Gonorrhoea

I. Definition
Gonorrhoea is a serious infection of the genital tract
in both men and women, caused by a bacterium
Neisseria gonorrhoeae, sometimes called the
gonococcus.
II. Causative effect
(Neisseria gonorrheoae)
III. Signs and Symptoms
An unusual vaginal discharge which may be thin or
watery, yellow or green. Pain when passing urine.
Lower abdominal pain or tenderness.
Rarely, bleeding between periods or heavier
periods (including women who are using hormonal
contraception). Unprotected vaginal, anal or oral
sex. sharing sex toys if you dont wash them or
cover them with a new condom each time theyre
used.
VI. Period of Communicability
After full treatment, subjects should not have
intercourse for seven (7) days.
VII. Treatment
Penicillin, Tetracycline, and Doxycycline should not
be used for treatment.
General drug of choice is Ceftriaxone +
Azithromycin IM / IV.
Ciprofloxacin may be substituted for Ceftriaxone.
Uncomplicated Genital & Anal Infections IM
Ceftriaxone 250mg, Spectinomycin 2g

Oral Ciprofloxacin 500mg, Cefixime 400mg

Ciprofloxacin must not be given to pregnant
patients.
Pharyngeal Infection
IM Ceftriaxone 250mg
Oral Co-Trimoxazole 400mg/80mg
Disseminated Infection
IM / IV Ceftriaxone 1g OD, for 7 days IV
Spectinomycin 2g 2x/day, for 7 days

For meningeal infection extend to 2weeks tx. For

endocardial infection extend to 4 weeks tx.

Gonococcal Conjunctivitis Frequent saline irrigation

Single Dose IM Ceftriaxone 250mg Spectinomycin
2g, Kanamycin 2g Single Dose Oral Ciprofloxacin
500mg

Opthalmia Neonatorum
IM Ceftriaxone 50mg/kg BW (nmt 125mg),
Spectinomycin 25mg/kg BW (nmt 75mg)
Topical Tetracycline ointment 1% hourly

VIII. Prognosis
It is greatly influenced by correct diagnosis and
treatment
Gonorrhoea responds well with appropriate
treatment.
IX. Prevention
Education in avoidance of contact & prevention of
transmission.
Promotion and provision of condoms.

strain of influenza evolved from the combination of

genes from human, pig, and bird flu (antigenic shift)
Haemagglutinin causes red blood cells to clump
together and binds the virus to the infected cell
II. Causation
Neuraminidase is a type of glycoside hydrolase
enzyme which help to move the virus particles
through the infected cell and assist in budding from
the host cells
III. Symptoms fever

Tracing, treating, counseling of sexual partners.

Early treatment.
Appropriate clinical follow-up.
Opthalmia Neonatorum
Tetracycline ointment 1% immediately after birth.
Erythromycin ointment 1% may also be used, but it
is more expensive.
Silver Nitrate ointment 1% may also be used, but it
is more toxic.
Influenza A subtype: AH1N1
I. Definition
Orthomyxoviridae family of viruses

diarrhea sore throat muscle pains vomiting coughing

weakness

IV. Mode of Transmission

COUGHING
SNEEZING DIRECT CONTACT
*A single droplet of 0.5 to 5m in diameter or a
single virus is enough to infect a person.
V. Incubation Period
7 days after illness onset
24 hours after the resolution of fever and
respiratory symptoms
VI. Period of Communicability
7 days, with transmission apparently correlating
with fever
VIII. Treatment Antivirals:

Oseltamivir
Zanamivir

seasonal peak incidence during the rainy months of

July to October
SIGNS AND SYMPTOMS

LAIV (Live Attenuated Influenza Vaccine)

High fever Headache Chills

FluMist
Fluenz
LEPTOSPIROSIS
Leptospirosis is a bacterial disease that affects
humans and animals.
Causative agent: Leptospira
PREVALENCE AND INCIDENCE endemic zoonosis
in the Philippines

an average of 680 leptospirosis cases every year

40 deaths from the disease reported every year
prevalence of 10/100,000

Muscle aches Vomiting

Jaundice (yellow skin and eyes)

Red eyes
Abdominal Pain Diarrhea
Rash
MODE OF TRANSMISSION
ANIMAL-HUMAN TRANSMISSION
-contact with urine (or other body fluids, except
saliva) from infected animals (e.g. cattle, pigs,
horses, dogs, rodents, wild animals)
-contact with water, soil, or food contaminated with

the urine of infected animals (Recreational Risk,

Occupational Risk, Household Exposure)

not treated promptly.

COMPLICATIONS kidney damage meningitis

HUMAN-HUMAN TRANSMISSION -Breastfeeding

-Sexual Transmission
INCUBATION PERIOD
2 days to 26 days Average: 10 days

DIAGNOSIS
Detailed personal history is usually required
Blood test- check for the presence of antibodies to
the bacteria
Other tests that may be done: -Complete blood
count (CBC) -Creatine kinase
-Liver enzymes -Urinalysis -Chest X-ray

PROGNOSIS
The outlook is generally good. However, a
complicated case can be life-threatening if it is

liver failure respiratory distress severe bleeding

Jarisch- Herxheimer reaction when penicillin is

given
TREATMENT/DRUG OF CHOICE
Ampicillin Azithromycin Ceftriaxone Doxycycline
Penicillin
Complicated or serious cases may need supportive
care or treatment in a hospital intensive care unit
(ICU)- ventilator, dialysis, IV fluids
PREVENTION
Protective clothing or footwear should be worn by
those exposed to contaminated water or soil
because of their job or recreational activities.
Avoid areas of stagnant water, especially in tropical
climates.
Eliminating contact with potentially infected animals
Rodent control
Vaccinate cattle, dogs and some other animals.
Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
Origin
The exact origin is still unknown
Zoonotic virus found in bats, but more recent
evidence suggests that the virus may be more
strongly linked to camels
Confirmed in nose swabs from 3 camels by 3
independent RT-PCR and sequencing assays.
Coronaviruses largest of all RNA viruses
4 GENERA:
Alphacoronavirus
Betacoronavirus lineage C
Gammacoronavirus Deltacoronavirus
Respiratory disease

Caused by a newly recognized coronavirus

Middle East Respiratory Syndrome Coronavirus
(MERS-CoV)
2012 Saudi Arabia (first case)
Egypt, Turkey, Netherlands As of May 2014 2 cases
in US
Symptoms
Cough, Fever, SOB
Severe acute respiratory illness
Anorexia, Nausea, Diarrhea, Abdominal pain
Multiorgan dysfunction
Mortality rate
>40% (688 cases reported, with 282 deaths.)
Incubation Period
5.2 days 12 days
Mode of Transmission
Close contact but without sustained community
transmission
Potentially at risk individuals include caregivers and
close contact with infected persons, including from
patients to healthcare personnel
Treatment
No vaccine currently exists
No specific treatment recommended Supportive
management
hydration, antipyretic, analgesics, respiratory
supports, antibiotics for infections However, at least
one group has
recommended consideration of interferon alfa 2b
plus ribavirin
SALMONELLA
What is Salmonella?
Water-borne disease
Salmonella infection, or salmonellosis, is a bacterial
disease of the intestinal tract.

Salmonella is a gram-negative,
rod-shaped bacilli that can cause diarrheal illness in
humans.
What causes Salmonella infections?

UAE, Qatar, Oman, Jordan, Kuwait, Yemen,

Lebanon
UK,

France, Tunisia, Italy, Malaysia, Greece,

Uncooked meat, seafood and poultry Uncooked

egg Fruits and vegetables Lack of
hygiene
Pet reptiles or amphibians
Mode of Transmission
raw and undercooked eggs and egg products raw
milk and raw milk products
poultry and poultry products raw red meats
unwashed salads, fruits and vegetables, grains,
seeds and nuts
some shellfish and filter feeders such as oysters
Incubation period
12-72 hours
Duration of illness
4-7 days
Diagnosis
Many different kinds of illnesses can cause
diarrhea, fever, or abdominal cramps. Determining
that Salmonella is the cause of the illness depends
on laboratory tests that identify Salmonella in the
stool of an infected person. Once Salmonella has
been identified, further testing can determine its
specific type.
Complications
Dehydration
Decreased urine output Dry mouth and tongue
Sunken eyes
Reduced production of tears
Bacteremia
Meningitis Endocarditis Osteomyelitis

Reactive arthritis

water after contact with raw meat or eggs.

Eye irritation Painful urination Painful joints

Do not allow uncooked meats to come in contact

with other foods in the kitchen, including utensils
and work surfaces that will be used to prepare
other foods.

How Can Salmonella Infections Be Treated?

Require rehydration with intravenous fluids
Antibiotic therapy
Choices for antibiotic therapy for severe infections
include fluoroquinolones, third-generation
cephalosporins, and ampicillin (for susceptible
infections).
Prevention
Wash hands thoroughly after using the bathroom.
Cook meats and eggs thoroughly.
Do not consume raw eggs / unpasteurized milk.
Wash hands and kitchen surfaces with soap and
100,000 population, among the major countries in
the WHO Western Pacific Region in 1999.

Wash hands thoroughly after contact with animal

feces and after all contact with reptiles, birds, and
small rodents.

TUBERCULOSIS
-(TB) remains a major public health in the
Philippines.
-In 1998, TB ranked fifth in the 10 leading cause of
death and fifth in the 10 leading causes of illness.
-Our country ranks second to Cambodia in terms of
new smear-positive TB notification rate, 99.7 per
CAUSATIVE AGENT
Mycobacterium tuberculosis Mycobacterium bovis

DESCRIPTION
MODE OF TRANSMISSION
-Tuberculosis is defined as an infectious disease
caused by a bacterium; that most commonly affects
the lungs

-Because the bacteria that cause tuberculosis are

transmitted through the air , the disease can be
contagious .

-Infectious droplets can be produced by coughing,

sneezing, talking and singing.
-Coughing is generally considered as the most
efficient way of producing infectious droplets.

-It can be passed through the air when a person

who is sick with TB disease coughs, sings,
sneezes, or laughs

-It can also be a crippling and deadly disease, and

is on the rise in both developed and developing
worlds.

-The amount of time, the environment, and how

sick the person is all contribute to whether or not
you get infected

INCUBATION PERIOD

Symptoms

From infection to development of a positive TB skin

test reaction (the incubation period) is
approximately 2 to 12 weeks. The risk for
developing active disease is the highest in the first
two years after infection and development of a
positive TB skin test reaction.

-The primary stage of the disease may be

symptom-free, or the individual may experience a
flu-like illness. This is called the inactive stage.
-Within the active stage of the disease, there might
be a slight fever, night sweats, weight loss, fatigue.
-The symptoms may vary depending on what type
of tuberculosis you contract.
TYPES of TB (some)
Pulmonary Tuberculosis Types:

PREVALENCE
The prevalence of TB in 2007 was 2.0 per 1000 for
smear- positive TB and 4.7 per 1000 for culturepositive TB. Compared with 1997 , there was a
28% and 38% decline in prevalence for smearpositive and culture-positive TB, respectively.

Primary Tuberculosis Pneumonia

Tuberculosis Pleurisy

Cavitary Tuberculosis

Miliary Tuberculosis
Laryngeal Tuberculosis
DIAGNOSIS
Chest X-ray : The most common diagnostic test
that leads to the suspicion of infection is a chest Xray.
The Mantoux skin test also known as a tuberculin
skin test (TST or PPD test): This test helps identify
people infected with M. tuberculosis but who have
no symptoms .
QuantiFERON-TB Gold test : This is a blood test
that is an aid in the diagnosis of TB. This test can
help detect active and latent tuberculosis .
Sputum testing: Sputum testing for acid-fast bacilli
is the only test that confirms a TB diagnosis .
PROGNOSIS
Tuberculosis is a curable disease.
Progress of tuberculosis from infection to frank
illness involves overcoming of the immune system
defenses by the bacteria. Once diagnosed, with
effective, adequate and appropriate therapy with
anti tubercular drugs, treatment is possible and so
is cure.
TREATMENT
The most common medications used to treat
tuberculosis include:
Isoniazid
Rifampin (Rifadin, Rimactane) Ethambutol
(Myambutol) Pyrazinamide
-If you have drug-resistant TB, a combination of
antibiotics called fluoroquinolones and injectable
medications, such as amikacin , kanamycin or
capreomycin
PREVENTION
If you have active TB, keep your germs to yourself.
It generally takes a few weeks of treatment with TB
medications before you're not contagious anymore.
Follow these tips to help keep your friends and
family from getting sick:
-Stay home. Don't go to work or school or sleep in
a room with other people during the first few weeks
of treatment for active tuberculosis.
-Ventilate the room. Tuberculosis germs spread
more easily in small closed spaces where air

doesn't move. If it's not too cold outdoors, open the

windows and use a fan to blow indoor air outside.
-Cover your mouth. Use a tissue to cover your
mouth anytime you laugh, sneeze or cough. Put the
dirty tissue in a bag, seal it and throw it away.

-Wear a mask. Wearing a surgical mask when

you're around other people during the first three
weeks of treatment may help lessen the risk of
transmission.
-Finish your medications.

-When you stop treatment early or skip doses, TB

bacteria have a chance to develop mutations that
allow them to survive the most potent TB drugs.

driving etc.)

-In countries where tuberculosis is more common,

infants often are vaccinated with bacille CalmetteGuerin (BCG) vaccine because it can prevent
severe tuberculosis in children.

The Road and Traffic Authority (RTA) of the

Australian
state
of New
South
Wales (NSW)
asserts

VEHICULAR ACCIDENTS
Motor vehicle accidents (MVAs) are a major cause
of both internal and external wounds, many of
which cannot be treated with simple dressings - if at
all.
In 2004, it is estimated that 1.2 million people were
killed (2.2% of all deaths) and 50 million more were
injured in motor vehicle collisions. It is also
estimated that by the year 2020, 8.4 million people
will die every year from injury, and injuries from
road traffic accidents will be the third most common
cause of disability worldwide and the second most
common cause in the developing world.
CAUSES OF VEHICULAR ACCIDENTS Human
Factors
Human factors in vehicle collisions include all
factors related to drivers and other road users that
may contribute to a collision. Examples include
driver behavior, visual and auditory acuity, decisionmaking ability, and reaction speed.

CAUSES OF VEHICULAR ACCIDENTS

Driver impairment
Driver impairment describes factors that prevent
the driver from driving at their normal level of skill.
Common impairments include:
Alcohol
Physical Impaiment ( poor eyesight etc.)
Youth Old Age

Sleep Deprivation Drug use

Distraction ( using of mobile phone while

Motor vehicle speed

speeding

(traveling too fast for the prevailing conditions or

above the posted speed limit) is a factor in about 40
percent of road deaths. The RTA also say speeding
increases the risk of a crash and its severity.

As they say speed thrills and also kills. Keep a rein

on your speed.
Obey traffic rules.
Wear seat belts.

Road Design

Pedestrians and children come first

Research has shown that careful design and

maintenance, with well-designed intersections, road
surfaces, visibility and traffic control devices, can
result in significant improvements in accident rates.

Read caution signs

Adopt antiskid break systems in the cars

Vehicle design and maintenance

Reflectors to be used on the rear of the vehicle.

Vehicle must be in good working condition.

Air bags in vehicles

Seatbelts
Research has shown that, across all collision types,
it is less likely that seat belts were worn in collisions
involving death or serious injury, rather than light
injury; wearing a seat belt reduces the risk of death
by about two thirds.
Maintenance
well-designed and well-maintained vehicle, with
good brakes, tires and well-adjusted suspension
will be more controllable in an emergency and thus
be better equipped to avoid
collisions.
PREVENTION
of diarrhoeal disease.
Indoor smoke from solid fuels kills an estimated
1.6 million people annually due to respiratory
diseases.
Malaria kills over 1.2 million people annually, mostly
African children under the age of five. Poorly
designed irrigation and water systems, inadequate
housing, poor waste disposal and water storage,
deforestation and loss of biodiversity, all may be
contributing factors to the most common vector- borne
diseases including malaria, dengue and
leishmaniasis.

Urban air pollution generated by vehicles,

industries and energy production kills
approximately 800 000 people annually.
Unintentional acute poisonings kill 355 000
people globally each year. In developing countries,
where two-thirds of these deaths occur, such
poisonings are associated strongly with excessive
exposure to, and inappropriate use of, toxic

Roads should be in good condition with proper sign

boards.
Avoid drugs and alcohol while driving.
Avoid falling asleep behind the wheel.
ENVIRONMENTAL ISSUES
Environmental factors are a root cause of a
significant disease burden, particularly in
developing countries. An estimated 25% of death
and disease globally, and nearly 35% in regions
such as sub-Saharan Africa, is linked to
environmental hazards. Some key areas of risk
include the following:
Unsafe water, poor sanitation and hygiene kill an
estimated 1.7 million people annually, particularly
as a result
chemicals and pesticides present in occupational
and/or domestic environments.
Climate change impacts including more extreme
weather events, changed patterns of disease and
effects on agricultural production, are estimated to
cause over 150 000 deaths annually.
Pneumonia
Description
Pneumonia is a general term that refers to an
infection of the lungs, which can be caused by a
variety of microorganisms, including viruses,
bacteria, fungi, and parasites.
An inflammatory condition of the lung affecting
primarily the microscopic air sacs known as alveoli.
Causative Agent
Infectious
Bacteria (streptococcus pneumoniae) Virus

Fungi Non-infectious
Inhalation of toxic gases and chemicals Aspiration of
foreign substances Secondary to other existing
diseases
Virulence factors, strains
Certain proteins or enzymes displayed on the
surface of gram-positive organisms significantly
contribute to pathogenesis and might be involved in
the disease process caused by these pathogens.
Often, these proteins are involved in

direct interactions with host tissues or in concealing

the bacterial surface from the host defense
mechanisms. S. pneumoniae is not an exception in
this regard. In the past, the polysaccharide capsule
was considered the primary virulence factor of S.
pneumoniae because nonencapsulated bacteria
are almost completely harmless compared with the
same encapsulated strain.
Epidemiology
Affects approximately 450 million people a year
Major cause of death among all age groups
resulting in 4 million deaths (7% of the worlds
yearly total)
Rates are greatest in children less than five and
adults older than 75 years of age.
Occurs about five times more frequently in the
developing world versus the developed world.
Viral pneumonia accounts for about 200 million
cases.
Prevalence and Incidence
The Philippines is one of the 15 countries that
together account for 75% of childhood pneumonia
cases worldwide. In children aged under 5 years,
pneumonia is the leading cause of mortality with a
mortality rate of 23.4 x 100,000 population recorded
in 2009
In Regions VI, VII and VIII of the Philippines, the
total number of children under five years of age
with pneumonia that have been seen and given
treatment from January to December 2012 were
89,221 and 85,923, respectively
Signs and symptoms
Fever chills cough
nasal congestion
unusually rapid breathing (in some cases, this is
the only symptom)
breathing with grunting or wheezing sounds labored
breathing that makes the rib muscles
retract (when muscles under the ribcage or
between ribs draw inward with each breath) and
causes nasal flaring
vomiting chest pain
abdominal pain decreased activity

loss of appetite (in older kids) or poor feeding (in

infants), which may lead to dehydration

in extreme cases, bluish or gray color of the lips
and fingernails
How do you get pneumonia?
person, either through the air or by touching a
contaminated surface. Typically, they enter the
person's body through their mouth, nose, or
eyes. When this happens, a battle begins -- the
person's immune system tries to kill the germs,
while the germs try to multiply.
Although a person with either viral or bacterial
pneumonia is contagious, that person's germs are
more likely to cause an upper respiratory
infection in another person (such as the common
cold) than pneumonia. This is because many of the
viruses and bacteria that cause people to get
pneumonia are the same ones that cause upper
respiratory infections.

The germs that cause pneumonia are usually

found in the mouth and nose of the infected
person. They can be spread easily to another
with a stethoscope. If you have pneumonia, your
lungs may make crackling, bubbling, and rumbling
sounds when you inhale. You also may be
wheezing, and it may be hard to hear sounds of
breathing in some areas of your chest.
Chest x-ray (if your doctor suspects pneumonia)
Some patients may need other tests, including:
CBC blood test to check white blood cell
count
Arterial blood gases to see if enough oxygen is
getting into your blood from the lungs
CT (or CAT) scan of the chest to see how the lungs
are functioning

You may get pneumonia:

After you breathe infected air particles into your
lungs.
After you breathe certain bacteria from your nose
and throat into your lungs. (This generally occurs
during sleep)
During or after a viral upper respiratory infection,
such as a cold or influenza (flu).
As a complication of a viral illness, such as
measles or chickenpox.
If you breathe large amounts of food, gastric juices
from the stomach, or vomit into the lungs
(aspiration pneumonia). This can happen when you
have had a medical condition that affects your
ability to swallow, such as a seizure or a stroke.
You can get pneumonia in your daily life, such as at
school or work (community -associated pneumonia)
or when you are in a hospital or nursing home
(healthcare-associated pneumonia).
INCUBATION PERIOD
The incubation period (the length of time between
exposure and feeling sick) for pneumonia varies,
depending on the type of virus or bacteria causing
the infection. For instance, for RSV, this is 4 to 6
days; for influenza, 18 to 72 hours and for
pneumococcal pneumonia, about 1 to 3 days
How Is Pneumonia Diagnosed?
Physical exam: Your doctor will listen to your lungs

Sputum tests to look for the organism (that can

detected by studying your spit) causing your
symptoms
Pleural fluid culture if there is fluid in the space
surrounding the lungs
Pulse oximetry to measure how much oxygen is
moving through your bloodstream, done by simply
attaching a small clip to your finger for a brief time
Bronchoscopy, a procedure used to look into the
lungs' airways, which would be performed if you are
hospitalized and antibiotics are not working well
Prognosis
Pneumonia can be fatal. The mortality (death) rate
is up to 30% for patients with severe pneumonia
who require treatment in an intensive-care unit.
Overall, around 5%-10% of patients who are
treated in a hospital setting die from the disease.
Pneumonia is more likely to be fatal in the elderly or
those with chronic medical conditions or a
weakened immune system.
COMPLICATIONS
Bacteria in the bloodstream (bacteremia). Lung
abscess. (Coughing up unpleasant-smelling
phlegm and swelling in your fingers and toes are
signs of a lung abscess)
Fluid accumulation around your lungs (pleural
effusion).
Difficulty breathing.

Blood poisoning also known as septicaemia.

How Is Pneumonia Treated?
**Treatment for pneumonia depends on the type of
pneumonia you have and how severe it is, and if
you have other chronic diseases. The goals of
treatment are to cure the infection and prevent
complications.
Most people can be treated at home by following
these steps:
or naproxen), or acetaminophen. DO NOT give
aspirin to children.
If your pneumonia becomes so severe that you are
treated in the hospital, you may receive fluids and
antibiotics in your veins, oxygen therapy, and
possibly breathing treatments.
Most people with pneumonia improve after three to
five days of antibiotic treatment, but a mild cough
and fatigue can last longer, up to a month. Patients
who required treatment in a hospital may take
longer to see improvement.
Viral Pneumonia
Typical antibiotics will not work for viral pneumonia;
sometimes, however, your doctor may use antiviral
medication. Viral pneumonia usually improves in 1
to 3 weeks.
Bacterial Pneumonia
Patients with mild pneumonia who are otherwise
healthy are sometimes treated with oral macrolide
antibiotics (azithromycin, clarithromycin, or
erythromycin). Patients with other serious illnesses,
such as heart disease, chronic obstructive
pulmonary disease, or emphysema, kidney
disease, or diabetes are often given more powerful
or higher dose antibiotics.
In addition to antibiotics, treatment includes: proper
diet and oxygen to increase oxygen in the blood
when needed. In some patients, medication to ease
chest pain and to provide relief from violent cough
may be necessary.
PREVENTION
Is it possible to prevent pneumonia? Is there a
pneumonia vaccine?
It is not possible to prevent all types of pneumonia,
but you can take steps to reduce your chances of
contracting the condition by quitting smoking,
practicing good hand-washing, and avoiding

Drink plenty of fluids to help loosen secretions and

bring up phlegm.
Get lots of rest. Have someone else do household
chores.
Do not take cough medicines without first talking to
your doctor. Cough medicines may make it harder
for your body to cough up the extra sputum.
Control your fever with aspirin, nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen
contact with people who have colds, the flu, or
other infections.
A vaccine is available against the most common
bacterial cause of pneumonia, Streptococcus
pneumoniae (also known as Pneumococcus).
There are two types of vaccine: PPSV23, a
pneumococcal polysaccharide vaccine against 23
types of the bacteria, and PCV13, a pneumococcal
conjugate vaccine that protects against 13 types of
the bacteria. These vaccines may not always
prevent pneumococcal pneumonia, but they may
prevent serious complications of pneumonia if it
does occur.
PPSV23 is recommended for all people over age
65 and all people over age 2 who are at risk for
pneumonia. Adults aged 19-65 with

certain conditions (diabetes, heart or liver

disease, alcoholism, cirrhosis, lung disease)
should also receive the PPSV23. The PCV13
vaccine is recommended for all infants and for
young children who did not receive it earlier in life
and for adults with a weakened immune system or
certain other risk factors.
-Seasonal influenza vaccines are available yearly
and are recommended to decrease the chance of
contracting influenza.
-Avoidance of areas where fungal pathogens are
endemic is recommended to prevent fungal
pneumonias. There is no antifungal vaccine
available; however, for some high-risk patients,
some clinicians have recommended prophylactic
antifungal drugs.
Syphilis
What is Syphilis?
Syphilis is a sexually transmitted infection caused
by the spirochete bacterium Treponema pallidum
subspecies pallidum.
It is a bacterial infection usually spread by sexual
contact.
Incubation Period
After the initial infection, usually by sexual contact
with a syphilitic lesion, there is an incubation period
of about 3 weeks before the symptoms of primary
Confirmation is either via blood test
(Nontreponemal test and Treponemal test)
Direct visual inspection using microscopy. (Dark
ground microscopy of serous fluid)
Prognosis
The morbidity of syphilis ranges from the relatively
minor symptoms of the primary stages of infection
to the more significant constitutional systemic
symptoms of secondary syphilis and the significant
neurological and cardiovascular consequences of
tertiary disease.

syphilis develop.
Untreated it has a mortality of 8% to 58% with a
greater death rate in males
Signs and Symptoms
vary depending in which of the four stages it
presents (primary, secondary, latent, and
tertiary)primary stage
presents with a single chancre
Chancre is a firm, painless, non-itchy skin
ulceration
secondary syphilis
ash (palms of the hands and soles of the feet)
latent syphilis with little to no symptoms
tertiary syphilis with gummas, neurological, or
cardiac symptoms
Mode of Transmission
sexual contact (primary route of transmission)
transmitted from mother to fetus during pregnancy
or at birth (congenital syphilis)
The bacteria die very quickly outside of the body,
making transmission via objects extremely difficult.
Diagnosis
Syphilis is easy to diagnose in the primary or
secondary stage if there's a visible sore or ulcer.
Depends on the duration and extent of disease
activity, along with prior attempts to treat the
disease.
Complications
Include bulging (aneurysm) and inflammation of the
aorta your body's major artery and of other
blood vessels
Congenital syphilis greatly increases the risk of
miscarriage, stillbirth or your newborn's death
within a few days after birth.
Increases the risk of HIV infection

Patients diagnosed with tertiary syphilis: the

prognosis is less sanguine. Twenty percent of
untreated patients with tertiary syphilis die of the
disease, although a significant number of patients
demonstrate cure with antibiotic therapy.

Damage to the retina and the vital nerves and

blood vessels at the back of the eye
Treatment
Preferred treatment at all stages is penicillin, an

antibiotic medication that can kill the organism that

causes syphilis
Penicillin is the only recommended treatment for
pregnant women with syphilis. Women who are
allergic to penicillin can undergo a desensitization
process that may allow them to take penicillin.
Penicillin stops the infectivity within a day or two,
and cures the disease in a week or two
It is important to keep your follow-up appointments
with your doctor.
The best way to avoid these complications is to
avoid syphilis by practicing safe sex.
Prevention
avoid having sex with multiple partners
use a dental dam (square piece of latex) or
condoms during oral sex
avoid sharing sex toys
get screened for sexually transmitted infections and
talk to your partners about their results
avoid contact with infected tissue and body fluids of
an infected person
to prevent passing congenital syphilis to their
unborn babies, all pregnant women should be

tested for syphilis. Most cases of congenital syphilis

can be avoided with appropriate screening and
treatment of pregnant women.
Cholera
Cholera is an acute diarrhoeal disease that can kill
within hours if left untreated
There are an estimated 35 million cholera cases
and 100 000120 000 deaths due to cholera every
year.
Up to 80% of cases can be successfully treated
with oral rehydration salts.
Key Facts
Provision of safe water and sanitation is critical in
reducing the impact of cholera
Oral cholera vaccines are considered an additional
means to control cholera, but should not replace
conventional control measures.
Definition (WHO)
intestinal infection caused by ingestion of food or
water contaminated with Vibrio cholerae
produces an enterotoxin that causes a copious,
painless, watery diarrhoea
short incubation period of 2 hours to 5 days,
enhances the potentially explosive pattern of
outbreaks.
Causative Agent : Vibrio Cholerae
one of the most common organisms in surface
waters of the world
main reservoirs : people and aquatic sources such
as brackish water and estuaries, often associated
with algal bloom
Causative Agent : Vibrio Cholerae
Two serogroups O1 O139
Description
Over 100 serotypes of V. cholerae exist but only
two cause disease. V. cholerae O1 has two
variants called classical and El Tor. The other
pathogen is O139.
About 75 %, do not develop any symptoms.
Although the bacteria are present in their feces. (714 days)
Risk Factors & Disease Burdens transmission is
closely linked to:

inadequate environmental management

consequences of a disaster
Risk Factors & Disease Burdens
Signs and Symptoms

The number of cholera cases reported to WHO

continues to rise.
2011 : a total of 589 854 cases (85 countries) with
7816 deaths
Washing dishes and utensils that you use to eat or
prepare food
Washing fruits and vegetables

severe watery diarrhea accompanied by vomiting,

which can quickly lead to dehydration.

WHO Response

Signs & Symptoms of dehydration

Rapid heart rate
Loss of skin elasticity (the ability to return to original
position quickly if pinched)

Through the WHO Global Task Force on Cholera

Control, WHO works to:
provide technical advice and support for cholera
control and prevention at country level

Dry mucous membranes, including the inside of the

mouth, throat, nose, and eyelids
Low blood pressure Thirst
Muscle cramps

train health professionals at national, regional and

international levels in prevention, preparedness and
response of diarrhoeal disease outbreaks
disseminate information and guidelines on cholera

Treatment
Oral rehydration salts (WHO/UNICEF ORS
standard sachet)
IV Fluids (severely dehydrated patients require
administration )
Antibiotics (to diminish the duration of diarrhoea,
reduce the volume of rehydration fluids needed,
and shorten the duration of V. cholerae excretion)
Outbreak response
reduce deaths by ensuring prompt access to
treatment
control the spread of the disease (by providing safe
water, proper sanitation and health education for
improved hygiene and safe food handling practices
by the community.)
provision of safe water and sanitation Prevention
and Control
use only water that has been boiled, water that has
been chemically disinfected, or bottled water. Be
sure to use the bottled, boiled, or chemically
disinfected water for the following purposes:
Drinking
Preparing food or drinks Making ice
Brushing your teeth
Washing your face and hands

and other epidemic- prone enteric diseases to

health professionals and the general public.

system is unable to create effective long term

immunity since due to the various strains.

Cholera in the Philippines

b.) Antigenic variation - an individual pathogen

renders the immune system less effective as the
pathogens surface antigens change during
infection.
Signs and Symptoms fever

The Department of Health is also encouraging

communities to chlorinate water or boil water for
over three minutes when they are unsure of the
water quality. A common cause of cholera
outbreaks in the Philippines are contaminated
water sources.
The WHO is currently supporting the training of
health professionals at the sub-national level to
enhance the Philippine Integrated Disease and
Surveillance System Response in order to rapidly
detect and respond to these kinds of outbreaks.
MALARIA
mosquito-borne infectious disease of humans and
other animals caused by parasitic protozoans of the
Plasmodium type. In the human body, the parasites
multiply in the liver, and then infect red blood cells

flu-like symptoms (chills, headache, muscle aches,

tiredness, nausea, vomiting and diarrhea)
Mode of Transmission
All species are transmitted by the bite of an
infective female Anopheles mosquito. In some
cases, malaria can be transferred via organ
transplant or blood transfusion. In addition, malaria
parasites can cross the placenta, and so can be
transmitted from a mother to her unborn child,
either in the womb or during childbirth. This is
known as congenital malaria.
Incubation Period
7 to 30 days

Causative Agents
Plasmodium falciparum Plasmodium vivax
Plasmodium ovale Plasmodium malariae
Main virulence mechanism
a.) Genetic variation in the species, the immune
health -care providers of any travel in areas where
malaria occurs during the past 12 months.

Diagnosis
Health care providers should suspect malaria in
anyone who has been:
In tropics
an organ transplant a transfusion
shared use of needles or syringes

Antimalarial drugs taken for prophylaxis by

travelers can delay the appearance of malaria
symptoms by weeks or months, long after the
traveler has left the malaria-endemic area.
Returned travelers should always remind their
severe malaria have the greatest danger of death.
From 10% to 40% of patients with severe malaria
die even with advanced medical treatment. P.
falciparum is more likely to cause severe disease
among young children, pregnant women and
travelers who are exposed to malaria for the first
time.
COMPLICATIONS
The Plasmodium falciparum parasite causes the
most severe malaria symptoms and most deaths.

*If possible, clinical findings should always be

confirmed by a laboratory test for malaria

Cerebral malaria. Breathing problems

The health- care provider should conduct an initial

workup and request a complete blood count and a
routine chemistry panel.

Organ failure - kidneys or liver to fail, or your spleen

to rupture
Severe anemia Low blood sugar

Prognosis

Treatment/ Drug of Choice

most people with malaria have an excellent

prognosis if they are treated properly with
antimalarial drugs. Without treatment, malaria can
be fatal, particularly P. falciparum. People with

The most common antimalarial drugs include:

Chloroquine (Aralen)
Quinine sulfate (Qualaquin) Hydroxychloroquine
(Plaquenil) Mefloquine

Combination of atovaquone and proguanil

(Malarone)

ABCD for prevention of malaria. This is: Awareness

of risk of malaria.
Bite prevention.

Prevention
No vaccine yet
Scientists around the world are trying to develop a
safe and effective vaccine for malaria. As of yet,
however, there is still no malaria vaccine approved
for human use
Prevention

Antimalarial medication - Chemoprophylaxis (taking

antimalarial medication exactly as prescribed).
Prompt Diagnosis and treatment.