COMMUNICABLE DISEASE NURSING - Destruction of pathogenic microorganism through

DAY 1 INTENSIVE REVIEW physical or chemical means

BASICS OF COMMUNICABLE DISEASE NURSING - Concurrent Disinfection - Done after patient

• Meningitis & Encephalitis produces infectious material. Patient is still
and Acute the source of infection.
Meningococcemia
COMMUNICABLE DISEASES
• Poliomyelitis
OF THE NERVOUS SYSTEM - TERMINAL DISINFECTION- When patient is no
• Rabies
• Leprosy longer the source of infection.
• Tetanus
• Influenza
HOST
• Coronavirus Diseases
COMMUNICABLE DISEASES • Diphtheria - Person or animal where the parasite depends for its
OF THE RESPIRATORY • Pertussis survival
SYSTEM • Mumps
• Pneumonia
RESERVOIR
• Pulmonary Tuberculosis
• Tinea infections - Animal or plant where the infectious agent
FUNGAL INFECTION • Candidiasis multiplies
• Onychomycosis

ISOLATION
INFECTION - Separation of an individual suffering from CD from
other people
Entry and multiplication of an infectious agent in or
on the tissue of a host. QUARANTINE
- Limitation of movement imposed on people
Infectious agent did not cause injury = NO HARM exposed to CD for period of time equivalent to
longest incubation period of particular CD.
Infectious agent cause signs and symptoms =
SYMPTOMATIC INFECTION SURVEILLANCE
- Watching, collecting, recording data from
Infectious agent can be transmitted ＝ particular population or area
COMMUNICABLE DISEASE

CARRIER
- Harbors the microorganism and can transmit it to a
susceptible host Often ASYMPTOMATIC

COMMUNICABLE DISEASE
- Caused by an infectious agent or its toxic products
Transmitted directly or indirectly to a healthy person.

CONTACT
- Any person or animal in close contact with another
infected person, animal contaminated material

CONTAGIOUS DISEASE
- Easily transmitted from one person to another

HABITAT
- Place where organism is usually found.

DISINFECTION
 REASONS FOR INFECTION KINDS OF INFECTION

1. Lack of immunization
• No signs and symptom
2. Multiple strains of different microorganisms Subclinical or • Laboratory-verified
3. Resistance to anti-infectives (antibiotics, Asymptomatic • Person is a carrier and
antivirals) . can transmit infection
4. Difficult to reach areas in body for treatment.
(Bones, CNS) • Microorganism is inactive
Latent Infection
5. Opportunistic infections in immunocompromised and dormant in the host
patients .
6. Immunosuppressive drugs and invasive • Due to microorganism
Exogenous Infection
procedures entering the host's body
7. Biological welfare and bioterrorism
• Due to host's normal flora
Endogenous Infection in the case of host's own
bacteria
STAGES OF INFECTION
• Developed while the
Healthcare-associated patient is in the
INCUBATION PERIOD - time between exposure to a
infections healthcare facility
pathogen and appearance of first sign and
(Nosocomial infections) • Mostly transmitted via
symptoms droplet contact

PRODROMAL PERIOD - Time between end of DISEASE

incubation period and appearance of
characteristic symptoms of illness Any condition in which normal structure or function
of an organ or the body is impaired or damaged.
CRITICAL ILLNESS PERIOD - Phase of rapid
multiplication of pathogen with exponential growth SIGNS - objective and measurable
and peak in its population. SYMPTOMS are very • Respiratory Rate
pronounced. • Blood Pressure
• Cardiac Rate
CONVALESCENCE PERIOD - Gradual recovery of host • Skin appearance

INFECTION CONTROL SYMPTOMS - subjective

• Difficulty of breathing
1. Standard precaution practices
• Palpitations
2. Hand hygiene practices
• Pruritus
3. Appropriate use of personal protective
equipment (PP or universal barriers
GEOGRAPHICAL DISTRIBUTION OF DISEASE
4. Precautionary measures against needlestick
and sharps injury
ENDEMIC DISEASE
5. Regular cleaning and disinfecting of working
- Certain geographic area/region
areas and supplies used
- Specific group of people within the country
6. Implementation of proper waste disposal
• P.D. 825: penalty for improper disposal of
EPIDEMIC DISEASE
garbage and other forms of uncleanliness
- Greater than expected numbers in a specific
• P.D. 856: Code of Sanitation (sanitation for
area. over particular time
food establishments and refuse collections
- Sudden increase in number of cases more than
and disposal system of cities and municapilities
what is expected.
nationwide.)
PANDEMIC DISEASE STRATEGIES FOR INFECTION PREVENTION AND
- Epidemic that attacks several countries or CONTROL
continents.
1. Hand hygiene
SPORADIC DISEASE 2. Environment hygiene
- Involve few people in a particular time. 3. Screening and cohorting patients
4. Vaccinations
5. Surveillance
6. Antibiotic stewardship
7. Care coordination
8. Following the evidence
9. Institutional culture
10. Comprehensive Unit based safety programs.

EPIDEMIOLOGIC TRIAD

INFECTIOUS AGENT- Microorganism that cause

RESPONSIBILITY OF A CD NURSE infection.
• Factors influencing cause of disease.
RESPONSIBILITY: Nursing care of patients with • Pathogenicity - ability of the organism to cause
communicable disease a disease.
• INFECTIVITY - ability of the organism to infect
Must be knowledgeable regarding: the host.
• Nature of the specific microorganism • VIRULENCE - ability of the organism to produce
• Method to eliminate the microorganism. disease.
• Mode of infection of microorganism • Measure of severity of the disease
• Mechanism of action of medications used to • Infective dose - number of organisms and toxin
treat the infection. released by organism to induce disease.
• Prophylaxis for communicable diseases
• Infection control measures HOST
• Level of prevention • Patient (case) - infected person
• Carrier - healthy person but carries and can
LEVELS OF PREVENTION transmit the Infection.
• Suspect - person with clinical manifestation
PRIMARY PREVENTION suggesting presence of infection.
• Evades risk factors and avoid unhealthy • Contact - person in close association with an
behaviors. infected
• TRUE prevention - problem has not yet
occurred. ENVIRONMENT
- Sum total of all external conditions affecting the
SECONDARY PREVENTION development of an organism.
• Identify people at risk of contracting various
illness. Components:
• EARLY DIAGNOSIS AND TREATMENT • Physical environment
• Biologic environment
TERTIARY PREVENTION • Socio-economic environment
• Manage illness and prevent further
deterioration.
• COMPLICATION PREVENTION
 • Vector-Borne Transmission
• VERTICAL TRANSMISSION

PORTAL OF ENTRY- Venue where organism infiltrates

the susceptible host.

SUSCEPTIBLE HOST- Individual who has the potential

to contract an infection.

BODY DEFENSES

FIRST LINE OF DEFENSE

- Physical and chemical barriers that defend
body from infection.
CHAIN OF INFECTION - Example: skin, tears, mucus, cilia, gastric acid

INFECTIOUS AGENT SECOND LINE OF DEFENSE

- Microbes capable of producing disease - Acts when pathogens get past the first line of
• Bacteria defense.
• Virus - Acts through IMMUNE RESPONSE
• Fungi - White blood cells - destroy disease-causing
• Protozoa organisms or substances.
• Parasites
COMPONENTS OF WHITE BLOOD CELLS
RESERVOIR - NEUTROPHILS - primarily attacks bacteria
- Area where infectious agent lives and multiply until - T HELPER CELLS - gives instruction to other cells
it can infect susceptible host by producing signals
• Human - CYTOTOXIC T CELLS - killer cells that punch
• Animal holes in the walls of pathogenic cells
• Environmental reservoir - MACROPHAGES - ingest or clean up dead cells
- DENDRITIC CELLS - monitor for pathogens and
PORTAL OF EXIT presents the evidence to T cells in lymph
• Route where microorganism leaves the nodes
reservoir. - B CELLS - produces antibodies which attaches
• Respiratory tract to antigen until macrophages consume the
• Genitourinary tract pathogen
• Gastrointestinal tract - SUPPRESSOR T CELLS - slows immune response
• Skin and mucous membrane once infection is eliminated.
• Placenta or vertical transmission
IMMUNITY
MODE OF TRANSMISSION
- Means by which the infectious agent passes from 1.INNATE IMMUNITY (NON-SPECIFIC)
the portal of exit from the reservoir to the susceptible - Early warning system
host - Does not have a memory.
- Present at birth
CONTACT - Rapid response
• Direct contact
• Indirect contact TYPES
• Droplet - FIRST LINE (skin and mucous membrane)
• Airborne - SECOND LINE (Natural killer cells, inflammation,
• Vehicle Transmission fever, antimicrobial substances)
2.ADAPTIVE IMMUNITY (SPECIFIC)
- Specific response
- Does have memory
- Slow response

TYPES
- Antibodies
- T-Lymphocytes
- B-Lymphocytes
ETIOLOGIC AGENTS
TYPES OF IMMUNITY ENCEPHALITIS MENINGITIS
Herpes simplex Enteroviruses
NATURAL ACTIVE IMMUNITY (most common) Arboviruses
Mumps, EBV, HIV, Poliovirus
- Acquired through recovery from a certain VIRAL
CMV Mumps,
disease. Arboviruses Adenovirus,
- When a person is exposed to antigens Measles, VZV
- Body produces its own antibody. Streptococcus
agalactiae
(neonates)
NATURAL PASSIVE IMMUNITY Primary (from
Haemophilus
- Acquired through placental transfer or through meningitis)
influenza B
colostrum. BACTERIAL Secondary
(children)
- Antibody was passed and not produced by Neisseria
(complication of
meningitides
the body current infectious
(adolescents)
disease)
Strepotococcus
ARTIFICIAL ACTIVE IMMUNITY pneumonia
- Acquired through vaccines and toxoid (Elderly)
FUNGAL
- Introduction of antigen for the body to
Toxoplasma,
produce antibody. PROTOZOAL
Malaria, Amoeba

ARTIFICIAL PASSIVE IMMUNITY CLASSIFICATION OF ENCEPHALITIS

- Acquired through administration of an
antitoxin, antiserum, convalescent serum, or PRIMARY ENCEPHALITIS: direct invasion of the CNS by
gamma globulin. arboviruses
- Introduction of antibodies rather than antigen
- Young children + older
COMMUNICABLE DISEASES AFFECTING THE NERVOUS than 55 years
Easter Equine Encephalitis - More fatal!
SYSTEM
(EEE) - Infants (severe):
permanent nerve + brain
ENCEPHALITIS AND MENINGITIS damage
- All age groups (more
common in < 1 yr.
ENCEPHALITIS
old)
- Acute inflammatory condition or infection in the - Caused by
Westem Equine Encephalitis
BRAIN arboviruses thru bites
(WEE
of culex and aedes
- Infants (severe):
MENINGITIS
permanent nerve +
- Acute inflammatory condition or infection in the brain damage
MENINGES (membranes) that surround the brain - Children < 10 years;
Japanese Encephalitis M>F (3:1)
- SEVERE!
 - Caused by bite of
Culex
tritaeniorhynchus
(found in rice-
growing, pig- and
poultry-raising
regions)
- Older people:
increased risk of
St. Louise Encephalitis death.
- Enters thru olfactory
tract

SECONDARY ENCEPHALITIS
Post-infection encephalitis - Complication of viral
diseases (mumps, measles, chickenpox)
Post-vaccinal encephalitis - Commonly associated
with anti-rabies vaccine.

MODE OF TRANSMISSION
*Varies depending on microorganism:
- Group B Streptococcus & Escherichia coli:
vertical
DIAGNOSTIC EVALUATION
- S. pneumoniae, H. influenzae, N. meningitides:
CEREBROSPINAL FLUID (CSF) ANALYSIS
droplet
- Done through lumbar puncture or spinal tap
- As diagnostic
INCUBATION PERIOD
§ Obtain specimen for analysis
- ENCEPHALITIS - 4 to 21 days
- As therapeutic
- MENINGITIS - 1 to 10 days
- Reduces intracranial pressure
- Introduce serum and other medication
CLINICAL MANIFESTATIONS
- Inject anesthetic agent
ENCEPHALITIS
PRODROMAL PERIOD
Fever Chills Abdominal pain
Headache Sore throat
Dizziness Conjunctivitis
Vomiting Arthralgia
Apathy myalgia

PERIOD OF CRITICAL ILLNESS (Encephalitic Signs)

Nuchal rigidity Aphasia Flaccid Paralysis
Ataxia Hyperexcitability Dysphagia
Tremors convulsions
Uncontrollable
Confusion Ocular palsy
contraction or TESTS
Speech
Ptosis twitching SEROLOGIC TESTS
difficulty
- Gram stain and culture/sensitivity
MENINGITIS - Blood cultures
Hallmark Benign Syndrome - Smear from petechiae
Altered Exaggerated - Urine culture
**Fever
Consciousness DTRs
**Severe Neck & Spine IMAGING
Signs of INC. ICP
Headache Stiffness • CT scan or MRI of the head
**Stiff Neck Meningeal Irritation Sinus Arrythmia
OTHER TESTS - Watch out for possible adverse reactions from
• Enzyme-linked immunosorbent assay (ELISA) drugs
• Polymerase chain reaction (PCR) - Proper positioning of patient
• Electroencephalography (EEG) - Maintain adequate nutrition and elimination
- Ensure patient's comfort
COMPLICATIONS - Provide reassurance and support to the patient
NEUROLOGIC SEQUELAE and family
Motor Disturbances - STRICT ASEPTIC TECHNIQUE and ISOLATION
• Persistent convulsions PRECAUTION
• Parkinsonian syndrome or paralysis agitans
• Epilepsy ACUTE MENINGOCOCCEMA
ETIOLOGIC AGENT: Neisseria meningitides
Mental Disturbances
• Mental dullness, depression, and deterioration INCUBATION PERIOD: 3 to 35 days
• Lethargy
• Sleep disturbances MODE OF TRANSMISSION:
• Respiratory droplets
OTHER COMPLICATIONS • Indirect contact
• Subdural effusion • Prolonged contact with infected person
• Hydrocephalus • Rarely, through carriers
• Deaf-mutism
• Blindness
• Otitis media and mastoiditis
• Pneumonia

MANAGEMENT
- Management towards the cause (bacteria,
TB, fungi)
- Control seizures: anticonvulsants
- Temperature control: TSB or anti-pyretics
- Hydration (oral hydration if tolerable) WATERHOUSE-FRIDERICHSEN SYNDROME
- Oral hygiene - Dermal manifestations of acute
- Seizure precaution meningococcemia adrenal medullary
- Close neurologic observation hemorrhage
- Corticosteroids - anti-inflammatory - Rapid development of purpuric + ecchymotic
- Physical, occupation, speech therapy, spots with associated shock
psychotherapy - Highly fatal

PREVENTION POLIOMYELITIS
Vaccination
- Haemophilus influenzae for infants - "polios" - gray (gray matter of CNS) + "myelos" -
- Pneumococcal vaccine against Neisseria marrow (myelin sheath which covers the nerve
meningitides and Streptococcus pneumonia fibers
- Health education regarding prompt medical - Inflammation of motor neurons of the brainstem
attention to chronic conditions and infections and the spinal cord, resulting in motor paralysis
followed by muscle atrophy, and sometimes,
NURSING MANAGEMENT permanent disability.
- Neurologic assessment of patient. OBSERVE FOR
SIGNS OF INCREASED ICP ETIOLOGIC AGENT: Poliovirus
- Monitor fluid balance HUMANS are the only known hosts.
Three identified immunological types of viruses: • Encephalitic manifestations
1. Brunhilde - from rhesus monkey
2. Lansing - from bulbar polio in Michigan TYPES OF POLIOMYELITIS
3. Leon - named after a child from a LA Epidemic
PARALYTIC POLIOMYELITIS - involves large number of
MODE OF TRANSMISSION: nerves cells.
- Feco-oral route: infected oropharyngeal
- secretions or feces SPINAL PARALYTIC POLIOMYELITIS
- Person-to-person: through healthy carriers - Occurs in the motor neurons of the spinal
- Indirect: from contaminated articles cord.

PERIOD OF COMMUNICABILITY: 3 days to 3 months HIGHER SPINAL PARALYTIC POLIOMYELITIS

- UPPER PORTION - Respiration
PREDISPOSING FACTORS: § Diaphragm + Intercostal muscles =
- Age - 60% from patients < 10 years of age DIFFICULTY OF BREATHING
- Sex - M>F
- Environment and hygienic conditions LOWER SPINAL PARALYTIC POLIOMYELITIS
- Over exhaustion
- LOWER PORTION - Lower Limbs
ABORTIVE/NON-PARALYTIC TYPE § Asymmetry, scattered flaccid paralysis;
Non-specific symptoms Hyporeflexia; Hypersensitivity to touch;
- Headache/sore throat Autonomic involvement
- Slight or moderate fever
- Occasional vomiting with abdominal PARALYTIC POLIOMYELITIS involves large number of
discomfort nerves cells
- Low lumbar pain - BULBOSPINAL- Both BRAINSTEM and SPINAL
- No evidence of paralysis CORD

NON-PARALYTIC POLIOMYELITIS
- Virus reached the CNS
- Types and muscle spasms of the hamstring
- Changes in deep and superficial reflexes
- Pain in the neck, back, arms, legs, and
abdomen
- Inability to place the head in between the
knees.
- (+) Pandy's test: elev. Protein globulin in the
CSF
- Transient paresis

PARALYTIC POLIOMYELITIS - involves large number of

nerves cells.

BULBAR POLIO - develops rapidly and more serious.

• Virus settled at the medullary area.
• CN IX, X - difficulty in speech and swallowing
• Paralysis of facial and ocular muscles
• Hypothalamus - impaired thermoregulation
• (+) Hoyne's sign - head lag DIAGNOSTICS
• Regurgitation of food through nasal passage – - Throat swab or culture from stool or CSF
RISK FOR ASPIRATION
COMPLICATIONS PARALYTIC RABIES
- PARALYSIS, Seizures, Electrolyte abnormalities • Less dramatic & longer course
- Respiratory failure • Gradual muscle paralysis, starting at site of
- Intestinal erosion bite or scratch
- Cardiac irregularities • Coma slowly develops, eventually death
- Urinary problems
MODE OF TRANSMISSION
TREATMENT MODALITIES • Primarily through bite of rabid animal
• Analgesia - for fever, pain, spasms • Inhalation of virus-containing aerosols – rare
• Moist heat application - spasms
• Rehabilitation - paralysis PERIOD OF COMMUNICABILITY
• Antispasmodics - spasms Morphine - - Five days from onset of symptoms and during
contraindicated! entire course of illness

PREVENTION
Vaccination
• Proper disposal of GIT secretions
• Isolation
• Standard precautions Sanitation of
premises, proper food handling.

RABIES

- Acute, zoonotic, and life-threatening viral

infection transmitted to humans through the
saliva of an infected animal
- Most common reservoir: dogs

ETIOLOGIC AGENT: Rhabdoviruses

INCUBATION PERIOD
Dogs: 1 week to 7 ½ months
Humans: 10 days to 15 years CLINICAL MANIFESTATIONS

Factors influencing incubation period: PRODROMAL/INVASION PHASE

• Nerve and blood supply in the area of the PAIN at original
bite Fever Irritability bite site
Body malaise Hyperexcitability Paresthesia,
• Extensiveness of the bite
Headache Apprehensiveness numbness,
• Resistance of the host Lacrimation Restlessness tingling, cold
• Distance of the bite from the CNS Perspiration Drowsiness sensation
• Specie of the animal Sore throat Mental depression
Mild dysphagia Melancholia Sensitivity to light,
Nausea Marked insomnia sound and
FORMS OF RABIES temperature
FURIOUS RABIES
• Hyperactivity EXCITEMENT OR NEUROLOGIC/ ENCEPHALIC PHASE
• Excitable behavior Excessive motor Muscle spasms SEVERE PAINFUL
• Hydrophobia (fear of water) activity Focal paralysis spasms of muscles
Excitation Hyperesthesia of mouth, pharynx,
• Photophobia (sensitivity to light)
Agitation Autonomic and larynx on
• Aerophobia (fear of drafts or of fresh air) Confusion dysfunction attempts to
Combativeness swallow water or
 Aberration of HYPERPTYALISM - food or mere sight POST-EXPOSURE PROPHYLAXIS
thoughts foaming of of them
- Increased risk of rabies if the following are
Shortening periods mouth/profuse
of lucidity drooling of saliva AEROPHOBIA
present:
Seizures PHOTOPHOBIA - Biting animal is known rabies reservoir or
Violent involuntary HYDROPHOBIA vector species.
contraction of
- Exposure occurs in geographical area where
diaphragm and
accessory muscles
rabies is present.
of respiration - Animal looks sick or displays abnormal
behavior.
TERMINAL OR PARALYTIC PHASE - Wound or mucous membrane was
DEATH due to contaminated by animal's saliva.
Quiet and loss bowel &
respiratory - Bite was unprovoked.
unconscious urinary control
paralysis,
spasms with Tachycardia and - Animal has not been vaccinated.
circulatory
progressive labored, irregular
collapse, or heart
paralysis respiration
failure PREVENTION & CONTROL
• Vaccination of all dogs
DIAGNOSTIC PROCEDURES • Enforcement of regulations for pick up and
- Isolation of virus from patient's saliva or throat removal of stray dogs
- Fluorescent antibody test (FAT) - most • Confinement for 10-14 days of any dog that
definitive test has bitten a person
- (+) Negri bodies from the dog's brain • Laboratory facilities for observation and
diagnosis
POST-EXPOSURE PROPHYLAXIS • Public education, especially children, in
- Immediate treatment or management of a avoiding and reporting all animals that
bite victim after rabies exposure appear sick.
- Prevents virus from entering CSF • Implementation of Republic Act 9482 "Anti-
Rabies Act of 2007" and Republic Act 8485
Consists of: "Animal Welfare Act of 1998"
- Extensive washing and local treatment of
wound ANTI-RABIES VACCINATION
- Mandatory immunization with effective rabies ACTIVE
vaccine STANDARD REGIMEN
- Administration of rabies immunoglobulin (RIG) DAY DOSAGE ROUTE SITE
if indicated DAY 0, 3, 7, 0.1 cc x 2
ID Deltoid
28-30 sites
- Tetanus antiserum is infiltrated around the
wound or given via IM after negative skin test
SPECIAL REGIMEN
DAY DOSAGE ROUTE SITE
CATEGORIES OF CONTACT WITH SUSPECTED RABID DAY 0 1 vial x 2 sites IM Deltoid
ANIMAL DAY 3 & 7 1 vial x 1 site IM Deltoid
Touching or feeding
CATEGORY I animals; licks on intact PVRV: Purified Vero cell rabies vaccine (Verorab)
skin
PCEC: Purified chick's embryo cell (Rabipur)
Nibbling of uncovered
skin; minor scratch or
CATEGORY II PASSIVE
abrasions without
VACCINE DOSAGE ROUTE SITE
bleeding Vastus
Equine rabies
Single or multiple 0.2 cc/kg BW IM ANST lateralis/Glut
Ig (ERIg)
transdermal scratch eal muscles
Human Rabies
CATEGORY III Licks on broken skin 0.13 cc/kg BW IM on ST SAME
Ig (HRIg)
Contamination of broken IM or inoculated
ATS 1,500 – 6,000 IU Deltoid
skin with saliva around wound
TETANUS TOXOID
- Given at a regular schedule.
Criteria:
- Biting animal has died or its whereabouts are
unknown.
- Bite is above the waistline.
- Bite is multiple.
- Bite has a rich blood supply and many nerves.

NURSING MANAGEMENT
- Isolation of patient
- Provide emotional and spiritual support.
- Provide optimum comfort and prevent injury.
DISTINCT FORMS OF LEPROSY
- Provide a darken, quiet environment.
LEPROMATOUS LEPROSY
- Wrap IV bottles.
- Most infectious type
- Do not bathe the patient.
- Cutaneous involvement and lesions
- Concurrent and terminal disinfection
§ Site of predilection are the face, ears,
§ wrists, elbows, buttocks, and knees.
LEPROSY
- Damages RT, eyes, testes, nerves, and skin.
- Chronic systemic infection characterized by
- Lepromin (-) but lesions has 1 Hansen's
progressive cutaneous lesions
- bacillus.
- ETIOLOGIC AGENT: Mycobacterium leprae
- Slow involvement of PN -> anesthesia + loss
Attacks cutaneous tissue and peripheral
- of sensation + gradual degradation of
nerves
nerves
- Produces skin lesions, anesthesia, infection,
- Atrophy of skin and muscles
and deformities.
- Absorption of bones of hands and feet
§ May lead to natural amputation.
INCUBATION PERIOD: 5 ½ months to 8 years
TUBERCULOID LEPROSY
MODE OF TRANSMISSION:
- Affects PN and surrounding skin on face, eyes,
- Airborne transmission through droplet nuclei
testes, nerves, and skin.
Inoculation through a break in skin and
- Elevated macules with central clearing with
mucous membranes.
more defined borders
- Leprosy is not passed from mother to unborn
- Anesthesia present with rapid involvement of
baby during pregnancy and during sexual
PN
contact.
- Lepromin (+) but lesions rarely has Hansen's
- Prolonged close contact for many months
bacillus.
required to contract the disease.
BORDERLINE LEPROSY
- Between lepromatous &Tuberculoid
- BORDERLINE LEPROMATOUS
- BORDERLINE TUBERCULOID

CLASSIFICATION BASED ON SMEAD

PAUBACILLARY LEPROSY (PB)
- Negative skin lesions at all sites.
- Smear: bacterial counts from skin slit lesions in
cool areas of body.
- Skin specimens: active borders of lesions + SC
tissue.
MULTIBACILLARY LEPROSY (MB) - Avoid prolonged skin-to-skin contact
- Positive skin lesions at all sites. - Good personal hygiene, proper nutrition,
and health education
CLINICAL MANIFESTATIONS
EARLY STAGE LEPROSY IN THE PHILIPPINES
- Changes in skin color (red or white)
- Lesion is hypesthetic and loss of sweating R.A. 4073 (Liberalization of Treatment of People
(Anhydrosis) Afflicted with Leprosy)
- Ulcers that do not heal Section 1058
- Muscle weakness and paralysis - Persons afflicted with leprosy should not be
- Painful and thickened nerves segregated.
§ Except when certified by secretary of health
LATE STAGE or authorized representatives that the stage
- Clawing of fingers and toes of disease requires institutional treatment.
- Leonine appearance - No person afflicted with leprosy shall be
- Inability to close eyelids (lagophthalmos) confined in a leprosarium provided that the
- Sinking of nose bridge (saddle nose) person will be treated in any government skin
- Madarosis (loss of eyebrows) clinic, rural health, or by a duly licensed
physician.
DIAGNOSTIC EVALUATION
- Tissue biopsy R.A. 4073 (Liberalization of Treatment of People
- Identification of signs and symptoms Afflicted with Leprosy)
- Skin slit smear – CONFIRMATORY. Section 1059
- Blood tests - Confinement and treatment in a sanitarium
- Increased RBC and ESR when necessary.
- Decreased serum calcium, albumin, and
cholesterol TETANUS
- Lepromin Test: Mitsuda reaction Infectious disease caused by an anaerobic bacteria
which produces a potent exotoxin
MEDICAL MANAGEMENT
- Sulfone therapy ETIOLOGIC AGENT: Clostridium tetani
- Rehabilitation, recreational, and occupational - Anaerobic bacteria which produce a potent
therapy exotoxin prominent systemic neuromuscular
symptom generalized spasmodic contraction
MULTIPLE DRUG THERAPY (MDT) of skeletal musculature.
- MULTIBACILLARY (LEPROMATOUS): - Commonly found in soil, dust, manure, and
Clofazimine, and Dapsone saliva.
§ 12 months -> Cured.
- PAUBACILLARY (TUBERCULOID): Rifampicin CLOSTRIDIUM TETANI
and Dapsone - Found in soil and intestinal wall of herbivorous
§ 6 months -> Cured. animals.
- Two forms:
NURSING MANAGEMENT § Spore-forming Form
- Isolation and asepsis § Vegetative Form
- Moral support and encouragement - Toxins:
- Full and nutritious diet § Tetanospasmin: muscle spasms
- Attention to personal hygiene § Tetanolysin: destruction of RBCs
- Terminal disinfection
INCUBATION PERIOD
PREVENTION - Neonates: 30 days
- VACCINATION: BCG
 - Adults: 3 days to 3 weeks CEPHALIC TETANUS
- Principle: the farther the injury from CNS = - Rarest form
longer - Limited to muscles and nerves in the head
- incubation period - Occurs in relation to trauma to head area
- MC symptom: paralysis of facial nerve (CN VII)
MODE OF TRANSMISSION - lock jaw + facial palsy + ptosis
- Punctured contaminated wound.
- Umbilical stump in neonates CLINICAL MANIFESTATION
- First manifestation: feeding and
sucking difficulty
- Excessive crying or voiceless crying
- Attempt to suck -> spasms +
cyanosis.
- Fever due to infection +
NEONATES
dehydration
- Jaw stiffness -> baby cannot suck or
swallow.
- Tonic or rigid muscular contraction,
spasm, or convulsions
- Flaccidity, exhaustion -> death
FORMS OF TETANUS
GENERALIZED TETANUS
- Spasms + increased muscle tone
- Most common type
near or around the wound
CLINICAL - Trismus (lock jaw) - first sign
- Hypertonicity + hyperactive DTRs
MANIFESTATIONS - Risus sardonicus (facial spasms)
- Neck stiffness + rigidity of pectorals + tachycardia + profuse sweating
and hamstring muscles + low-grade fever + painful
- Fever, sweating, elevated BP
involuntary muscle contractions
- Opisthotonos: arching of back
SYMPATHETIC OVERACTIVITY (SOA) - TRISMUS: neck and facial muscle
- Labile HPN OLDER rigidity
- Tachycardia/dysrhythmia CHILDREN + - RISUS SARDONICUS: grinning
- Peripheral vasculature constriction
ADULTS expression -PATHOGNOMONIC
- Increased CO, output
- Increased catecholamine excretion - Board-like abdomen/abdominal
and late hypotension rigidity
- Intermittent clonic convulsions ->
NEONATAL TETANUS cyanosis
- Newborns - Laryngospasms
- Occurs in babies born to mothers who have - Facture of vertebrae secondary
not been vaccinated with tetanus toxoid to spasms
during or before pregnancy.
- Occurs through infection of the unhealed TETANUS-PRONE WOUND
umbilical stump, especially when stump is cut - Wound or burn that requires surgical
with a nonsterile instrument or faulty cord care. intervention that is delayed for 6 hours.
- Wound or burn that has a considerable
LOCAL TETANUS amount of removed or devitalized tissue
- Occurs when there is persistent contraction of - Any puncture-type injury that has been in
muscles close to the injury site. contact with animal manure or soil
- Generally milder but may precede the onset - Serious fractures where the bone is exposed to
of generalized tetanus. infection.
- Wounds or burns in patients with systemic
sepsis.
COMPLICATIONS - Provide optimum comfort measures.
- Nutrition
- Fractures
- Aspiration pneumonia
RESPIRATORY SYSTEM
- Laryngospasm
LIFE-THREATENING INFLUENZA
- Tetanic seizures
COMPLICATIONS • Acute and highly contagious viral infection of
- Pulmonary embolism
the respiratory system
- Severe kidney failure
• Affects millions of people every year due to
- Hypostatic pneumonia
numerous strains of influenza virus

- Laceration of tongue and

ETIOLOGIC AGENT: RNA-containing myxoviruses
buccal mucosa
DUE TO TRAUMA INCUBATION PERIOD: 24-48 hours
- Intramuscular hematoma
- Fracture of spine and ribs
MODE OF TRANSMISSION
- Airborne spread in crowded populations
SEPTICEMIA
- Direct contact through droplet
- Dried mucus may harbor virus for hours
TREATMENT
- Cleanse wound PERIOD OF COMMUNICABILITY
immediately! Until 5th day of illness or 7th day in children
- Within 72 hours of injury
SPECIFIC
§ ATS, TAT, or TIG CLINICAL MANIFESTATIONS
immediately - Chills
- Penicillin or Metronidazole - Fever
- Oxygen inhalation - Body malaise
- Feed though NGT - Sore throat
NON-SPECIFIC - Tracheostomy - Rhinorrhea
- Adequate fluid, electrolyte, - Myalgia
and caloric intake - Headache
- Anticonvulsants (diazepam)
FOR MUSCLE DIAGNOSTIC EVALUATION
- Muscle relaxants (baclofen)
SPASMS AND - Complete blood count (CBC) -> leukopenia
- Neuromuscular blocking
STIFFNESS - Viral culture
agents
- Viral serology Complement fixation test
PREVENTIONS CONTROL - Hemo-agglutination test
- Active immunization with tetanus toxoid for - Neutralization test
pregnant women
- DPT for babies and children COMPLICATIONS
- Early consultation - PNEUMONIA: most common complication
- Encephalitis
NURSING MANAGEMENT - Reye syndrome
- Maintain a patent airway. - Acute encephalopathy + fatty degeneration
- Keep an accurate cardiac monitoring record. of liver due to epidemic influenza B
- Maintain an IV line for medication and - Myocarditis - heart failure
emergency care if necessary. - Sudden infant death syndrome
- Efficient wound care
- Avoid stimulation. MANAGEMENT
- Prevent contractures and pressure sores. - No specific treatment
- Watch for urinary retention. - Bed rest
- Monitor VS and muscle tone closely. - Adequate oral fluid intake
- Control body temperature
 - Paracetamol MODE OF TRANSMISSION
- Aspirin (unless contraindicated) - Respiratory droplets
- Ibuprofen - Fecal shedding
- Tepid sponge bath - Casual and social contacts: requires
prolonged exposure
PREVENTION - Indirect contact through inanimate
- Immunization materials/objects
§ Elderly
§ Immunocompromised state CLINICAL MANIFESTATIONS
§ Diabetics, patients with lung, kidney, heart, - Severe, acute, respiratory illness, similar to
or liver diseases pneumonia
- Avoidance of crowded places § Fever, headache, increased WBC
- Basic personal hygiene § Cough (non-productive > productive)
§ Shortness of breath
AVIAN INFLUENZA - Gl symptoms: diarrhea, nausea & vomiting
- Kidney failure
Caused by Influenza strain H5N1 which have spread - Chills, body aches, and joint pains
in Egypt and other parts of Asia.
DIAGNOSTIC EVALUATION
ETIOLOGIC AGENT: Orthomyxoviridae type A - Reverse Transcriptase Polymerase Chain
Reaction (RT-PCR)
INCUBATION PERIOD: 3 to 5 days § Confirmatory test
- Virus isolation
MODE OF TRANSMISSION - Stool and urine culture
- Close contact with infected birds or bird - Complete blood count
- droppings - Chest radiography or Computed tomography
- Plucking of infected birds (CT) scan
- Inhalation of aerosolized materials in live bird
markets CLASSIFICATION OF CORONAVIRUS
- Swimming or bathing in water contaminated
with
- droppings of infected birds

PREVENTION
VACCINATION with Influenza vaccine
- Age 50 years old and above
- Children 6-24 months of age
- Adults and children with chronic health
conditions
MEDICAL MANAGEMENT
CORONAVIRUS DISEASES • Supportive
• Glucocorticoids: for severe cases requiring
- MERS-CoV: Middle East Respiratory Syndrome oxygen
- SARS-CoV 1: severe acute respiratory • Antivirals Remdesivir: in severe to critical
syndrome(2002, China)
cases
- SARS-CoV 2: severe acute respiratory
syndrome 2 (2019, China) • Molnupiravir: in mild to moderate cases
• IL-6 inhibitors (Tocilizumab)
INCUBATION PERIOD: 2-14 days • JAK inhibitors (Baricitinib)
• Antibiotics: for secondary bacterial
pneumonia
PREVENTIVE MEASURES - DOB, heart failure symptoms, paralysis, coma,
- Identification and isolation of all cases as early death
as possible - High mortality rates due to respiratory
- Rigorous infection control measures depression and circulatory collapse

DIPHTHERIA CUTANEOUS DIPHTHERIA

- Rare but most common among persons with
Inflammation & formation of false membrane on poor hygiene in crowded areas
throat, tonsils, pharynx, and larynx that interferes with - MORE CONTAGIOUS
breathing. - Scaling rashes, sores, or blisters that are
painful, swollen, reddened
ETIOLOGIC AGENT: Corynebacterium diphtheria - May occur anywhere in the body
(Klebs-Loeffler bacillus)
CLINICAL MANIFESTATIONS
INCUBATION PERIOD: 2-5 days - Fatigue, malaise, sore throat, fever
- Pseudomembrane (pathognomonic sign)
CORYNEBACTERIUM DIPHTHERIAE - Bull neck appearance (pathognomonic sign)
- Gram-positive, non-sporulating, - Respiratory problems - if membrane forms in
- aerobic bacteria the larynx
- Produces diphtheria toxin - damages tissue § DOB
(cardiac muscles, nerves, kidney, liver) § Husky voice
- Easily damaged by light, heat, and aging § Stridor
§ Nasal drainage
MODE OF TRANSMISSION § Swelling of palate Increased HR
- Respiratory droplets §
- Indirect contact through contaminated DIAGNOSTIC PROCEDURES
objects - Physical examination for lymphadenopathies
- Nose and throat swab
PERIOD OF COMMUNICABILITY - Virulence test
- 2-4 weeks in untreated patients - Schick test - determine susceptibility to
- 1-2 days in treated patients diphtheria
§ Intradermal injection of diluted diphtheria
toxin
§ Read after 48-72 hours
§ (+) if there is local circumscribed area or
redness, 3-4 cm in diameter
- Loeffler slant - used to grow diphtheria bacilli
for confirmation of diagnosis

COMPLICATIONS
TYPES OF DIPHTHERIA - Myocarditis
- Polyneuropathy (paralysis of soft palate, ciliary
RESPIRATORY DIPHTHERIA - tonsils, pharynx, muscles of the eye, pharynx, larynx,
nose extremities)
- Sore throat with low-grade fever - Airway obstruction
- Whitish-gray membrane - Respiratory failure or pneumonia
- (pseudomembrane) attached to the tonsils, - Peripheral neuropathy
pharynx, and larynx
- Cervical lymphadenopathy (bull neck MEDICAL MANAGEMENT
appearance) - in severe cases - PENICILLIN
- ERYTHROMYCIN
 - Anti-toxin (Anti-Diphtheria serum)
§ Skin test prior to administration INCIDENCE
§ Fractional doses given in positive cases - Infants
- Supportive management - One attack usually produces lifetime immunity
§ Nutrition - Second attack may be due to microorganisms
§ Fluid and electrolyte balance causing whooping cough syndrome
§ Bed rest
§ Oxygen support
- Never attempt to remove the
pseudomembrane -> BLEEDING

PREVENTION
- Mandatory reporting of cases
- Isolation of patients for minimum 14 days until
cultures are negative.
- Contact with children and food handling
should be restricted.
- Booster dose of diphtheria vaccine in children
less than 5 years old
- Mandatory pentavalent immunization for STAGES OF PERTUSSIS
infants CATARRHAL STAGE
- 1 to 2 weeks
NURSING MANAGEMENT - Rhinorrhea, sneezing, lacrimation
- Bed rest for 2 weeks. Avoid strenuous activities - Cough: dry, irritating, hacking, and nocturnal
- Soft food is recommended. Small frequent that becomes progressively
feeding is advised. - worse
- Ice pack on neck for inflammation - MOST COMMUNICABLE STAGE
- Provide appropriate care for the nose and
throat. PAROXYSMAL STAGE
- 4 to 6 weeks
PERTUSSIS - COUGH: spasmodic and recurrent with
excessive explosive outbursts in a series of
Infectious disease characterized by repeated rapid 5-10 rapid coughs in one expiration.
attacks of spasmodic cough which consists of a - Ends in a loud, crowing inspiratory whoop.
series of explosive expiration that ends with a - Cyanosis, dilated face and neck veins,
"whoop". tongue protrusion during paroxysms
- May also accompany profuse sweating,
ETIOLOGIC AGENT: Bordetella pertussis involuntary urination, lethargy, exhaustion.

MODE OF TRANSMISSION Paroxysmal cough may result in:

- Direct - Nosebleed
- Indirect - Increased venous pressure
- Droplet spread - Periorbital edema
- Hemorrhage of anterior chamber of the eye
SOURCES OF INFECTION and conjunctiva
- Nose and throat of infected person
CONVALESCENT STAGE
PERIOD OF COMMUNICABILITY - 2 to 3 weeks
- 7 days after exposure to 3 weeks after typical - Marked by gradual decrease paroxysms of
paroxysms coughing.
DIAGNOSTIC EVALUATION
- Nasopharyngeal swab
- Sputum culture
- CBC (Leukocytosis)

COMPLICATIONS
- Interstitial pneumonia
- Bronchopneumonia
- Atelectasis
- Convulsions
- Umbilical hernia
- Otitis media
- Apnea
- Severe malnutrition
- Loss of bladder control Fracture of ribs
-
PREVENTION
- Reporting of cases of pertussis
- Vaccination with pentavalent vaccine
- Isolation of patient for 4-6 weeks from onset of
illness INCUBATION PERIOD
- Locate subclinical or unreported cases - 14 to 25 days (average of 18 days)
- Respiratory etiquette
PERIOD OF COMMUNICABILITY
MEDICAL MANAGEMENT - 1-2 days before and 5 days after the onset of
- Ampicillin or erythromycin parotid gland swelling.
- Hyperimmune convalescent serum or gamma - HIGHEST: 48 hours prior to swelling of parotid
globulin glands
- Fluid and electrolyte replacement
- Adequate nutrition CLINICAL MANIFESTATIONS
- Oxygen therapy - Headache
- Earache
NURSING MANAGEMENT - Loss of appetite
- Isolation and aseptic technique - Fever
- Do not leave the patient in times of paroxysms - Swelling of parotid glands
- Suction equipment should be available § Pain related to extent of swelling of glands.
- Sunshine and fresh air § Unilateral à bilateral swelling
- Provide warm baths
- Monitor intake and output DIAGNOSTIC EVALUATION
- Aspiration precaution - Compliment fixation: presumptive evidence of
infection
MUMPS - Hemagglutination inhibition test: Immune
status
Acute viral disease characterized by swelling of one - Neutralization test: immunity to mumps
or both parotid glands, with occasional involvement - Viral culture Serum amylase: most useful test
of other glandular structures, particularly the testes in for early presumptive diagnosis of mumps
males
COMPLICATIONS
CAUSTATIVE AGE: Paramyxovirus - Epididymo-orchitis
§ Testicular involvement Occurs 7 to 10 days
MODE OF TRANSMISSION: Direct and droplet spread after parotid gland swelling.
 § Accompanied by fever. CLASSIFICATIONS OF PNEUMONIA
§ Painful (excruciating) and aggravated by
movement GENERAL CLASSIFICATIONS
§ Swollen testis + tender on palpation Primary Pneumonia
- Oophoritis Direct inhalation or aspiration of pathogens or
- Mastitis noxious substances
- CNS involvement (Meningoencephalitis)
§ Headache + elevated CSF protein + cell count Secondary Pneumonia
changes Secondary to a complication to a particular
§ Nuchal rigidity + altered LOC +
convulsions/delirium ANATOMICAL CLASSIFICATIONS
- Deafness Bronchopneumonia
- Pancreatitis - Lobular or catarrhal
§ Epigastric pain + vomiting + chills + prostration - .Most common type
- RARE: Transverse myelitis, ataxia, - Bronchus à Bronchioles à Alveoli
thrombocytopenia, myocarditis, arthritis, nephritis - Pneumococcus, Klebsiella pneumoniae, H.
influenzae
MEDICAL MANAGEMENT - Slow onset
- No treatment indicated.
- Paracetamol or NSAIDS, Lobar Pneumonia
- Cold or hot compress - to aid for the - Cropous pneumonia
inflammation. - One or two lobes of the lung
- Chills + pleural chest pain + cough with blood-
NURSING MANAGEMENT streaked, prune juice-like, or rusty-looking
• Isolation of patient sputum (PATHOGNOMONIC)
• Terminal disinfection
• Oral care and personal hygiene Interstitial Pneumonia
• Bed rest - Interstitial pneumonitis
• Soft and semi-solid food - Involves areas in between the alveoli
• Avoid highly spiced and acidic foods - Progressive scarring of both lungs (fibrosis)
- Mycoplasma pneumoniae
PNEUMONIA

Infectious disease caused by pneumococcus

associated with general toxemia and inflammation
then consolidation to the lungs

CAUSATIVE AGENTS
- Streptococcus pneumoniae
- Staphylococcus aureus
- Haemophilus influenzae
- Klebsiella pneumoniae
- Other bacteria, virus, mycoplasma, fungi CLASSIFICATION ACCDG. TO ACQUISITION

INCUBATION PERIOD:1 to 3 days COMMUNITY-ACQUIRED PNEUMONIA

- Less than 36 hours during patient's stay at
MODE OF TRANSMISSION hospital.
- Droplet HOSPITAL-ACQUIRED PNEUMONIA
- Indirect contact - More than 36 hours during patient's stay at
hospital
 MEDICAL MANAGEMENT
ASPIRATION PNEUMONIA - Antimicrobial agents: depending on type of
- When foreign matter is inhaled or aspirated infection.
into the lungs - Bronchodilators
- MC: Gastric contents - Expectorants
- Supportive management
VENTILATOR-ASSOCIATED PNEUMONIA § Humidified oxygen
- Occurs in patients using a mechanical § Mechanical ventilator: in cases of ARDS or
ventilator. respiratory failure
§ High caloric diet and adequate fluid intake
PNEUMOCYSTIS JIROVECI PNEUMONIA (PCP) § Bed rest
- In patients with immunocompromised state § Pain relief
(HIV/AIDS, sickle cell disease, patients
receiving chemotherapy) PREVENTION
• Prevent common colds, influenza, and other
HYPOSTATIC PNEUMONIA • URTIs
- Occurs in patients not turned to their sides • Avoid environmental factors: cold, pollution,
§ Secondary to fluid collection in the dorsal fatigue, alcohol.
region of lungs sec. to prolonged supine • Enough rest
position • Healthy diet
• Handwashing
CLINICAL MANIFESTATIONS • Respiratory etiquette
- Rusty or Prune juice-colored sputum • immunization (pneumonia vaccine)
PATHOGNOMONIC •
- Stabbing chest pain aggravated by PNUEMOCOCCAL PNEUMOCOCCAL
respirations or coughing. CONJUGATE POLYSACCHARIDE
- Chills and rising fever (PCV13 OR Prevnar 13) (PPSV23 or Pneumovax 23)
13 kinds of bacteria 23 kinds of bacteria
- Body malaise
Children + Adults Adults
- Labored respiration with orthopnea
Babies: 3-4 doses series
- Rapid and bounding pulse
Start at 6 weeks old.
- Altered LOC - in elderly. Booster at 15 months old
Adults: one time Adults over 65 y/o: One
DIAGNOSTIC EVALUATION injection year after receiving PCV13
- Chest radiography: confirmatory + extent of Revaccination: after 5-
lesions 10 years
- Sputum analysis: determine causative agent At risk Adults who received
- Pulse oximetry: oxygenation in blood (immunocompromised). PPSV23 at age 65: No
- Computed tomography (CT) scan: more recommended revaccination
recommended
detailed image of the lungs.
- Pleural fluid culture
NURSING MANAGEMENT
• Maintain patent airway and adequate
COMPLICATIONS
• oxygenation
- Bacteremia: bacteria in blood
• Proper coughing and deep breathing
- May lead to SEPSIS and SEPTIC SHOCK
exercises
- Lung abscess: pockets of pus in lungs
• Sputum examinations as needed
- Pleural effusion: excess fluids in pleural layer of
• Adequate nutrition: High-caloric diet
lungs à limited lung expansion
• Calm environment for adequate bed rest
- Empyema: pus in pleural cavity
• Proper disposal of secretions
- Pleurisy/pleuritis: inflammation of pleura
• Control of body temperature
 TUBERCULOSIS PRESUMPTIVE PULMONARY TB
Refers to a person with either:
PULMONARY TUBERCULOSIS - ≥ 2 weeks of cough, unexplained fever and
- Chronic, contagious, infectious disease weight loss, or night sweats
caused by formation of tubercles in the lung OR
tissue. - Chest X-ray finding suggestive of TB
§ Tubercles à caseation necrosis +
calcification DIAGNOSIS OF TUBERCULOSIS
- May also affect other areas of the body. ACTIVE TB DISEASE - A presumptive TB case that is
either bacteriologically confirmed or clinically
ETIOLOGIC AGENTS: diagnosed
- Mycobacterium tuberculosis
- Mycobacterium bovis BACTERIOLOGICALLY-CONFIRMED TB - patient from
whom a biological specimen is positive for TB by
INCUBATION: 2-10 days smear microscopy (SM), culture, or rapid diagnostic
tests (Xpert MTB)
TRANSMISSION: airborne
CLINICALLY DIAGNOSED-TB - patient for which the
CLINICAL MANIFESTATIONS criterion for bacteriological confirmation is not
- COUGH fulfilled, but diagnosis is made on the basis of clinical
- LOW-GRADE AFTERNOON FEVER findings, X-ray abnormalities, suggestive histology,
- UNEXPLAINED WEIGHT LOSS and/or other biochemistry or imaging tests
- NIGHT SWEATS
- Body malaise DIAGNOSTIC PROCEDURES
- Dyspnea CHEST-XRAY - determine extent of lesion
- Hemoptysis Xpert MTB/RIF Assay - Rapid molecular diagnostic
- Occasional chest pains tests Primary diagnostic test for PTB Should be used
for TB diagnosis among:
DEFINITION OF TERMS § Smear-negative adults with CXR findings
CASE FINDING - identification of presumptive TB, suggestive of TB
either by clinical manifestations or chest x-ray, § Presumptive drug-resistant TB
followed by diagnosis of active TB disease through § Individuals with HIV and manifestations of TB
bacteriological testing or clinical diagnosis.
MTB RIF RESISTANCE
SYSTEMATIC SCREENING FOR ACTIVE TB - systematic T Detected Not detected
identification of presumptive TB in a predetermined RR Detected Detected
target group TI Detected Intedeterminate
N NOT DETECTED -
SYMPTOM-BASED SCREENING - Screening using any I INVALID/ NO RESULT/ ERROR
of the FOUR cardinal TB symptoms or signs (at least 2
weeks duration): Direct Sputum Smear Microscopy (DSSM)
- COUGH - Direct visualization of TB bacilli using either
- UNEXPLAINED FEVER brightfield microscopy or fluorescence
- UNEXPLAINED WEIGHT LOSS microscopy
- NIGHT SWEATS - Used TO MONITOR progress of BCTB patients
during treatment & confirm cure upon course
SCREENING BY CHEST X-RAY - Using chest x-ray to completion.
identify presumptive pulmonary tuberculosis - Sample: 3-5 mL (saliva not acceptable)
- Two specimens are sent (to be collected within
3 days, at the most)
 § 1st sample: time of consultation (spot
sample)
§ 2nd sample: after at least 1 hour or early
morning specimen the following day
1 SPUTUM SMEAR-POSITIVE CONFIRMED TB =
BACTERIOLOGICALLY-CONFIRMED TB

- Loop Mediated Isothermal Amplification (TB

LAMP)
- TB Culture and Drug Susceptibility Testing (TBC &
DST)
- Interferon-Gamma Release Assays (IGRA)
- TUBERCULIN SKIN TEST (TST)
§ Screening tool for TB infection in children
§ Used to screen for patient's eligibility for
receiving treatment for latent TB infection (TB
preventive treatment)
§ Read after 48-72 hours.
o Interpretation: (+) INDURATION
o 5 mm - Immunocompromised
o 10 mm - Normal individual
o (-) induration - NOT SIGNIFICANT
SECOND LINE ANTI-TB MEDICATIONS
REGIMEN - Cycloserine and ethionamide
Intensive Continuation ELIGIBLE PATIENTS - Preomycin
Phase Phase - Amikacin
- PTB or EPTB (except - Quinolone
CNS, bones, joints)
whether new or
retreatment, with final DIRECT OBSERVED THERAPY
Xpert result (MB, RIF - Strategy by WHO to improve compliance in TB
sensitive or treatment.
indeterminate)
- FIVE ELEMENTS
1 2-HRZE 4-HR - New PTB or EPTB
(except CNS, bones, § Political commitment with increased sustained
joints), with positive financing
SM/TB LAMP or § Case detection through quality-assured
clinically diagnosed, and bacteriology
Xpert not done or MTB is § Standardized treatment, with supervision, and
not detected patient support
- PTB or EPTBof CNS, § An effective drug supply and management
bones, joints whether system
new or retreatment, with
final Xpert result (MTB,
§ *Monitoring and evaluation system, and
RIF sensitive or impact
indeterminate) § measurement.
2 2-HRZE 10-HR - New PTB or EPTB of
CNS, bones, joints, with NURSING MANAGEMENT
positive SM/TB LAMP or - Promoting airway clearance Hydration
clinically diagnosed, and
Postural drainage
Xpert not done or MTB is
- Advocating treatment regimen
not detected.
- Empty stomach, 1 hour before meals I
Promoting activity and nutrition
 - " Preventing spread of infection TINEA BARBAE (Barber's itch)
- Mouth care - Colonization of the bearded areas of the face
- Cough etiquette and neck
- Handwashing - Restricted to males only
- Proper referral - Common to dairy farmers and cattle ranchers
ETIOLOGIC AGENT: Trichopyton mentegophytes &
FUNGAL INFECTIONS Trichopyton Verrucosum
FUNGAL INFECTIONS (MYCOSES)
TINEA CORPORIS (Ringworm) - Circular, red, flat sore,
SYSTEMIC FUNGAL INFECTIONS - Affects internal with scaling
organs.
MODE OF TRANSMISSION
SUPERFICIAL FUNGAL INFECTIONS - Affects skin, nails, - Direct contact
and scalp. - Indirect contact
- Heat and humidity may trigger
RISK FACTORS - Spread
1. Use of some antibiotics
2. Use of corticosteroids TINEA PEDIS (Athlete's Foot) - Occurs in warm and
3. Medical conditions Compromised immune moist environments (socks and shoes, sports
system, equipment, locker rooms)
4. Environmental factors
5. Transmission ONYCHOMYCOSIS - Fungal infection of toenails and
fingernails
TINEA FLAVA (Tinea alba)
Superficial cutaneous fungal infection NURSING MANAGEMENT
Hypo/hyper-pigmentation of skin at chest or back - Avoid sharing utensils
- Meticulous mouth care
TINEA VERSICOLOR - Proper disposal of oral secretions
Small patches of skin, they become scaly or - Good perineal hygiene
discolored. - Avoid self-medications (antibiotics)

CANDIDIASIS

Fungal infection that usually infects the nails

(onychomycosis), skin (diaper rash), and mucus
membranes of oropharynx (thrush), vagina
(moniliasis), esophagus, and GIT

ETIOLOGIC AGENT: Candida albicans

Infection susceptibility is increased among:

- Immunocompromised state - DM, drugs,
radiation therapy, HIV
- chemotherapeutic
ETIOLOGIC AGENT: Malassezia furfur - Increase in estrogen level
- Broad spectrum antibiotics are used
CLINICAL MANIFESTATIONS
- Disturbing abnormal pigmentation CLINICAL MANIFESTATIONS
- White to reddish-brown or fawn-colored lesions - Scaly skin with erythema and rash
- Fine, dust-like scaling - Nails - red and swollen, separation of pruritic
- Mild pruritus nails from nailbed
 - Cream-colored or bluish-white patches and
exudates on the tongue, mouth, and
oropharynx
- Vagina - white or yellowish

MEDICAL MANAGEMENT
- Nystatin - oral thrush
- Clotrimazole, Fluconazole, Ketoconazole -
- mucus membrane and vagina
- Fluconazole and amphotericin - systemic
infection

NURSING MANAGEMENT
- Avoid sharing utensils
- Meticulous mouth care
- Proper disposal of oral secretions
- Good perineal hygiene
- Avoid self-medications (antibiotics)

HOME REMEDIES FOR FUNGAL INFECTIONS

- Plain yogurt: (+) live lactobacilli strains
- Coconut oil: (+) medium-chain fatty acids -
fungicides)
- Garlic
- Apple cidar vinegar: oral
- Cranberry juice: prevents sticking of fungi to
mucous membranes.