PULMONARY TUBERCULOSIS

 MANTOUX SKIN TEST

 A.K.A : Koch’s Disease o Also called PPD – ID (Purified Protein Derivative)
 Pedia: Primary Complex  TREATMENT
 World’s deadliest disease and remains as a major public health problem in the o DOTS Program (Directly Observed Treatment Short Course)
Philippines.  Rifampicin
 Highly infectious chronic disease  Isoniazid
 Common among malnourished individuals living in crowded areas.  Pyrazinamide
 MILIARY TUBERCULOSIS – TB that spread all over the body.  Ethambutol
ETIOLOGIC AGENT Mycobacterium tuberculosis | Tubercle bacilli  Streptomycin
MODE OF
TRANSMISSION  Airborne droplet | Direct invasion on mucus membrane
- As long as viable tubercle bacilli is being discharge.
- 2-10 weeks
INCUBATION PERIOD
- From the first entry until the appearance of the first signs
and symptoms
PATHOGNOMIC SIGN Hemoptysis 2RIPE 4RI
- Cough for 2 weeks (Non-prod to Prod)
- Fever/ Afternoon Fever
- Hemoptysis
- Excessive sweating at night 2RIPES/
- Chest pain 1RIPE 5RIE
SIGNS AND SYMPTOMS - Difficulty of Breathing
- Lack of appetite
- Weight loss 2RIPE 4RI
- Body Malaise
- Pleural Effusion and Hypoxemia

- Most hazardous period for development of clinical

disease is the first 6-12 months after infection
SUSCEPTIBILITY AND
- Highest in children under 3 years old
RESISTANCE
- Lower in later childhood and High in adolescents, young
adults and very old. o Multi-drug-resistant tuberculosis (MDR-TB) - TB that is resistant at least
- Chest XRay – Cavity lesions to isoniazid (INH) and rifampicin (RMP), the two most powerful first-
- Sputum exam line anti-TB drugs.
DIAGNOSIS - Sputum culture (3 consecutive days)  SIDE EFFECTS OF RIPES:
- Thoracentesis  R – ORANGE URINE S – CN8 DAMAGE | NEPHROTOXIC
- Mantoux Skin Test
 I – PERIPHERAL NEURITIS
 P – HYPERURICEMIA
 E – OPTIC NEURITIS
LEPROSY the lesion
 Thickened and/or painful nerves
 Ancient disease and leading cause of permanent physical disability among the  Muscle weakness or paralysis of the extremities
 Pain and redness of the eye
communicable disease.
 Nasal obstruction or bleeding
 Chronic mildly communicable disease that mainly affects the skin, the peripheral  Ulcers that do not heal
nerves, the eyes and mucosa of the URT. - Late signs and symptoms
 It has been a public health problem in the Philippines for several decades.  Loss of eyebrows - MADAROSIS
 Not hereditary  Inability to close eyelids – LAGOPHTHALMOS
 3 forms of Leprosy  Clawing of fingers and toes
 Contractures
o Lepromatous leprosy (multibacillary)
 Sinking of nose bridge
 Many microorganisms  Enlargement of the breast in males –
 Open of infectious cases GYNECOMASTIA
 Negative lepromin test  Chronic ulcers
 Causes damage to the respiratory tract, eyes, and testes as well as SUSCEPTIBILITY AND - Children especially 12 y.o and below
the nerves and the skin. RESISTANCE
- Slit Skin Smear Test
o Tuberculoid Leprosy
- Skin lesion biopsy
 Few organism - Lepromin test
 Non-infectious DIAGNOSIS - Graphesthesia
 Positive reaction to lepromin test - Stereognosis
o Borderline - Blood test (increased RBC & ESR, decreased CA, and albumin
 Also called Dimorphous Leprosy has the characteristics of both & cholesterol level.)
- Avoidance of prolonged skin-skin contact
lepromatous and tuberculoid leprosy.
- BCG vaccination
 Skin lesions of this type of leprosy are diffused and poorly defined. PREVENTION - Good personal hygiene
- Adequate Nutrition
ETIOLOGIC AGENT Mycobacterium leprae - Health Eduation
MODE OF - Airborne (Inhalation) >Woolsorter’s disease  WOOLSORTER’S DISEASE – URTI(fever for 3-5 dyas | Metabolis acidosis | Hypoxia
TRANSMISSION - Prolonged skin-skin contact
 MANAGEMENT/TREATMENT
INCUBATION PERIOD Ranges from 5 and half months to 8 years.
o Ambulatory Chemotherapy
- Presence of localized areas of anesthesia
CARDINAL SIGN - Presence of Hansen’s bacilli in stained smear/dried  MDT (Multiple Drug Therapy)
biopsy  Multibacillary
SIGNS AND SYMPTOMS - Early signs and symptoms o Rifampicin(600mg once a month)
 Change in skin color (reddish or white) o Clofazimine 50mg OD 12 months
 Loss of sensation on the skin lesion
o Dapsone 100mg OD
 Decrease/loss of sweating and hair growth over
 Pausibacillary
 o Rimfampicin 600mg(once a month) - Kato katz technique
o Dapsone OD 6mos - Liver & rectal biopsy
o Domiciliary Treatment - ELISA
 R.A. 4073 – Home treatment - Cercum Ova Precipetin test(COPT)- Confirmatory
 NURSING DIAGNOSIS diagnosis test
o Impaired skin integrity - Educate the public regarding the mode of transmission
o Social isolation and methods of protection.
o Ineffective coping - Proper disposal of feces and urine
METHODS OF CONTROL
o Knowledge deficit - Prevent exposure to contaminated water. To minimize
o Anxiety penetration after accidental water exposure, towel dry
o Impaired body image and apply 70% alcohol.
- Praziquantel(6mos)
TREATMENT
- Fuadin injection –IM or IV
SCHISTOSOMIASIS  The male and female parasites live in the blood vessels of the intestines and liver.
 KATO-KATZ TECHNIQUE - laboratory method for preparing human stool samples
 A.K.A : Bilhariasis | Snail fever
prior to searching for parasite eggs.
 Endemic in the Philippines
 HIGH PREVALENCE: Region 5 (Bicol), Region 8 (Samar and Leyte) and Region 11  ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA), also known as an enzyme
(Davao) immunoassay (EIA), is a biochemical technique used mainly in immunology to
 INTERMEDIATE HOST: Oncomelania quadrasi detect the presence of an antibody or an antigen in a sample.
- Schistosomiasis japonicum (transmitted by a tiny snail  COMPLICATION:
oncomelania quadrasi) o Liver cirrhosis
ETIOLOGIC AGENT
- Schistosomiasis haematobium o Portal hypertension
- Schistosomiasis mansoni o Cor polmonale
Infection occurs when skin comes in contact with o Pulmonary hypertension
MODE OF
contaminated fresh water in which certain types of snails o Heart Failure
TRANSMISSION
that carry schistosomes are living. o Ascites
INCUBATION PERIOD Atleast 2 months o Hematemesis
- Diarrhea o Renal failure
- Bloody stools
- Enlargement of abdomen
- Spleenomegaly DENGUE HEMORRHAGIC FEVER (DHF)
- Weakness
SIGNS AND SYMPTOMS
- Anemia  CLASSIFICATION:
- Inflamed liver o Severe, frank type – with flushing, sudden high fever, severe hemorrhage,
- Severe jaundice followed by sudden drop of temperature, shock and terminating in recovery
- Edema or death.
- S/sx of Portal Hypertension o Moderate – with high grade fever but less hemorrhage, no shock
DIAGNOSIS - Fecalysis or direct stool exam
 o Mild – with slight fever, with or without petechial hemorrhage but  Bleeding of GIT (MELENA or HEMATOCHEZIA)
epidemiologically related to typical cases usually discovered.  Unstable B.P
 Narrow pulse pressure
 Shock
 Positive Torniquet test on the 3rd day may
 CLASSIFICATION ACCORDING TO GRADE/SEVERITY: become negative due to low or vasomotor
o GRADE I collapse.
 Dengue Fever - th th
7 – 10 day – Convalescent or recovery stage
 Saddleback fever + Constitutional signs and symptoms + Positive  Generalized flushing
Torniquet Test  Blanching appetite regained
 BP already stable
o GRADE II
 Platelet count normalized
 Grade I + Spontaneous bleeding, Epistaxis, GIT and Cutaneous
SUSCEPTIBILITY AND - ALL
bleeding. RESISTANCE
o GRADE III - Torniquet Test (Rumpel Leads Test)
DIAGNOSIS
 Dengue Shock Syndrome  20 or more petechiae
 All of the following symptoms + evidence of Circulatory Failure - CBC with PC
o GRADE IV - Bleeding Parameters
 Serologic Test
 Grade III + Irreversible shock and massive bleeding
 Dengue blot | Dengue Igm
LABORATORY
- Other:
- Aedes aegypti PROCEDURE
ETIOLOGIC AGENT  PT (Prothrombin Time)
- Flaviviruses 1,2,3,4
 APTT (Activated Partial Thromboplastin Time)
MODE OF
 Bleeding time
TRANSMISSION  Mosquito bite
 Coagulation Time
- 3 to 14 days
INCUBATION PERIOD  MANAGEMENT:
- Commonly 7-10 days
SIGNS AND SYMPTOMS - First 4 days – Febrile or invasive stage o Specific Therapy – NONE
 High fever o Symptomatic/Supportive Therapy
 Abdominal pain  Intravenous Fluid (IVF)
 Headache  With hematoconcentration (5-7 ml/kg/hr)
 Flushing  With shock (10-30 ml/kg in <20mins)
 Vomiting
 Use of Blood/Blood Products
 Conjunctival infection
 Epistaxis  Platelet concentrate (1unit/5-7kg)
th th
- 4 -7 days – Toxic or hemorrhagic stage  50k and < with signs of bleeding
 Low fever  20k and < with or without signs of bleeding
 Severe abdominal pain  Cryoprecipitate (1unit/5kg)
 Vomiting (HEMATEMESIS)  Elevated PTT
 Fresh frozen Plasma (15ml/kg x 24hours)
  Given in patients with Impending Shock - Rashes
 Fresh Whole Blood (20cc/kg) - Grayish Pecks (Koplik spot) – 2nd day
 Active bleeding - Branny desquamation progression
 NURSING INTERVENTION: SUSCEPTIBILITY AND ALL
RESISTANCE
o Paracetamol (NO ASPIRIN)
- Swab test
o Gastric lavage - Urinalysis
DIAGNOSIS
o Trendelenberg Psn – Shock - Blood exam (CBC, Leukopenia/leukocytosis/complement
o Nasal Packing with Epinephrine – Epistaxis fixation or hemogglutinin test)
o No IM - Protect eyes of patients from glare of strong light as
they are apt to be inflamed.
 COMPLICATION:
NURSING CARE - Keep patient in an adequate ventilated room but free
o Metabolic acidosis
from drafts and chilling to avoid complications of
o Hyperkalemia
pneumonia.
o Myocarditis
o Uterine bleeding - Bronchopneumonia - Otitis media
o Hemorrhage COMPLICATIONS - Pneumonia - Bronchitis
o Tissue anoxia - Nephritis - Encephalitis
 DOH program for the control of DHF - Isoprenosine
o Seek and destroy breeding places TREATMENT - Antibiotics if w/complications
o Say no to left and right defogging - Supportive therapy (O2 inhalation, IV fluids)
o Seek early consultation

DIPTHERIA
MEASLES
 Acute Contagious Disease
 Acute highly communicable infection.
 Characterized by generalized systemic toxemia from a localized inflammatory focus
 Death is due to complication.
 Produces exotoxin
ETIOLOGIC AGENT Filterable virus: genus Morbillivirus, family Paramyxoviridae
 Capable of damaging muscles especially cardiac, nerve, kidney and liver.
- Droplet spread
MODE OF
- Direct Contact
TRANSMISSION ETIOLOGIC AGENT Corynebacterium diphtheria (Klebs-Loeffler bacillus)
- Airborne
MODE OF Contact with a patient or carrier or with articles soiled with
- 10 days from exposure to appearance of fever.
INCUBATION PERIOD TRANSMISSION discharges of infected persons. Milk has served as a vehicle.
- 14 days until rash appears.
INCUBATION PERIOD 2-5 days
PERIOD OF 9 days
PERIOD OF Variable until virulent bacilli has disappeared from secretion
COMMUNICABILITY
COMMUNICABILITY and lesions; usually 2 weeks and seldom more than 4 weeks.
PATHOGNOMONIC SIGN Rashes
SIGNS AND SYMPTOMS - Low grade fever
SIGNS AND SYMPTOMS - Fever
- Pseudomembrane (thin layer of gray smooth and spider-
web like structure that bleeds when detached)
 - Nasal INCUBATION PERIOD Average of 2 weeks
 Serous to serosanguinous to mucopurulent PATHOGNOMIC SIGN Rose spots (abdominal rashes)
discharge and excoriating anterior nares. - Rose spots
Pseudomembrane on septum. - Stepladder fever (40-41 deg)
- Faucial and pharyngeal - Gead ache
 Pseudomembrane on faucial and pharyngeal area - Abdominal pain
(slough off 7-10 days) - Constipation (adult)
 Bull neck (Cervical adenitis) SIGNS AND SYMPTOMS
- Mild diarrhea (child)
 Sore throat causing dysphagia - Anorexia
- Laryngeal - Slow pulse
 Laryngeal obstruction (stridor, hoarseness) - Ulceration of Peyer’s Patches
 Dry metallic cough - Spleenomegaly
 Membrane cough out 6-10 days PERIOD OF - As long as patient is excreting the microorganism
- Infants born of mothers who had diphtheria infection COMMUNICABILITY
SUSCEPTIBILITY AND
are relatively immune but that immunity disappears - Blood examination
RESISTANCE
before the 6th month.  WBC (Leukopenia with Lymphocytosis)
- Culture specimen from beneath membrane (Reliable) - Blood culture (1st week)
- Gram stain of fluorescent antibody stain (Not reliable) - Urine culture (2nd week)
DIAGNOSIS DIAGNOSIS
- Maloney test – determines hypersensitivity to - Stool culture (3rd week)
diphtheria toxoid. - Typhidot – confirmatory
MANAGEMENT ISOLATION!!! - ELISA
TREATMENT Penicillin | Erythromycin - Widal test
- Toxic Myocarditis > due to toxins in the heart muscles - Chloramphenicol (can cause bone marrow suppression)
(10th – 14th day) - Amoxicillin
- Neuritis > Cause by absorption of toxin in the nerve MANAGEMENT - Sulfonamides
COMPLICATIONS  Palate paralysis ( 2nd week) – Aspiration - Ciprofloxacin
 Ocular palsy (5th week) – Opthalmalgia - Ceftriaxone
 Diaphgram paralysis (6th – 10th week) – GBS - Typhoid Psychosis
 Motor and skeletal muscle paralysis - Typhoid Ilitis
- Hemorrhage or perforation( the 2 most dreaded
complications)
TYPHOID FEVER COMPLICATION
- Peritonitis |Bronchitis & Pneumonia
- Thrombosis & embolism
 A.K.A : Stepladder fever - Early Heart Failure
 Occurs more common in May to August - Typhoid spine or neuritis
- Septicemia
ETIOLOGIC AGENT Salmonella typhosa - Reiter’s Syndrome( joint pain)
MODE OF
TRANSMISSION Fecal/oral route
LEPTOSPIROSIS  Excessive Motor Activity
 Hypersensitivity to bright light, loud noise
 A.K.A : Weil’s disease | Mud fever | Trench fever | Flood Fever | Spiroketal jaundice  Hypersalivation
| Japanese Seven Days fever.  Dilated Pupils
 MAIN HOST: Rat o Brainstem Dysfunction
 Dysphagia
 Hydrophobia
ETIOLOGIC AGENT Leptospira interrogans  Apnea
MODE OF Contact of the skin ( Open wounds with water, moist soil or o Death
TRANSMISSION vegetation contaminated with urine of infected host.
 Healthy dog is observed for 14 days, if it dies and shows signs of rabies, consult a
INCUBATION PERIOD 7-19 days | Average of 10 days
physician.
- Leptospiremic phase
 Present in blood and CSF.  Kill rabid dog and bring head for examination (positive for negri bodies)
 Abrupt fever
 Headcahe ETIOLOGIC AGENT RNA virus | rhabdovirus of genus lyssavirus
SIGNS AND SYMPTOMS  Myalgia MODE OF
 Nausea and vomiting TRANSMISSION Animal bite
 Cough and chest pain INCUBATION PERIOD 4 days – 19 years
- Immune phase PERIOD OF
COMMUNICABILITY In dogs and cats, for 3-10 days before onset of clinical signs.
- BUN - Sense of apprehension
DIAGNOSIS - ELISA - Headache
- AST | ALT | GGT | LAAT | LAT - Fever
- Penicillins - Sensory change near the site
TREATMENT - Tetracycline (Doxycycline at 100mg q 12h p.o) - Spasms of muscles or deglutition on attempts to
SIGNS AND SYMPTOMS
- Erythromycin 500mg q 12h p.o swallow
- Hydrophobia and Fear of Air
- Paralysis
- Delirium
RABIES - Convulsion
SUSCEPTIBILITY AND Warm blooded mammals.
 Acute Viral Encephalomyelitis RESISTANCE Natural immunity in man is unknown.
 4 STAGES DIAGNOSIS - FAT (Fluorescent antibody test)
o Prodrome - Intensive supportive symptomatic care
 Fever - Proper wound care
MANAGEMENT - Active immunization by rabies vaccine
 Headache
- Passive immunization by Rabies Human immunoglobulin
 Paresthesia (IM)
o Encephalitic
  TREATMENT: - Hemorrhagic rash
o Post-exposure Prophylaxis - From few petechial rash to wide spread purpura
 Active vaccine (PDEV, PCEC, PVRV) - Ecchymoses
- Meningeal irritation (Headache, N&V, Stiff neck, Bulging
 ID (0, 3, 7, 30, 90)
fontanel(infant), Seizure, Convulsion and Sensorial
 IM (0, 3, 7, 14, 28) changes)
 Passive vaccine
 ERIG wt. in kg x .2 = cc to be injected IM(ANST) - Blood culture
 HRIG wt. in kg x .1333 = cc to be injected DIAGNOSIS - Gram stain of peripheral smear, CSF and skin lesion
- CBC
o Pre-exposure Prophylaxis - Penicillin 250k-400k u/kg/day
TREATMENT
- Chloramphenicol 100mg/kg/day
 ID | IM (0, 7, 21) every 2 years
- Rifampicin 300-600 mg q 12 hrs x 4doses
CHEMOPROPHYLAXIS - Ofloxacin 400 mg single dose
MENINGOCOCCEMIA - Ceftriaxone 125-250mg I single dose.

 Sporadic
 NATURAL RESERVOIR: Human Nasopharynx
 CLASSIFICATION:
o Meningococcemia
 Spiking fever
 Chills
 Arthralgia
 Sudden hemorrhagic rash
o Fulminant Meningococcemia
 Septic shock
 Hypotension
 Tachycardia
 Adrenal insufficiency

ETIOLOGIC AGENT Neisseria meningitides, a gram (-) diplococcus

MODE OF
TRANSMISSION Airborne | Close contacts
INCUBATION PERIOD 1-3 days
- High grade fever (for the 1st 24 hours)
SIGNS AND SYMPTOMS - Weakness
- Joint and muscle pain