Created by: Michael Anthony C.

Macaballug, R.N.

Medical microbiology- the study of

the pathogenic microbes and the role
of microbes in human illness.
Includes the study of microbial
pathogenesis and epidemiology and is
related to the study of disease
pathology and immunology.

Bacteria- are a large domain of

prokaryotic microorganism. Typically a
few micrometres in length, bacteria have a
wide range of shapes, ranging from
spheres to rods and spirals. Bacteria are
present in most habitats on Earth, growing
in soil, acidic hot springs, radioactive
waste, water, and deep in the Earths crust,
as well as in organic matter and the live
bodies of plants and animals, providing
outstanding examples of mutualism in the
digestive tracts of humans, termites and
cockroaches.

Virus- a small infectious agent that can

replicate only inside the living cells of an
organism. Viruses can infect all types of
organism.

Virulence- the relative capacity of a

pathogen to overcome body defenses.

Fungus- any of the kingdom Fungi

of saprophytic and parasitic sporeproducing eukaryotic typically
filamentous organisms formerly
classified as plants that lack
chlorophyll and include molds,
rusts, mildews, smuts, mushrooms,
and yeasts.

Protozoa- are a diverse group of

unicellular eukaryotic organisms, many of
which are motile.
Cell- the basic and functional unit of all
known living organisms. It is the smallest
unit of life that is classified as a living
thing, and is often called the building
block of life.

Beginning is the invention of the

microscope
Anton van Leewenheok
1673-1723
Described live microorganism

Golden age of microbiology

1857-1914
Concepts
Pure

culture of bacteria
Relationships between microbes and disease
Anti-microbial drugs
Louis Pasteur
Appreciation of microbial causes of things
(such as disease)
Fermentation

 Pasteurization-

kills the agent that causes

spoiling with heat
Developed the branch of microbiology
known as Immunology
Robert Koch
Proved that specific microbe causes
specific disease.
Discovered several more specific
microbes
1. Bacillus antracis- Anthrax

2. Mycobacterium tuberculosis
3. Vibrio cholerae
His methods (postulate)
Make an association between an organism
and a disease.
Isolate the microorganism in a pure
culture.
Use the pure culture to infect an
experimental animal and observe similar
disease.

You must be able to isolate the

microorganism from the test animal
Koch invented photomicroscopy and perfected
solid media
Also developed the branch of microbiology
known as bacteriology.
Vaccination
1786 Edward Jenner inoculated a person with
cowpox who was protected from smallpox
afterward.
Vaccination comes from the word vacca (cow)

Attenuated: causes mild illness and then immunity.

Modern developments
Chemotherapy
Treated with chemicals
Can be used to treat infectious disease
Synthetic drugs
Quinine: Malaria
Antibiotics
Chemicals produced by bacteria that kills other
bacteria
Normal Microbiota or normal flora
The microbes normally present in and on the
human body

Prevents osmotic lyses

This is when a cell explodes because the
environment is more dilute than the cell.
But it lets water in, because the cell needs a
lot of water for certain functions.
Turgor pressure causes lyses
Cell wall resist this pressure

Turgor pressure- the tension in cells caused

by water pressing against the walls of the
membrane

The polypeptides are short amino acid chains.

A special kind of amino acids found on some
bacteria and is called B amino acids.
They are used for protection from lysosomes
and other eukaryotic cells that would engulf the
cell, but cannot breakdown these amino acids
Some drugs target these amino acids to destroy
certain bacteria.
In gram positive cells
Layers of straps (peptidoglycan) on top of the
cell membrane
Very thick
Provides osmotic protection with its thickness

In gram negative cells

Only a single layer of peptidoglycan
Not a good barrier to turgor pressure
Not the same as the cytoplasmic membrane
Lipid A: endotoxin
o When a cell is ingested by a lysosome, it
releases this
o The release of endotoxin causes
overreactions
Gram stains
In a gram positive cell, you can see staining

Communicable disease is an illness caused by an

infectious agent or its toxic products that are
transmitted directly or indirectly to a well person
through an agency, and a vector or an inanimate
object.
Infection- invasion and multiplication of
microorganisms on the tissues of the host
resulting to signs and symptoms as well as
immunologic response.

1.

2.

3.

4.

5.

The nature of the specific microorganism and its

capacity for survival both within and outside the
body.
The most effective method of destruction of the
specific organism.
How the organism invades the host and its route to
escape from the body.
The incubation period, prodromata, and the
length of communicability.
How a specific drug alters the clinical signs and the
infectious course of the diseases.

6.

7.

The most recent methods and concepts of

prophylaxis for communicable diseases.
The rationale and control measures, including
isolation techniques.

Is a disease of the human immune system caused by

the human immunodeficiency virus (HIV).
During the initial infection a person may experience a
brief period of influenza-like illness. This is then
typically followed by a prolonged period of without
symptoms.
As the illness progresses it interferes more and more
with the immune system, making people much more
likely to get infections, including opportunistic
infections and tumors that do not usually affect
people with working immune systems.

Mode of Transmission:
1. Sexual intercourse
The majority of HIV infections are acquired
through unprotected sexual relations where one
partner has HIV.
Worldwide, sexual contact between members
of the opposite sex, rather than between
members of the same sex, result in most cases
of transmission.
In the United States of America, as of 2009,
most sexual transmission occurred in men who
have sex with men with this population
accounting for 64% of all new cases.

2.

3.

Body fluids
The second most frequent mode of HIV
transmission is via blood and blood products. It
is not possible for mosquitoes or other insects to
transmit HIV.
Blood transfusions with infected blood result in
transmission of infection 93% of the time.
Mother-to-child
HIV can be transmitted from mother to child
during pregnancy, during delivery, and after
delivery via breastfeeding.
It is the third most common way HIV is
transmitted globally.

4.

Needle stick injury

The most common transmission of HIV to
health care professionals.
A high percentage of health care professionals
does not report needle puncture to Infectious
Disease Committee (IDC).
Proper handling and disposal of sharps
prevents transmission of HIV to health care
providers.
The sharing of needles for drug addicts
increases the risk of HIV exposure.

Disease staging:
The United States Center for Disease Control and
Prevention updated their classification system for
HIV/AIDS in 2008. In this system HIV infections
are classified based on CD4 count and clinical
symptoms.

Stage 1: CD4 count 500 cells/uL and no AIDS

defining conditions
Stage 2: CD4 count 200 to 500 cells/uL and no AIDS
defining conditions
Stage 3: CD4 count 200 cells/uL or AIDS defining
conditions

Unknown: if insufficient information is known to

make one of the above classifications

Prevention:
1. Sexual contact
Consistent use of condom reduces the risk of HIV
transmission by approximately 80% over the long
term
Circumcision in sub-Saharan Africa reduces the
risk of HIV infection in heterosexual men by 38
percent and 66 percent over two years
Comprehensive sexual education provided at
school may decrease high risk behavior. A
substantial minority of young people continue to
engage in high-risk practices despite HIV/AIDS
knowledge, underestimating their own risk of
becoming infected with HIV.

Pre-exposure:
Early treatment of HIV-infected people with
antiretrovirals protected 96% of partners from
infection.
Pre-exposure prophylaxis with a daily dose of the
medications tenofovir with or without
emtricitabine is effective in a number of groups
including: men who have sex with men, couples
where one is HIV positive, and young
heterosexuals in Africa.
Universal precaution within the health care
environment are believed to be effective in
decreasing the risk of HIV.

Post exposure:

A course of antiretrovirals administered within 48 to

72 hours after exposure to HIV positive blood or
genital secretions is referred to as post exposure
prophylaxis.
The use of the single agent zidovudine reduces the
risk of subsequent HIV infection fivefold following a
needle stick injury.
Current treatment regimes typical use
lopinavir/ritonavir and lamivudine/zidovudine or
emtricitabine/tenofovir and may decrease the risk
further.
The duration of treatment is usually four weeks and is
associated with significant rates of adverse effects (for
zidovudine ~70% including: nausea 24%, fatigue
22%, emotional distress 13%, headaches 9%).

Mother-to-Child:
Programs to prevent the transmission of HIV
from mothers to children can reduce rates of
transmission by 9299%.
This primarily involves the use of a combination
of antivirals during pregnancy and after birth in
the infant but also potentially include bottle
feeding rather than breastfeeding.
If exclusive breast feeding is carried out the
provision of extended antiretroviral prophylaxis to
the infant decreases the risk of transmission.

Vaccination:
As of 2012 there is no effective vaccine for
HIV/AIDS.
Management:
There is no cure or effective HIV vaccine.
Treatment consist of high active retroviral therapy
(HAART) which slows progression of the disease
and as of 2010 more than 6.6 million people were
taking them in low and middle income countries.
Treatment also includes preventive and active
treatment of opportunistic infections.

High Active Antiretroviral Therapy (HAART):

Current HAART options are combinations (or
"cocktails") consisting of at least three medications
belonging to at least two types, or "classes," of
antiretroviral agents.
Initially treatment is typically, a non-nucleoside
reverse transcriptase inhibitor (NNRTI) plus two
nucleoside analogue reverse transcriptase
inhibitors (NRTIs).
Typical NRTIs include: zidovudine (AZT) or
tenofovir (TDF) and lamivudine (3TC) or
emtricitabine (FTC).

Combinations of agents which include a protease

inhibitors (PI) are used if the above regime loses
effectiveness.
When to start antiretroviral therapy is subject to
debate. Both the World Health Organization,
European guidelines and the United States
recommends antiretrovirals in all adolescents,
adults and pregnant women with a CD4 count less
than 350/uL or those with symptoms regardless of
CD4 count. This is supported by the fact that
beginning treatment at this level reduces the risk
of death.

Once treatment is begun it is recommended that it is

continued without breaks or "holidays".
Many people are diagnosed only after when treatment
ideally should have begun.
The desired outcome of treatment is a long term
plasma HIV-RNA count below 50 copies/mL.
Levels to determine if treatment is effective are
initially recommended after four weeks and once
levels fall below 50 copies/mL checks every three to
six months are typically adequate.
Inadequate control is deemed to be greater than
400 copies/mL.
Based on these criteria treatment is effective in more
than 95% of people during the first year.

Benefits of treatment include a decreased risk of

progression to AIDS and a decreased risk of
death.
With treatment there is a 70% reduced risk of
acquiring tuberculosis.
Additional benefits include a decreased risk of
transmission of the disease to sexual partners and
a decrease in mother to child transmission.
Adverse effects:
Some relatively common ones include:
lipodystrophy syndrome, dyslipidemia, and
diabetes mellitus especially with protease
inhibitors.

Other common symptoms include: diarrhea, and

an increased risk of cardiovascular disease.
Adverse effects are however less with some of the
newer recommended treatments.
Cost may be an issue with some medications being
expensive however as of 2010, 47% of those who
needed them were taking them in low and middle
income countries.
Certain medications may be associated with birth
defects and thus not suitable for women hoping to
have children.

Common Opportunistic Infections:

Pneumocystis carini pneumonia
Oral candidiasis
Toxoplasmosis of CNS
Chronic diarrhea/ wasting syndrome
Pulmonary or extra pulmonary tuberculosis
Cancers (Kaposis sarcoma, cervical dysplasia and
cancer, Non-Hodgkins lymphoma)
Prognosis:
HIV/AIDS has become a chronic rather than an
actually fatal disease in many areas of the world.

Prognosis varies between people and both the

CD4 count and viral load are useful for predicted
outcomes.
Without treatment, average survival time after
infection with HIV is estimated to be 9 to
11 years, depending on the HIV subtype.
After the diagnosis of AIDS, if treatment is not
available, survival ranges between 6 and
19 months.
HAART and appropriate prevention of
opportunistic infections reduces the death rate by
80%, and raises the life expectancy for a newly
diagnosed young adult to 2050 years.

Tuberculosis co-infection is one of the leading causes

of sickness and death in those with HIV/AIDS being
present in a third of all HIV infected people and
resulting in 25% of HIV related deaths.
The two most common cancers associated with
HIV/AIDS are Kaposi's sarcoma and AIDS-related
non-Hodgkin's lymphoma.
Stigma:

AIDS stigma exists around the world in a variety

of ways, including ostracism, rejection,
discrimination and avoidance of HIV infected
people; compulsory HIV testing without prior
consent or protection of confidentiality; violence
against HIV infected individuals or people who
are perceived to be infected with HIV; and the
quarantine of HIV infected individuals.

Is a common, and in many cases lethal, infectious

disease caused by various strains of mycobacteria,
usually Mycobacterium tuberculosis.
Tuberculosis typically attacks the lungs, but can
also affect other parts of the body. It is spread
through the air when people who have an active
TB infection cough, sneeze, or otherwise
transmit their saliva through the air.

Signs and symptoms:

Risk factors:
HIV
Overcrowding and malnutrition
Inject illicit drugs
Medically underprivileged and resource poor
communities
Children in close contact with high-risk category
patients
Health care providers serving these patients
Cigarette smokers
Alcoholism
Diabetes mellitus

Transmission:
Sneeze
Speak
Sing or spit
A single sneeze can release up to 40,000 droplets
Airborne
Diagnosis:
(+) constitutional symptoms lasting longer than 2 weeks
Chest x-ray
Sputum AFB x 3 takes
Sputum Gram Staining and Culture Sensitivity test (GSCS)
Mantoux tubercullin skin test or Purified Protein
Derivatives test (PPD)

Prevention:
Vaccines (BCG)
Public Health
WHO declared TB a global health
emergency
Global Plan to Stop Tuberculosis
Aims to save 14 million lives between its launch
and 2015
A number targets they have set are not likely to
be achieved by 2015, mostly due to the increase
in HIV-associated tuberculosis and the
emergence of Multiple Drug-Resistant
Tuberculosis (MDR-TB)

Treatment:
H- INH (Isoniazid)
R- Rifampicin
Z- Pyrazinamide
E- Ethambutol
S- Streptomycin
PTB Category
New- a patient who has never had treatment for TB or
who has taken anti-tuberculosis drugs for less than 1
month (Category I)
Relapse- a patient previously treated for TB who has
been declared cured or treatment completed, and is
diagnosed with bacteriologically positive (smear or
culture) (Category II)

Treatment after failure- a patient who is started on a retreatment regimen after having failed previous treatment.
Treatment after default- a patient who returns to
treatment, positive bacteriologically, following
interruption of treatment for 2 months or more.
Transfer in- a patient who has been transferred from
another TB register to continue treatment.
Other- all cases that do not fit the above definitions.
This group includes chronic case, a patient who is
sputum positive at the end of re-treatment regimen.
Note: Smear-negative pulmonary and extrapulmonary
cases may also be relapses, failures, returns after default
or chronic cases. This should, however, be a rare event,
supported by pathological or bacteriological evidence
(culture).

Category I and III treatment

2 HRZE
(Isoniazid+Rifampicin+Pyrazinamide+Ethambutol)
4 HR (Isoniazid+Rifampicin)

Category II
2 HRZES
(Isoniazid+Rifampicin+Pyrazinamide+Ethambutol+Strept
omycin)
1 HRZE
5 HRE
Category IV
Specially designed standardized or individualized regimens

Health Teachings:
Always wear face mask for the first month of
treatment.
Intake of medicine must be at the same time of
the day for the whole duration of treatment.
Eat high protein foods.
Weight gain is normal but should be monitored
for dosage of medicine.
Avoid sneezing and coughing in public places.
Body weakness is normal during the first month of
treatment.

Is an inflammatory condition of the lung especially

affecting the microscopic air sacs (alveoli).
Pneumonia is typically caused by an infection but
there are number of other causes.
Infectious agents include: bacteria, viruses, fungi,
and parasites.
Although pneumonia was regarded by William
Osler in the 19th century as the captain of the
men of death the advent of antibiotic therapy and
vaccines in the 20th century have seen radical
improvements in survival outcomes.

Signs and symptoms:

Etiologic agent:
Bacteria are the most common cause of
community acquired pneumonia, with
Streptococcus pneumoniae isolated in nearly 50%
of cases.
Other commonly isolated bacteria include:
Haemophilus influenzae in 20%, Chlamydophila
pneumoniae in 13%, Mycoplasma pneumoniae in
3%,
Staphylococcus aureus, Moraxella catarrhalis,
Legionella pneumophila and gram-negative bacilli.

In adults, viruses account for approximately a third of

pneumonia cases.
Commonly implicated agents include: rhinoviruses,
coronaviruses, respiratory syncytial virus (RSV),
adenovirus, and parainfluenza.
Herpes simplex virus is a rare cause of pneumonia,
except in newborns.
People with weakened immune systems are at
increased risk of pneumonia caused by cytomegalovirus
(CMV).
Fungal pneumonia is uncommon, but it may occur in
individuals with weakened immune system due to
AIDS, immunosuppresive drugs or other medical
problems.

Fungal pneumonia is most often caused by

Histoplasma capsulatum, blastomyces,
Cryptococcus neoformans, Pneumocystis jiroveci,
and Coccidioides immitis.
The most common parasites causing pneumonia
are Toxoplasma gondii, Strongyloides stercoralis,
and Ascariasis.

Diagnosis:
Chest x-ray
Chest CT-scan
Sputum culture
Complete blood count
Serum electrolytes
Crackles upon auscultation

Prevention:
Vaccination
is effective for preventing certain bacterial and
viral pneumonias in both children and adults.
Vaccinations against Haemophilus influenzae
and Streptococcus pneumoniae have good
evidence to support their use.
A vaccine against Streptococcus pneumoniae is
also available for adults, and has been found to
decrease the risk of invasive pneumococcal
disease.
Influenza vaccines are modestly effective against
influenza A and B.

Environmental- reducing air pollution as is smoking

cessation.
Management:
Typically, oral antibiotics, rest, simple analgesics and
fluids suffice for complete resolution.
Antibiotics improve outcomes in those with bacterial
pneumonia.
In the UK, empiric treatment with Amoxicillin is
recommended as the first line for communityacquired pneumonia, with Doxycycline or
Clarithromycin as alternatives.
In North America, where the atypical forms of
CAP are more common, macrolides (e.g.
Azithromycin), and Doxycycline have displaced
Amoxicillin as first-line outpatient treatment in adults.

Neuraminidase inhibitors may be used to treat viral

pneumonia caused by influenza viruses (influenza A
and influenza B).
Fluid hydration
Prognosis:
With treatment, most types of bacterial pneumonia
can be cleared within two to four weeks and mortality
is very low.
Viral pneumonia may last.
The eventual outcome of an episode of pneumonia
depends on how ill the person is when he or she was
first diagnosed.
Before the advent of antibiotics mortality was
typically 30% for hospitalized patients.

The death rate (or mortality) also depends on the

underlying cause of the pneumonia. Pneumonia
caused by Mycoplasma, for instance, is associated
with lower mortality. However, about half of the
people who develop methicillin-resistant
Staphylococcus aureus (MRSA) pneumonia while on
a ventilator will die.
In regions of the world without advanced health care
systems, pneumonia is even more deadly. Limited
access to clinics and hospitals, limited access to x-rays,
limited antibiotic choices, and inability to diagnose
and treat underlying conditions inevitably lead to
higher rates of death from pneumonia. For these
reasons, the majority of deaths in children under five
due to pneumococcal disease occur in developing
countries.

Are illnesses that have a significant probability of

transmission between humans by means of human
sexual behavior, including vaginal intercourse, oral
sex, and anal sex.
STI affect men and women of all ages and
backgrounds, including children.
STI have become more common in recent years,
partly because people are becoming sexually active
at a younger age, are having multiple sexual
partners, and do not use preventive methods to
lessen their chance of acquiring STI.

People can pass STI to sexual partners even if

they themselves do not have any symptoms.
Frequently, STI can be present but cause no
symptoms, especially in women (for example
chlamydia, genital herpes, or gonorrhea).

Hepatitis B

Is an infectious inflammatory illness of the liver

caused by the Hepatitis B virus (HBV) that affects
humans.
The virus is transmitted by exposure to infectious
blood or body fluids such as semen and vaginal
fluids, while viral DNA has been detected in the
saliva, tears, and urine of chronic carriers.

Signs and symptoms:

Acute infection with hepatitis B virus is associated with
acute viral hepatitis- an illness that begins with general illhealth, loss of appetite, nausea, vomiting, body aches,
mild fever, and dark urine, and then progresses to
development of jaundice.
The illness lasts for a few weeks and then gradually
improves in most affected people.
The infection may be entirely asymptomatic and may go
unrecognized.
Chronic infection with hepatitis B virus either may be
asymptomatic or may be associated with a chronic
inflammation of the liver (chronic hepatitis), leading to
cirrhosis over a period of several years.

Transmission:
Possible forms of transmission include sexual
contact, blood transfusions, re-use of
contaminated needles and syringes, and vertical
transmission from mother to child during
childbirth.
Without intervention, a mother is positive for
HBsAg confers a 20% risk of passing the infection
to her offspring at the time of birth.
Diagnosis:
The hepatitis B surface antigen (HBsAg) is most
frequently used to screen for the presence of this
infection.

It is the first detectable viral antigen to appear

during infection.
Shortly after the appearance of the HBsAg,
another antigen called hepatitis B e antigen
(HBeAg) will appear.
A person negative for HBsAg but positive for antiHBs either has cleared an infection or has been
vaccinated previously.
Individuals who remain HBsAg positive for at
least six months are considered to be hepatitis B
carriers.

Prevention:
Several vaccines have been developed for the
prevention of hepatitis B virus infection.
These rely on the use of one of the viral envelope
proteins (hepatitis B surface antigen or HBsAg).
The vaccine was originally prepared from plasma
obtained from people who had long-standing
hepatitis B virus infection.
One cannot be infected with hepatitis B from this
vaccine.

The risk of transmission from mother to newborn

can be reduced from 2090% to 510% by
administering to the newborn hepatitis B vaccine
(HBV 1) and hepatitis B immune globulin
(HBIG) within 12 hours of birth, followed by a
second dose of hepatitis B vaccine (HBV 2) at 1
2 months and a third dose at and no earlier than
6 months (24 weeks).
Treatment:
The hepatitis B infection does not usually require
treatment because most adults clear the infection
spontaneously.

Early antiviral treatment may be required in fewer

than 1% of people, whose infection takes a very
aggressive course (fulminant hepatitis) or who are
immunocompromised.
On the other hand, treatment of chronic infection
may be necessary to reduce the risk of cirrhosis
and liver cancer.
Chronically infected individuals with persistently
elevated serum alanine aminotransferase, a
marker of liver damage, and HBV DNA levels are
candidates for therapy.

Treatment lasts from six months to a year,

depending on medication and genotype.
Although none of the available drugs can clear the
infection, they can stop the virus from replicating,
thus minimizing liver damage.
Currently, there are seven medications licensed
for treatment of hepatitis B infection in the United
States.
These include antiviral drugs lamivudine (Epivir),
adefovir (Hepsera), tenofovir (Viread), telbivudine
(Tyzeka) and entecavir (Baraclude), and the two
immune system modulators interferon alpha-2a
and PEGylated interferon alpha-2a (Pegasys).

Prognosis:
Hepatitis B virus infection may be either acute (selflimiting) or chronic (long-standing). Persons with selflimiting infection clear the infection spontaneously
within weeks to months.
Children are less likely than adults to clear the
infection.
More than 95% of people who become infected as
adults or older children will stage a full recovery and
develop protective immunity to the virus.
However, this drops to 30% for younger children, and
only 5% of newborns that acquire the infection from
their mother at birth will clear the infection.

It is a bacterial infection of the urethra in men and

the urethra, cervix, or both in women.
Gonorrhea can also affect the rectum, anus,
throat, pelvic organs, and in rare cases, the
conjunctiva, which is the membrane that lines the
eyelid and eye surface.
Popular names for gonorrhea are clap, drip, dose,
and strain.
Causative agent:
Neisseria gonorrhea. This bacterium has a pili
attached to the mucosal tissue of the humans.

Diagnosis:

Gonorrhea that is present in the cervix or urethra

can be diagnosed in a laboratory by testing a urine
sample.
Gram staining of sample from urethra or cervix
allows the doctor to see gonorrhea bacterium
under a microscope.
Incubation period:
The symptom usually have an incubation period of
3-5 days and during the 3rd day the symptoms may
reveal themselves.

Signs and symptoms:

Men:
Burning sensation during urination
Yellowish-white discharge from the penis
Painful and swollen testicles
Women:
Increased vaginal discharge
Painful or burning sensation when urinating
Vaginal bleeding between periods

Medical management:

Previously, a class of antibiotics known as the

fluoroquinolones [examples are ciprofloxacin (Cirpo,
Cipro XR), ofloxacin (Floxin), and levofloxacin
(Levaquin)] was widely used in the treatment of
gonorrheal infection.
Because of increasing resistance of many tested
samples of N. gonorrheae to the fluoroquinolone
drugs, the CDC now recommends that only one class
of antibiotics, the cephalosporins, be used to treat
gonorrheal infections.
The cephalosporins include cefotaxime (Claforan),
cephalexin (Keflex, Keftabs), cefaclor (Ceclor),
cefoxitin (Mefoxin), ceftazidime (Ceptaz), cefixime
(Suprax), and many other antibiotics.

Have your sexual partner be treated for gonorrhea as

well.
Abstain from sex until your symptoms clear up, and
for at least 7 days after the start of treatment, in order
no to infect your sexual partners.
If abstaining is not possible, make certain to use
condoms for all sexual encounters- including oral sex.
Because people who are infected with gonorrhea
once are likely to become infected again, many
doctors recommend that patients with a gonorrhea
diagnosis return 3 months later for a check up.
This is not because treatment is ineffective, but to
make certain that you have not been re-infected by
your partners.

Is caused by the single-celled protozoan parasite

producing mechanical stress on host cells and
then ingesting cell fragments after cell death.
It is the most common sexually transmitted
disease, affecting about 120 million women
worldwide each year.
Causative agent:

Trichomonas vaginalis
Diagnosis:
Vaginal swab

Signs and symptoms:

Men
Irritation inside the penis
Mild discharge
Slight burning after urination or ejaculation
Women
Frothy; yellow-green vaginal discharge with a
strong odor
Treatment:
Metronidazole 2000 mg once
Avoid intake of alcoholic beverages

Caused by the spirochete bacterium

The primary route of transmission is through
sexual contact
It may also be transmitted from mother to fetus
during pregnancy or at birth, resulting in
congenital syphilis
Syphilis is believed to have infected 12 million
people worldwide in 1999, with greater than 90%
of cases in the developing world.
Causative agent:

Treponema pallidum

Signs and symptoms:

Syphilis can present in one of four different stages:
primary, secondary, latent, and tertiary, and may also
occur congenitally.
Primary
Approximately 3 to 90 days after the initial exposure
(average 21 days) a skin lesion, called a chancre,
appears at the point of contact.
This is classically (40% of the time) a single, firm,
painless, non-itchy skin ulceration with a clean base
and sharp borders between 0.3 and 3.0 cm in size.
In the classic form, it evolves from a macule to a
papule and finally to an erosion or ulcer.
The most common location in women is the cervix
(44%), the penis in heterosexual men (99%), and anally
and rectally relatively commonly in men who have sex
with men.

Secondary

Secondary syphilis occurs approximately four to ten

weeks after the primary infection.
While secondary disease is known for the many
different ways it can manifest, symptoms most
commonly involve the skin, mucous membranes, and
lymph nodes.
There may be a symmetrical, reddish-pink, non-itchy
rash on the trunk and extremities, including the palms
and soles.
The rash may become maculopapular or pustular.
It may form flat, broad, whitish, wart-like lesions
known as condyloma latum on mucous membranes.
All of these lesions harbor bacteria and are infectious.
Other symptoms may include fever, sore throat,
malaise, weight loss, hair loss, and headache.

Latent

Latent syphilis is defined as having serologic proof of

infection without symptoms of disease.
Late latent syphilis is asymptomatic, and not as
contagious as early latent syphilis.
It is further described as either early (less than 1 year
after secondary syphilis) or late (more than 1 year after
secondary syphilis) in the United States.
The United Kingdom uses a cut-off of two years for
early and late latent syphilis.
Early latent syphilis may have a relapse of symptoms.

Tertiary

Tertiary syphilis may occur approximately 3 to 15 years

after the initial infection, and may be divided into three
different forms: gummatous syphilis (15%), late
neurosyphilis (6.5%), and cardiovascular syphilis (10%).
People with tertiary syphilis are not infectious.
Gummatous syphilis or late benign syphilis usually occurs 1
to 46 years after the initial infection, with an average of
15 years. This stage is characterized by the formation of
chronic gummas, which are soft, tumor-like balls of
inflammation which may vary considerably in size. They
typically affect the skin, bone, and liver, but can occur
anywhere.
Neurosyphilis refers to an infection involving the central
nervous system.
Cardiovascular syphilis usually occurs 1030 years after the
initial infection. The most common complication is
syphilitic aortitis, which may result in aneurysm formation.

Treatment:
Benzathine penicillin G 1.5 grams IM in a single
dose injection
Or Doxycycline P.O. for 14 days
Syphillis of indeterminate length or more than 1
years duration: Benzathine penicillin G 1.5 grams
IM weekly for 3 weeks or Doxycycline P.O. for
28 days.

Causative agent:
HSV-1 and HSV-2
Incubation period:
2-10 days
Common signs and symptoms:
Painful bumps or sores that crust over and heal in
days
Itching, burning pain in legs, buttocks or genital
area

Vaginal discharge
Pressure in abdomen
Complications:
Recurrent sores
Complications during pregnancy or to the newborn
Death of an infant if there are active lesions during
childbirth
Treatment:
No cure, antiviral drugs can reduce severity and
duration of outbreaks, and can delay recurrences.
Acyclovir P.O. or Famcyclovir P.O. for 7-10 days or
until symptoms resolve

Causative agent:

Chlamydia trachomatis
Signs and symptoms:
In females: asymptomatic but can include
dysuria, mucopurulent vaginal or cervical
discharge, vaginal bleeding or pelvic pain
In males: sometimes asymptomatic but can
include dysuria, white or clear urethral discharge,
testicular pain (epididymitis)

Diagnostic test:

Cultures of tissue from the female endocervix and

urethra, or from the male urethra
Test for antibodies to chlamydia such as Direct
fluorescent antibody (DFA) and Enzyme-linked
immunosorbent assay (ELISA)

Treatment:

Doxycycline P.O. for 7 days or Azithromycin P.O.

once

Complications:

In females: Pelvic Inflammatory Disease, infertility,

pelvic abscess, spontaneous abortion, still-birth
In neonates: Ophthalmia neonatorum or pneumonia
In males: nongonococcal urethritis, epididymitis,
prostatitis, disease transmission

Causative agent:

Condyloma acuminatum

Human papillomavirus (HPV)

Signs and symptoms:
Single or multiple painless warts on genitals or
perianal area
Treatment:
No cure; recurrence in 80% of cases
Client-applied podofilox topical solution or gel or
imiquimod cream

1.
2.
3.
4.
5.

Dengue Fever (Breakbone fever)

Causative Agent: Dengue Virus
Signs and symptoms:
Fever
Petechiae (rashes)
Joint pains
Vomiting and Diarrhea
Hypotension
Mode of Transmission: Vector type
Vector: low flying mosquito (female Aedes
aegypti)

1.
2.
3.
4.

Diagnosis: Complete blood count (CBC),

Tourniquet test (Rumpel-Leede CapillaryFragility Test)
Warning signs: Worsening abdominal pain,
ongoing vomiting, liver enlargement, mucosal
bleeding, high hematocrit and low platelets,
lethargy or restlessness, serosal effusions.
Prevention:
Clean environment (4 Oclock habit)
Avoid indiscriminate fogging
Apply insect repellant to the skin
Cover water containers

1.
2.
3.
4.

5.

Treatment:
Symptomatic management
Provide adequate fluids
Avoid dark colored foods
Avoid intake of thrombolytic meds (Ibuprofen,
Aspirin)
Blood transfusion

II.

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

Chikungunya (CHIKV)
Etiologic agent: Chikungunya virus
Mode of Transmission: Vector type
Vector: Aedes mosquitoes
Signs and symptoms:
Fever
Petechiae or maculopapular rash of the trunk
Arthralgia
Headache
Conjuctivitis
Slight photophobia
Partial loss of taste

Diagnosis: Blood test

Prevention: Same as dengue fever
Treatment: Same as dengue fever

III.

Malaria
Etiologic agent: Plasmodium falciparum,

Plasmodiun vivax, Plasmodium ovale,

Plasmodium malariae

Signs and symptoms: headache, fever,

shivering, joint pain, vomiting, hemolytic
anemia, jaundice, hemoglobin in the urine,
retinal damage, convulsions
Mode of transmission: Vector type
Vector: Anopheles mosquitoes
Diagnosis: Blood test (rapid diagnostic test)

Treatment: Anti-malarial drug (artemisininscombination therapy), amodiaquine,

lumefantrine, mefloquine or
sulfadoxine/pyrimethamine.
Prevention: Same as dengue fever

Leptospirosis

Leptospirosis is a disease that is caused by

pathogenic spirochetes of the genus

Leptospira.

Human leptospirosis is often acquired via

contact with fresh water contaminated by
bovine, rat, or canine urine as part of
occupational contact with these animals.
Causative agent: Spirochaeta interrogans
Signs and symptoms:
Fever (40oC)
Liver enlargement

Oliguria- is defined as a urine output that is

less than 1mL/kg/hr in infants, less than 0.5
mL/kg/hr in children, and less than 400 mL
daily in adults.
Hypotension
Jaundice
Treatment: Leptospirosis is treated primarily
with antimicrobial therapy.
In uncomplicated infections that do not
require hospitalization, oral doxycycline has
been shown to decrease duration of fever and
most symptoms.

Hospitalized patients should be treated with

intravenous penicillin G therapy, the
treatment of choice.
Renal function should be evaluated carefully
and dialysis considered in cases of renal
failure.
Drug of choice: Penicillin G, Doxycycline
(Vibramycin), Cefotaxime, Ceftriaxone
Nursing care:
Weigh patient daily
Assess for signs of renal failure e.g. edema,
oliguria/dysuria

Tepid Sponge Bath (TSB) for fever

Encourage patient to have adequate fluid
intake to avoid volume depletion
In severe cases, electrolyte and protein
restriction in cases of renal insufficiency
Monitor intake and output
Hourly urine monitoring
Regulate IVF especially in fluid challenge
Catheter care

The End