FINALS COVERAGE

CONTROL OF COMMUNICABLE DISEASES

COMMUNICABLE DISEASES

Goal of WHO
1. Prevention of disease
2. Prevention of disability and death from infection
3.Prevention through immunization

LESSON 1: CHAIN OF INFECTION AND RELATED CONCEPTS

1. Pathogen, etiologic agent or causative agent

biologic agent (organism) capable of causing disease
Eliminate organism by:
 Sterilizing surgical instruments and anything that touches sterile spaces of the body
 Using good food safety methods
 Providing safe drinking water
 Vaccinating people so they do not become reservoirs of illness
 Treating people who are ill
2. Reservoir
Any person, animal, arthropod, plant, soil, or substance (or combination of these) in which an
causative agent normally lives and multiplies, on which it depends primarily for survival, and
where it reproduces in such numbers that it can be transmitted to a susceptible host
Eliminate reservoirs by:
 Treating people who are ill
 Vaccinating people
 Handling and disposing of body fluids responsibly
 Handling food safely
 Monitoring soil and contaminated water in sensitive areas of the hospital and washing
hands carefully after contact with either
3. Portal of exit
the way the causative agent gets out of the reservoir (body fluid or skin)
Reduce risk from portals of exit by:
 Covering coughs and sneezes with a tissue
 Handling body fluids with gloves, then doing hand hygiene
 Keeping draining wounds covered with a dressing
 Not working when you have exudative (wet) lesions or weeping dermatitis
4. Mode of transmission
any mechanism by which a pathogen is spread from a source or reservoir to a person

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unwashed hands, things which are not cleaned between patients, droplets, or, for a few
diseases, the air
Eliminate the mode of transmission by:
 Hand hygiene
 Wearing gloves to minimize contamination of hands and discarding them after each
patient
 Cleaning, disinfection, or sterilization of equipment used by more than one patient
 Cleaning of the environment, especially high-touch surfaces
5. Portal of entry
hole in the skin that allows the infectious agent to get into the body (mouth, nose, eyes,
rashes, cuts, needlestick injuries, surgical wounds and IV sites)
Protect portals of entry (our own and our patients) by:
 Dressings on surgical wounds
 IV site dressings and care
 Elimination of tubes as soon as possible
 Masks, goggles and face shields
 Keeping unwashed hands and objects away from the mouth
 Actions and devices to prevent needlesticks
 Food and water safety
6. Susceptible host
a person or animal lacking effective resistance to a particular infectious agent
Minimize risk to susceptible hosts by:
 Vaccinating people against illnesses to which they may be exposed
 Preventing new exposure to infection in people who are already ill, are receiving
immunocompromising treatment, or are infected with HIV
 Maintaining good nutrition
 Maintaining good skin condition
 Covering skin breaks
 Encouraging rest and balance in our lives

Related terms:
Symptoms
evidence of disease that is experienced or perceived (subjective)
subjective changes in body function noted by patient but not apparent to an observer
Signs
objective evidence of a disease the physician can observe and measure
Syndrome
a specific group of signs and symptoms that accompany a particular disease
Incidence
the number of people in a population who develop a disease during a particular time
period
Prevalence
the number of people in a population who develop a disease, regardless of when it
appeared refers to both old and new cases

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Classification of Infectious Disease

Based on Behavior within host

Infectious Disease
- Any disease caused by invasion and multiplication of microorganisms
Contagious Disease
disease that easily spreads from one person to another

Based on Occurrence of Disease

Sporadic Disease
disease occurs only occasionally
i.e. botulism, tetanus
Endemic Disease
constantly present in a population, country or community
i.e. Pulmonary Tuberculosis
Epidemic Disease
acquire disease in a relatively short period greater than normal number of cases in an area
within a short period of time
Pandemic Disease
epidemic disease that occurs worldwide
i.e. HIV infection

Based on Severity or Duration of Disease

Acute Disease
develops rapidly (rapid onset) but lasts only a short time
i.e. measles, mumps, influenza
Chronic Disease
Develops slowly, milder but longer lasting clinical manifestation

Based on State of Host Resistance

Primary Infection
acute infection that causes the initial illness
Secondary Infection
one caused by an opportunistic pathogen after primary infection has weakened the body’s
defenses

Stages of Disease
Incubation Period
time interval between the initial infection and the first appearance of any s/sx
Prodromal Period
early, mild symptoms of disease

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Period of Illness
overt s/sx of disease
WBC may increase or decrease
can result to death if immune response or medical intervention fails
Period of Decline
s/sx subside
vulnerable to secondary infection
Period of Convalescence
regains strength and the body returns to its pre diseased state
recovery has occurred

Modes of Transmission
The process of the infectious agent moving from the reservoir to the susceptible host

CONTACT TRANSMISSION
- the most important and frequent mode of transmission

Type of Contact Transmission

a. Direct Contact Transmission
 Person to person transmission of an agent by
 physical contact between its source and
 susceptible host
 No intermediate object involved
 i.e. kissing, touching, sexual contact
 Source → Susceptible Host
b. Indirect Contact Transmission
 reservoir to a susceptible host by means of a
 non living object (fomites)
 Source → Non Living Object → Susceptible Host

Susceptible Host
Recognition of high-risk patients
 Immunocompromised
 DM
 Surgery
 Burns
 Elderly
Percentage Nosocomial Infection
 17% Surgical
 34% UTI
 13% LRI
 14% Bacteremia
 22% Other (incldng skin infection)

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Factors for Nosocomial Infection

Microorganism/Hospital Environment
Most common cause
 Staph aureus, Coag Neg Staph Enterococci
 E. coli, Pseudomonas, Enterobacter, Klebsiella
 Clostridium Difficile
 Fungi ( C. Albicans)
 Other ( Gram (-) bacteria)
 70% are drug resistant bacteria
Compromised Host
One whose resistance to infection is impaired by broken skin, mucous membranes and a
suppressed immune system

Skin and Mucous Membrane

physical barrier
i.e. burns, surgical wounds, trauma, IV site, invasive procedures
Suppressed Immune System
i.e. drugs, radiation, steroids, DM, AIDS

IMMUNITY
The human body has the ability to resist almost all types of organisms or toxins that tend to
damage the tissues and organs. This is called immunity
Functions of Immune System
1. Protects the body from internal threats
2. Maintains the internal environment by removing dead or damaged cells.
3. Provides protection against invasion from outside the body.

THE IMMUNE SYSTEM

The major components of the immune system include the bone marrow which produces the
white blood cells (WBC), the lymphoid tissues which includes the thymus, spleen, lymph nodes,
tonsils and adenoids.

Natural Immunity
Non-specific immunity present at birth. This includes;
a. Phagocytosis of bacteria and other invaders by white blood cells and cells of the tissue
macrophage system
b. Destruction by the acid secretions of the stomach and by the digestive enzymes on
organisms swallowed into the stomach.
c. Resistance of the skin invasion by organisms
d. Presence in the blood of certain chemical compounds that attach to foreign organism or
toxins and destroy them like lysozyme, natural killer cells and complement complex.

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Acquired Immunity
The human body has the ability to develop extremely powerful specific immunity against
individual invading agents. It usually develops as a result of prior exposure to an antigen
through immunization or by contracting a disease.
Active Acquired Immunity - immune defense are developed by the person’s own body. This
immunity last many years or a lifetime.
Passive Acquired Immunity - temporary immunity from another source that has developed
immunity through previous disease or immunization. It is used in emergencies to provide
immediate, short acting immunity when the risk is high.

ANTIBODIES
Agglutination - clumping effect of antibodies between two antigen. It helps to clear the body
of invading organisms by facilitating phagocytosis.
Opsonization – in this process, the antigen-antibody molecule is coated with a sticky
substance that facilitates phagocytosis.
1. IgG (75%)
 Appears in serum and tissues
 Assumes a major role in bloodborne and tissue infections
 Activates the complement system
 Enhances phagocytosis
 Crosses placenta
2. IgA (15%)
 Appears in body fluids (blood,saliva, tears, breat milk)
 Protects against respiratory, GIT and GUT
 Prevents absorption of antigens from food
 Passes to neonate in breast milk for protection
3. IgM (10%)
 Appears mostly in intravascular serum
 First immunoglobulin produced in response to bacterial or viral infection
 Activates complement systems
4. IgD (.2%)
Appears in small amount in serum
5. IgE (.004%)
Allergic and hypersensitivity reactions
Combats parasitic infections

IMMUNIZATION AND VACCINES

IMMUNIZATION
Process inducing immunity artificially by either vaccination (active) or administration of antibody
(passive)
Active : stimulates the immune system to produce antibodies, cellular immune responses to
protect against infectious agent

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Passive : provides temporary protection through administration of exogenous antibody

IMMUNIZING AGENTS
Vaccines : a preparation of proteins, polysaccharides or nucleic acids of pathogens that are
administered inducing specific responses that inactivate or destroy or suppress the pathogen
Toxoid : a modified bacterial toxin that has been made nontoxic but retains the capacity to
stimulate the formation of antitoxin
Immune globulin : an antibody containing solution derived from human blood obtained by cold
ethanol fractionation of large pools of plasma and used primarily for immunodeficient persons
or for passive immunization
Antitoxin : an antibody derived from serum of human or animals after stimulation with specific
antigens used for passive immunity

INFECTION CONTROL PROCEDURE

Medical Asepsis
- CLEAN Technique
- Involves procedures and practices that reduce the number and transfer of pathogens
- Will exclude pathogens ONLY
Attain by:
- Frequent and thorough hand washing
- Personal grooming
- Proper cleaning of supplies and equipment
- Disinfection
- Proper disposal of needles, contaminated materials and infectious waste
- Sterilization

Surgical Asepsis
STERILE technique
- Practices used to render and keep objects and areas sterile
- Exclude ALL microorganism
Attain by:
- Use strict aseptic precautions for invasive procedures
- Scrub hands and fingernails before entering O.R.
- Use sterile gloves, masks, gowns and shoe covers
- Use sterile solutions and dressings
- Use sterile drapes and create an sterile field
- Heat –sterilized surgical instruments

Universal Precautions
Universal Precautions
- Infection control guidelines designed to protect workers from exposure to diseases
spread by blood and certain body fluids.
- For prevention of transmission of blood-borne pathogens in health care settings to
prevent contact with patient blood and body fluids

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 - Stress that all patients should be assumed to be infectious for blood-borne diseases such
as AIDS and hepatitis B.
- Universal Precautions
Followed when workers are exposed to blood and certain other body fluids, including:
- semen
- vaginal secretions
- synovial fluid
- cerebrospinal fluid
- pleural fluid
- peritoneal fluid
- pericardial fluid
- amniotic fluid
- Universal Precautions
do not apply to:
- feces
- nasal secretions
- sputum
- sweat
- tears
- urine
- vomitus
- saliva (except in the dental setting, where saliva is likely to be contaminated with blood)

Standard Precautions

Replaced universal precautions

Apply to all patients
Stipulate that gloves should be worn to touch any of the following:
- blood
- all body fluids
- secretions and excretions, except sweat, regardless of whether they are visibly bloody
- non-intact skin
- mucous membranes

Gloves
- Prevent contamination of the hands with microorganisms
- Prevent exposure of the HCW to blood-borne pathogens
- Reduce the risk of transmission of microorganisms from the hands of HCWs to the
patient
- Do not replace the need for hand hygiene

Hands washed immediately after gloves are removed and between patient contacts
- For procedures that are likely to generate splashes or sprays of body fluid, a mask with
eye protection or a face shield and a gown should be worn
- Disposable gowns should be constructed of an impervious material to prevent
penetration and subsequent contamination of the skin or clothing

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 - Needles should not be recapped, bent, or broken but should be disposed of in puncture-
resistant containers

Hand Hygiene
- Single most important means to prevent transmission of nosocomial pathogens
- Removes the transient flora recently acquired by contact with patients or environmental
surfaces
- Alcohol-based hand rubs are recommended (if hands are visibly soiled, washing with
soap and water is recommended)
- Ring removal prior to patient care

Transmission-Based Precautions
Transmission-Based Precautions
Apply to selected patients based on a suspected or confirmed clinical syndrome, a specific
diagnosis, or colonization or infection with epidemiologically important organisms
Always implemented in conjunction with standard precautions
3 types:
- Airborne
- Droplet
- Contact
Airborne Precautions
Prevent transmission of diseases by droplet nuclei (particles smaller than 5 µm) or dust particles
containing the infectious agent
- Airborne Precautions
- All persons entering the room of these patients must wear a personal respirator that
filters 1 µm particles with a n efficiency of at least 95% (N95 mask)
- Gowns and gloves are used as dictated by standard precautions
1. Disseminated zoster
2. Measles
3. Smallpox
4. SARS
5. Tuberculosis (pulmonary or laryngeal)
6. Varicella

- Patient placed in a private room with monitored negative air pressure in relation to
surrounding areas, and the room air must undergo at least 6 exchanges per hour
- Door to the isolation room must remain closed
- Air from the isolation room should be exhausted directly to the outside, away from air
intakes, and not recirculated (high efficiency filters may be used also)
- Cough etiquette
- Patients should be instructed to cover his/her mouth and nose with tissue when
coughing or sneezing

Droplet Precautions
Prevent transmission by large-particle (droplet) aerosols

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 (unlike droplet nuclei, droplets are larger, do not remain suspended in the air, and do not
travel long distances)
Droplets are produced when the infected patient talks, coughs, or sneezes and during some
procedures (e.g., suctioning, bronchoscopy)
A susceptible host may become infected if the infectious droplets land on the mucosal surfaces
of the nose, mouth, or eye.
- Require patients to be placed in a private room, but no special air handling is necessary
(patients with same disease can be placed in the same room if private rooms are not
available)
- Droplets do not travel long distances (generally no more than 3 feet), the door to the
room may remain open
- HCW should wear a standard surgical mask when working within 3 feet of the patient
- Gowns and gloves should be worn by HCWs when dictated by standard precautions
1. Diphtheria, pharyngeal
2. H. influenzae meningitis, epiglottitis, pneumonia
3. Influenza
4. Meningococcal infections
5. Multi-drug resistant pneumococcal disease
6. Mumps
7. Mycoplasma pneumonia
8. Parvovirus B19 infections
9. Pertussis
10. Plague, pneumonic
11. Rubella
12. Streptococcal pharyngitis

Contact Precautions
- Prevent the transmission of epidemiologically important organisms from an infected or
colonized patient through direct contact (touching the patient) or indirect contact
(touching contaminated objects or surfaces in the patient’s environment)
- Patients are placed in a private room or patients infected with same organism may be
placed in the same roo
- Barrier precautions to prevent contamination should be employed
- Gloves and Hand hygiene
- Gowns – worn if the HCW anticipates substantial contact of his or her clothing with the
patient or surfaces in the patient’s environment or there is an increased risk of contact
with potentially infective material
- Noncritical patient care equipment should remain in the room and not used for other
patients, if items must be shared, they should be cleaned and disinfected before reuse
-
1. Acute diarrheal illnesses likely to be infectious in origin
2. Acute viral conjunctivitis
3. Clostridium difficile diarrhea
4. Ectoparasistic infections (lies and scabies)
5. HSV/Varicella/Disseminated zoster
6. MDR bacteria (MRSA, VRE, VISA, VRSA) infection or colonization
7. SARS

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 8. Smallpox
9. Streptococcal (group A) major skin, burn or wound infection
10. Viral hemorrhagic fevers

ISOLATION OF PATIENTS
Source Isolation
Reverse Isolation
- Protective or neutropenic isolation
- Used for patients with severe burns, leukemia, transplant, immuno deficient persons,
receiving radiation treatment, leukopenic patients
- Those that enter the room must wear masks and sterile gowns to prevent from
introducing microorganisms to the room

AFB ISOLATION
- VISITORS - report to nurses’ station before entering the room
- MASKS – worn in patient’s room
- GOWNS – prevent clothing contamination
- GLOVES – for body fluids and non-intact skin
- HANDWASHING - after touching patient or potentially contaminated articles and after
removing gloves
- articles discarded, cleaned or sent for decontamination and reprocessing
- room remains closed
- patients wear masks during transport

Personal Protective Equipment

- mask
- gloves
- gown
- shoe cover
- goggles

LESSON 2: BLOOD/VECTOR BORNE DISEASES

Prevention
Eradicate the source DOH CLEAN
- C – chemically treated mosquito net
- L - larvae eating fish
- E – environmental sanitation
- A – anti-mosquito
- N – neem tree (oregano, eucalyptus)

A. Dengue Hemorrhagic Fever

- caused by dengue virus (Flaviviridae) with 4 serotypes
- transmitted to a bite of female aedes aegypti mosquito
- incubation period 2-7 days

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 Vectors: (day biting)
- Aedes aegypti (breeds in water stored in houses)
- Aedes albopictus
- Culex fatigans

Clinical manifestations:
> First 4 days – Febrile or Invasive stage – high grade fever, headache, body malaise,
conjuctival injection, vomitting, epistaxis or gum bleeding, positive tornique test.
> 4th – 7th day – Toxic or Hemorrhagic Stage – After the lyze of the fever, this is were the
complication of dengue is expected to come out as manifested by abdominal pain, melena,
indicating bleeding in the upper gastrointestinal tract, Unstable BP, narrow pulse pressure and
shock.
> 7th – 10th day – Convalescent or recovery stage – after 3 days of afebrile stage and the
patient was properly hydrated and monitored BP will become stable and laboratory values of
platelet count and bleeding parameters will begin to normalize.

Classification of Dengue Fever according to severity

1. Grade I – Dengue fever, saddleback fever plus constitutional signs and symptoms plus
positive tornique test
2. Grade II – Stage I plus spontaneous bleeding, epistaxis, GI, cutaneous bleeding
3. Grade III – Dengue Shock Syndrome, all of the following signs and symptoms plus
evidence of circulatory failure
4. Grade IV – Grade III plus irreversible shock and massive bleeding

Diagnostics
Tourniquet test or Rumpel Leede Test – presumptive test for capillary fragility
- keep cuff inflated for 6-10 mins (child), 10-15 min (adults)
- count the petechiae formation 1 sq inch (>10-15 petechiae/sq inch)

Laboratory Procedures
- CBC
- Bleeding Parameters
- Serologic test
- Dengue blot, Dengue Igm
- Other :
- PT (Prothrombin Time)
- APTT (Activated Partial Thromboplastin Time)
- Bleeding time
- Coagulation time

Management: symptomatic and supportive

- Specific Therapy – none

- Symptomatic/Supportive therapy
- Intravenous Fluids (IVF)

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 - with hemoconcentration, 5-7 ml/kg/hr
- with shock, 10-30ml/kg in <20mins
- Use of Blood/Blood Products
- Platelet concentrate 1 unit/5-7kg
- Cryoprecipitate, 1unit/5kg
- FFP, 15ml/kg x 2-4hrs
- given in patient in impending shock and unresponsive to isotonic or colloid transfusion.
- Prolonged PT
- FWB 20cc/kg
- active bleeding
- check serum calcium
- PRBC 10cc/kg

Nursing Intervention
- Paracetamol (no aspirin)
- Giving of cytoprotectors
- Gastric Lavage
- Trendelenberg position for shock
- Nasal packing with epinephrine
- No intramuscular injections
- manage anxiety of patient and family

Preventive measures
Department of Health program for the control of Dengue Hemorrhagic Fever
Seek and destroy breeding places
Say no to indiscriminate fogging
Seek early consultation

B. Filariasis
- The disease often progresses to become chronic, debilitating and disfiguring disease
since it’s symptoms are unnoticed or unfamiliar to health workers.
- High rates in region 5(bicol), 8 (samar and leyte, II (davao)
- Wuchereria bancrofti and Bulgaria malayi
- Transmitted to the bite of infected female mosquito (Aedes, Anopheles, Mansonia)
- The larvae are carried in the blood stream and lodged in lymphatic vessels and lymph
glands where they mature in adult form

Two biological type

>Nocturnal - microfilaria circulate in peripheral blood at night (10pm – 2am)
> Diurnal - microfilaria circulate in greater concentration at daytime

Clinical Manifestation
Acute stage
- filarial fever and lymphatic inflammation that occurs frequently as 10 times per year and
usually abates spontaneously after 7 days

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- Lymphadenitis (Inflammation of the lymphnodes)
- Lymphangitis (Inflammation of the lymph vessels)

Chronic Stage (10-15 years from the onset of the first attack)
- Hydrocele (Swelling of the scotum)
- Lymphedema (Temporary swelling of the upper and lower extremities)
- Elephantiasis (enlargement and thickening of the skin of the lower or upper extremities)

Laboratory Diagnosis
- Blood smear – presence of microfilaria
- Immunochromatographic Test (ICT)
- Eosinophil count

Management:
- Specific Therapy
- Dietylcarbamazine (DEC) 6mg/KBW in divided doses for 12 consecutive days - Drug of
Choice
- Ivermectine (Mectican)
- Supportive Therapy
- Paracetamol
- Antihistamine for allergic reaction due to DEC
- Vitamin B complex
- Elevation of infected limb, elastic stocking

DEC should be taken immediately after meals

It may cause loss of vision, night blindness, or tunnel vision with prolonged used.
Ivermectin is best taken as single dose with a full glass of water in en empty stomach.
Cannot be used in patient with asthma

Preventive Measures
Health teachings
Environmental Sanitation

C. Leptosiprosis (Weil’s disease)

- a zoonotic systemic infection caused by Leptospires, that penetrate intact and abraded
skin through exposure to water, wet soil contaminated with urine of infected animals.

Types:
Anicteric Type (without jaundice)
- manifested by fever, conjunctival injection; signs of meningeal irritation

Icteric Type (Weil Syndrome)

- Hepatic and renal manifestation: Jaundice, hepatomegaly,
- Oliguria, anuria which progress to renal failure

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 - Shock, coma, CHF
- Convalescent Period

Diagnosis:
Clinical history and manifestation
Culture
Blood: during the 1st week
CSF: from the 5th to the 12th day
Urine: after the 1st week until convalescent period
LAAT (Leptospira Agglutination Test)
other laboratory
BUN,CREA, liver enzymes

Treatment:
Specific:
- Penicillin 50000 units/kg/day
- Tetracycline 20-40mg/kg/day
Non-specific
- Supportive and symptomatic
- Administration of fluids
- Peritoneal dialysis for renal failure
- Educate public regarding the mode of transmission, avoid swimming or wadding in
potentially contaminated waters and use proper protective equipment.

Nursing Responsibilities
1. Dispose and isolate urine of patient.
2. Environmental sanitation like cleaning the esteros or dirty places with stagnant water,
eradication of rats and avoidance of wading or bathing in contaminated pools of water.
3. Give supportive and asymptomatic therapy
4. Administration of fluids and electrolytes.
5. Assist in peritoneal dialysis for renal failure patient (The most important sign of renal failure
is presence of oliguria.)

D. MALARIA

- “King of the Tropical Disease”

- an acute and chronic infection caused by protozoa plasmodia
- Infectious but not contagious
- transmitted through the bite of female anopheles mosquito
- Malaria Exacts Heavy Toll in Africa

Vector: (night biting)

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 - Female: anopheles mosquito
- or minimus flavire
Life cycle:
- Sexual cycle/sporogony (mosquito)
- sporozoites injected into humans
- Asexual cycle/schizogony (human)
- gametes is the infective stage taken up by biting mosquito

Strains:
Plasmodium Vivax
- more widely distributed
- causes benign tertian malaria
- chills and fever every 48 hours in 3 days
Plasmodium Falciparum
- common in the Philippines
- Causes the most serious type of malaria because of high parasitic densities in blood.
- Causes malignant tertian malaria
Plasmodium malaria
- much less frequent
- causes quartan malaria, fever and chills every 72 hrs in 4 days
- Plasmodium Ovale
- rarely seen.
Plasmodium ovale

Pathology
- the most characteristic pathology of malaria is destruction of red blood cells,
hypertrophy of the spleen and liver and pigmentation of organs.
- The pigmentation is due to the phagocytocis of malarial pigments released into the
blood stream upon rupture of red cells

Clinical Manifestations:
Uncomplicated
- fever, chills, sweating every 24 – 36 hrs
Complicated
- sporulation or segmentation and rupture of erythrocytes occurs in the brain and visceral
organs.
- Cerebral malaria
- changes of sensorium, severe headache and vomiting
- seizures

Stages:
1. Cold stage – 10-15 mins, chills, shakes
2. hot stage – 4-6 hours, recurring high grade fever, severe headache, vomitting,
abdominal pain, face is blue

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 3. Diaphoretic Stage – excessive sweating

Diagnosis:
- Malarial smear
- Quantitative Buffy Coat (QBC)
Travel in endemic areas

Treatment:
Determine the species of parasite
Objectives of treatment
1. Destroy all sexual forms of parasite to cure the clinical attack
2. Destroy the excerythrocytes (EE) to prevent relapse
3. Destroy gametocytes to prevent mosquito infections

Treatment for P. Falciparum

1. chloroquine tablet (150mg/base/tab) Day 1,2,3 (4,4,2)
2. Sulfadoxine/Pyrimethamine 500mg/25mg/tab, 3tab single dose
3. Primaquine (15mg/tab) 3 tabs single dose
Treatment for P. Vivax
1. Choloroquine, Day 1,2,3 (4,4,2)
2. Primaquine 1 tab OD for 14 days
Treatment for mixed
- chloroquine (4,4,2)
- Sulfadoxine/Pyrimethamine 3 tabs once
- Primaquine 1 tab for 14 days

*Multi-drug resistant P. Falciparum:

quinine plus doxycycline, or tetracycline and primaquine

Complications:
- severe anemia
- cerebral malaria
- hypoglycemia

Prevention and Control:

- Eliminate anopheles mosquito vectors
- Advise travelers
- limit dusk to dawn outdoor exposure
- insect repellant, nets

Nursing Care
1. Consider a patient with cerebral malaria to be an emergency
- Administer IV quinine as IV infusion
- Watch for neurologic toxicity from quinine transfusion like delirium, confusion, convulsion and
coma

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2. Watch for jaundice – this is related to the density of the falciparum parasitemia,
3. Evaluate degree of anemia
4. Watch for abnormal bleeding that are may be due to decrease production of clotting factors
by damage liver.

Chemoprophylaxis:
- doxycycline 100mg/tab, 2-3 days prior to travel, continue up to 4 weeks upon leaving
the area
- Mefloquine 250mg/tab, 1 week before travel, continue up to four weeks upon leaving
the area
- Pregnant, 1st trimester, chloroquine, 2 tabs weekly, 2 weeks before travel, during stay
and until 4 weeks after leaving
- 2nd and 3rd trimester, Pyrimethamine-sulfadoxine

LESSON 3: CENTRAL NERVOUS SYSTEM DISEASES

A. Inflammation of the meniges

Caused by bacterial pathogen, N. menigitidis, H. Influenza, Strep. Pneumoniae, Mycobacterium
Tuberculosis

Pathology:
Primary – spread of bacteria from the bloodstream to the meniges
Secondary – results from direct spread of infection from other sources or focus of infection.

The disease usually begins as an infection by normal body flora, of:

1.     The ear (otitis media) - Haemophilus influenzae
2.     The lung (lobar pneumoniae) - Streptococcus pneumoniae
3.     The upper respiratory tract (rhinopharyngitis) - Neisseria meningitidis, Haemophilus
           influenzae, Streptococcus, Group B
4     The skin and subcutaneous tissue (furunculosis) S. aureus
5.     The bone (osteomyelitis) - S. aureus
6.     The intestine - E. coli

Clinical manifestation:
- Fever
- Rapid pulse, respiratory arrythmia
- Soreness of skin and muscles
- Convulsion/seizures
- headache
- irritability
- fever
- neck stiffness
- pathologic reflexes: kernig’s, Babinski, Brudzinski

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Diagnosis:
- Lumbar puncture
- Blood C/S
- other laboratories

a. Lumbar Puncture
- To obtain specimen of CSF
- To reduce ICP
- To Introduce medication
- To inject anesthetic

b. CSF Examination
- Fluid is turbid/purulent >1000cc/mm cells
- WBC count increase
- Sugar content markedly reduced
- CHON increased
- Presence of microorganism

Treatment:
Bacterial meningitis
- TB meningitis
- Intensive Phase
- Maintainance Phase
- Fungal meningitis
- cryptococcal meningitis – fluconazole or amphotericin B

2. Supportive/Symptomatic
a. Antipyretic
b. treat signs of increased ICP
c. Control of seizures
d. adequate nutrition

Nursing care:
Prevent occurrence of further complication
- Maintain strict aseptic technique when doing dressing or lumbar puncture.
- Early symptom should be recognize
- Vital signs monitoring
- Observe signs of increase ICP
- Protect eyes from light and noises
Maintain normal amount of fluid and electrolyte balance
- Note and record the amount of vomitus
- Check signs of dehydration

19
Prevent Spread of the disease
- Having proper disposal of secretions
- Emphasize the importance of masking
- Explain the importance of isolation
Ensure patient’s full recovery
- Maintain side rails up in episodes of siezures
- Prevent sudden jar of bed
- Keep patient in a dark room and complete physical rest
- Diversional activities and passive exercises

B. Meningococcemia
- caused by Neisseria meningitides, a gram negative diplococcus
- transmitted through airborne or close contact
- incubation is 1-3 days
- natural reservoir is human nasopharynx

Clinical Manifestation
sudden onset of high grade fever, rash and rapid deterioration of clinical condition within 24
hours
S/sx:
1. Meningococcemia – spiking fever, chills, arthralgia, sudden appearance of hemorrhagic
rash
2. Fulminant Meningococcemia (Waterhouse Friderichsen) – septic shock; hypotension,
tachycardia, enlarging petecchial rash, adrenal insufficiency

Diagnostics:
- Blood Culture
- Gram stain of peripheral smear, CSF and skin lesions
- CBC
-
Treatment:
antimicrobial
- Benzyl Penicillin 250-400000 u/kg/day
- Chloramphenicol 100mg/kg/day
Symptomatic and supportive
- fever
- seizures
- hydration
- respiratory function

Chemoprophylaxis
1. Rifampicin 300-600mg q 12hrs x 4 doses
2. Ofloxacin 400mg single dose
3. Ceftriaxone 125-250mg IM single dose

20
Nursing Intervention
- Provide strict isolation
- Wearing of PPE
- Health teaching
- Contact tracing
- Prophylaxis
- Meninggococcal vaccine for high risk patient

C. Rabies
- acute viral encephalomyelitis
- incubation period is 4 days up to 19 years
- risk of developing rabies, face bite 60%, upper extremities 15-40%, lower extremities
10%
- 100% fatal

Clinical Manifestations:
- pain or numbness at the site of bite
- fear of water
- fear of air

4 STAGES
1. prodrome - fever, headache, paresthesia,
2. encephalitic – excessive motor activity, hypersensitivity to bright light, loud noise,
hypersalivation, dilated pupils
3. brainstem dysfunction – dysphagia, hydrophobia, apnea
4. death

Diagnosis:
- FAT (fluorescent antibody test)
- Clinical history and signs and symptoms

Management:
- No treatment for clinical rabies
- Prophylaxis

Postexposure prophylaxis

A. Active vaccine (PDEV,PCEC,PVRV)

Intradermal (0,3,7,30,90)
Intramuscular (0,3,7,14,28)
(0,7,21)
B. Passive Vaccine
a. ERIG wt in kg x .2 = cc to be injected im (ANST)

21
 b. HRIG wt in Kg x .1333

Pre-exposure Prophylaxis
Intradermal/Intramuscular (0,7,21)

Infection control
- Patient is isolated to prevent exposure of hospital personnel, watchers and visitors
- PPE
- Preventive Measures
- Education
- Post-exposure and Pre-exposure Prophylaxis

D. Poliomyelitis
- RNA, Polio virus
- Fecal oral route/droplets
- IP 7-12 days
- Disease of the lower motor neurin involving the anterior horn cells
- Infantile paralysis; Helne-Medin disease

Predisposing Factors
- Children below 10 years old
- Male more often affected
- Poor environmental and hygienic conditions

Causative Agent:
- Legio debilitans
- Brunhilde (permanent)
- Lansing and Leon (temporary)
- May exist in contaminated water, sewage and milk

Clinical manifestations:
1. mild febrile illness – fever, malaise, sore throat (abortive stage)
2. Pre-paralytic stage - flaccid asymetrical ascending paralysis (Landry’s sign), Hayne’s sign
(head drop), Pofer’s sign (opisthotonus)
3. Paralytic stage
bulbar or spinal

Mode of Transmission
- Droplet infection – in early infection
- Body secretions – nasopharyngeal
- Fecal oral – during late stage
- Flies may act as mechanical vectors

B. I – Abortive or inapparent

22
 C. II – Meningitis (non-paralytic)
D. III – Paralytic (anterior horn of spinal cord)
E. IV – Bulbar (encephalitis)

Diagnostics:
Pandy’s test - CSF (increased CHON)

Management:
Active – OPV (Sabin) and IPV (Salk)

Immunity is acquired for 3 strains

A. Legio brunhilde (fatal)
B. Legio lansing
C. Legio leon

Respiratory distress
A. Respirator
B. Tracheostomy – life saving procedure when respiratory failure and inability to
swallow are not corrected
C. Oxygen therapy
D. Rehabilitation (Physical)

E. Tetanus
- caused by Clostridium tetani, grows anaeronically
- Tetanus spores are introduced into the wound contaminated with soil.
- Incubation period 4-21 days

Clinical manifestation:
- Difficulty of opening the mouth (trismus or lockjaw)
- Risus sardonicus
- Abdominal rigidity
- Localized or generalized muscle spasm

Treatment:
1. Neutralize the toxin
2. Kill the microorganism
3. Prevent and control the spasm
- muscle relaxants
- Sedatives
- Tranquilizers
4. Tracheostomy

Anti-toxin:
Tetanus Anti-Toxin (TAT)

23
 - Adult,children,infant 40,000 IU ½ IM,1/2 IV
- Neonatal Tetanus 20000 IU, 1/2IM, ½ IV
TIG
- Neonates 1000 IU, IV drip or IM
- Adult, infant, children 3000 IU, IV drip or IM
Antimicrobial Therapy
Penicillin (drug of choice) -3 mil units q 4hours
Pedia 500000 – 2mil units q 4 hrs
Neonatal 200000 units IVP q 12hrs or q8hrs
Control of spasms
- diazepam
- chlorpromazine

Nursing care
- Patient should be in a quiet, darkened room, well ventilated.
- Minimal/gentle handling of patient
- Liquid diet via NGT
- Prevent Injury
- Preventive Measures
- Treatment of wounds
- Tetanus toxoid (0,1,6,1,1)

LESSON 4: HEPATO-ENTERIC DISEASES

A. Schistosomiasis
- caused by blood flukes, Schistosoma
- has 3 species, S. haematobium, S. Mansoni, S. japonicum
- S. japonicum is endemic in the Philippines (leyte, Samar, Sorsogon, Mindoro,Bohol)
- Intermediate host, Oncomelania Quadrasi

Diagnosis:
- Schistosoma eggs in stool
- Rectal bipsy
- Kato Katz
- Ultrasound of HBT

Clinical Manifestations:
- severe jaundice
- edema
- ascites
- epatosplenomegaly
- S/S of portal hypertention

Management:

24
 - Praziquantrel 60mg/kg Once dosing
- Supportive and sympromatic

Methods of Control:
- Educate the public regarding the mode of transmission and methods of protection.
- Proper disposal of feces and urine
- Prevent exposure to contaminated water. To minimize penetration after accidental water
exposure, towel dry and apply 70% alcohol.
- The organism is pathogenic only in man

B. Typhoid Fever

- Spread chiefly by carriers, ingestion of infected foods

- Endemic particularly in areas of low sanitation levels
- Occurs more common in may to august

Mode of Transmission: oral fecal route

Clinical manifestations:
Rose spot (abdominal rashes), more than 7days Step ladder fever 40-41 deg, headache,
abdominal pain, constipation (adults), mild diarrhea (children)

Diagnosis:
Blood examination WBC usually leukopenia with lymphocytosis
Isolation
- Blood culture 1st week\
- Urine culture 2nd week
- Stool culture 3rd week
- Widal test O or H
- 1st week step ladder fever (BLOOD)
- 2nd week rose spot and fastidial
- typhoid psychosis (URINE & STOOL)

Management: Chloramphenicol (drug of choice), Amoxicillin, Sulfonamides, Ciprofloxacin,

Ceftriaxone

Watch for complication

a. Perforation – symptoms of sharp abdominal pain, abdominal rigidity and absent of
bowel sounds.
- prepare for intestinal decompression or surgical intervention
b. Intestinal hemorrhage - withold food and give blood transfusion

Nursing Interventions:

25
 - Environmental Sanitation
- Food handlers sanitation permit
- Supportive therapy
- Assessment of complication (occuring on the 2nd to 3rd week of infection ):
Typhoid psychosis, typhoid meningitis, typhoid ileitis

C. Hepatitis
- Hepa A – fecal oral route
- Hepa B – body fluids
- Hepa C – non A non B, BT, body fluids
- Hepa D – hypodermic, body fluids
- Hepa E – fecal oral route, fatal and common among pregnant women
- Hepa G – BT, parenteral

Hepatitis A
- Infectious hepatitis, epidemic hepatitis
- Young people especially school children are most commonly affected.
- Predisposing factors:
- Poor sanitation, contaminated water supply, unsanitary preparation of food,
malnutrition, disaster conditions

Incubation Period: 15-50 days

Clinical manifestations:
- Influenza
- Malaise and easy fatigability
- Anorexia and abdominal discomfort
- Nausea and vomiting
- Fever, CLAD
- jaundice

Diagnostics: Anti HAV IgM – active infection; Anti HAV IgG – old infection; no active disease

Management:
- Prophylaxis
- Complete bed rest
- Low fat diet but high sugar
- Ensure safe water for drinking
- Sanitary method in preparing handling and serving of food.
- Proper disposal of feces and urine.
- Washing hands before eating and after toilet use.
- Separate and proper cleaning of articles used by patient

Hepatitis B

26
 - DNA, Hepa B virus
- Serum hepa
- Worldwide distribution
- Main cause of liver cirrhosis and liver cancer

Incubation Period: 2-5 months

Mode of Transmission:
- From person to person through
- contact with infected blood through broken skin and mucous membrane
- sexual contact
- sharing of personal items
- Parenteral transmission through
- blood and blood products
- use of contaminated materials
- Perinatal transmission

High Risk group:

- Newborns and infants of infected mothers
- Health workers exposed to handling blood
- Persons requiring frequent transfusions
- Sexually promiscuous individuals
- Commercial sex workers
- Drug addicts

Possible Outcome:
- Most get well completely and develop life long immunity.
- Some become carriers of the virus and transmit disease to others.
- Almost 90% of infected newborns become carriers

Hepatitis C
- Post transfusion Hepatitis
- Mode of transmission – percutaneous, BT
- Predisposing factors – paramedical teams and blood recepients
- Incubation period – 2weeks – 6 months

Hepatitis D
- Dormant type
- Can be acquired only if with hepatitis B

Hepatitis E
- If hepatitis E recurs at age 20-30, it can lead to cancer of the liver
- Enteric hepatitis
- Fecal-oral route

Diagnostics:

27
 - Elevated AST or SGPT (specific) and ALT or SGOT
- Increased IgM during acute phase
- (+) or REACTIVE HBsAg = INFECTED, may be acute, chronic or carrier
- (+) HBeAg = highly infectious
- ALT – 1st to increase in liver damage
o HBcAg = found only in the liver cells
- (+) Anti-HBc = acute infection
- (+) Anti-HBe = reduced infectiousness
- (+) Anti-HBs = with antibodies (FROM vaccine or disease)
- Blood Chem. Analysis (to monitor progression)
- Liver biopsy (to detect progression to CA)

Management:
- Prevention of spread – Immunization and Health Education
- Enteric and Universal precautions
- Assess LOC
- Bed rest
- ADEK deficiency intervention
- High CHO, Moderate CHON, Low fat
- FVE prevention

Complications:
1. Fulminant Hepatitis – s/sx of encephalopathy
2. Chronic Hepatitis - lack of complete resolution of clinical sx and persistence of hepatomegaly
3. HBsAg carrier

LESSON 5: ERUPTIVE FEVER

A. Measles
- Extremely contagious
- Breastfed babies of mothers have 3 months immunity for measles
- The most common complication is otitis media
- The most serious complications are bronchopneumonia and encephalitis

Measles, Rubeola, 7 Day Fever, Hard Red Measles

- RNA, Paramyxoviridae
- Active MMR and Measles vaccine
- Passive Measles immune globulin
- Lifetime Immunity
- IP: 7-14 days

Mode of transmission: droplets, airborne

- *Contagious 4 days before rash and 4 days after rash

Clinical Manifestations:

28
a. Pre eruptive stage
- Patient is highly communicable
- 4 characteristic features
A. Coryza
B. Conjunctivitis
C. Photophobia
D. Cough
E. Koplik’s spots ( Small, blue-white spots with a red base found on the buccal mucosa
-
- Stmsons line

b. Eruptive stage
- Maculopapular rashes appears first on the hairline, forehead, post auricular area the
spread to the extremities (cephalocaudal)
- Rashes are too hot to touch and dry
- High grade fever and increases steadily at the height of the rashes

c. Stage of convalescence
- Rashes fade in the same manner leaving a dirty brownish pigmentation (desquamation)
- Black measles – severe form of measles with hemorrhagic rashes, epistaxis and melena

Rashes: maculopapaular, cephalocaudal (hairline and behind the ears to trunk and limbs),
confluent, desquamation, pruritus

Complications:
- Bronchopneumonia
- Secondary infections
- Encephalitis
- Increase predisposition to TB

Managements:
1. Supportive –TSB for fever
2. Hydration
3. Proper nutrition
4. Vitamin A
5. Antibiotics
6. Vaccine

Nursing Care:
- Respiratory precautions
- Restrict to quite environment
- Dim light if photophobia is present
- Administer antipyretic
- Use cool mist vaporizer for cough

29
 B. German Measles (Rubella)
- Acute infection caused by rubella virus characterized by fever, exanthem and
retroauricular adenopathy.
- Has a teratogenic potential on the fetuse of women in the 1 st trimester

Clinical Manifestations:
- forschheimer’s (petecchial lesion on buccal cavity or soft palate),
- cervical lymphadenopathy, low grade fever
- “ Oval, rose red papules about the size of pinhead

Diagnostics: clinical
Complications: rare; pneumonia, meningoencephalitis
Complications to pregnant women:
- 1st tri-congenital anomalies
- 2nd tri-abortion
- 3rd tri-pre mature delivery
Rashes: Maculopapular, Diffuse/not confluent, No desquamation, spreads from the face
downwards

C. Roseola Infantum,
Exanthem Subitum, Sixth disease
- Human herpes virus 6
- 3mos-4 yo, peak 6-24 mos
- MOT: probably respiratory secretions

Clinical manifestations:
Spiking fever w/c subsides 2-3 days, Face and trunk rashes appear after fever subsides, Mild
pharyngitis and lymph node enlargement

D. Chicken Pox, Varicella

- Herpes zoster virus (shingles),
varicella zoster virus(chocken pox)
- Active : Varicella vaccine
- Passive: VZIG, ZIG – given 72-96 hrs
w/n exposure
- Lifetime Immunity
- IP: 14-21 days

Mode of transmission: Respiratory route

* Contagious 1 day before rash and 6 days after first crop of vesicles
- S/sx:
fever, malaise, headache
- Rashes: Maculopapulovesicular (covered areas), Centrifugal, starts on face and trunk
and spreads to entire body

30
 - Leaves a pitted scar (pockmark)
- CX furunculosis, erysipelas, meningoencephalitis
- Dormant: remain at the dorsal root ganglion and may recur as shingles (VZV)

Management:
a. oral acyclovir
b. Tepid water and wet compresses for pruritus
c. Aluminum acetate soak for VZV
d. Potassium Permanganate (ABO)
a. Astringent effect
b. Bactericidal effect
c. Oxidizing effect (deodorize the rash)

E. Small Pox, Variola

- DNA, Pox virus
- Last case 1977
- spreads from man-to-man only
- Active: Vaccinia pox virus
- IP: 1-3 weeks

Clinical Manifestations:
- Rashes:
- Maculopapulovesiculopustular
- Centripetal
- contagious until all crusts disappeared

Diagnostics:
- Paul’s test - instilling of vesicular fluid w/ small pox into the cornea; if keratitis develops,
small pox
- Cx: same with chicken pox

F. Kawasaki Disease
- Mucocutaneous lymph node syndrome
- Children younger than 5 years old are primarily affected.
- Associated with large coronary blood vessel vasculitits
- A febrile, exanthematous, multisystem illness characterized by
o Acute febrile phase manifested by high spiking fever, rash, adenopathy,
peripheral edema, conjunctivitis and exanthem
o sub acute phase, thrombocytosis, desquamation and resolution of fever.
o Convalescent stage

Manifestations:
- bilateral, non purulent conjuctivitis

31
 - congested oropharynx, strawberry tongue, erythematous lymphs
- erythematous palms/soles, edematous hands/feet
- periungal desquamation, truncal rash
- CLADP ( 1node >1.5cm)

Diagnosis
- CBC: leukocytosis
- Platelet count >400000
- 2D echo (if coronary artery involvement is highly suggestive
- ESR and CRP elevated

Management
- IV Gamma globulin – 2g/kg as single dose for 10-12 hours. Effective to prevent coronary
vascular damage if given within 10 days of onset.
- Salicylates: 80-100mg/kg/24 hours in 4 divided doses
- Symptomatic and supportive therapy

LESSON 6: RESPIRATORY SYSTEM DISEASES

A. Mumps
Etiologic agent: RNA, Mumps virus
- Mumps vaccine - > 1yo
- MMR – 15 mos
- Lifetime Immunity
Incubation Period: 12-16 days
Mode of transmission: Droplet, saliva, fomites

Clinical Manifestations: Unilateral or bilateral

- parotitis, Orchitis - sterility if bilateral,
- Oophoritis, Stimulating food cause severe pain, aseptic meningitis
- Dx: serologic testing, ELISA

Management: supportive

Nursing care:
- Respiratory precautions
- Bed rest until the parotid gland swelling subsides
- Avoid foods that require Chewing
- Apply hot or cold compress
- To relieve orchitis, apply warmth and local support with tight fitting underpants

B. Diptheria
- Acute contagious disease

32
 - Characterized by generalized systemic toxemia from a localized inflammatory focus
- Infants immune for 6 months of life
- Produces exotoxin
- Capable of damaging muscles especially cardiac, nerve, kidney and liver
- Increase incidence prevalence during cooler months
- Mainly a disease of childhood with peak at 2-5 years, uncommon in >6months

Etiologic agent: Corynebacterium diphtheriae, gram (+), slender, curved clubbed organism
“Klebs-Loeffler Bacillus”
Incubation Period: 2-6 days

Mode of transmission: direct or indirect contact

1. Nasal – invades nose by extension from pharynx
2. Pharygeal
- sorethroat causing dysphagia
- Pseudomembrane in uvula, tonsils, soft palate (grayish-white membrane)
- Bullneck – inflammation of cervical LN
3. Laryngeal
- increasing hoarseness until aphonia
- wheezing on expiration
- dyspnea

Diagnosis:
- Nose and throat swab using loeffler’s medium
- Schick test – determine susceptibility or immunity in diptheria
- Maloney test – determines hypersensitivity to diptheria toxoid

Complications:
Toxic myocarditis – due to action of toxin in the heart muscles (1 st 10-14 days)
Neuritis caused by absorption of toxin in the nerve
- Palate paralysis (2nd week)
- Ocular palsy (5th week)
- Diapgram paralysis (6-10wk causing GBS)
- Motor and skeletal muscle paralysis

Treatment:
A. Neutralize the toxins – antidiptheria serum
B. Kill the microorganism – penicillin
C. Prevent respiratory obstruction – tracheostomy, intubation

Serum therapy (Diptheria antitoxin)

- early administration aimed at neutralizing the toxin present in the general circulation
Antibiotics
- Penicillin G 100000mg/kg.day (drug of choice)

33
 - Erythromycin 40mg/kg
Nursing Intervention
- Rest.
- Patient should be confined to bed for at least 2 weeks
- Prevent straining on defecation
- vomiting is very exhausting, do not do procedures that may cause nausea
- Care for the nose and throat
- Ice collar to reduce the pain of sorethroat
- Soft and liquid diet

C. Whooping Cough, 100 day fever

Etiologic agent: Bordetella pertussis, B. parapertussis, B. bronchiseptica, gram (-)
Incubation Period: 3-21 days

Mode of transmission: airborne/droplet

Clinical manifestations:
- Invasion or catarrhal stage (7-14days) starts with ordinary cough
- Spasmodic or paroxysmal
- 5-10 spasms of explosive cough (no time to catch breath. A peculiar inspiratory crowing
sound followed by prolonged expiration and a sudden noisy inspiration with a long high
pitched “whoop”
- During attack the child becomes cyanotic and the eyes appear to bulge or popping out
of the eyeball and tongue protrudes

Diagnosis:
- WBC count 20000-50000
- Culture with Bordet Gengou Agar

Treatment:
- Erythromycin shorten the period of communicability
- Ampicillin if with allergy to erythromycin
- Heperimmune pertusis gamma globulin in <2 years old (1.25ml IM)
- Control of cough with sedatives

Diagnostics:
WHO - >21 days cough + close contact w/ pertussis px + (+) culture OR rise in Ab to FHA or
pertussis toxin
* throat culture w/ Bordet gengou agar

Management:
- CBR to conserve energy
- Prevent aspiration

34
 - High calorie, bland diet
- Omit milk and milk product because it increases the mucous
- Refeeding of infants 20 min after vomitting
- Milk should be given at room temperature

Complications:
- Bronchopneumonia
- Abdominal hernia
- Severe malnutrition
- TB, asthma
- encephalitis

Pre exposure prophylaxis for Diphtheria, Pertussis, Tetanus

DPT- 0.5 ml IM
- 1 - 1 ½ months old
2 - after 4 weeks
3 - after 4 weeks
- 1st booster – 18 mos
- 2nd booster – 4-6 yo
- subsequent booster – every 10 yrs thereafter

D. Pulmonary Tuberculosis
- The world’s deadliest disease and remains as a major public health problem.
- Badly nourished, neglected and fatigued individuals are more prone
- Susceptibility is highest in children under 3 years
- AKA: Koch’s disease: Galloping consumption
- Causative agent: Mycobacterium tuberculosis
Clinical manifestations:
- Wt loss
- night sweats
- low fever,
- non productive to productive cough
- anorexia,
- Pleural effusion and hypoxemia
- cervical lymphadenopathy
- hemoptysis ( blood in the sputum)

Dx:
- Chest xray - cavitary lesion in lungs
- Sputum exam/sputum culture (confirmatory)
- Tuberculin test - Mantoux test)
-Purified protein derivatives ( ID)
macrophages in skin take up Ag and deliver it to T cells
T cells move to skin site, release lymphokines
activate macrophages and in 48-72 hrs, skin becomes indurated
> 10 mm is (+)

35
The National Tuberculosis Control Program
- Vision: A country where TB is no longer a public health problem.
- Mission: Ensure that TB DOTS services are available to the communities.
- Goal: To reduce the prevalence and mortality from TB by half by the year 2015

Targets:
1. To cure at least 85% of the sputum smear positive TB patient discovered.
2. Detect at least 70% of the estimated new sputum smear positive TB cases.

Management:
short course – 6-9 months
long course – 9-12 months
Follow-up
 2 weeks after medications – non communicable
o 3 successive (-) sputum - non communicable
o rifampicin - prophylactic

Recommended Treatment Regimen for Adults and Children

Category of Treatment Classification and Treatment Regimen
Registration Group
Category I Pulmonary TB, new (whether
bacteriologicallyconfi rmed or
clinically-diagnosed) Extra- 2HRZE/4HR
pulmonary TB, new (whether
bacteriologically-confi rmed or
clinically-diagnosed) except
CNS/ bones or joints
Category Ia Extra-pulmonary TB, new 2HRZE/10HR
(CNS/bones or joints)
Category II Pulmonary or extra-pulmonary, 2HRZES/1HRZE /5HRE
previously treated drug-
susceptible TB (whether
bacteriologically-confirmed or
clinically diagnosed)
• Relapse
• Treatment After Failure
• Treatment After Lost to
Follow-up (TALF)
• Previous Treatment Outcome
Unknown
• Other
Category IIa Extra-pulmonary, Previously 2HRZES/1HRZE /9HRE

36
 treated drugsusceptible TB
(whether
bacteriologicallyconfirmed or
clinically-diagnosed - CNS/bones
or joints)
Standard Regimen Drug- Rifampicin-resistant TB or ZKmLfxPtoCs
resistant (SRDR) Multidrug-resistant TB • Individualized once DST
result is available
• Treatment duration for at
least 18 months
XDR-TB Regimen Extensively drug-resistant TB Individualized based on DST
result and history of
previous treatment
Legend: R - Rifampicin, I - Isoniazid, E - Ethambutol, Z - Pyrazinamide, S - Streptomycin, Km - Kanamycin.
Lfx - Levofloxacin, Pto - Prothionamide. C - Cycloserine

Guide in Managing Adverse Reactions to Anti-TB Drugs

Adverse Reactions Drug(s) probably Management

responsible
Minor
1. Gastro-intestinal Rifampicin/Isoniazid/ Give drugs at bedtime or
intolerance Pyrazinamide with small meals.
2. Mild or localized skin Any kind of drugs Give anti-histamines.
reactions
3. Orange/red colored urine Rifampicin Reassure the patient
4. Pain at the injection site Streptomycin Apply warm compress.
Rotate sites of injection.
5. Burning sensation in the Isoniazid Give Pyridoxine (Vitamin B6):
feet due to peripheral 50-100 mg daily for
neuropathy (numbness, treatment, 10 mg daily for
paresthesias, and tingling in prevention.
the extremities) (Cheese and milk –rich in Vit
B6 )
6. Arthralgia due to Pyrazinamide Give aspirin or NSAID. If
hyperuricemia symptoms persist, consider
gout and request for blood
chemistry (uric acid
determination) and manage
accordingly
7. Flu-like symptoms (fever, Rifampicin Give antipyretics

37
 muscle pains, inflammation
of the respiratory tract)
Major
1. Severe skin rash due to Any kind of drugs (especially Discontinue anti-TB drugs
hypersensitivity Streptomycin) and refer to appropriate
specialist.
2. Jaundice due to hepatitis Any kind of drugs (especially Discontinue anti-TB drugs
Isoniazid, Rifampicin, and and refer to appropriate
Pyrazinamide) specialist. If symptoms
subside, resume treatment
and monitor clinically
3. Impairment of visual Ethambutol Discontinue Ethambutol and
acuity and color vision due refer to an ophthalmologist.
to optic neuritis
4. Hearing impairment, Streptomycin Discontinue Streptomycin
ringing of the ear, and and refer to appropriate
dizziness due to damage of specialist .
the eighth cranial nerve
5. Oliguria or albuminuria Streptomycin/ Rifampicin Discontinue anti-TB drugs
due to renal disorder and refer to appropriate
specialist
6. Psychosis and convulsion Isoniazid Discontinue Isoniazid and
refer to appropriate
specialist.
7. Discontinue Isoniazid and Rifampicin Discontinue anti-TB drugs
refer to appropriate and refer to appropriate
specialist. specialist

Methods of Control:
 Prompt treatment and diagnosis
 BCG vaccination
 Educate the public in mode of transmission and importance of early diagnosid
 Improve social condition

E. Pneumonia
1. Community acquired
Typical– Strep. Pneumoniae, H. Influenzae type B
Atypical Pneumonia – S. Aureus, M. Pneumoniae, L. Pneumophila, P. Cariini
2. Nosocomial – Pseudomonas, S. Aureus

Mode of transmission: aspiration, inhalation, hematogenous, direct inoculation, contiguous

spread

38
CHILDHOOD PNEUMONIA
1. No pneumonia
- infant, 60/min and no chest indrawing
2. Pneumonia
- young infant >60/min, fast breathing without chest indrawing
3. Severe pneumonia
- fast breathing, severe chest indrawing, with one of danger signs
4. Very severe pneumonia
- below 2 mos old, fast breathing, chest indrawing, with danger signs
4 Danger Signs
1. Vomits
2. Convulsion
3. Drowsiness/lethargy
4. Difficulty of swallowing or feeding

Clinical manifestations:
1. Typical – sudden onset Fever of > 38 x 7-10 days, productive cough, pleuritic chest
pain, dullness, inc fremitus, rales
2. Atypical – gradual onset, dry cough, headache, myalgia, sore throat
Watch out for complications; In 24 hours death will occur from respiratory failure

Nursing Diagnosis:
 Ineffective airway clearance
 Ineffective breathing pattern
 Impaired gas exchange
 Risk for activity intolerance

Management:
 Antibiotics, hydration, nutrition, nebulization
 CARI-health teaching
 Nursing Interventions
 Respiratory support
- oxygen supplementation
- mechanical ventilation
 Positioning
 Rest
 Suctioning of secretions
 Antipyretic and TSB
 Nutrition

LESSON 7: GASTROINTESTINAL SYSTEM DISEASES

A. Amoebiasis

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 Etiologic agent: Entamoeba Hystolitica, protozoa
- IP: few days to months to years,
- usually 2- 4 weeks
- MOT: Ingestion of cysts from fecally contaminated sources (Oral fecal route)
oral and anal sexual practices
- Extraintestinal amoebiasis- genitalia, spleen, liver, anal, lungs and meninges

Clinical manifestations:
- Blood streaked, watery mucoid diarrhea, foul smelling,
- abdominal cramps
- Pain on defecation (tenesmus)
- Hyperactive bowel sounds

Diagnostic tests:
- Stool culture of 3 stool specimens
- Sigmoidoscopy
- Recto-sigmoidoscopy and coloscopy for intestinal amoebiasis

Medical treatment:
- Metronidazole – trichomonocide and amoebicide for intestinal and extra intestinal sites
(monitor liver function test)
- Diloxanide furoate – luminal amoebicide
- Paromomycin – eradicate cyst of histolytica
- Tinidazole – hepatic amebic abscess

B. Bacillary Dysentery
Shigellosis
- Shiga bacillus: dysenteriae (fatal), flexneri (Philippines), boydii, sonnei; gram (-)
- Shiga toxin destroys intestinal mucosa
- Humans are the only hosts
- Not part of normal intestinal flora
- IP: 1-7 days
- MOT : oral fecal route

Clinical manifestations: fever, severe abdominal pain, diarrhea is watery to bloody with pus,
tenesmus

Diagnostics: stool culture

Management: Oresol, Ampicillin, Trimethoprim-Sulfamethoxazole, Chloramphenicol,

Tetracycline, Ciprofloxacin

C. Cholera

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 - Etiologic agent: Vibrio coma (inaba, ogawa, hikojima), vibrio cholerae, vibrio el tor;
gram (-)
- Choleragen toxin induces active secretion of NaCl
- Active Immunization
- Incubation Period: few hours to 5 days
- Mode of transmission: oral fecal route
Clinical manifestations: Rice watery stool with flecks of mucus, s/sx of severe dehydration ie
Washerwoman’s skin, poor skin turgor

Diagnostics: stool culture

Management: IV fluids, Tetracycline (drug of choice), Doxycycline, Erythromycin, Quinolones,

Furazolidone and Sulfonamides (children)

D. Paragonimiasis
- Chronic parasitic infection
- Closely resembles PTB
- Endemic areas: orsogo, camarines sur, norte, samar, orsogon, leyte, albay, basilan
- Paragonimiasis
- AKA: Lung fluke disease
- causative agent: paragonimus westermani; Trematode
- Eating raw or partially cooked fish or fresh water crabs

Signs and symptoms

- Cough of long duration
- Hemoptysis
- Chest/back pain
- PTB not responding to anti-koch’s meds

Diagnosis:
- sputum examination – eggs in brown spots

Treatment:
1. Praziquantrel (biltrizide) (drug of choice)
2. Bithionol

E. Parasitic worms
Ascariasis
- Common worldwide with greatest frequency in tropical countries.
- Has an infection rate of 70-90% in rural areas
- MOT: ingestion of embryonated egss (fecal-oral)
- Worms reach maturity 2 months after ingestion of eggs.
- Adult worms live less than 10 months(18 months max.)
- Female can produce up to 200000 eggs per day
- Eggs may be viable in soils for months or years

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 - Worms can reach 10-30cm in length

Clinical manifestations:
- loss of appetite
- Worms in the stool
- Fever
- Wheezing
- Vomiting
- Abdominal distention
- Diarhea
- dehydration

Medical Management:
A. Mebendazole (antihelmintic) effect occurs by blocking the glucose uptake of the
organisms, reducing the energy until death
B. Pyrantel pamoate: neuromuscular blocking effect which paralyze the helminth, allowing
it to be expelled in the feces
C. Pierazine citrate: paralyze muscles of parasite, this dislodges the parasites promoting
their elimination

Nursing care:
- Environmental sanitation
- Health teachings
- Assessment of hydration status
- Use of ORS
- Proper waste disposal
- Enteric precautions

Complications:
- Migration of the worm to different parts of the body Ears, mouth,nose
- Loefflers Pneumonia
- Energy protein malnutrition
- Intestinal obstruction

Tapeworm (Flatworms)
- Etiologic agent: Taenia Saginata (cattle), Taenia Solium (pigs)
- Mode of transmission: fecal oral route (ingestion of food contaminated by the agent)
- Clinical manifestations: neurocysticercosis – seizures, hydrocephalus
- Diagnostics: Stool Exam
- Management: Praziquantel, Niclosamide

Pinworm
- Etiologic agent:Enterobius Vermicularis
- Mode of transmission: fecal oral route
- Clinical manifestations: Itchiness at the anal area d/t eggs of the agent

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 - Diagnostics: tape test at night time (agents release their eggs during night time); use
flashlight
- Management: Pyrantel Pamoate, Mebendazole

Hookworm
- Etiologic agent: Necator Americanus, Ancylostoma Duodenale
- Leads to iron deficiency and hypochromic microcytic anemia
- Gain entry via the skin
- Diagnostics: microscopic exam (stool exam)
- Management: Pyrantel Pamoate and Mebendazole
- don’t give drug without (+) stool exam
- members of the family must be examined and treated also

Nursing Intervention:
- Promote hygiene
- Environmental Sanitation
- Proper waste and sewage disposal
- Antihelmintic medications repeated after 2 weeks (entire family)

E. PARALYTIC SHELLFISH POISONING

- A syndrome of characteristic symptoms predominantly neurologic which occurs within
minutes or several hours after ingestion of poisonous shellfish
- Single celled dinoflagellates (red planktons) become poisonous after heavy rain fall
preceded by prolonged summer
- Common in seas around Manila bay, Samar, Bataan and Zambales
-
Mode of transmission: Ingestion of contaminated bi-valve shellfish

Incubation period: within 30 minutes

Clinical manifestations:
- numbness of the face especially around the mouth
- vomiting, dizziness, headache
- tingling sensation, weakness
- rapid pulse, difficulty of speech (ataxia), dysphagia, respi paralysis, death.

Management and control measures:

- no definite medications
- induce vomiting (early intervention)
- drinking pure coconut milk (weakens toxic effect) don’t give during late stage it may
worsen the condition.
- nahco3 solution (25 grams in ½ glass of water)
- respiratory support
- avoid using vinegar in cooking shellfish affected by red tide (15x virulence)
- toxin of red tide is not totally destroyed in cooking.
- avoid tahong, talaba, halaan, kabiya, abaniko. when red tide is on the rise.

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F. BOTULISM
- A True poison known to be one of the deadliest substance and usually released into the
food shortly after it has been canned
- Botulism
- Etiologic agent: Clostridium Botulinum, gram (+), spore forming
- Ingestion of contaminated foods (canned foods), wound contamination, infant botulism
(most common; ingestion of honey)
- Neurotoxins block AcH
- Incubation period: 12-36H (canned food)
- Incubation period: 4-14 days (wound)
- Active and passive immunization

Clinical manifestations: Diplopia, dysphagia, symmetric descending flaccid paralysis, ptosis,

depressed gag reflex, nausea, vomiting, dry mouth, respiratory paralysis

Diagnostics: gastric siphoning, wound culture, serum bioassay (food borne)

Management: respiratory support, antitoxin

LESSON 8: CONTACT TRANSMISSION

A. Pediculosis
Blood sucking lice/Pediculus humanus
p. capitis-scalp
p. palpebrarum-eyelids and eyelashes
p. pubis-pubic hair
p. corporis-body

Mode of transmission: skin contact, sharing of grooming implements

Clinical manifestations: nits in hair/clothing, irritating maculopapular or urticarial rash

Management: disinfect implements, Lindane (Kwell) topical, Permethrin (Nix) topical

B. Scabies
- Sarcoptes scabiei
- Pruritus (excreta of mites)
- Mites come-out from burrows to mate at night
- Mode of transmission: skin contact

Clinical manifestations:: itching worse at night and after hot shower; rash; burrows (dark wavy
lines that end in a bleb w/ female mite) in between fingers, volar wrists, elbow, penis; papules
and vesicles in navel, axillae, belt line, buttocks, upper thighs and scrotum

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Diagnostics: biopsies/scrapings of lesions

Management: Permethrin (Nix) cream, crotamiton cream, Sulfur soap, antihistamines and
calamine for pruritus, wash linens with hot water, single dose of Ivermectin, treat close contacts

Nursing Care:
A. Administer antihistamines or topical steroids to relieve itching.
B. Apply topical antiscabies creams or lotion like lindasne(kwell), Crotamiton (Eurax),
permithrin
C. d. Lindane (kwell) not used in <2 years old, causes neurotoxicity and seizures
D. e. Apply thinly from the neck down and leave for 12-14hrs then rinse
E. f. Apply to dry skin, moist skin increases absorption
F. g. All family members and close contacts
G. h. Beddings and clothings should be washed in very hot water and dried on hot dryer

C. Leprosy
- Chronic infectious and communicable disease
- No new case arises without previous contact
- Majority are contracted in childhood, manifestation arises by 15 yrs old and will
definitely diagnose at 20
- it is no hereditary
- Does not cross placenta

Cardinal Sign:
A. Presence of Hansen’s bacilli in stained smear or dried biopsy material.
B. Presence of localized areas of anesthesia

* Lepromatous or malignant
- many microorganisms
- open or infectious cases
- negative lepromin test
* Tuberculoid or benign
- few organism
- noninfectious
- positive reaction to lepromin test

Clinical manifestations:
• Early/Indeterminate – hypopigmented / hyperpigmented anesthetic macules/plaques
• Tuberculoid – solitary hypopigmened hypesthetic macule, neuritic pain, contractures of
hand and foot, ulcers, eye involvement ie keratitis
• Lepromatous – multiple lesions, Loss of lateral portion of eyebrows (madarosis),
corugated skin (leonine facies), septal collapse (saddlenose)
Late: gynecomastia- enlargement of breast in male

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Diagnosis:
- Skin smear test
- Skin lesion biopsy
- Lepromin test -

Management:
Multidrug Therapy and home treatment-RA 4073 (home meds)

Paucibacillary - 6-9 months

1. Dapsone
2. Rifampicin

Multibacillary- 12-24 months

1. Dapsone – mainstay; hemolysis, agranulocytosis
2. Clofazimine – reddish skin pimentation, intestinal toxicity
3. Rifampicin – bactericidal; renal and liver toxicity

Nursing Intervention:
- Health teachings
- Counseling involving the family members and even the community
- Prevention of transmission ( use of mask )

LESSON 9: SEXUALLY-TRANSMITTED DISEASES

A. Gonorrhea, Morning drop, Clap, Jack

o Etiologic agent: Neisseria gonorrheae, gram (+)
o Incubation period: 3-7 days

Clinical manifestations:
- Females: usually asymptomatic or minimal urethral discharge w/ lower abdominal pain
sterility or ectopic pregnancy
- Male: Mucopurulent discharge, Painful urination
decreased sperm count

Diagnostics:
- gram stain and culture of cervical secretions on Thayer Martin VCN medium

Management: single dose only

- Ceftriaxone (Rocephin) 125 mg IM
- Ofloxacin (Floxin) 400 mg orally
- treat concurrently with Doxycycline or Azithromycin for 50% infected w/ Clamydia

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Complications:
PID, ectopic pregnancy and infertility, peritonitis, perihepatitis, Ophthalmia neonatorum, sepsis
and arthritis

B. Syphilis
Etiologic agent: Treponema pallidum, spirochete
“ Beautiful” fast moving but delicate spiral thread
Incubation period: 10-90 days

Clinical manifestations:
 Primary (3-6 wks after contact) – nontender lymphadenopathy and chancre; most
infectious; resolves 4-6 wks
Chancre – painless ulcer with heaped up firm edges appears at the site where the
treponema enters. Related to pattern of sexual behavior (genitalia, rectal, oral, lips);
BUBO – swelling of the regional lymphnode
 Secondary – systemic; generalized macular papular rash including palms and soles and
painless wartlike lesions in vulva or scrotum ( condylomata lata) and lymphadenopathy
 Tertiary – (6-40 years) - neurosyphilis/permanent damage (insanity); gumma (necrotic
granulomatous lesions), aortic aneurysm

Diagnostics:
Dark-field examination of lesion- 1st and 2nd stage
Non specific VDRL and RPR
FTA-ABS

Management:
- Primary and secondary - Pen G
- Tertiary - IV Pen G

C. Chlamydia
- Etiologic agent: Chlamydia trachomatis, gram (-)
- Incubation period: 2-10 days

Clinical manifestations:
- Maybe asymptomatic
- Gray white discharge, Burning and itchiness at the urethral opening

Diagnostics:
- Gram stain
- Antigen detection test on cervical smear
- Urinalysis

Management:
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 - Doxycycline or Azithromycin
- Erythromycin and Ofloxacin

Complications:
- PID
- Ectopic pregnancy
- Fetus transmittal (vaginal birth)

D. Herpes Genitalis
Etiologic agent: Herpes Simplex Virus 2

Clinical manifestations: Painful sexual intercourse, Painful vesicles (cervix, vagina, perineum,
glans penis)

Diagnostics:
- Viral culture
- Pap smear (shows cellular changes)
- Tzanck smear (scraping of ulcer for staining)

Management:
Anti viral - acyclovir (zovirax)

Complications:
- Meningitis
- Neonatal infection (vaginal birth)

E. Genital Warts, Condyloma Acuminatum

- Etiologic agents: HPV type 6 & 11, papilloma virus
- Clinical manifestations: Single or multiple soft, fleshy painless growth of the vulva,
vagina, cervix, urethra, or anal area, Vaginal bleeding, discharge, odor and dyspareunia

Diagnostics:
- Pap smear-shows cellular changes (koilocytosis)
- Acetic acid swabbing (will whiten lesion)
- Cauliflower or hyperkeratotic papular lesions

Treatment:
- liquid nitrogen
- podophylin resin

Management:
Laser treatment is more effective

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Complications:
- Neoplasia
- Neonatal laryngeal papillomatosis (vaginal birth)

F. Candidiasis, Moniliasis
- Etiologic agent: Candida Albicans, Yeast or fungus
- Clinical manifestations: cheesy white discharge, extreme itchiness

Diagnostics:
KOH (wet smear indicates positive result)

Management:
Imidazole, Monistat, Diflucan

Complications:
Oral thrush to baby (vaginal birth)

G. Trichomoniasis
- Etiologic agent: Trichomona vaginalis, parasite

- Clinical manifestations: Females: itching, burning on urination, yellow gray frothy

malodorous vaginal discharge, foul smelling; Males: usually asymptomatic

- Diagnostics: microscopic exam of vaginal discharge

- Management: Metronidazole (Flagyl); include partners

- Complications: Premature rupture of membranes (PROM)

H. HIV and AIDS
- Retrovirus (HIV1 & HIV2)
- Attacks and kills CD4+ lymphocytes (T-helper)
- Capable of replicating in the lymphocytes undetected by the immune system
- Immunity declines and opportunistic microbes set in
- No known cure
- HIV/AIDS Reverses Development and Poses Serious Threat to Future Generations
- Since 1980s, 60m have been infected and 25m have died
- About 40m live with HIV/AIDS – 38m in developing countries and 28m in Africa
alone
- The spread is accelerating in India, Russia, the Caribbean and China
- AIDS is stretching health care systems beyond their limits
- There are 12m AIDS orphans – they are estimated to rise to 40m by 2010
- In Sub-Saharan Africa, 58% of HIV/AIDS infected adults are women. More than two-
thirds of newly infected teenagers are female.
- Life expectancy has declined by more than 10 years in South Africa and Botswana –
Swaziland faces the risk of extinction

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 - Most HIV/AIDS Infected Live in Africa and South Asia

Health
Health care workers often have rates of infection as high or higher than adults in general
Illness and death of skilled personnel further weakens the sector
Education
Education faces decimation of skilled teachers
Children of families struck by AIDS often have to leave school to help generate income or
undertake basic household tasks

Mode of transmission:
- Sexual intercourse (oral, vaginal and anal)
- Exposure to contaminated blood, semen, breast milk and other body fluids
- Blood Transfusion
- IV drug use
- Transplacental
- Needlestick injuries

High risk group:

 Homosexual or bisexual
 Intravenous drug users
 BT recipients before 1985
 Sexual contact with HIV+
 Babies of mothers who are HIV+

Clinical manifestations:
1. Acute viral illness (1 month after initial exposure) – fever, malaise, lymphadenopathy
2. Clinical latency – 8 years w/ no manifestations; towards end, bacterial and skin
infections and constitutional signs – AIDS related complex; CD4 counts 400-200
3. AIDS – 2 years; CD4 T lymphocyte < 200 w/ (+) ELISA or Western Blot and
opportunistic infections

HIV CLASSIFICATION
CATEGORY 1 – CD4+ 500 OR MORE
CATEGORY 2 – CD4+ 200-499
CATEGORY 3 – CD4+ LESS THAN 200

HIV test/Diagnostics:
- Elisa
- Western Blot
- Rapid HIV test

How to Diagnose

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  HIV+
2 consecutive positive ELISA and
1 positive Western Blot Test
 AIDS+
HIV+
CD4+ count below 500/ml
Exhibits one or more of the ff: (next slide)
 Full blown AIDS
CD4 is less than 200/ml

Exhibits one or more of the ff:

- Extreme fatigue
- Intermittent fever
- Night sweats
- Chills
- Lymphadenopathy
- Enlarged spleen
- Anorexia
- Weight loss
- Severe diarrhea
- Apathy and depression
- PTB
- Kaposis sarcoma
- Pneumocystis carinii
- AIDS dementia

Treatment
Anti-retroviral Therapy (ART) – ziduvirine (AZT)
a. Prolong life
b. Reduce risk of opportunistic infection
c. Prolong incubation period

Prevention:
 A – ABSTINENCE
 B – BE FAITHFUL
 C – CONDOMS
 D – DON’T USE DRUGS

LAWS RELATED
Laws Description
Republic Act 3573 Reporting of Communicable diseases
Requires all individuals and health facilities to
report notifiable diseases to local and
national public health authorities. Refer to

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 Section 3 of the Act for the list of diseases
covered.
Republic Act 4073 An Act Liberalizing the Treatment of Leprosy
No persons afflicted with leprosy shall be
confined in a leprosarium provided that such
person shall be treated in any government
skin clinic, rural health unit or duly licensed
physician
Republic Act 8504 Philippine AIDS Prevention and Control Act of
1998
An act promulgating policies and prescribing
measures for the prevention and control of
HIV AIDS in the Philippines, instituting a
nationwide HIV AIDS information and
educational program, establishing a
comprehensive HIV AIDS monitoring system,
strengthening the Philippine National AIDS
Council and for other purposes.
Republic Act 9482 The Rabies Act of 2007
Rabies control ordinances shall be strictly
implemented and the public shall be informed
on the proper management of animal bites
and/or rabies exposures.
Republic Act 1136 Tuberculosis Law of 1954
Creation of Division of Tuberculosis under an
appointed Director of the National
Tuberculosis of the Philippines (NTCP)
established at the DOH compound

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