COMMUNICABLE DISEASE MARK ARON MARTIREZ.....

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1. COMMUNICABLE DISEASE MARK ARON T. MARTIREZ

2. LEGEND: D: DISEASE CA : CAUSATIVE AGENT MOT : MODE OF TRANSMISSION S/SX : SIGNS AND SYMPTOMS TX : TREATMENT P : PREVENTION

3. EPI DISEASES MARK ARON T. MARTIREZ

4. D: TUBERCULOSIS -Koch’s Disease CA: Mycobacterium Tuberculosis -rod-shaped bacteria MOT: Airborne -Incubation: 4-6 weeks S/SX: Low grade afternoon fever Night sweats Anorexia Weight loss Amenorrhea Nonproductive-productive cough Hemoptysis: late sign

5. TX: RIPES(SCC-Short Course Chemotherapy) 1.Rifampicin: Red –Orange body discharge -hepatotoxic -tell px its normal(remove contact lens) 2. Isoniazid: Peripheral Neuropathy -Take Vitamin B6 3. Pyrazinamide Hepatotoxic, Increase Uric Acid Increase OFI 4. Ethambutol -Eye problem(Optic Neuritis) -not given below 5 years old (unable to complain loss of vision) 5. Streptomycin -Ototoxic Directly Observed Treatment-Short Course(DOTS): Observing the patient taking medication in his mouth

6. TX: DIAGNOSTIC TEST Mantoux Test/PPD Test: - Exposure to TB -Intradermal (15 degrees), 1mL -9:1 Ratio: PNSS( 0.9 mL): PPD(0.1 mL) -read after 48-72 hours -Wheal: elevation -induration: widening 0-4 mm: negative 5 mm or more: immunocompromised 10 mm or more: normal people TINE TEST: mass screening for TB

7. TX: DIAGNOSTIC TEST 2.Chest X Ray -determine lesions(upper area) Minimal: very small Moderate: lesion is less than 4cm Severe: lesion more than 4 cm 3.DSSM/AFB - Confirmatory test -early morning sputum (3-5 mL), before breakfast -send to laboratory immediately -3 positive sputum results(collected within 2 days) -Contraindication: hemoptysis

8. TX: WHO TB Diagnostic Category Category 1: 2:HRZE, 4:HR New ,smear positive TB New smear (-) PTB but with extra PTB Category 1a: -TB Meningitis Category 2: 3: HRZES, 5 HRE Relapse Treatment Failure Category 3: 2:HRZE, 4:HR New, smear (-) TB: Latent Category 4: (REFERRAL) Chronic TB Multi Drug Resistant TB

9. P: -Negative pressure room -Cover the mouth and nose when sneezing to avoid transmission -Give BCG Intradermal,15 At birth Deltoid TB, Leprosy, Meningitis Koch’s Phenomenon: skin reaction when BCG is given to a TB positive patient -Improve social conditions

10. -MEDTECHS: perform DSSM -Passive case finding should be facilitated by all health stations Domicilliary treatment(HOME TREATMENT):preferred mode of care DSSM: basis for all TB cases TB Primary Complex 1.Cough or wheezing more than 2 weeks 2.Unexplained fever more than 2 weeks 3.Weight loss 4.Failure to Thrive Latent TB: PPD, then CXR

11. TB MANAGEMENT IN CHILD -All TB symptomatic children, 0-9 years old shall be subjected for tuberculin testing (except DSSM +) Done once a week, Monday or Tuesday 10 children-avoid wastage Criteria to be TB symptomatic: symptoms should last more than 2 weeks (3 or more symptoms) Conditions confirming TB diagnosis + hx of exposure to adult + tuberculin test + signs and symptoms suggestive of TB

12. DPT

13. D: Diphteria -nasal -pharyngeal(most common) -laryngeal(most fatal) CA: Corynebacterium Diphteriae MOT: Droplet -Milk served as vehicle Incubation: 2-5 days S/SX: 1. Pseudomembrane- white membrane in the oropharynx 2. Bull neck appearance ( dysphagia) TX: Moloney’s test: confirmatory Schick’s Test: susceptibility to bacteria DOC: Erythromycin IM Complication: Myocarditis(BED REST) P: DPT Pasteurization of Milk

14. D: Pertussis - Whooping Cough - No day cough CA: Bordetella Pertussis MOT: Droplet Incubation: 7-21 days >TB S/SX: Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop cough COMPLICATION: abdominal hernia TX: Bordet- gengou agar test: Confirmatory -DOC: Erythromycin//Penicillin -Complete Bed Rest -Avoid Pollutants -Abdominal Binder P: DPT Patient should be segregated at 3 weeks after appearance of paroxysmal cough

15. D: Tetanus - Lock Jaw CA: Clostridium Tetani Neonate: Umbilical cord Children: Dental caries Adult: punctured wound MOT: Indirect Contact : soil, street dust, animal/human feces, punctured wound Incubation: 7-14 days S/SX: Risus sardonicus - grinning smile Opisthotonus - arching of back TX: No specific test - Tetanus Immunoglobulin - Diazepam: muscle spasms -risk of aspiration P: DPT 2. Tetanus toxoid (5 doses women)

16. D: Poliomyelitis CA: Legio Debilitans /Polio Virus - attacks anterior horn of neuron(motor movement) - Man is the only reservoir MOT: Fecal-oral route 7-21 days S/SX: Paralysis(RESPIRATORY PROBLEM) Hoyne’s sign: head lag after 4 months SAFETY! TX: CSF analysis( Pandy’s Test) ROM exercises P: IPV(Salk), OPV(Sabin) Frequent handwashing

17. D: Measles - Rubeola CA: RNA containing paramyxovirus MOT: Airborne Incubation: 2 weeks -10 days(fever) -14 days(rashes) Communicability: 4 days before and 5 days after rash appearance S/SX: Koplik’s spot: whitish patches on buccal cavity Cephalocaudal rashes 3Cs: cough,coryza , conjunctivitis TX:- no specific test - Supportive and symptomatic P: 1.MMR 2. Disinfection of soiled articles

18. D: Hepatitis B CA: Hepatitis B virus MOT: Blood and body fluids - Placenta Incubation: 45-100 days S/SX: RUQ Abdominal pain Jaundice Anorexia Pruritus Steatorrhea Dark Colored urine TX: -Hepatitis B surface agglutination ( HBSAg )Test -Hepatitis B Immunoglobulin -High calorie diet Complication: Hepatitis D and Liver Cancer P: Hepatitis B immunization Hand washing Safe sex Screening of blood products

19. DISEASES TRANSMITTED THROUGH FOOD AND WATER

20. D: Cholera -El Tor CA: Vibrio Cholera MOT: 5 F’s -fluids , fingers, flies, foods, and fields Incubation: 3 days S/SX: 1.Rice, watery stool Communicability: 7-14 days after onset TX: Stool Culture ORESOL IVF DOC: Tetracycline(teeth stain) P: 1.Proper handwashing 2.Proper food and water sanitation 3.Vaccine: Chole-vac

21. D: Amoebic Dysentery CA: Entamoeba histolytica (protozoan=Slipper-shaped) MOT: Fecal-oral route S/SX: Abdominal cramping Bloody mucoid stool Tenesmus(feeling of incomplete defecation) TX: 1.Stool Culture 2. Metronidazole- avoid alcohol P: Proper handwashing Proper food and water sanitation

22. D: Shigellosis -Bacillary dysentery CA: Shigella bacillus - Shigella dysenterae : most infectious - Shigella flesneri : common in the Philippines MOT: Fecal-oral route 5F’s: : Finger, Foods, Feces, Flies, Fomites Incubation: less than 4 days S/SX: Abdominal cramping Bloody mucoid stool Tenesmus(feeling of incomplete defecation ) TX: DOC:Co-trimoxazole Low fiber Increase OFI P: 1. Handwashing 2.Proper food and water handling 3.Fly control

23. D: Typhoid Fever CA: Salmonella typhi MOT: 5F’s -Incubation: 2 weeks S/SX: Rose Spots in the Abdomen : bleeding caused by perforation of the Peyer’s patches Ladderlike fever TX: 1. Typhi Dot-confirms(fecal) 2.Widal’s Test: blood serum DOC: Chlormaphenicol P: Proper handwashing Proper food and water sanitation

24. ERUPTIVE DISEASES

25. D: Chickenpox -Varicella CA: Varicella-zoster virus Communicability: 1 day before and 6 days after appearance MOT: Airborne Direct contact Incubation: 2-3 weeks S/SX: 1.Vesiculopapular rash 2. Centrifugal appearance 3.Pruritus TX: 1.Supportive and symptomatic P: 1.15 years old above: increase risk for smallpox 2. Exclusion from school for 1 week after eruption first appears 3.Avoid contact with susceptibles

26. D: German Measles - Rubella CA: Rubella virus -Teratogenic MOT: Droplet Incubation: 3 days S/SX: 1.Forscheimer spots- red pinpoint patches on oral cavity 2. Maculopapular rashes 3.Sore Throat TX: 1.Rubella Titer: Normal Value 1:10 2. Avoid pregnancy for 3 months after MMR vaccine 3. Rubella Immunoglobulin P: 1.MMR: Live attenuated virus (contra: allergy to eggs)

27. VECTOR-BORNE DISEASE

28. D: Dengue Hemorrhagic Fever CA: Flavivirus - Sporadic -Epidemic (June to November) MOT: Aedes Aegypti (vector) DLSU S/SX: Febrile/Invasive Stage(first 4 days) -fever -abdominal pain 2. Hemorrhagic Stage(4-7 days) Decrease in temperature GI bleeding Narrowed pulse pressure 3.Convalescent(7-10 days) -appetite regained -BP stable

29. DENGUE CLASSIFICATION(WHO) Grade 1: a.flu -like symptoms b. Herman’s sign c. + Torniquet sign 2. Grade 2 a.manifestations of Grade I b . petechiae , ecchymosis purpura, gum bleeding 3. Grade 3 a.manifestations of Grade II plus beginning of circulatory failure 4. Grade 4 a. Manifestation of Grade III plus shock

30. D: Dengue Hemorrhagic Fever TX: Torniquet Test - Rompel Lede’s Test -PRESUMPTIVE -BP APP -+: 20 or more petechiae 2. Platelet count -CONFIRMATORY -less than 150,000 3. Tx is supportive and symptomatic 4.Paracetamol for fever 5. No ASPIRIN 6.IVF- most important tx 7. Blood Transfusion 8. Low-fat, low-fiber (avoid dark-colored food) P: 4S S - earch and Destroy S - eek Early Consultation S - elf Protection Measures S - ay yes to fogging only during outbreaks

31. D: Malaria CA: Plasmodium - Falciparum: most fatal, most common in Philippines MOT: Anopheles -DLSU Opposite S/SX: 1.Cold stage: severe,recurrent chills a. Keep patient warm 2.Hot stage: Fever(4-6 hours) - ladderlike fever -TSB 3.Wet Stage: Profuse sweating - Change wet clothing - TX: Peripheral Blood Smear: take at fever 2.Chemoprophylaxis: Chloroquine (taken before entering endemic area) -pregnancy: given throughout duration P: On-Stream Seeding: construction of bioponds for fish propagation On Stream Clearing: cutting of vegetation overhanging along stream banks -Avoid night activities -wear clothes that covers arms and legs in evening -ZOOPROPHYLAXIS: diversion of biting from humans to animals

32. D: Filariasis CA: Wuchereria Bancrofti (Parasites) MOT: Aedes Poecillus - Incubation: 8-16 months S/SX: 1.Asymptomatic: -presence of parasite in blood but no clinical signs 2.Acute: -Lymphadenitis 3.Chronic: (10-15 years) -Elephantiasis TX: Nocturnal Blood Examination- blood are taken after 8 pm Immunochromatographic Test(ICT)- rapid assessment,can be done at daytime DOC: Diethylcarbamazine Citrate(DEC) or Hetrazan P: Proper handwashing Proper food and water sanitation

33. D: Schistosomiasis CA: Schistosoma Mansoni Schistosoma Japonicum ( Philipines ) MOT: Contact with infected freshwater Vector: Oncomelania Quadrasi S/SX: Diarrhea 2.Bloody stool 3.Hepatomegaly TX: 1.COPT(cecum ova precipitin test) 2.DOC: Praziquantel P: 1.Dispose feces properly not reaching body of water 2.Use molluscides 3.Prevent exposure to contaminated water(boots)

34. DISEASE TRANSMITTED BY ANIMALS

35. D: Leptospirosis CA: Leptospira Interrogans (bacteria) RAT is the main host - MOT: Contact with infected open skin Incubation: 10 days S/SX: Leptospiremic Phase Leptospires present in blood and CSF Abrupt onset(fever, headache, myalgia) Immune Phase - presence of IgM TX: Examination of blood and CSF during first week of illness and urine after 10 th day -Penicillin P: 1.Boots 2.Rat Eradication

36. D: Rabies -Lyssa CA: Rhabdovirus of genus lyssavirus -Degeneration and necrosis of brain(formation of negri bodies) a.Urban /Canine: transmitted by dogs b. Sylvatic: disease of wild animals MOT: Bite or scratch of rabid animal Source of infection: saliva of infected Incubation: 2- 8 weeks(years depending on wound severity) S/SX: 1. Cognitive problems 2.Hydrophobia 3.Aerophobia 4.FATAL once symptoms appear - TX: History of bite of animal -Wash wounds with running water and mild soap -Antibiotics and anti-tetanus Immunization - Antirabies -Observe pet for 14 days

37. D: Rabies P: 1.Pet immunized at 3 months of age and every year after 2.Never allow pets to roam streets 3.Take care of pets. You are responsible for your pets action Rabies Prevention Program: Eliminate rabies in the country CATEGORY 1: Licking of intact skin (observe dog,14 days) CATEGORY 2: abrasion, laceration, punctured wound on the lower extremities(observe dog, active vaccine) CATEGORY 3: laceration on upper extremities, dog is killed,lost , stray (observe dog, passive vaccine) ACTIVE: PCEC,RABIPUR,VEROWELL PASSIVE: ERIG DAY: 0,3, 7, 14

38. D: Leprosy -Hansen’s Disease CA: Mycobacterium leprae MOT: Droplet - Prolonged skin-skin contact S/SX: Early --Change in skin color -Thickened painful nerves -Muscle weakness -Nasal obstruction Late(MALLICCCES) - Madarosis -Loss of Eyebrows Inability to close eyelids( lagophthalmos ) -Clawing of fingers and toes -Contractures -Chronic ulcers -enlargement of breast -Sinking of nosebridge

39. TX: 1.Slit Skin Smear:confirmatory test 2.Domiciliary Treatment (RA 4073) -PAUCIBACILLARY: noninfectious Duration of treatment: 6-9 months MULTIBACILLARY:infectious type Duration:24-30 months 3.DOC:Rifampicin and Dapsone P: 1.BCG Vaccine

40. ASCARIASIS TRICHURIASIS HOOKWORM Clinical manifestations Malabsorption and malnutrition Rectal prolapse and anemia Iron deficiency anemia SOIL TRANSMITTED HELMINTHIASIS PREVENT: -Hand washing -Wearing of Slippers -Proper use of toilet facilities Proper food sanitation MEBENDAZOLE: PREGNANCY ALBENDAZOLE: ADULT