parenteral med and gamma rays administration, insertion of Boiling - using heat at 100°C catheter, surgery/OR, sterile Liquid chemical sterilants - need dressing changes, nsg tasks) long exposure time (3-12 hours) Aseptic technique - absence of Liquid sterilant used in the OR: disease of illness producing Cidex (chlorhexidine) microorganism; maintained by hand Antimicrobial Therapy - antibacterials, hygiene antivirals, antifungal, antiparasitic Safe injection practices Needle accidents are most : Portals of Exit → Mode of Transmission → common cases occur during Portal of Entry the procedure, then after Precaution: Tier I: Standard Precaution ○ Needleless system - ○ a.k.a. Universal precaution retractable needles (lowers ○ Applied to ALL hospitalized individuals risk by 80%) regardless of their diagnosis, or possible ○ Do NOT recap, bend/break infection status ○ Never carry syringes in ○ Applied to ALL body fluids (discharges, uniform pocket secretions, excretions) with or without ○ Do not overfill the sharps blood container ○ Handle and treat all blood and fluids ¾ full as if they are contaminated (!) Color: White, translucent High Risk Low Risk Puncture and leak proof Blood Urine ○ Dispose sharps Body fluids with or without Vomit immediately blood Feces Semen *Waste products ○ Double or triple gloving Vaginal secretions Needle stick injury measures CSF ○ First aid Amniotic fluid Synovial fluid Encourage to bleed Peritoneal fluid under running water Pleural fluid Wash injury with soap Breastmilk and running water Saliva Wash the needlestick but do not touch the ○ Measures: needle Handwashing - most effective way Clean by flushing if on of infection control face Medical Handwashing (Clean) - Irrigate with saline or to prevent transfer of sterile water if eyes pathogens; to reduce the are affected number of microorganisms (ex:  ○ Report to the nurse goggles → gloves gown → mask supervisor ○ Treat COVID-19 PEP - post-exposure prophylaxis Wash hand → shoe Gown → wash gloves cover → hair cover → → hair cover → shoe Within 48 hours gown → mask → eye cover → goggles → Hazards: Blood-borne Diseases protection → gloves gloves → wash gloves ○ Malaria (double) → mask ○ Hepatitis B/C ○ HIV/AIDS Tier II - Transmission precaution ○ TB ○ Depending on mode of transmission ○ Diphtheria ○ Contact precaution Coughing & Sneezing Etiquette Can be applied in a private room, Cover mouth and nose with - cohorting (room-sharing) - = tissue - Cohorting Rule: Patients with If no tissue, cough on the upper the same diagnosis, infection sleeve) status, infectious agent and Dispose properly level of infection are in one PPE room Gloves - mostly used in the Exemption to cohorting rule: hospital Pandemic d/t affected room ○ Clean Gloves patient ratio and hospital ○ Sterile Gloves - wound capacity : cleaning Gloves and gown must be worn by Gown (Apron) - used to protect HCT and visitors the uniform *masks are unnecessary unless there is ○ In infectious wards, plastic respi infection is inside the disposable Proper disposal of infectious gown to follow proper dressings in a single, non-porous disposal technique (rolling material technique) where Both direct and indirect disposable should be rolled Diseases: inside the plastic Respiratory infections Mask - part of respiratory Influenza hygiene Wound infections ○ If the color of the mask is Skin infections shown outside, you are Conjunctivitis protecting yourself (reverse Indirect contact isolation) Enteric infections Goggles ○ Droplet Precaution Hair cover - worn second Can be private and cohort room Shoe cover - worn first ; Can be private room or cohort everything from the waist down (same diagnosis, infection status, is unsterile infectious agent and level of infection are in one room) Donning Doffing Masks should be worn by HCT and (GowMaGogGlov) (GlovGogGowMa) visitors (3 ft) Mask on patient when leaving the Gown → mask → Glove → goggles → room  ○ Airborne Precautions ○ Secondary - Inflammatory Response Can be private room but not cohort ○ Tertiary - Immune System (cohorting only allowed in pandemic bcs bed capacity is more important) Immunology Uses Negative Pressure room (pressure inside the room is lower Study of the immune system in relation to - than the surroundings to prevent the disease - cross-contamination from room to 2 major responses: room) ○ Innate Immune Response Must have air outlet - commonly Physical defense: skin, cilia, flora, exhausted to the roof of the building gastric contents Exchange of air inside is NO MEMORY of the disease needed - 6 exchanges/hour ○ Adaptive Immune Response (every 10 minutes) HAS MEMORY of the disease Mask/respiratory protection device Produces antibodies N95 2 major reponses Surgical Mask minimum for the Cell Mediated Response patients if leaving the room ○ T-cells HCTs must wear mask at all times ○ Ex: Lymphocytes, WBC, helper T-cells (CD4) Contact Droplet Airborne Antibody Mediated Response ○ Antibodies Respiratory Diphtheria MTVC ○ B-cells infections Influenza Influenza Meningitis M - Measles ○ Retains memory Wound infections Mumps T - Pulmonary TB Skin infections Pertussis V - Chicken Pox Conjunctivitis Rubella (Varicella) Antigen Antibodies Indirect contact Streptococcal C - Covid-19 Enteric infections Pharyngitis Carried by the pathogen Immunoglobulins; carried Adenovirus by the human body MRS. WEE (common flu) M - multidrug Parvovirus B19 Usually seen in the Y-shaped proteins that resistant organism SPIDERMAN surface/spike proteins of respond, attack, and R - Respiratory S - Sepsis/Scarlet the microorganism; destroy the antigen infection Fever/ triggers antibody S - Skin infections Streptococcal response W - Wound pharyngitis infections P - Pneumonia/ E - Enteric Pertussis/ (Clostridium Parvovirus B19 Body is exposed to foreign organism Difficile) I - Influenza E - Eye infection D - Diphtheria ↓ (conjunctivitis) E - Epiglottitis R - Rubella Infection M- Mumps/Meningitis ↓ / mycoplasma/ meningeal Phagocytosis pneumonia An - Adenovirus ↓ ↓ Susceptible Host Cell mediated response Antibody Response (T-cells) (B-Cells) Lines of Defense ↓ ↓ ○ Primary - Skin or mucous membrane  Elimination of microorganism IgE Epsilon Protects against allergies Binds to the allergen and triggers Types of Sensitivity Tests histamine release Protection from parasitic worms Antibody test - antibody that is being IgD Delta produced by the body; detects presence of Antimicrobial factors the antibodies (IgG and IgM) Signals B-cells to activate → release of ○ IgG - detects late infection or WBC. previous/past infection, or may indicate that the patient is already at the Interpretations recovery stage (always present in the IgG IgM Interpretation blood) ○ IgM - detects active/ current infection; ↑ ↓ Recovery/ late infection still at early infection stage (first to ↓ ↑ Early infection/ active come) Antigen test - seen in surface of the ↑ ↑ Presence of active/current microorganism; detects the presence of infection and past infection; also confirms immunity antigens Molecular - confirmatory; detecting specific ↓ ↓ Delayed/absent antibody molecule/specific viral proteins present in response; viral load is still not adequate to elicit antibody the body response ○ Ex. Polymerase Chain Reaction (PCR), Nucleic Acid Amplification Test (NAAT) IMMUNIZATION Isotopes/ Antibodies Immunization GAMED IgG “Gamma” Introduction or administration of Hate) Most common type of antibody which is ○ Antibody (mAb) - Monoclonal Antibody. found in the blood (75%) Only antibody capable of crossing the ○ Agents that trigger antibody response placenta → Natural passive GOAL: Immunity immunity ○ “Immunis” - exempt Onset of symptoms to at least 21 days ○ Condition of being secured against a of infection particular disease IgA Alpha Found in Mucosal areas (GIT, Infection Pathology Respiratory Tract, Urogenital Tract) Prevents binding/attaching of the Virus enters and attaches to the cell pathogens on the linings → prevent inoculation or contamination to the Binds to the cell linings (acts as a coat and protection to Releases viral proteins into the cell = the linings) Attachment Saliva, tears, breast milk Viral proteins integrate/mix with our Natural passive immunity proteins → replication occurs Mau Una Mala ki Cell dies because of foreign object - IgM Macro , Leahy) Largest antibody APOPTOSIS or PYROPTOSIS First antibody to appear to respond ○ Apoptosis - cell death Onset of symptoms for at least 5 days of infections ○ Pyroptosis - cell suicide *IgMauuna, IgMalaki If cell doesn’t die = BUDDING New virus EXITS the cell; cell die  Invades the neighboring cell and infection Long-lasting immunity spreads Inactivated ( Sinovac , Bharat Biotech , Sino pharma ) Types of Immunity Most common vaccine → safest and easiest to create Immunity Not long lasting ↓ ↓ Requires multiple doses → booster dose Moderna ) MRNA : Pfizer & Natural Artificial Active Component ( Vijealuor : Astrazeneca, J&T V , Sputnik Biological means (infection Pharmacological Means of chickenpox, etc) (Vaccines, immunization) Only part, conjugate, or component of the organism if introduced ↓ ↓ ↓ ↓ ○ No surface protein → no binding and Active Passive Active Passive infection pathology ○ Floats through the circulation → create Antigen- Antibodies- Antigen- Antibodies- immunity and memory delayed; immediate; delayed; immediate; - - long-term short-term long-term short-term Separated from the organism Good immunity but expensive, and Exposure Maternal Vaccine Immunoglo challenging to manufacture to an antibodies (polio, bulins, antigen (ex: (IgG and chickenpox antitoxins Ex: HBV, mRNA vaccine (Pfizer & Moderna) chicken IgA) ) and (TIG), pox) through toxoids antiserum colostrum/ (tetanus Toxoids Breastmilk toxoid) Toxoid - triggers antibody response Weakened toxin; detoxified ○ Preventive/prophylactic measure Does not prevent infections Immune globulin - transfers actual Counteracts the effects of toxins antibodies ○ Treatment measure COVID-19 Vaccines Monoclonal Antibody (mAb) Live Attenuated - NONE ○ New pharmaceutical breakthrough Inactivated ○ Genetically engineered, cloned ○ Sinovac antibodies from humans in the form of ○ Bharat Biotech medicine therapy ○ Sinopharma ○ “-mab” drugs Active component ○ Still being studied for HIV and cancers ○ mRNA - best type Pfizer - newest vaccine; first ÷ VACCINES approved vaccine by FDA Brand name: Comirnaty Live Attenuated ( NONE ) Moderna - second to be approved by FDA Introducing actual infection → can produce Brand name: Spike Vax active infection to the body → creates ○ Viral vector inflammation and antibody response → Adenovirus - component of good memory - Sars-Cov2 Best type of vaccine Non-replicating vaccine Not all vaccines can be live attenuated Oxford AstraZeneca Single dose needed  Gamaleya Sputnik V - from Russia - ○ 20 y.o - 1 mL Janssen (J&J) Route: IM Dose: at birth VACCINES FOR PREVENTABLE DISEASES IN Brands: Engerix B, Genvac B PH Polio Vaccine Preventable Disease in the PH Vaccine: OPV & IPV Published: 2019 (Philippine Pediatrics Amount: Society ○ IPV: 0.5 mL Target: Birth - 18 y.o ○ OPV: 2-3 drops Route: IM or SubQ Tuberculosis and Leprosy Dose: 6-4-4 weeks ○ 1st, 2nd Vaccine: BCG (Bacillus Calmette Guerin) ○ 3rd: 4 weeks + IPV (Inactivated Polio Type: Live Attenuated Vaccine Given: at birth ○ Brands: IPV, iPoL Amount: 0.5 mL Route: ID Rotavirus Brands: BCG vaccine (India), TheraCys BCG #1 cause of diarrhea in children Vaccine: Diphtheria, Pertussis, Tuberculosis, Hep. B, HiB Type: Live Attenuated Route: Oral Vaccine: Pentavalent vaccine Brands and Dose: Type: ○ RotaRix (1mL) ○ DPT - Inactivated 1st (2 mos) ○ Hep. B & HiB - Activated recot 2nd (4 mos) Amount: 0.5 mL ○ RotateQ (2mL) Route: IM 1st (2 mos) Doses; 6-4-4 weeks 2nd (4 mos) Brands: Pentavac, Pentabio, Quinvaxem 3rd (6 mos) Measles, Mumps, Rubella Influenza Vaccine: MMR Vaccine: Flu Vaccine Type: Live-attenuated Type: Inactivated Amount: 0.5 ml CDC: yearly; annually as early as 6 months Route: SubQ Amount: 0.5 mL Doses: Route: IM ○ 12-15 months Ex. Fluarix, Flulaval, Fluzone ○ 4-6 years old Brands: Priorix, M-M-R-II HPV (Human Papillomavirus) Hepatitis B Vaccine: Vaccine: HBV Type: Recumbent Type: Active Recombinant Amount:  Introduced during adolescent stage - 11 to 2nd dose: 65 years old and up 12 y.o.; 2 doses; 6-12 mo. interval ○ Brand: Amount: 0.5 mL PCV - Prevnar 13 Route: IM PPSV - Pneumovax 23 (interval Dose: should be at least 5 years apart) ○ 11 or 12 y.o.: 2 doses; 6-12 mo. interval ○ 15 y.o. and above: 3 doses; 6 mo. apart PCV 13 - less than 19 years old Brand: Gardasil, Cervarix ○ To be followed when client received PCV 13 when 1st: 12-15 months ○ 1st (2 mos) ○ >2nd: 4-6 years old ○ 2nd (4 mos) Brand: Varivax, ProQuad ○ 3rd (6 mos) ○ 4th (12-15 mos) Hepatitis A Brand: Prevnar 13 Vaccine: Hep. A vaccine Adults Type: Inactivated ○ Vaccine: Amount: 0.5 mL PCV 13 - 13-valent Pneumococcal Dose: Conjugate Vaccine ○ 1st: 12-23 months PPSV 23 - 23-valent Pneumococcal ○ 2nd: 6 months after Polysaccharide Vaccine Brand: Havrix, Vaqta ○ Type: ○ Amount: SUMMARY: PCV: 0.5 mL VACCINES FOR PREVENTABLE DISEASES… ○ Route: Ty cal PCV: IM or SubQ: ○ Dose: PCV: 2 years old and below 1st dose: 19-64 years old  Red - Bathrooms, washrooms, showers, " naay napkin " toilets Blue - general areas, wards, office ADDITIONAL NOTES Green - catering, food services (ward level) Yellow - isolation area Virus Handwashing Intracellular ○ Attacks directly the cells Components: Rhabdo virus - brain cells ○ Most effective way of infection control COVID 19 - pneumocyte I and II ○ Soap at least 4-5 mL cells ○ Running water ○ Friction: most important ○ At least 20 seconds (2x happy birthday) Pneumocytes 5 moments: ○ Before touching a patient Linings of the alveolar sac ○ Before a clean/aseptic procedure Responsible for gas exchange (CO2-O2 ○ After exposure to blood or body fluids exchange) ○ After touching a patient ○ After touching the patient’s surroundings Virulence Hepatitis D potency/power of organism to cause a disease to manifest s/sx Co-infection hepatitis Forschheimer Spots Fecal-oral route Hepatitis Present in both German measles and Precaution: Contact precautions Scarlet fever Ex. Hep A and E Acute infection (faster) Spanish Flu Blood-borne Hepatitis Strain: Influenza H1N1 Did not come from Spain Precaution: Blood-borne precaution Currently the common flu Ex. Hep B, C, D Considered as endemic since people Chronic infections (slower) developed immunity to the strain 2 Classifications of HEP B Ringworms (FUNGI) Co-infection - Hep B & Hep D (together) Tinea capitis: head itchiness Superinfection - Hep B first, then Hep D Tinea pedis: athletes foot Tinea cruris: jock’s itch Hepatitis X Autoclaving Hepatitis from unknown cause even if there are manifestations of symptoms >121⁰C or 250 ⁰F for at least 30 minutes Malaria Color Coding of Cleaning Materials in Hospital Agents:  ○ Plasmodium falciparum - common in the Protection from droplet, aerosols, Philippines; most dangerous and fatal protein nucleus, virus, bacteria, Malignant malaria fungi, spores, asbestos Goes to the brain and causes 99% cerebral malaria Ex: N99, KN9, EN149, P-3 ○ Plasmodium vivax - 2nd most common; Standards: causative agent of tertian malaria ○ KN - China ○ Plasmodium ovale ○ N - USA ○ Plasmodium malariae - Rarest ○ EN - EU Vector - female Anopheles mosquito ○ KF - Korea and Japan Pathognomonic Sign: Masks should be changed every 75 min ○ Cold (chills) N95 can be reused after 24-48 hours; can ○ Hot (recurrent high fever) hang it if no visible dirt ○ wet (diaphoresis) *Appears simultaneously Parvovirus B-19 Tertian Malaria ○ Agents: P. Falciparum, vivax, ovale Causative agent of Erythema infectiosum; ○ Episodes or paroxysms happen every a.k.a Slap cheek disease 3rd day (chills, fever, diaphoresis) Not froms dogs ○ Interval: 2 days (Day 1, 3, 5) A rash disease common in children ○ Attacks RBCs → rupture of RBCs happen in every 3rd day → hemolytic Pertussis anemia Quartan Malaria AKA “100 day cough”, “Whooping Cough” ○ Agent: P. Malariae Inspiratory whoop after each cough ○ Episodes or paroxysm happen in every 4th day (chills, fever, diaphoresis) ○ Interval: 3 days (Day 1, 4, 7) ○ “Rare” Masks Simple face mask - cloth Surgical Mask - medical grade ○ Color out - protect your patient ○ White out - protect yourself Filtering Facepiece Mask ○ FFP 1 Better than surgical No protection from viruses 80% of infiltration ○ FFP 2 Level of protection against viruses 94% - 95% Ex: N95, KN95M P-2 ○ FFP 3 High quality fiber/filter  COMMUNICABLE DISEASE AND PUBLIC HEALTH NURSING TOPIC 2: IMMUNIZABLE DISEASES SLRC COMPREHENSIVE REVIEW | (OCTOBER 17, 2022) Lecturer: Michael Bryan Flores Reference Lecture: None Signs and Symptoms TUBERCULOSIS ☆ Low grade afternoon fever _ Cough for 2 weeks AKA Koch’s Disease, Phthisis, Chest pain Consumption Disease, Great White Plague Malaise Discovered by Robert Koch (1882) - Fatigue Mycobacterium tuberculosis ☆ Night Sweats Commonly found in: Weight loss ○ Asia and Africa - 80% Hemoptysis - Blood in the phlegm ○ USA - 5 to 10% (low) Extra Pulmonary TB Causative Agent Infection outside the lungs Mycobacterium tuberculosis - Aerobic Common in children and in type (likes O2) - attacks the alveoli - immunocompromised M. African - West African Countries Common sites: M. Canetti - common in Horn of Africa ○ Pleura (Somalia, Ethiopia); ○ Meninges ○ reservoir = UNKNOWN ○ Lymphatic System ○ Associated with domestic farm animals ○ Genitourinary M. Bovis - TB in cattles; humans can be ○ Bones infected from drinking unpasteurized milk M. Microti - from rodents Pathophysiology M. Avium - opportunistic infection (food, water, soil) = MAC: Mycobacterium Avium Mycobacterium - aerobic - needs O2 to ( Non TB Complex (AIDS) survive - targets organs with high levels of - mycobacteria - ○ One of the common opportunistic O2 : infection for AIDS Inhaled into the body M. Kansai - opportunistic infection (AIDS) Pulmonary Alveoli (where gas exchange ○ Avium and Kansaii - classified as occurs - O2 present) non-Tuberculosis Mycobacteria; does Affects respiration not attack the respiratory system ○ Cough ○ Sputum Incubation Period ○ Fever Replicate and inoculate in the alveoli - 2 to 12 weeks spread - lung tissues ○ Fibrosis Mode of Transmission ○ Parenchymal lesions ○ Necrosis Airborne and Droplet X-ray: Lung opacities Diagnostic Tests Positive 1 to 9 AFB (100 fields) Primary: Mantoux Test - aka. Tuberculin 1+ 10-99 AFB (100 field) test, PPD (Purified Protein Derivative) Test ○ Through ID injection - 0.1 ml PPD → 2+ 1-10 AFB (at least 50 fields) site: Inner aspect of the lower arm 3+ >10 AFB (at least 20 fields) ○ Result: read after 48-72 hrs - Unit: Induration Positive Results: Chest X-Ray ○ Detects fibrosis and parenchymal Classification Induration lesions HIV & Immunocompromised ≥ 5mm ○ Not confirmatory ○ Confirmatory only if there is HC workers, prisoners, children 10 mm travel to countries with ↑risk of TB → hemoptysis - contraindication for Culture and Sensitivity/DSSM CII : General Population ≥ 15 mm CRS, DSSM Management Confirmatory: ○ If CHN - DSSM: Direct Sputum Prevention Smear Microscopy ○ BCG Vaccine ○ If hospital - Sputum Culture and ○ Airborne precaution - negative Sensitivity pressure room (isolation); end of the Will confirm active infection hallway, far from the Nurses’ Station Method: Fluorescence Acid ○ PPE - masks; N95 - FFP 2 Fast Microscopy Staining - DOH Program detect acid fast bacilli (AFB) ○ National Tuberculosis Control count in the sputum Program ○ Procedure: 3 sputum specimen ○ Strategy - Direct Observation samples Treatment Short Course (TB DOTS) Amount of samples to get: at “Tutok Gamutan” least 5 mL/specimen - ask Multidrug therapy them to deep cough Short course for treating TB Best time to obtain sample - ○ Methods of administration morning (nothing done in Fixed dose combination - 2 mouth - brushing, gargle, etc) or more anti TB drugs are ○ Positive Results; combined in one pill 2-3 positive samples: Single drug preparation - confirms smear positive each drug is prepared if only 1 (+): repeat 3 sputum individually - = sampling ○ Negative result: Drugs 3 samples are smear negative X Drug Side Effects Laboratory Interpretation: H Isoniazid Neurotoxicity R Rifampicin Red colored/ Tears, Diagnosis Result Red-orange secretions urine Negative No AFB seen in 100 fields of microscope Z Pyrazinamide Hepatotoxicity  E Ethambutol Optic Neuritis Eyes Common sign of Paget’s = Disease → malignant bone S Streptomycin Ototoxicity & Ears = cancer Nephrotoxicity Lepos = skin *all are hepatotoxic Lepros = scaly man Lepers/ leperos = man with leprosy Categories of TB Not a highly contagious disease Phases Total Causative Agent TB Patients Duration Intensive Maintenance in Months Mycobacterium leprae I (+) S/sx 2 months 4 months RI 6 ○ Stays and reproduces in cooler (+) Chest X-ray RIPE temperatures New smear (+) Reservoir: Armadillos (have cool bodies) New smear (-) but with ○ Natural reservoir; usually found in extensive Southern US; low transmission rate parenchymal lesions With extra Incubation Period pulmonary TB II Relapse 2 months 5 months 8 9 months to 20 years (treatment RIPES RIE Ave: 5 years (CDC) failure; after 5 mos or more) 1 month RIPE Mode of Transmission III (-) S/sx 2 months 4 months 6 CDC - not known how it spreads in human (+) Chest X-ray RIPE RI Asymptomatic Associated with direct contact - coughing, TB sneezing, inhalation of droplets New smear (-) with minimal Prolonged close contact with infected & parenchymal untreated leprosy (for months or years) lesions IV Chronic REFER DOTS Signs and Symptoms TO –will move DOTS on to 2nd Pathognomonic Signs: -Usually line resistant *○ Cutaneous Skin Lesions to 1st ○ Neuropathies (hands and toes) line = ○ Sensory loss (limbs) Classifications LEPROSY Paucibacillary - low quantity Aka Hansen’s Disease or Hansenosis or ○ Tubercular type of leprosy " Leper’s Disease or Leontiasis lion face " - 5 or less skin lesions ○ Discovered by Gerhard Armauer 2-5 only Hansen - 1973) ○ Single Lesion Paucibacillary ○ Leper Colonies (confinement) Only 1 lesion ○ Leontiasis - lion face; Lepromatous Multibacillary - lepromatous Leprosy ○ 6 or more lesions ☆○ Leontiasis Ossea - overgrowth of - facial and cranial bones Pathophysiology To the skin: Treatment Mycobacterium leprae infiltrates body via direct contact → goes to portions of the MDT - Multidrug Therapy body that have cool temperature (skin) → - ○ To prevent resistance from antibiotics skin nodules → loss of sensation at the WHO Treatment protocol: Blister Packs site of skin lesion → non-healing lesions → ○ Paucibacillary - negative skin smear anhidrosis (loss of function of sebaceous *Pau(six)bacillary glands) → dry skin → loss of hair (eyebrows Rifampicin 600 mg once/month and eyelashes) → Dapsone 100 mg OD Skin lesions → formation of large plaques, For 6 months enlarged lesions (earlobes, nose, eyebrows, Day 1: R + D forehead) → Leonine face Day 2-28: D To the peripheral nerves: Full course: 6 blister packs Nerve damage → atrophy of the muscles in ○ Multibacillary - positive skin smear the hands and toes → claw hand Rifampicin 600 mg once/month (radial-ulnar neuropathy) and claw toes Clofazimine 300 mg once/month; 50 (posterior tibial neuropathy) → foot drop → mg OD Muscle weakness → paresthesia Dapsone 100 mg OD Facial nerve paralysis → lagophthalmos For 12 months (inability of the eyelids to open) → paralysis Day 1: R + C (300 mg) + D of eyelids related to corneal ulcerations and Day 2-28: C (50 mg) + D lesions → corneal scarring → blindness Full course: 12 blister packs To the mucosa (upper respiratory mucosa): ○ Single Lesions - negative skin smear Infiltration → nasal perforation → infection Single dose of: ROM → Saddle nose (collapse of the nasal Rifampicin 600 mg 600 100 400 bridge) → epistaxis Ofloxacin 400 mg Infection → epistaxis and ulcerations on Minocycline 100 mg uvula and tonsils Note: given simultaneously Diagnosis DIPHTHERIA aka. Bull Neck Disease, Klebs-Loeffler's ☆ Confirmatory Test: Skin/Nerve Biopsy (CDC) Disease, Pseudomembrane ( bubble gum on the throat ) - Skin Smear/ Skin Slit Smear (WHO) ○ Both are similar tests; both get sample Causative Agent tissue to examine presence and number Corynebacterium diphtheriae or Klebs E- of mycobacterium Loeffler bacillus ○ Must be active lesions ○ Bacterial spore → releases diphtheria ○ Size: 8 mm skin sample toxin ○ Areas: Any part of the body with active ○ Discovered by Edwin Klebs and lesions (e.g. earlobes, chin, forehead) Friedrich Loeffler ○ 1% acid alcohol or 5% sulfuric acid for 10 secs and examine - 100 fields Incubation Period Prevention 2 to 5 days BCG Mode of Transmission Direct contact with an infected person Signs and Symptoms Management Pathognomonic Sign: Pseudomembrane - Isolation → highly contagious smooth, adherent whitish or grayish membrane on the hard palate (like a bubble Precaution gum) DPT Vaccine (part of Pentavalent) Site of Infection Treatment of Choice Upper respiratory tract Most common: Tonsillopharyngeal area Horse Serum Based Antitoxin (Equine) - ○ Must request from WHO Pathophysiology ○ Neutralizes the toxins - given thru IV; 10,000 IU/ampule Infection is in descending pattern from the ○ Skin scratch test required prior to = nasal cavities to the upper GI system administration (for skin sensitivity) Phases: DOC: Erythromycin and Penicillin G for - ○ Nasal diphtheria - nasal congestion 14 days and bloody mucopurulent discharge → - ○ Complications: Respiratory arrest, toxic ○ Tonsillopharyngeal diphtheria → sore cardiomyopathy throat, low-grade fever → pain in throat Skin Scratch Test ○ Pseudomembrane - Mycobacteria feeds ○ 27 gauge needle 2 to 4 mm on tissues → fibrosis (increased fibrin) ○ 1st: Saline Solution (Upper Left Arm) → increased WBC (infection) → dead Negative control (noo reaction) cell tissues → pseudomembrane → ○ 2nd: Histamine phosphate (Lower Left extends/spreads to larynx Arm) ○ Laryngeal diphtheria - pseudomembrane Positive control (skin reaction but is extended to the larynx → respiratory not leading to any fatal condition; compromise d/t formation of foreign erythema of 3 mm or more) object/swelling in larynx → barking ○ 3rd: Diphtheria Antitoxin (Lower Right cough, stridor, hoarseness of voice Arm) ○ Swelling in larynx → Bull neck (swelling Negative: erythema of 1 month only Mode of Transmission ○ 21 days Complications Direct Contact Indirect contact (contaminated objects) Pneumonia Seizures Signs and Symptoms Encephalopathy Pathognomonic Sign: ○ Whooping cough TETANUS Inspiratory whoop Aka Lockjaw, Sardonic Smile Disease, Nocturnal coughing followed by a Trismus sudden inspiration associated with a *sardonic - bitter, mocking crowing sound or a whoop *trismus - tetanic spasms of the mastication muscles Pathophysiology Causative Agent 3 stages: Clostridium tetani (anaerobic bacteria) a. Catarrhal/ Prodromal Stage (1st sign ○ Commonly found in soil and manure to pathognomonic sign) - 7-10 days  ○ Characteristics: bacterial spore → ○ Happens when patient is partially releases toxin (Tetanospasmin causing immunized muscle spasm) ○ Localized or regional muscle spasm in = the proximity of the wound Incubation Period ○ Lowest mortality Neonatal Tetanus 3 to 21 days ○ Highest mortality/most fatal Average: 10 days ○ Common site of infection: Umbilicus - could lead to generalized tetanus Mode of Transmission Signs & symptoms: poor feeding → full blown disease (generalized Direct contact tetanus) Indirect contact Cephalic Tetanus ○ Enters through wounds or burns (point ○ Rarest form of entry) Usual cause: Head or neck injury/ wound Pathophysiology ○ Short incubation period: 1-2 days ○ Usually characterized by unilateral C. tetani → enters wound → releases toxin facial nerve palsy → disrupt neuromuscular functions → Ptosis occurs in descending pattern starting on the Sardonic smile face (trismus and risus sardonicus) → body (opisthotonus) → muscle Diagnostic Test tearing/bone fracture Spatula test - spatula touches the posterior Signs and Symptoms pharyngeal wall ○ Normal (-): Gag reflex occurs Pathognomonic Sign: (Triad) ○ Abnormal (+): Muscle contractions/lock ○ Lock jaw with trismus jaw l bites the spatula) Spasm and rigidity of the facial muscles caused by tetanospasmin Prevention toxin ○ Risus Sardonicus DPT Vaccine (part of Pentavalent Vaccine) ○ Opisthotonus - arching of the back and clenched arms Treatment of Choice Spasms: ○ Sudden Antitoxin - Tetanus Immunoglobulin (TIG) ○ Powerful ○ IM ○ Lasting ○ 500 IU single dose ○ Painful Antibiotic ○ Penicillin Types of Tetanus Muscle relaxant ○ Benzodiazepine Generalized Tetanus Pain meds ○ Most common; 80% ○ Shows triad of tetanus Management ○ Mortality: 10-20% (d/t laryngospasm) Localized Tetanus Supportive care ○ Mild form of tetanus  Intubation/ mechanical ventilation if DOB Common Bacteria: ( mostly Streptococcus) occurs from laryngospasms ○ Newborn - Group B Streptococci, E. Coli, Listeria Monocytogenes Complications ○ Children / Teens - Neisseria meningitidis, Streptococcus pneumoniae Fractures opisthotonus - no - most common Pulmonary embolism ○ Adults / Elders - Streptococcus pneumoniae, Listeria monocytogenes Meningitis TB Meningitis - Mycobacterium tuberculosis → Chronic TB (common during the chronic AKA cerebrospinal fever tuberculosis stage of the patient → high Inflammation of the first 2 inner layers of the - AFB) meninges (protects the brain) where CSF is Virus: located ○ Enterovirus - fecal-oral ○ 2 inner layers aka leptomeninges ○ Herpes Simplex Arachnoid mater ○ HIV = (subarachnoid) Pia mater Fungi: ○ Cryptococcus - opportunistic *Dura mater is not included Parasite: Has no specific causative agent ○ Protozoa - P. falciparum (Malaria) Bacterial and Viral → Acute Meningitis Meningitis Meningococcal Meningococcemia Fungal → Chronic Meningitis = Inflammatory Bacteria Infection + septicemia Immunocompromised response to - Neisseria (infection of the blood) No person to person spread ; from fungal any foreign meningitidis blood infection ✗ person person spread - microorganism Starts with blood ✓ Fungal blood infection or foreign infection → infecting object (no CSF Incubation Period specific causative agent) 2 days to 2 weeks; depending on the causative agent 6 types of Neisseria meningitidis ○ ABCWXY Mode of Transmission ○ Men ACWY - Menactra, Menveo, Droplet infection MenQuadfi ○ Anatomical defect - congenital defect ○ Men B - Bexsero, Trumenba (ex. Spina bifida) ○ No vaccine for type X ○ Skull fracture Blood vessels are located between the Hematogenous spread - bacteria spread subarachnoid and pia mater through the bloodstream from a distant Two ways of meningococcemia infection: source to the lesion ○ Infection from the CSF may cross to the bloodstream → septicemia Pathophysiology = ○ Infection from the bloodstream may cross to the CSF Infection → CSF → inflammatory response (leptomeninges) → Causative Agent ○ Hematogenous → bloodstream → Any foreign microorganism (no specific agent) blood brain barriers → CSF - ○ Droplet spread → I CSF → multiplication and replication of ○ Most common: Bacteria  organism → meningitis → increased ○ Bacteria: >100 WBC/microliter WBC → s/sx ○ Viral: 10 - 1000 WBC/microliter → Meningo-encephalitis → altered mental ○ Fungi: 10-500 WBC/microliter state and seizures → encephalitis → coma → death Prevention Signs and Symptoms Meningococcal Vaccine ○ Men ACWY - Menveo Triad Sign ○ Men B - Trumenba ☆○ Fever ☆ ○ Headache Management - ○ Nuchal Rigidity Photophobia - discomfort with bright lights General rule for treatment: Identify the { Phonophobia - discomfort with loud sounds cause Meningo-encephalitis Bacterial ① ○ Altered mental state ○ Steroid (first) - prevent injury and ○ Seizure decrease inflammation of the Kernig’s and Brudzinski’s Sign leptomeninges ○ Antibiotic ② Viral Kernig’s Sign Brudzinski Sign ○ Antiviral Knee Batok; back of the head Parasite ○ Antiparasitic Knee flexed 90 degrees, Flexion of neck causes Hip 90 degrees flexion of hips & knees (+) Meningococcal Disease - N. Meningitidis Extension of knee going ○ Antibiotics - cephalosporins up = pain, resistance (+) Ceftriaxone, Cefotaxime Complications Otitis Media Mastoiditis Blindness Pneumonia Bronchitis ○ Could be multisystem INFLUENZA AKA Flu Now an endemic disease Causative Agent Diagnostic Tests Influenza Virus Lumbar Puncture ○ CSF sample Types of Influenza Virus ○ 3 samples in tubes; 1 mL/tube (CDC) ○ (+) 2-3 samples Type A - HN ○ Both humans and animals (commonly - WBC Count: ○ N: 1 microliter of CSF = 5 WBC birds, cattles, pigs)  ○ (H) hemagglutinin → attach to cells Runny nose ○ (N) neuraminidase → bud/exit Sore throat ○ H protein - 18 types; N protein - 11 types Cough (non-productive) 198 combinations → only 131 known Diagnostic Tests Bird Flu (A) Can cause pandemic because Rapid Influenza Diagnostic Test (RIDT) birds are migratory ○ Results are obtained within 15 minutes AH1N1 - Spanish Flu ○ Detects what type of infection Swine Flu ' Confirmatory: PCR (swabbing) Can only trigger outbreaks H1N1 , H1N2 , H3N1 , H3N2 Prevention Tybe B - common seasonal flu (winter flu) ○ Humans only and not animals Influenza vaccine ○ Strains/Lineages ○ Vaccine formula changes yearly d/t fast Yamagata mutation of flu strains Victoria ○ Recommended yearly Type C - mild flu ○ Can be received as early as 6 months ○ less common to human ○ common to children Management Type D - not known to humans ○ common to animals (cattles) Isolation: ○ Single room only (no cohort unless there Incubation Period is a pandemic) with negative pressure DOC: 1-4 days Average: 2 days ○ Severe: Neuraminidase Inhibitors - prevents exit and budding → preventing infection of other cells Mode of Transmission Oseltamivir (obsolete). Peramivir Droplet ○ M2-proton inhibitors (adamantanes; Fomites “-tadine”) → prevents attachment of viruses → inhibiting infection 8 Pathophysiology Amantadine Rimantadine Influenza virus → attacks upper respiratory system → binds to linings of upper Complications respiratory (endothelial cells) → attachment of viral proteins (H-proteins) → Hemorrhagic Pneumonia replication through integration → production Encephalitis of new viral proteins → budding/exciting Myocarditis using N-proteins → production of New Virus Sinusitis ○ → infection of other cells ○ → Droplet nuclei → inhalation → spread MUMPS of infection Aka Infectious Parotitis, Epidemic Signs and Symptoms Parotitis Attacks the glandular structures of the body Fever (esp. Parotid glands) ○ Salivary glands:  ⑦ Parotid gland - nearest to the - nose → first exposed Management Sublingual gland Submandibular gland Droplet precaution Supportive and symptomatic Causative Agent Tepid sponge bath - low grade fever Medications: Paracetamol - fever Mumps Virus (Paramyxovirus) → targets glands ADDITIONAL NOTES Incubation Period Skin slit smear 12-25 days Average: 16-18 days Obtain sample of skin or tissue from the affected area to be examined Mode of Transmission Size: 8 mm Location: Area of lesions Droplet and indirect contact (fomites) Actions: ○ Drop 1% acid alcohol or 5% sulfuric acid Pathophysiology to the lesion ○ Wait for 10 seconds Mumps Virus → droplet /fomites → targets ○ Examine tro 100-field microscope glandular tissues → inhaled into the upper respiratory tract → localize on the salivary Encephalitis glands → parotid gland → infection/inflammation (75%; commonly Inflammation of the brain bilateral) → swollen parotid (lasts 1 week) Meningo-encephalitis - infection from → S/Sx → late complications meninges to brain Signs and Symptoms Swine Flu Pathognomonic sign: Painful swelling of Combinations that caused outbreaks around one or both of the Parotid glands " bayook " the world Low grade fever ○ H1N1, H1N2, H3N1, H3N2, H2N3 Headache Malaise Mutation Late Symptoms - lower glands Orchitis (t