INFECTIOUS DISEASES IN THE

PHILIPPINES

Modes of transmission of
infectious diseases
A. Foodborne and waterborne diseases
B. Sexually transmitted diseases (STDs)
C. Airborne diseases
D. Vector-borne diseases
E. Zoonoses (diseases transmitted from animals)
F. Others:
- Bloodborne diseases
- Diseases transmitted from soil

A. Water / Food borne Diseases

Food- & water- borne diseases are

transmitted by consumption of contaminated
food & drink.
How do we reduce risk of infection?
E.g., typhoid fever, hepatitis A, cholera,
amebic dysentery, bacillary dysentery, & E.
coli diarrheal illness

Examples
1.
2.
3.
4.
5.
6.

Typhoid fever
Hepatitis A
Cholera
Amebic dysentery
Bacillary dysentery
E. coli diarrheal illness

1. Typhoid fever

CA: Salmonella enterica serovar

typhi, a Gram-negative short
bacillus that is motile (flagella).
Brief description: A.k.a. enteric

fever, an illness caused by the

bacterium.

MOT: by fecal-oral route the

ingestion of food or water
contaminated with feces from an
infected person.
Treatment:Antibiotics, such as
ampicillin, chloramphenicol,
trimethoprim-sulfamethoxazole,
and ciprofloxacin (old school)

2. Viral hepatitis

CA: viruses
Brief description: A disease which causes extensive
destruction of liver cells; the cause of most cases of
acute hepatitis
Incubation period: 2- 7 weeks
MOT: Man- to- man by the anal- oral route; blood;
respiratory spread and sometimes by sexual
transmission or through contaminated food and
water.
Treatment: Symptomatic

Viral hepatitis

Types include Hepatitis A, Hepatitis B, Hepatitis C,

Hepatitis B with D, Hepatitis E, Hepatitis F virus
(existence unknown), and Hepatitis G or GBV-C.
Hepatitis A or infectious jaundice is caused by a
picornavirus transmitted by the fecal-oral route, often
associated with ingestion of contaminated food or
with anal/oral sex.
Hepatitis B is caused by a hepadnavirus, which can
cause both acute and chronic hepatitis. Chronic
hepatitis develops in the 15% of patients who are
unable to eliminate the virus after an initial infection.

Viral hepatitis

Hepatitis C (originally "non-A non-B hepatitis") is caused by

a virus with an RNA genome that is a member of the
Flaviviridae family.
It can be transmitted through contact with blood (including
through sexual contact if the two parties' blood is mixed)
and can also cross the placenta.
Hepatitis C may lead to a chronic form of hepatitis,
culminating in cirrhosis. It can remain asymptomatic for
10-20 years.
Hepatitis D is caused by hepatitis delta agent, which is
similar to a viroid as it can only propagate in the presence
of the Hepatitis B virus.

Viral hepatitis

Hepatitis E produces symptoms similar to hepatitis

A and same MOT; it is more prevalent in the Indian
subcontinent.
Hepatitis F virus is a hypothetical virus linked to
hepatitis.
Another potential viral cause of hepatitis, initially
identified as hepatitis G virus, is probably spread
by blood & sexual contact. There is very little
evidence that this virus causes hepatitis, as it does
not appear to replicate primarily in the liver. It is
now classified as GB virus C.

3. Cholera

CA: Vibrio cholerae, a Gram-negative bacterium

that produces cholera toxin, an enterotoxin,
responsible for the characteristic massive
diarrhea of the disease
Brief description: A.ka. Asiatic cholera or
epidemic cholera, an infectious gastroenteritis;
One of the most rapidly fatal illness known
MOT: ingestion of contaminated water or food.
Treatment:
Water & electrolyte replacement for
dehydration & electrolyte depletion
Prompt use of oral rehydration therapy
IV rehydration in severe cases
Tetracycline, doxycycline, TMP/SMX,
ciprofloxacin, and furazolidone.

Cholera

A healthy person may become hypotensive

within an hour of the onset of symptoms;
infected patients may die within 3 hours if
treatment is not provided.
In a common scenario, the disease progresses
from the first liquid stool to shock in 4 to 12
hours, with death following in 18 hours to
several days without rehydration treatment.

4. Amebic dysentery

CA: Entamoeba histolytica

Brief description: An acute
disease caused by ingesting
substances contaminated
with the amoeba,
characterized by severe
diarrhea, nausea, and
inflammation of the
intestines.
Incubation period: 1- 6 days
MOT: transmitted through
contaminated food & water
Treatment: ORS,
metronidazole

5. Bacillary Dysentery

CA: Shigella sp.,

Campylobacter, and Salmonella
Brief description: A food- borne
illness caused by infection by
bacteria of the genus Shigella
which affects the intestinal tract
MOT: fecal-oral route; directly
person-to-person hand-tomouth, in the setting of poor
hygiene among children
Treatment: replace fluids and
salts lost because of diarrhea

Ulceration (rectum) of the intestinal lining

results in increased production of mucus,
& the loss of blood & serum proteins into
the intestinal cavity. This causes the
symptoms of dysentery, which include
blood & mucus in the stool (bloody
diarrhea); fever is also common.

6. E. coli diarrheal illness

E. coli a common bacterium that normally inhabits the IT of
humans & animals; the most common member of the genus
Escherichia; named for Theodor Escherich, a German physician;
a Gram-negative, rod-shaped bacterium propelled by long,
rapidly rotating flagella.

Escherichia coli 0157:H7 - an emerging cause of

food- borne illness; this strain produces a powerful
toxin & can cause severe illness. This was first

recognized as a cause of illness in 1982 during an

outbreak of severe bloody diarrhea & abdominal
cramps.

How is E.coli O157:H7 spread?

Meat can become contaminated during slaughter, & organisms can
be thoroughly mixed into beef when it is ground.
Eating meat, especially ground beef, that has not been cooked
sufficiently to kill E. coli can cause infection

Other known sources of infection: consumption of lettuce,

unpasteurized milk & juice, & swimming in or drinking sewagecontaminated water.
Bacteria in diarrheal stools of infected
persons can be passed from one person to
another if hygiene or handwashing habits
are inadequate.

How is the illness treated?

Most persons recover without antibiotics or
other specific treatment in 5-10 days. There is
no evidence that antibiotics improve the
course of disease, & it is thought that
treatment with some antibiotics may
precipitate kidney complications.

What can you do to prevent E.

coli O157:H7 infection?
Cook all ground beef & hamburger thoroughly.
Avoid spreading harmful bacteria in your kitchen.
Keep raw meat separate from ready-to-eat foods.
Wash hands, counters, & utensils with hot soapy
water after they touch raw meat.
Drink municipal water that has been treated with
chlorine or other effective disinfectants
Wash fruits and vegetables thoroughly, especially
those that will not be cooked.
Avoid swallowing lake or pool water while swimming.

B. Sexually transmitted
diseases (STDs)

These diseases are passed

from person to person
through unsafe sexual
practices.
How do we reduce risk of
infection?
Examples?
Bacterial STDs include
gonorrhea,
nongonococcal urethritis
& chlamydial cervicitis,
Arthropod STDs include
pubic lice, a.k.a. "crabs" &
scabies.

Examples
1.
2.
3.
4.
5.
6.

Syphilis
AIDS
Non-gonococcal urethritis
Herpes simplex genitalia
Gonorrhea
Hepatitis C

SYPHILIS

1. Syphilis

a curable STD
The disease was dubbed the "Great Imitator"
because it was often confused with other diseases,
particularly in its tertiary stage.
If not treated, syphilis can cause serious effects such
as damage to the heart, aorta, brain, eyes, & bones.
In some cases these effects can be fatal.

Can infect a fetus during pregnancy, causing birth

defects & other problems.

Syphilis

Treponema pallidum
spirochete
MOT: by sexual contact, an
example of congenital
syphilis via transmission from
mother to child in utero.
Treatment: antibiotics
including penicillin. The
oldest and still most effective
method is an intramuscular
injection of benzathine
penicillin.

STAGES
Primary
Secondary
Latent
Tertiary

PRIMARY STAGE

A painless sore or ulcer (chancre)

appears at the infection site
typically the penis, vulva, or vagina.
Begins as a small red raised
area, which soon turns into a
painless open sore.
About half of infected
women and one third of
infected men are unaware
of it

SECONDARY STAGE

in
k
s
a
ith
w
s
n
i
beg
y
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lly
a
a
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c
i
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Us
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ter
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h
a
c
i
s
h
k
e
rash, w 6 to 12 we
rs
appea
on
i
t
c
e
f
in
Rashes commonly appear
on the palms or soles

The skin rash

may be shortlived or may last
for months

Mouth sores develop

in more than 80% of
people

LATENT STAGE

Infection persists but no

symptoms occur
May last for years to
decadesor for the
rest of the person's
life

Not contagious in
this stage!

TERTIARY STAGE

Not contagious but

produces symptoms
that range from mild to
devastating

Face with tertiary syphilis

Three main types of tertiary syphilis

may occur: benign tertiary syphilis,
cardiovascular syphilis, and
neurosyphilis.

Benign tertiary syphilis

- Lumps called gummas appear on the skin or in various
organs.
- These lumps grow slowly, heal gradually, & leave scars.
-The bones may be affected, resulting in a deep,
penetrating pain that is usually worse at night.

Cardiovascular syphilis
- A person may develop an aneurysm (weakening and
dilation) of the aorta (the main artery leaving the heart) or
leakage of the aortic valve. These changes may lead to
chest pain, heart failure, or death

Neurosyphilis
- affects about 5% of all people with untreated syphilis
- can cause many serious problems in the brain &
spinal cord

2. Acquired Immune Deficiency

Syndrome (AIDS)

A disease that recognizes not territorial,

social, political and economic boundaries for
which a cure has yet to be discovered.

Acquired means you can get infected with it;

Immune Deficiency means a weakness in the
body's system that fights diseases.
Syndrome means a group of health problems that
make up a disease.

Acquired Immune Deficiency

Syndrome (AIDS)

AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus.

If you get infected with HIV, your body will try to fight the infection. It will
make "antibodies," special molecules to fight HIV.
A blood test for HIV looks for these antibodies. If you have them in your
blood, it means that you have HIV infection. People who have the HIV
antibodies are called "HIV-Positive."
Being HIV-positive, or having HIV disease, is not the same as having
AIDS. Many people are HIV-positive but don't get sick for many years. As
HIV disease continues, it slowly wears down the immune system. Viruses,
parasites, fungi and bacteria that usually don't cause any problems can
make you very sick if your immune system is damaged. These are called
"opportunistic infections."

Acquired Immune Deficiency

Syndrome (AIDS)

HOW DO YOU GET AIDS?

You can get infected with HIV from anyone who's infected,
even if they don't look sick and even if they haven't tested
HIV-positive yet. The blood, vaginal fluid, semen, and
breast milk of people infected with HIV has enough of the
virus in it to infect other people. Most people get the HIV
virus by:
having sex with an infected person
sharing a needle (shooting drugs) with someone who's
infected
being born when their mother is infected, or drinking the
breast milk of an infected woman

Acquired Immune Deficiency

Syndrome (AIDS)

HOW DO YOU GET AIDS?

Getting a transfusion of infected blood used to be a way people got AIDS,
but now the blood supply is screened very carefully and the risk is
extremely low.
There are no documented cases of HIV being transmitted by tears or
saliva, but it is possible to be infected with HIV through oral sex or in rare
cases through deep kissing, especially if you have open sores in your
mouth or bleeding gums.
The Centers for Disease Control and Prevention (CDC) estimates that 1 to
1.2 million U.S. residents are living with HIV infection or AIDS; about a
quarter of them do not know they have it. About 75% of the 40,000 new
infections each year are in men, and about 25% in women. About half of
the new infections are in Blacks, even though they make up only 12
percent of the US population.
In the mid-1990s, AIDS was a leading cause of death. However, newer
treatments have cut the AIDS death rate significantly.

Acquired Immune Deficiency

Syndrome (AIDS)

WHAT HAPPENS IF I'M HIV POSITIVE?

You might not know if you get infected by HIV.
Within a few weeks after being infected, some
people get fever, headache, sore muscles and
joints, stomach ache, swollen lymph glands, or
a skin rash for one or two weeks. Most people
think it's the flu. Some people have no symptoms.
The virus will multiply in your body for a few weeks
or even months before your immune system
responds. During this time, you won't test positive
for HIV, but you can infect other people.

Acquired Immune Deficiency

Syndrome (AIDS)

WHAT HAPPENS IF I'M HIV POSITIVE?

When your immune system responds, it starts to make antibodies. When
this happens, you will test positive for HIV.
After the first flu-like symptoms, some people with HIV stay healthy for ten
years or longer. But during this time, HIV is damaging your immune
system.
One way to measure the damage to your immune system is to count your
CD4 cells you have. These cells, also called "T-helper" cells, are an
important part of the immune system. Healthy people have between 500
and 1,500 CD4 cells in a milliliter of blood.
Without treatment, your CD4 cell count will most likely go down. You might
start having signs of HIV disease like fevers, night sweats, diarrhea, or
swollen lymph nodes. If you have HIV disease, these problems will last
more than a few days, and probably continue for several weeks.

Acquired Immune Deficiency

Syndrome (AIDS)

HOW DO I KNOW IF I HAVE AIDS?

HIV disease becomes AIDS when your immune system is
seriously damaged. If you have less than 200 CD4 cells or
if your CD4 percentage is less than 14%, you have AIDS.
If you get an opportunistic infection, you have AIDS. There
is an "official" list of these opportunistic infections put out by
the Centers for Disease Control (CDC). The most common
ones are:
PCP (Pneumocystis pneumonia), a lung infection;
KS (Kaposi's sarcoma), a skin cancer;
CMV (Cytomegalovirus), an infection that usually affects
the eyes

Acquired Immune Deficiency

Syndrome (AIDS)

HOW DO I KNOW IF I HAVE AIDS?

Candida, a fungal infection that can cause thrush (a white
film in your mouth) or infections in your throat or vagina
AIDS-related symptoms also includes serious weight loss,
brain tumors, and other health problems. Without treatment,
these opportunistic infections can kill you.
AIDS is different in every infected person. A few people may
die a few months after getting infected, but most live fairly
normal lives for many years, even after they "officially" have
AIDS. A few HIV-positive people stay healthy for many
years even without taking antiretroviral medications (ART).

Acquired Immune Deficiency

Syndrome (AIDS)

IS THERE A CURE FOR AIDS?

There is no cure for AIDS. Antiretroviral therapy can slow down the
HIV virus, and slow down the damage to your immune system.
Most people stay healthy as long as they continue ART. There is
no way to "clear" the HIV out of your body.
Other drugs can prevent or treat opportunistic infections (OIs). In
most cases, these drugs work very well. The newer, stronger ARVs
have also helped reduce the rates of most OIs. A few OIs,
however, are still very difficult to treat.

The single most common cause of pneumonia in AIDS

patient Pneumocystis carinii

Acquired Immune Deficiency

Syndrome (AIDS)

Commonly- prescribed drugs:

Protease inhibitors
Nucleotide reverse transcriptase inhibitors (NRTIs)
Non- nucleoside reverse transcriptase inhibitors (NNRTIs)

3. Non-gonococcal urethritis
CA: Chlamydia trachomatis
Chlamydia causes about half of the urethral
infections not caused by gonorrhea.

What is Chlamydia?

A common STD caused by the bacterium,

Chlamydia trachomatis, which can damage a
woman's reproductive organs.
Even though symptoms of chlamydia are
usually mild or absent, serious complications
that cause irreversible damage, including
infertility, can occur "silently" before a
woman ever recognizes a problem.
Chlamydia also can cause discharge from the
penis of an infected man.

How do people get Chlamydia?

Chlamydia can be transmitted during vaginal, anal, or oral

sex.
Men who have sex with men are also at risk for chlamydial
infection.
Chlamydia can also be passed from an infected mother to
her baby during vaginal childbirth.
Any sexually active person can be infected with chlamydia.
The greater the number of sex partners, the greater the risk
of infection.
Because the cervix (opening to the uterus) of teenage girls
and young women is not fully matured and is probably more
susceptible to infection, they are at particularly high risk for
infection if sexually active.

*Symptoms?

Chlamydia is known as a "silent" disease

Women who have symptoms
an abnormal vaginal discharge or a burning sensation when urinating.
When the infection spreads from the cervix to the fallopian tubes
(tubes that carry fertilized eggs from the ovaries to the uterus), some
women still have no signs or symptoms; others have lower abdominal
pain, low back pain, nausea, fever, pain during intercourse, or bleeding
between menstrual periods.
Men with signs or symptoms
discharge from their penis or a burning sensation when urinating.
burning and itching around the opening of the penis.
Pain and swelling in the testicles are uncommon.
Men or women who have receptive anal intercourse may acquire
chlamydial infection in the rectum, which can cause rectal pain,
discharge, or bleeding. Chlamydia can also be found in the throats of
women and men having oral sex with an infected partner.

*Complications when left

untreated?

In women,

PID (can cause permanent damage to the fallopian tubes, uterus,

and surrounding tissues). The damage can lead to chronic pelvic
pain, infertility, and potentially fatal ectopic pregnancy (pregnancy
outside the uterus).
Women infected with chlamydia are up to five times more likely to
become infected with HIV, if exposed.

In men,

rare
Infection sometimes spreads to the epididymis (the tube that carries
sperm from the testis), causing pain, fever, and, rarely, sterility.

How does chlamydia affect a pregnant woman and her baby?

Prevention?

The surest way to avoid transmission of STDs

is to abstain from sexual contact, or to be in a
long-term mutually monogamous relationship
with a partner who has been tested and is
known to be uninfected.

TREATMENT

Ceftriaxone to treat
gonorrhea at the same time.
Tetracycline, Doxycycline, or
Levofloxacin taken by mouth
for at least 7 days

A single dose of Azithromycin

taken by mouth

! Pregnant women are

given Azithromycin 1g
orally instead of
tetracycline or
doxycycline.

4. Herpes simplex genitalia

CA: HSV causes blisters & sores around the mouth, nose, genitals, and
buttocks, but they may occur almost anywhere on the skin.
BD: Genital herpes affects the genitals, buttocks or anal area.
MOT: through sexual contact.
Signs & Symptoms: Some people have no symptoms. Others get painful
and unsightly sores near the area where the virus has entered the body.
They turn into blisters, become itchy & painful, & then heal.
Tx: latex condoms; Oral anti-viral medications such as acyclovir,
famciclovir, or valacyclovir
Prevention? no vaccine

4. Herpes simplex genitalia

5. Gonorrhea

One of the most common STD in the world

The first place this bacterium infects is usually the
columnar epithelium of the urethra and endocervix.
Non-genital sites in which it thrives are in the rectum,
the oropharynx and the conjunctiva of the eyes.
The vulva and vagina in women are usually spared
because they are lined by stratified epithelial cellsin
women the cervix is the usual first site of infection.

Gonorrhea

CA: Gram-negative bacterium

Neisseria gonorrhea
MOT: sexual intercourse
Infected women also can pass
gonorrhea to their newborn
infants during delivery, causing
eye infections (conjunctivitis) in
their babies (which if left
untreated, can cause blindness).
Treatment:

Doctors have often attempted to

treat this immediately by
applying small amounts of silver
nitrate to the eyes of all newborn
babies.
Penicillin

Gonorrhea

Treatment

1. Uncomplicated Gonococcal Infections of the Cervix,

Urethra, Rectum and Pharynx: Ceftriaxone 250 mg single
dose IM + Azith 1g PO single dose. (Alternative: Cefixime
400 mg PO single dose + Azith 1g PO single dose)
2. Gonococcal Conjunctivitis: Ceftriaxone 1g IM single dose +
Azith 1g PO single dose
3. Opthalmia Neonatorum Prophylaxis: Erythromycin (0.5%)
ophthalmic ointment o.u. in single application + Ceftriaxone
25-50 mg/kg IM in a single dose, not to exceed 125 mg

SIGNS AND SYMPTOMS

In Men:

In Women:

discomfort in the
urethra

a frequent
need to
urinate

mild to severe
pain during
urination
discharge of pus
from the penis
a frequent and
urgent need to
urinate
penile opening
may become red
and swollen

pain while
urinating
a discharge
from the
vagina
fever

6. Hepatitis C

CA: RNA virus (member of the Flaviviridae family)

Brief description: Originally "non-A non-B hepatitis"
MOT: It can be transmitted through contact with blood
(including through sexual contact if the two parties'
blood is mixed) and can also cross the placenta.
Hepatitis C may lead to a chronic form of hepatitis,
culminating in cirrhosis. It can remain asymptomatic
for 10-20 years.

ATHROPODS

ARTHROPODS
Largest phylum of animals
Characterized by the possession of a

segmented body with appendages on

each segment

COMMON
ARTHOPODS

A. PUBIC LICE A.K.A CRABS

B. SCABIES

PUBIC LICE
tiny insects that can crawl from the pubic hair of one person
to the pubic hair of another person during sexual intercourse
The female lice can survive up to 40 days and each can lay 20
to 30 eggs . Lice can also live off the body for 2 to 3 days

Called "crabs" because they

look like tiny crabs

:
OMS
T
P
SYM

Itching

grayis
h
abdom colored ras
h on y
en and
our
thighs
.
ur
o
y
in
ts
o
d
y
ra
g
r
o
e
it
h
W
pubic hair; these are
louse eggs

Notice the lice for

2-3 weeks after
you've been exposed

Symptoms

These are noticed about 5 days to several

weeks after infection:

Itchy skin or inflammation of the affected area.

Black powder (lice droppings) in underwear
Brown eggs on pubic hair
Occasionally, visible lice and eggs
Spots of blood as lice feed from blood vessels

MALATHION
TREATMENT

LIndane
How to treat pubic lice infestations:

1.Wash the infested area

2.Thoroughly saturate hair with lice medication
and rinse off medication with water. Dry off with
a clean towel.
3. Following treatment, most nits will still be
attached to hair shafts. Nits may be removed
with fingernails.
4. Put on clean underwear and clothing after
treatment.

TREATMENT

5. To kill any lice or nits that may be left on clothing or bedding,

machine-wash those washable items that the infested person
used during the 2-3 days before treatment. Use the hot water
cycle (130F).
6. Dry-clean clothing that is not washable.
7. Inform any sexual partners that they are at risk for infestation.
8. Do not have sex until treatment is complete.
9. Do not have sex with infected partners until partners have
been treated and infestation has been cured.
10. Repeat treatment in 7-10 days if lice are still found.

SCABIES

SCABIES
CONTAGIOUS
usually TRANSMITTED by skin-to-skin contact
or through Sexual contact with someone else who is
infected with it.

Intense itching

SYMPTOMS

Small, raised,
red bumps,
blisters or
rashes

DIAGNOSIS

1. Physician collects several skin scrapings

2. A microscope is used to see if the mite is in the skin scrapings
3. A specific way of applying
ink to the skin also can help
the doctor identify scabies
burrows.

TREATMENT
Skin lotions or creams containing Lindane,Permethrin,
Pyrethrin or Crotamiton are applied to the skin of a person
with scabies

Necessary to apply the lotion or cream thoroughly

to all areas of the body from the chin down to, &
including, the soles of the feet.
Treatment is repeated in 7 days to get rid of any eggs
that survive the first treatment

3. Airborne diseases

Airborne diseases are transmitted from

person to person by aerosol and droplets from
the nose and mouth.
How do we reduce risk of infection?
Examples?

3. Airborne Diseases/ Droplet

1.
2.
3.
4.
5.
6.
7.

Pulmonary tuberculosis
Chickenpox
Measles
SARS
Pneumonia
Diphtheria
Mumps

1. Pulmonary Tuberculosis (TB)

1. Pulmonary Tuberculosis (TB)

CA: M. tuberculosis
Brief description: A common &
deadly infectious disease caused by
mycobacteria. It attacks the lungs
(as pulmonary TB) but can also
affect the CNS, the lymphatic
system, the circulatory system, the
genitourinary system, bones, joints
& even the skin.
MOT: Inhalation of droplets with a
single tubercle bacilli. can cause a
new infection.
Treatment: Antibiotics (RIPES)

1. Pulmonary Tuberculosis (TB)

1. Pulmonary Tuberculosis (TB)

1. Pulmonary Tuberculosis (TB)

1. Pulmonary Tuberculosis (TB)

2. Chickenpox (Varicella)

CA: Varicella
Brief description: A highly contagious illness caused by
primary infection with VZV. Itchy skin rash and red
spots or blisters (pox) appearing in crops and fever. It
is most common in children, but most people will get
chickenpox at some point in their lives if they have not
had the chickenpox vaccine.
Incubation period: 14-21 days
MOT: through aerosolized droplets from the
nasopharynx of ill individuals or through direct contact
with secretions from the rash
Treatment: acyclovir, valacyclovir, famciclovir
Prevention: Avoid exposure. Chickenpox vaccine
One attack confers permanent immunity.

Chickenpox (Varicella)

It generally begins with a vesicular skin rash,

mainly on the body and head rather than the
hands and becoming itchy raw pockmarks, small
open sores which heal mostly without scarring.

Chickenpox (Varicella)

The most common late complication of chicken

pox is shingles, caused by reactivation of the VZV
decades after the initial episode of chickenpox.

Here's why:

After the red spots appear on your body, they fill up

with a clear liquid.
These liquid-filled blisters are called vesicles (say:
veh-sih-kulz).
The vesicles release chemicals in your skin that
excite the nerves that make you itch.
The good news is that your skin is supposed to be
itchy when you have chickenpox. Itching is a sign
that your body is doing its job defending itself.

An oatmeal bath is a
common treatment used
to make chicken pox
patients more
comfortable while the
illness runs its course.

Shingles

Herpes zoster (or simply

zoster), commonly known as
shingles, is a viral disease
characterized by a painful
skin rash with blisters in a
limited area on one side of the
body, often in a stripe.
The initial infection with VZV
causes the acute (short-lived)
illness chickenpox, and
generally occurs in children
and young people.

3. Measles (Rubeola)

CA: paramyxovirus (genus Morbillivirus). Morbilliviruses, like other

paramyxoviruses, are enveloped, single-stranded, negative-sense RNA
viruses.
Brief description: A highly- contagious disease.
Incubation period: 10- 14 days
MOT: spread through respiration (contact with fluids from an infected
person's nose and mouth, either directly or through aerosol transmission),
90% of people without immunity sharing a house with an infected person
will catch it.
Infected people remain contagious from the appearance of the first
symptoms until 35 days after the rash appears.
Treatment: Symptomatic
Prevention: Vaccination

Measles (Rubeola)

Classical symptoms include:

4- day fever (up to 40C (104F),

3 Cs (cough, runny nose, red eyes) and
a generalized, maculopapular, erythematous rash.

Koplik spots
also called "Grains of salt on a wet background"

They are small, irregular

red spots, each with a
minute bluish white speck
in the center, seen on the
buccal mucosa and lingual
mucosa (mucous
membrane of the inside of
the cheek and tongue) and
are pathognomonic of
early stage measles.
They are named after
Henry Koplik (1858-1927),
an American pediatrician
who first described them in
1896.

These are found on the mucosa which are

often associated with measles.

German Measles (Rubella)

CA: Rubella virus

Brief description: Sometimes called 3-day measles
because the skin rash usually disappears on the 3rd
day. There is enlargement of the lymph nodes for as
long as 7 days prior to the appearance of the rash.
One attack usually confers permanent immunity.
Incubation period:14- 21 days
MOT: transmitted via airborne droplet emission from
the upper respiratory tract of active cases.
Treatment: Symptomatic

German measles (Rubella)

A common childhood
infection usually with
minimal systemic upset
although transient
arthropathy may occur in
adults.

German measles (Rubella)

German measles (Rubella)

The name is derived from the Latin, meaning little red.

It is also known as German measles because the disease was
first described by German physicians in the mid-eighteenth
century.
This disease is often mild and attacks often pass unnoticed.
The disease can last one to three days.
Children recover more quickly than adults.
Infection of the mother by Rubella virus during pregnancy can be
serious; if the mother is infected within the first 20 weeks of
pregnancy, the child may be born with congenital rubella
syndrome (CRS), which entails a range of serious incurable
illnesses. Spontaneous abortion occurs in up to 20% of cases.

What is the difference between measles

(rubeola) and German measles (rubella)?

Measles (rubeola) is a serious disease and is

sometimes called "hard", "red", or "seven day
measles".
Individuals infected with measles frequently suffer
from ear infections and/or pneumonia.
German measles (rubella) is a mild, 3- day infection
that seldom leads to complications in children.
However, rubella may cause birth deformities in
babies born to mothers who are infected with the
virus during pregnancy.

5. Viral pneumonia
(Atypical pneumonia)

CA: virus
Brief description: An infection or inflammation
of the lungs
Incubation period: few days to 1 week
MOT: Direct contact; droplet spread; Indirect
contact with soiled articles contaminated with
respiratory secretions.
Treatment: Oxygen therapy if necessary, bed
rest.

Viral pneumonia
(Atypical pneumonia)

Diphtheria

CA: Corynebacterium diphtheriae, a

facultativel anaerobic Gram-positive
bacterium
MOT: by direct physical contact or
breathing the aerosolized secretions
of infected individuals.
Treatment:
Erythromycin for 14 days or
Procaine penicillin G IM for 14
days
Patients with allergies to
penicillin G or erythromycin can
use rifampin or clindamycin
DPT vaccine, recommended for
those traveling to areas where
the disease has not been
eradicated.

Diphtheria

Greek diphthera pair of leather scrolls, an upper

respiratory tract illness characterized by sore throat, low
fever, and an adherent membrane (a pseudomembrane)
on the tonsils, pharynx, and/or nasal cavity.

7. Mumps (Epidemic parotitis)

CA: mumps virus, A viral organism well- known to involve

infection of the parotid gland & testes in males

Brief description: A moderately communicable disease affecting the

parotid gland which is located in front and below the ear. Sometimes, the
salivary glands become involved. There is swelling, fever, loss of
appetite and earache.
One attack confers lasting immunity.
Incubation period: 14- 21 days
MOT: 1. Direct contact; droplet infection.
2. Indirect contact with articles soiled mouth or throat secretions
Treatment: Symptomatic
Prevention: Immunization

Mumps (Epidemic parotitis)

Painful testicular swelling and rash may also

occur.
The symptoms are generally not severe in
children.
In teenage males and men, complications such
as infertility or subfertility are more common,
although still rare in absolute terms.

Mumps (Epidemic parotitis)

4. Vector-borne diseases

A number of particularly serious infections are

transmitted by insects and other vectors such
as ticks.
How do we reduce risk of infection?
Examples of vector-borne diseases are
malaria, yellow fever, dengue and tick-borne
encephalitis.

4. Vector-borne diseases
1.
2.

Dengue fever
Malaria

1. Dengue fever

1. Dengue fever

CA: virus serotypes of the genus Flavivirus, family Flaviviridae; (DEN-1, DEN-2, DEN-3,
or DEN-4)
BD: A.k.a. H-Fever, breakbone fever, dengue hemorrhagic fever (DHF); an
acute viral infection transmitted to humans by the Aedes aegypti mosquito, which
breeds in places where there is stagnant water. It causes heavy bleeding which can be
fatal. It is a potentially deadly complication characterized by high fever, hemorrhagic
phenomena- often with enlargement of the liver- and in severe cases, circulatory
failure.
Symptoms: severe headache, backache, muscle & joint pains (myalgias & arthralgias
severe pain that gives it the name break-bone fever or bonecrusher disease), high
fever (last for 2-7 days), nausea and vomiting, eye pain, weakness, nosebleeding,
abdominal pain, dark- colored stools & rash.
Treatment: No specific treatment or vaccine is yet available; complete bed rest, and
drink plenty of fluids (electrolyte replenishers to prevent loss of fluids due to diarrhea).
To relieve fever, paracetamol is recommended. Do not give aspirin for fever. If fever
persist for 2 or more days, bring the Px to the hospital.

Danger Signs of DHF

Spontaneous bleeding
Persistent abdominal pain
Persistent vomiting
Changes in mental status
Restlessness
Weak and rapid pulse
Cold, clammy skin
Difficulty of breathing
Seizures
Hypotension
Platelet count <100,000 cells/ mm3)
Prolonged bleeding time

1. Dengue fever

1. Dengue fever

low platelet & WBC count

Tx: supportive therapy to tackle shock due to bleeding.
Increased oral fluid intake is recommended to prevent
dehydration. A platelet transfusion is indicated in rare
cases if the platelet level drops significantly (below
20,000) or if there is significant bleeding. The presence
of melena may indicate internal GI bleeding requiring
platelet &/or RBC transfusion.
Aspirin & NSAIDs should be avoided. These drugs may
worsen the bleeding tendency associated with some
of these infections. Patients may receive paracetamol
preparations to deal with these symptoms if dengue is
suspected.

melena or melaena

Refers to the black, "tarry" feces that are

associated with GI hemorrhage.
The black color is caused by oxidation of the
iron in hemoglobin during its passage through
the ileum & colon.

What you can do when

suspecting a dengue
fever?

Consult a doctor
immediately or go to the
emergency room of the
nearest hospital.
- Early detection of
disease will help in early
treatment of the
symptoms and can be life
saving.

What are its preventive

measures?

Get rid of stagnant water in

your premises, e.g. canals
where the Aedes aegyti
mosquito can breed &
infect human.

- Disrupt possible breeding

places, e.g. water vases,
drums, tin cans &
containers & unused old
tires with water.

2. Malaria

CA: parasitic protozoa Plasmodium sp. that infect human RBCs.

Protozoa are one-celled organisms that are as sophisticated as
a human cell.
BD: A vector-borne infectious disease caused by protozoan
parasites.
MOT: transmitted by female Anopheles mosquitoes.
Tx: antimalarial drugs, such as quinine or artemisinin derivatives.
Prevention: Mosquito control; Use of prophylactic drugs,
mosquito eradication, and the prevention of mosquito bites.
There is currently no vaccine that will prevent malaria, but this
is an active field of research.

Symptoms: fever, shivering, arthralgia (joint pain),

vomiting, anemia caused by hemolysis,
hemoglobinuria, and convulsions.
Consequences of severe malaria include coma &
death if untreated.
Renal failure may cause blackwater fever, where
hemoglobin from lysed RBCs leaks into the urine.

Treatment

Propranolol has been shown to block both

Plasmodium's ability to enter RBC and establish an
infection, as well as parasite replication

Currently available anti-malarial drugs include:

Quinine (Therapy only)
Cotrifazid (Therapy and prophylaxis)
Doxycycline (Therapy and prophylaxis)

5. Zoonoses (diseases
transmitted from animals)

Zoonoses include many infections that can be

transmitted to humans through animal bites or
contact with contaminated body fluids or feces
from animals, or by consumption of foods of
animal origin, particularly meat and milk
products.
How do we reduce risk of infection?
Particular care should be taken to prevent
children from approaching & handling
animals.

5. Zoonoses (diseases
transmitted from animals)
1.
2.
3.
4.
5.

Rabies
Anthrax
Foot and Mouth disease
Birds flu
Mad Cow Disease

1. Rabies

CA: Rabies virus, a ssRNA virus in the genus Lyssavirus,

family Rhabdoviridae
BD: A zoonotic viral disease which infects domestic & wild
animals. It is a preventable viral disease that causes acute
encephalitis (inflammation of the brain). The virus exists in
the saliva of mammals
MOT: Transmitted from animal to animal or from animal to
human by biting &/or scratching. The virus can also be
spread by licking, when infected saliva makes contact with
open cuts or wounds, & with the mouth, eyes, & nose. If left
untreated in humans & animals, rabies is fatal.

1. Rabies

Rabies
Remember: The best way to
prevent the spread of rabies is
the vaccination of house pets &
people.

Signs and Symptoms

The symptoms of rabies typically appear about 4 days after the

bite occurs. But in rare cases, symptoms don't show up for more
than a year.
One of the most distinctive signs of a rabies infection is a tingling
or twitching sensation around the area of the animal bite. It is
often accompanied by a fever, headache, muscle aches, loss of
appetite, nausea, and fatigue.
As the infection progresses, someone infected with rabies may
develop any of the following symptoms:
irritability
excessive movements or agitation
confusion
hallucinations

Signs and Symptoms

aggressiveness
bizarre or abnormal thoughts
muscle spasms
abnormal postures
seizures (convulsions)
weakness or paralysis (when a person cannot move some part of the
body)
extreme sensitivity to bright lights, sounds, or touch
increased production of saliva or tears
difficulty speaking

Signs and Symptoms

In the advanced stage of the infection, as it spreads to other parts of

the nervous system, other symptoms may develop:
double vision
problems moving facial muscles
abnormal movements of the diaphragm and muscles that control
breathing
difficulty swallowing and increased production of saliva, causing the
"foaming at the mouth" usually associated with a rabies infection

Prevention

The first thing to do if you've been bitten by an animal is

thoroughly wash the wound or area of exposure with soap
and water. This is one of the most effective methods to
decrease the chance of infection.
If soap isn't available for example, when hiking you
can use water alone. But be sure to wash with soap and
water as soon as possible. Allowing the wound to bleed
also can help clean it.
Ways to help prevent exposure to rabies include:
Keep your pets and other domesticated animals up-todate with regular animal rabies shots.

Prevention

Avoid contact with wild or unfamiliar animals, whether they're alive or

dead.
Seal or close any openings where animals might find entry into your
home.
Report stray animals or any that act strangely or sick to your local
animal control authorities. Keep the phone number for animal control
near your phone. If you don't have animal control personnel in your
community, call the police or sheriff's office.
Teach your children to never handle unfamiliar animals.
If your work or activities might bring you into contact with the rabies
virus or a potentially rabid mammal, consider getting a preventive
vaccination. This vaccination called pre-exposure prophylaxis
involves three injections over three or four weeks. A booster shot can
maintain the vaccination's effectiveness.

Treatment

Treatment of rabies begins

with
treatment of the site of
infection.
The wound should be
thoroughly
cleansed with
water and
soap or another
substance that
deactivates viruses.
The WHO recommends anointing the wound with anti-rabies serum.
Initial treatment also involves injection of human rabies immune
globulin (HRIG).
Subsequent treatment involves five vaccine injections.
Rabies is one of the few infections that can be treated with active
immunization, because the progress of viral replication and movement
to the brain is slow enough to allow effective immunity to develop
before disease develops.

2. Anthrax

CA: bacterium Bacillus anthracis,

BD: An acute disease in humans and animals which is highly lethal in
some forms. The name anthrax comes from anthrakitis, the Greek word
for anthracite (coal), in reference to the black skin lesions victims develop
in a cutaneous skin infection.
MOT: It infects wild and domesticated herbivorous mammals which ingest
or inhale the spores while eating grass or browsing. Ingestion is assumed
to be the most common route by which herbivores contract anthrax.
Carnivores living in the same environment may ingest infected animals
and become infected themselves.
Anthrax can also infect humans when they are exposed to blood and other
tissues from infected animals (via inhalation or direct inoculation through
broken skin), eat tissue from infected animals, or are exposed to a high
density of anthrax spores from an animal's fur, hide, or wool.

2. Anthrax

MOT:
Pulmonary (pneumonic, respiratory, or inhalational) anthrax
Gastrointestinal (gastroenteric) anthrax
Cutaneous (skin) anthrax
TX: large doses of IV and oral antibiotics, such as fluoroquinolones, like
ciprofloxacin (cipro), doxycycline, erythromycin, vancomycin or penicillin.
Prevention: An FDA-licensed vaccine, produced from one non-virulent
strain of the anthrax bacterium, is manufactured by BioPort Corporation,
subsidiary of Emergent BioSolutions. The trade name is BioThrax,
although it is commonly called Anthrax Vaccine Adsorbed (AVA). It is
administered in a six-dose primary series at 0,2,4 weeks and 6,12,18
months; annual booster injections are required thereafter to maintain
immunity. The injections are typically very painful, and may leave the area
of injection with swelling; this area may be painful for several days.

3. Foot and Mouth disease

(FMD)

CA: It is caused by foot-and-mouth disease virus.

A.k.a. hoof-and-mouth disease (Aphtae epizooticae) is a highly
contagious and sometimes fatal viral disease of cloven-hoofed
animals, including domestic animals such as cattle, water buffalo,
sheep, goats and pigs, as well as antelope, bison and other wild
bovids, and deer.
The incubation period for foot-and-mouth disease virus has a
range between 2 and 12 days
The disease is characterized by high fever that declines rapidly
after two or three days; blisters inside the mouth that lead to
excessive secretion of stringy or foamy saliva and to drooling; and
blisters on the feet that may rupture and cause lameness.

3. Foot and Mouth disease

(FMD)

4. Bird flu

Avian influenza, influenza endemic to birds.

Influenzavirus A, the causative agent for bird flu; the genus
of the Orthomyxoviridae family. of viruses to which all
viruses responsible for Avian influenza belongs to, but also
includes viruses that are endemic to humans and other
animals.
H5N1, a subtype of Influenza A virus endemic to birds,
currently perceived as a significant emerging pandemic
threat.
There is no highly effective treatment for H5N1 flu, but
oseltamivir (commercially marketed by Roche as Tamiflu),
can sometimes inhibit the influenza virus from spreading
inside the user's body.

5. Mad Cow Disease

CA: prions
BD: It is the commonly used name for Bovine
Spongiform Encephalopathy (BSE), a slowly
progressive, degenerative, fatal disease
affecting the central nervous system of adult
cattle.
MOT: It is believed by most scientists that the
disease may be transmitted to human beings
who eat the brain or spinal cord of infected
carcasses.[

Mad Cow Disease

The exact cause of BSE is not known but it is

generally accepted by the scientific community that
the likely cause is infectious forms of a type of
protein, prions, normally found in animals cause BSE.
In cattle with BSE, these abnormal prions initially
occur in the small intestines and tonsils, and are
found in central nervous tissues, such as the brain
and spinal cord, and other tissues of infected animals
experiencing later stages of the disease.

Mad Cow Disease

Scientific research indicates that BSE is not

transmitted in cow's milk, even if the milk
comes from a cow with BSE.
Milk and milk products, even in countries with
a high incidence of BSE are, therefore,
considered safe.
But the reality is that all prion diseases cause
death. There are no effective treatments
available.

6. Others:
a. Bloodborne diseases

Bloodborne diseases are transmitted by direct

contact with infected blood or other body
fluids.
How do we reduce risk of infection?
Examples?

6. Others:
b. Diseases transmitted from soil

Soil-transmitted diseases include those

caused by dormant forms (spores) of
infectious agents, which can cause infection
by contact with broken skin (minor cuts,
scratches, etc.).
How do we reduce risk of infection?
Examples?

Leprosy or Hansens disease

A chronic infectious disease

A granulomatous disease of the peripheral nerves
and mucosa of the upper respiratory tract; skin
lesions are the primary external symptom.
Left untreated, leprosy can be progressive, causing
permanent damage to the skin, nerves, limbs, and
eyes.
Contrary to popular conception, leprosy does not
cause body parts to simply fall off, and it differs from
tzaraath, the malady described in the Hebrew
scriptures and previously translated into English as
leprosy.

Leprosy or Hansens disease

CA: Mycobacterium
leprae
MOT: Not known;
prolonged close contact
and transmission by
nasal droplet have both
been proposed, and,
while the latter fits the
pattern of disease, both
remain unproven.
Treatment: Dapsone
A 24-year-old man infected with leprosy.