5 Communicable Disease Nursing

I. EPI DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Tuberculosis Mycobacterium Airborne-droplet 1. Usually asymptomatic Diagnostic test: • Respiratory precautions
tuberculosis 2. Low-grade afternoon • Sputum examination or the Acid-fast bacilli • Cover the mouth and
Other names: Direct invasion fever (AFB) / sputum microscopy nose when sneezing to
Koch’s Disease TB bacillus through mucous 3. Night sweating 1. Confirmatory test avoid mode of
Consumption Koch’s bacillus membranes and 4. Loss of appetite 2. Early morning sputum about 3-5 cc transmission
Phthisis Mycobacterium bovis breaks in the skin 5. Weight loss 3. Maintain NPO before collecting sputum • Give BCG
Weak lungs (very rare) 6. Easy fatigability – due 4. Give oral care after the procedure BCG is ideally given at
(rod-shaped) to increased oxygen 5. Label and immediately send to laboratory birth, then at school
Most hazardous period for development of clinical Incubation period : demand 6. If the time of the collection of the sputum is entrance. If given at 12
disease is the first 6-12 months after infection 4 – 6 weeks 7. Temporary amenorrhea unknown, discard months, perform
Highest risk of developing disease is children under 8. Productive dry cough • Chest X-ray is used to: tuberculin testing
3years old 9. Hemoptysis 1. Determine the clinical activity of TB, whether (PPD), give BCG if
TREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS; it is inactive (in control) or active (ongoing) negative.
2. To determine the size of the lesion: • Improve social
Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S)
a. Minimal – very small conditions
CATEGORY 1: 6 CATEGORY 2: 8 CATEGORY 3: 6 SIDE EFFECTS: b. Moderately advance – lesion is < 4 cm
months SCC months SCC months SCC Rifampicin c. Far advance – lesion is > 4 cm
Indications: Indications: Indications: • body fluid • Tuberculin Test – purpose is to determine the SIDE EFFECTS:
> new (+) smear > treatment failure > new (-) smear PTB discoloration history of exposure to tuberculosis Ethambutol
> (-) smear PTB with > relapse with minimal lesions • hepatotoxic Other names: • Optic neuritis
extensive > return after default on CXR Mantoux Test – used for single screening, result • Blurring of vision
• permanent
parenchymal lesions Same meds with discoloration of interpreted after 72 hours (Not to be givento
Intensive Phase:3 mos
on CXR Category 1 contact lenses Tine test – used for mass screening read after 48 children below 6 y.o. due
R&I 1 tab each; P&E 2
> Extrapulmonary TB tabs each Intensive Phase: 2 Isoniazid hours to inability to complain
> severe concominant months Interpretation: blurring of vision)
Streptomycin – 1 • Peripheral
HIV disease vial/day IM for first 2 R&I 1 tab each; P&E 0 - 4 mm induration – not significant • Inability to recognize
neuropathy
Intensive Phase: 2 months = 56 vials (if 2 tabs each 5 mm or more – significant in individuals who green from blue
(Give Vit
months given for > 2mos can Continuation Phase: are considered at risk; positive for patients who Streptomycin
B6/Pyridoxine)
R&I : 1 tab each; P&E cause nephrotoxicity 4 months are HIV-positive or have HIV risk factors and are • Damage to 8th CN
Pyrazinamide
2 tabs each R&I 1 tab each of unknown HIV status, those who are close • Ototoxic
Continuation Phase: 5 • hyperuricemia contacts with an active case, and those who have
Continuation Phase: /gouty arthritis • Tinnitus
months CATEGORY 4: chest x-ray results consistent with tuberculosis.
4 months (increase fluid • nephrotoxic
R&I : 1 tab each Chronic (*Referral 10 mm or greater – significant in individuals
R&I : 1 tab each intake)
E : 2 tabs needed) who have normal or mildly impaired immunity
 6 Communicable Disease Nursing

NATIONAL TB CONTROL PROGRAM: s

MANAGEMENT OF CHILDREN WITH TUBERCULOSIS - for TB symptomatic children
Vision: A country where TB is no longer a public health problem *a TB symptomatic child with either known or
Mission: Ensure that TB DOTS Services are available, accessible, and Prevention: BCG immunization to all infants (EPI) unknown exposure to a TB case shall be referred
affordable to the communities in collaboration with LGUs and others for tuberculin testing
Goal: To reduce prevalence and mortality from TB by half by the year 2015 Casefinding: * (+) contact but (-) tuberculin test and unknown
(Millennium Development Goal) - cases of TB in children are reported and identified in 2 contact but (+) tuberculin test shall be referred for
Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered instances: (a) patient was screened and was found symptomatic CXR examination
2. Detect at least 70% new sputum smear (+) TB cases of TB after consultaion (b) patient was reported to have been *(-) CXR, repeat tuberculin test after 3 months
Objectives: 1. Improve access to and quality of services exposed to an adult TB patient * INH chemoprophylaxis for three months shall be
2. Enhance stakeholder’s health-seeking behavior - ALL TB symptomatic children 0-9 y.o, EXCEPT sputum given to children less than 5y.o. with (-) CXR; after
3. Increase and sustain support for TB control activities positive child shall be subjected to Tuberculin testing (Note: which tuberculin test shall be repeated
4. Strengthen management of TB control activities at all levels
Only a trained PHN or main health center midwife shall do
KEY POLICIES: tuberculin testing and reading which shall be conducted once a Treatment (Child with TB):
*Case finding: week either on a Monday or Tuesday. Ten children shall be Short course regimen
- DSSM shall be the primary diagnostic tool in NTP case finding gathered for testing to avoid wastage. PULMONARY TB
- No TB Dx shall be made based on CXR results alone Intensive: 3 anti-TB drugs (R.I.P.) for 2 months
- All TB symptomatic shall be asked to undergo DSSM before treatment - Criteria to be TB symptomatic (any three of the following:) Continuation: 2 anti-TB drugs (R&I) for 4 months
- Only contraindication for sputum collection is hemoptysis * cough/wheezing of 2 weeks or more
- PTB symptomatic shall be asked to undergo other tests (CXR and culture), * unexplained fever of 2 weeks or more EXTRA-PULMONARY TB
only after three sputum specimens yield negative results in DSSM * loss of appetite/loss of weight/failure to gain weight/weight Intensive: 4 anti-TB drugs (RIP&E/S) for 2 months
- Only trained med techs / microscopists shall perform DSSM faltering Continuation: 2 anti-TB drugs (R&I) for 10 months
- Passive case finding shall be implemented in all health stations * failure to respond to 2 weeks of appropriate antibiotic therapy
for lower respiratory tract infection
*Treatment: Domiciliary treatment – preferred mode of care * failure to regain previous state of health 2 weeks after a viral
DSSM – basis for treatment of all TB cases infection or exanthem (e.g. measles) PERIOD OF COMMUNICABILITY OF
*Hospitalization is recommended: massive hemoptysis, pleural effusion, TUBERCULOSIS:
military TB, TB meningitis, TB pneumonia, & surgery is needed or with -Conditions confirming TB diagnosis (any 3 of the following:)  as long as bacillus is contained in the
complications * (+) history of exposure to an adult/adolescent TB case sputum
*All patients undergoing treatment shall be supervised * (+) signs and symptoms suggestive of TB  Primary complex in children is NOT
*National & LGUs shall ensure provision of drugs to all smear (+) TB cases * (+) tuberculin test contagious
*Quality of fixed-dose combination (FDC) must be ensured * abnormal CXR suggestive of TB  Good compliance to regimen renders
*Treatment shall be based on recommended category of treatment regimen * Lab findings suggestive or indicative of TB person not contagious 2-4 weeks after
DOTS Strategy – internationally-recommended TB control strategy initiation of treatment
Five Elements of DOTS: (RUSAS) - for children with exposure to TB
Recording & reporting system enabling outcome assessment of all patients * a child w/ exposure to a TB registered adult patient shall
Uninterrupted supply of quality-assured drugs undergo physical exam and tuberculin testing
Standardized SCC for all TB cases * a child with productive cough shall be referred for sputum
Access to quality-assured sputum microscopy exam, for (+) sputum smear child, start treatment immediately
Sustained political commitment * TB asymptomatic but (+) tuberculin test and TB symptomatic
but (-) tuberculin test shall be referred for CXR examination
 7 Communicable Disease Nursing

2. Diphtheria Corynebacterium Droplet especially Pseudomembrane – Diagnostic test: DPT immunization

diphtheria secretions from mycelia of the oral mucosa • Nose/throat swab Pasteurization of milk
Types: mucous membranes causing formation of white • Moloney’s test – a test for hypersensitivity to Education of parents
> nasal Klebbs-loffler of the nose and membrane on the diphtheria toxin
> pharyngeal – nasopharynx and oropharynx • Schick’s test – determines susceptibility to ***Infants born to immune
most common from skin and other bacteria mothers maybe protected
> laryngeal – lesions Bull neck Drug-of-Choice: up to 6-9 months. Recovery
most fatal due to ***Diphtheria Dysphagia Erythromycin 20,000 - 100,000 units IM once only from clinical attack is
proximity to transmission is increased Milk has served as a Dyspnea always followed by a
epiglottis in hospitals, households, vehicle Complication: MYOCARDITIS (Encourage bed lasting immunity to the
schools, and other rest) disease.
crowded areas. Incubation Period:
2 – 5 days Plan nursing care to improve respiration.
3. Pertussis Bordetella pertussis Droplet especially Catarrhal period: 7 days Diagnostic: DPT immunization
Hemophilus pertussis from laryngeal and paroxysmal cough Booster: 2 years and 4-5
Whooping cough Bordet-gengou bacillus bronchial secretions followed by continuous • Bordet-gengou agar test years
Tusperina Pertussis bacillus nonstop accompanied by Patient should be
No day cough Incubation Period: vomiting Management: segregated until after 3
7 – 10 days but not 1. DOC: Erythromycin or Penicillin 20,000 - weeks from the appearance
exceeding 21 days Complication: abdominal 100,000 units of paroxysmal cough
hernia 2. Complete bed rest
3. Avoid pollutants
Incidence: highest under 7 years of age
4. Abdominal binder to prevent abdominal hernia
Mortality: highest among infants (<6 months)
One attack confers definite and prolonged
immunity. Second attack occasionally occurs
4. Tetanus Clostridium tetani – Indirect contact – Risus sardonicus (Latin: No specific test, only a history of punctured wound DPT immunization
anaerobic spore-forming inanimate objects, “devil smile”) – facial Tetanus toxoid (artificial
Other names: heat-resistant and lives in soil, street dust, spasm; sardonic grin Treatment: active) immunization
Lock jaw soil or intestine animal and human Antitoxin among pregnant women
feces, punctured Opisthotonus – arching of antitetanus serum (ATS) Training and Licensing
wound back tetanus immunoglobulin (TIG) (if the patient has of midwives/”hilots”
Neonate: umbilical cord allergy, should be administered in fractional doses) Health education of
Children: dental caries For newborn: Pen G mothers
Adult: punctured wound; 1. Difficulty of sucking Diazepam – for muscle spasms Puncture wounds are best
after septic abortion Incubation Period: 2. Excessive crying cleaned by thorough
Varies from 3 days 3. Stiffness of jaw Note: The nurse can give fluid provided that the washing with soap and
to 1 month, falling 4. Body malaise patient is able to swallow. There is risk of aspiration. water.
between 7 – 14 days Check first for the gag reflex
 8 Communicable Disease Nursing

5. Poliomyelitis Legio debilitans Fecal – oral route Paralysis Diagnostic test: OPV vaccination
Polio virus Muscular weakness Frequent hand washing
Other name: Enterovirus Incubation period: Uncoordinated body • CSF analysis / lumbar tap
Infantile paralysis 7 – 21 days movement • Pandy’s test
Attacks the anterior horn Hoyne’s sign – head lag
of the neuron, motor is after 4 months Management:
affected Rehabilitation involves ROM exercises
Man is the only reservoir (!Safety)
6. Measles RNA containing Droplet secretions 1. Koplik’s spots – No specific diagnostic test Measles vaccine
paramyxovirus from nose and throat whitish/bluish pinpoint Disinfection of soiled
Other names: patches on the buccal Management: articles
Morbilli Incubation period: cavity Supportive and symptomatic Isolation of cased from
Rubeola Period of 10 days – fever 2. cephalocaudal diagnosis until about 5-7
Communicability: 14 days – rashes appearance of days after onset of rash
4 days before and 5 days appear maculopapular rashes
after the appearance of (8-13 days) 3. Stimson’s line –
rash bilateral red line on the
lower conjunctiva

7. Hepatitis B Hepatitis B virus Blood and body 1. Right-sided Abdominal Diagnostic test: -Hepatitis B immunization
fluids pain -Wear protected clothing
Other names: Placenta 2. Jaundice • Hepatitis B surface agglutination (HBSAg) test -Hand washing
Serum Hepatitis 3. Yellow-colored sclera -Observe safe-sex
Incubation period: 4. Anorexia Management: -Sterilize instruments used
45 – 100 days 5. Nausea and vomiting > Hepatitis B Immunoglobulin in minor surgical-dental
6. Joint and Muscle pain procedures
7. Steatorrhea Diet: high in carbohydrates -Screening of blood
8. Dark-colored urine products for transfusion
9. Low grade fever

Hepatitis A – infectious hepatitis; oral-fecal

Hepatitis B – serum hepatitis; blood and body fluids
Hepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluids
Hepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis B
Hepatitis E – oral-fecal
 9 Communicable Disease Nursing

II. DISEASES TRANSMITTED THROUGH FOOD AND WATER

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Cholera Vibrio cholera Fecal-oral route Rice watery stool Diagnostic Test: Proper handwashing
Vibrio coma Stool culture Proper food and water
Other names: Ogawa and Inaba bacteria 5 Fs Period of Treatment: sanitation
El tor Communicability: Oral rehydration solution (ORESOL) Immunization of Chole-vac
Incubation Period: 7-14 days after onset, IVF
Few hours to 5 days; occasionally 2-3 months Drug-of-Choice: tetracycline (use straw; can cause
usually 3 days staining of teeth). Oral tetracycline should be
administered with meals or after milk.
2. Amoebic Entamoeba histolytica Fecal-oral route • Abdominal cramping Treatment: Proper handwashing
Dysentery • Bloody mucoid stool Proper food and water
Protozoan (slipper-shaped • Tenesmus - feeling of Metronidazole (Flagyl) sanitation
body) incomplete defecation * Avoid alcohol because of its Antabuse effect can
(Wikipedia) cause vomiting
3. Shigellosis Shigella bacillus Fecal-oral route • Abdominal cramping Drug-of-Choice: Co-trimoxazole Proper handwashing
• Bloody mucoid stool Proper food and water
Other names: Sh-dysenterae – most 5 Fs: Finger, Foods, • Tenesmus - feeling of Diet: Low fiber, plenty of fluids, easily digestible sanitation
Bacillary infectious Feces, Flies, incomplete defecation foods Fly control
dysentery Sh-flesneri – common in Fomites (Wikipedia)
the Philippines
Sh-connei Incubation Period:
Sh-boydii 1 day, usually less
than 4 days
4. Typhoid fever Salmonella typhosa Fecal-oral route • Rose Spots in the Diagnostic Test: Proper handwashing
(plural, typhi) abdomen – due to Typhi dot – confirmatory test; specimen is feces Proper food and water
5 Fs bleeding caused by Widal’s test – agglutination of the patient’s serum sanitation
perforation of the
Incubation Period: Peyer’s patches Drug-of-Choice: Chloramphenicol
Usual range 1 to 3
weeks, average 2 • Ladderlike fever
weeks
5. Hepatitis A Hepatitis A Virus Fecal-oral route • Fever Prophylaxis: “IM” injection of gamma globulin Proper handwashing
• Anorexia (early sign) Hepatitis A vaccine Proper food and water
Other names: 5 Fs • Headache Hepatitis immunoglobulin sanitation
Infectious • Jaundice (late sign) Avoid alcohol Proper disposal of urine
 10 Communicable Disease Nursing

Hepatitis / Incubation Period: • Clay-colored stool Complete bed rest – to reduce the breakdown of fats and feces
Epidemic 15-50 days, • Lymphadenopathy for metabolic needs of liver Separate and proper
Hepatitis / depending on dose, Low-fat diet; increase carbohydrates (high in sugar) cleaning of articles used by
Catarrhal Jaundice average 20-30 days patient
In convalescent period, patient may have difficulty
with maintaining a sense of well-being.
6. Paralytic Dinoflagellates Ingestion of raw of • Numbness of face Treatment: 1. Avoid eating shellfish
Shellfish inadequately cooked especially around the 1. No definite treatment such as tahong, talaba,
Poisoning (PSP I Phytoplankton seafood usually mouth 2. Induce vomiting halaan, kabiya, abaniko
Red tide bivalve mollusks • Vomiting and dizziness 3. Drink pure coconut milk – weakens the during red tide season
poisoning) during red tide • Headache toxic effect 2. Don’t mix vinegar to
season • Tingling 4. Sodium bicarbonate solution (25 grams in ½ shellfish it will increase
sensation/paresthesia and glass of water) toxic effect 15 times
Incubation Period: eventful paralysis of Advised only in the early stage of illness greater
30 minutes to hands because paralysis can lead to aspiration
several hours after NOTE: Persons who survived the first 12 hours after
• Floating sensation and
ingestion ingestion have a greater chance of survival.
weakness
• Rapid pulse
• Dysphonia
• Dysphagia
• Total muscle paralysis
leading to respiratory
arrest and death

ROBERT C. REÑA, BSN

Death from diarrhea is usually due to dehydration.

Food recall is the basis for the diagnosis of food poisoning.

 11 Communicable Disease Nursing

III. SEXUALLY TRANSMITTED DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Syphilis Treponema pallidum Direct contact Primary stage (4-6 Diagnostic test: Abstinence
(a spirochete) Transplacental (after weeks): painless chancre Dark field illumination test Be faithful
Other names: 16th week AOG) at site of entry of germ Fluorescent treponemal antibody absorption test Condom
Sy Incubation Period: Through blood with serous exudates – most reliable and sensitive diagnostic test for Secondary syphilis (6-8
Bad Blood 10 to 90 days (3 months); transfusion Syphilis; serologic test for syphilis which involves weeks: generalized rashes,
The pox average of 21 days Indirect contact with Tertiary stage (one to 35 antibody detection by microscopic flocculation of generalized tender discrete
Lues venereal contaminated years) : Gumma, syphilitic the antigen suspension lymphadenopathy, mucus
Morbus gallicus articles endocarditis and VDRL slide test, CSF analysis, Kalm test, patches, flu-like symptoms,
meningitis Wasseman test condylomata, patchy alopecia
Primary and secondary sores will go even without treatment but the germs continue
Treatment: Latent stage (one to two to
to spread throughout the body. Latent syphilis may continue 5 to 20+ years with NO
Drug of Choice: Penicillin (Tetracycline if resistant 50 years): non-infectious
symptoms, but the person is NO longer infectious to other people. A pregnant
mother can transmit the disease to her unborn child (congenital syphilis). to Penicillin)
2. Gonorrhea Neiserria gonorrheae Direct contact – Thick purulent yellowish Diagnostic test: Abstinence, Be faithful
genitals, anus, discharge Culture of urethral and cervical smear Condom
Other names: mouth Burning sensation upon Gram staining
GC, Clap, Drip, urination / dysuria Prevention of gonococcal
Stain, Gleet, Incubation Period: Treatment: ophthalmia is done through
Flores Blancas 2 – 10 days Drug of Choice: Penicillin the prophylactic use of
ophthalmic preparations
with erythromycin or
tetracycline
3. Trichomoniasis Trichomonas vaginalis Direct contact Females: Diagnostic Test: Abstinence
white or greenish-yellow Culture Be faithful
Other names: Incubation Period: odorous discharge Condom
Vaginitis 4 – 20 days; average vaginal itching and Treatment:
Trich of 7 days soreness Drug of Choice: Metronidazole (Flagyl) Personal Hygiene
painful urination
Males:
Slight itching of penis
Painful urination
Clear discharge from penis
4. Chlamydia Chlamydia trachomatis Direct contact Females: Diagnostic Test: Abstinence
(a rickettsia) Asymptomatic Culture Be faithful
 12 Communicable Disease Nursing

Incubation Period: Dyspareunia Condom

2 to 3 weeks for Fishy vaginal discharge Treatment:
males; usually no Drug of Choice: Tetracycline
symptoms for Males:
females Burning sensation during
urination
Burning and itching of
urethral opening
(urethritis)
5. Candidiasis Candida albicans Direct contact White, cheese-like vaginal Diagnostic Test: Abstinence
discharges Culture Be faithful
Other names: Curd like secretions Gram staining Condom
Moniliasis
Candidosis Treatment:
Nystatin for oral thrush
Cotrimazole, fluconazole for mucous membrane
and vaginal infection
Fluconazole or amphotericin for systemic infection
6. Acquired Retrovirus Direct contact 1. Window Phase Diagnostic tests: Abstinence
immune (Human T-cell Blood and body a. initial infection Enzyme-Linked Immuno-Sorbent Assay (ELISA) Be faithful
deficiency lymphotrophic virus 3 or fluids b. lasts 4 weeks to 6 - presumptive test Condom
syndrome (AIDS) HTLV 3) Transplacental months Western Blot – confirmatory
c. not observed by present Sterilize needles, syringes,
Attacks the T4 cells: T- Incubation period: laboratory test (test should Treatment: and instruments used for
helper cells; T- 3-6 months to 8-10 be repeated after 6 1. Treatment of opportunistic infection cutting operations
lymphocytes, and CD4 years months) 2. Nutritional rehabilitation
lymphocytes 3. AZT (Zidovudine) – retards the replication Proper screening of blood
Variable. Although 2. Acute Primary HIV of retrovirus; must be taken exactly as donors
The major route of HIV the time from Infection ordered
transmission to adolescent infection to the a. short, symptomatic 4. PK 1614 – mutagen Rigid examination of blood
is SEXUAL development of period and other blood products
TRANSMISSION. detectable antibodies b. flu-like symptoms Major signs of Pediatric AIDS:
is generally 1-3 c. ideal time to undergo  Chronic diarrhea > 1 month Avoid oral, anal contact
French kissing brings low months, the time screening test (ELISA)  Prolonged fever > 1 month and swallowing of semen
risk of HIV transmission. from HIV infection  Weight loss or abnormally slow growth
to diagnosis of 3. Asymptomatic HIV Avoid promiscuous sexual
AIDS has an Infection Breastmilk is important in preventing intercurrent contact
observed range of a. with antibodies against infection in HIV infected infants and children.
less than 1 year to HIV but not protective Avoid sharing of
13 Communicable Disease Nursing

15 years or longer. b. lasts for 1-20 years toothbrushes.

(PHN Book) depending upon factors The care of HIV patients is similar to the routine
care given to cases of other diseases.
4. ARC (AIDS Related HIV/AIDS Prevention
Complex) Not everybody is in danger of becoming infected and Control Program:
a. a group of symptoms with HIV through sex.
indicating the disease is Goal: Contain the
likely to progress to AIDS Never give live attenuated (weakened) vaccines e.g. transmission of HIV /AIDS
b. fever of unknown origin oral polio vaccine. and other reproductive tract
c. night sweats infections and mitigate
d. chronic intermittent HIV positive pregnant women and their partner must their impact
diarrhea be informed of the potential risk to the fetus.
e. lymphadenopathy LECTURE DISCUSSION
f. 10% body weight loss – best method to use in
teaching about safe sex
5. AIDS
a. manifestation of severe Priority intervention when
immunosuppression caring for AIDS patient:
b. CD4 Count: <200/dL Use disposable gloves
c. presence of variety of when in contact with non-
infections at one time: intact skin.

oral candidiasis
leukoplakia
AIDS dementia complex
Acute encephalopathy
Diarrhea, hepatitis
Anorectal disease
Cytomegalovirus
Pneumonocystis carinii
pneumonia (fungal)
TB
Kaposi’s sarcoma (skin
cancer; bilateral purplish
patches)
Herpes simplex
Pseudomonas infection
Blindness
Deafness
 14 Communicable Disease Nursing

IV. ERUPTIVE DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Chickenpox Human (alpha) herpes Droplet spread Vesiculo-pustular rashes No specific diagnostic exam Case over 15 years of age
virus 3 (varicella-zoster Treatment is supportive. should be investigated to
Other names: virus), a member of the Direct contact Centrifugal appearance of eliminate possibility of
Varicella Herpesvirus group rashes – rashes which Drug-of-choice: smallpox.
Indirect through articles begin on the trunk and Acyclovir / Zovirax ® (orally to reduce the number Report to local authority
freshly soiled by spread peripherally and of lesions; topically to lessen the pruritus) Isolation
discharges of infected more abundant on covered Concurrent disinfection of
Period of persons body parts NEVER give ASPIRIN. Aspirin when given to throat and nose discharges
Communicability: children with viral infection may lead to Exclusion from school for
From as early as 1 to 2 Incubation Period: Pruritus development of REYE’S SYNDROME. 1 week after eruption first
days before the rashes 2-3 weeks, commonly appears
appear until the lesions 13 to 17 days Nursing Diagnoses: Avoid contact with
have crusted. Disturbance in body image susceptibles
Impairment of skin integrity
2. German Rubella virus or RNA- Droplet Forscheimer spots – red Diagnostic Test: MMR vaccine (live
Measles containing Togavirus pinpoint patches on the Rubella Titer (Normal value is 1:10); below 1:10 attenuated virus)
(Pseudoparamyxovirus) Incubation Period: oral cavity indicates susceptibility to Rubella. - Derived from chick
Other Names: Three (3) days embryo
Rubella German measles is Maculopapular rashes Instruct the mother to avoid pregnancy for three Contraindication:
Three-day teratogenic infection, can Headache months after receiving MMR vaccine. - Allergy to eggs
Measles cause congenital heart Low-grade fever - If necessary, given in
disease and congenital Sore throat MMR is given at 15 months of age and is given divided or fractionated
cataract. Enlargement of posterior intramuscularly. doses and epinephrine
cervical and postauricular should be at the bedside.
lymph nodes
3. Herpes Zoster Herpes zoster virus Droplet Painful vesiculo-pustular Treatment is supportive and symptomatic Avoidance of mode of
(dormant varicella zoster Direct contact from lesions on limited portion transmission
Other names: virus) secretion of the body (trunk and Acyclovir to lessen the pain
Shingles shoulder)
Cold sores
Low-grade fever
4. Dengue Dengue virus 1, 2, 3, and Bite of infected Classification (WHO): Diagnostic Test: 4 o’clock habit
Hemorrhagic 4 and Chikungunya virus mosquito (Aedes
Fever Aegypti) - characterized Grade I: Torniquet test (Rumpel Leads Test / capillary Chemically treated
Types 1 and 2 are by black and white a. flu-like symptoms fragility test) – PRESUMPTIVE; positive when 20 mosquito net
 15
Other names: common in the
H-fever Philippines
Period of
communicability:
Unknown. Presumed to
be on the 1st week of
illness up to when the
virus is still present in the
blood
Occurrence is sporadic
throughout the year
Epidemic usually occur
during the rainy seasons
(June to November)
Peak months: September
and October
Communicable Disease Nursing
stripes b. Herman’s sign or more oetechiae per 2.5 cm square or 1 inch Larva eating fish
c. (+) tourniquet sign square are observed Environmental sanitation
Daytime biting Antimosquito soap
Low flying Grade II: Platelet count – CONFIRMATORY; (Normal is Neem tree (eucalyptus)
Stagnant clear water a. manifestations of Grade 150 - 400 x 103 / mL)
Urban I plus spontaneous Eliminate vector
bleeding Treatment:
Incubation Period: b. e.g. petechiae, Supportive and symptomatic Avoid too many hanging
Uncertain. Probably 6 ecchymosis purpura, gum Paracetamol for fever clothes inside the house
days to 1 week bleeding, hematemesis, Analgesic for pain
melena Residual spraying with
Manifestations: Rapid replacement of body fluids – most important insecticide
Grade III: treatment
First 4 days: a. manifestations of Grade Daytime fumigation
Febrile/Invasive Stage II plus beginning of ORESOL
- starts abruptly as fever circulatory failure Use of mosquito repellants
- abdominal pain b. hypotension, Blood tansfusion
- headache tachycardia, tachypnea Wear long sleeves, pants,
- vomiting Diet: low-fat, low-fiber, non-irritating, non- and socks
- conjunctival infection Grade IV: carbonated. Noodle soup may be given. ADCF
-epistaxis a. manifestations of Grade (Avoid Dark-Colored Foods)
III plus shock (Dengue For the control of H-fever,
4th – 7th days: Shock Syndome) ALERT! No Aspirin knowledge of the natural
Toxic/Hemorrhagic history of the disease is
Stage important.
- decrease in
temperature Environmental control is
- severe abdominal pain the most appropriate
- GIT bleeding primary prevention
- unstable BP (narrowed approach and control of H-
pulse pressure) fever.
- shock
- death may occur
7th – 10th days:
Recovery/Convalescent
Stage
- appetite regained
- BP stable
 16
V. VECTOR-BORNE DISEASES
MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT
TRANSMISSION SIGN
1. Malaria Plasmodium Parasites: Bite of infected Cold Stage: severe,
Vivax anopheles mosquito recurrent chills (30
Falciparum (most fatal; minutes to 2 hours)
most common in the Night time biting
Philippines) High-flying Hot Stage: fever (4-6
Ovale Rural areas hours)
Malariae Clear running water
Wet Stage: Profuse
-attacks the red blood sweating
cells
Episodes of chills, fevers,
and profuse sweating are
associated with rupture of
the red blood cells.
- intermittent chills and
sweating
- anemia / pallor
- tea-colored urine
- malaise
- hepatomegaly
- splenomegaly
- abdominal pain and
enlargement
- easy fatigability
NURSING CARE:
1. TSB (Hot Stage)
2. Keep patent warm
(Cold Stage)
3. Change wet clothing
(Wet Stage)
4. Encourage fluid intake
5. Avoid drafts
Communicable Disease Nursing
MANAGEMENT/TREATMENT PREVENTION
Early Diagnosis and Prompt Treatment *CLEAN Technique
Early diagnosis – identification of a patient with *Insecticide – treatment of
malaria as soon as he is seen through clinical mosquito net
and/or microscopic method *House Spraying (night
Clinical method – based on signs and symptoms time fumigation)
of the patient and the history of his having visited a *On Stream Seeding –
malaria-endemic area construction of bio-ponds
Microscopic method – based on the examination for fish propagation (2-4
of the blood smear of patient through microscope fishes/m2 for immediate
(done by the medical technologist) impact; 200-400/ha. for a
delayed effect)
QBC/quantitative Buffy Coat – fastest *On Stream Clearing –
Malarial Smear – best time to get the specimen is cutting of vegetation
at height of fever because the microorganisms are overhanging along stream
very active and easily identified banks
Chemoprophylaxis *Avoid outdoor night
Only chloroquine should be given (taken at weekly activities (9pm – 3am)
intervals starting from 1-2 weeks before entering *Wearing of clothing that
the endemic area). In pregnant women, it is given covers arms and legs in the
throughout the duration of pregnancy. evening
*Use mosquito repellents
Treatment: *Zooprophylaxis – typing
Blood Schizonticides - drugs acting on sexual of domestic animals like
blood stages of the parasites which are responsible the carabao, cow, etc near
for clinical manifestations human dwellings to
1. QUININE – oldest drug used to treat deviate mosquito bites
malaria; from the bark of Cinchona tree; from man to these animals
ALERT: Cinchonism – quinine toxicity
2. CHLOROQUINE Intensive IEC campaign
3. PRIMAQUINE – sometimes can also be
given as chemoprophylaxis
4. FANSIDAR – combination of
pyrimethamine and sulfadoxine
 17 Communicable Disease Nursing

2. Filariasis Wuchereria bancrofti Bite of Aedes poecillus Asymptomatic Stage: Diagnosis CLEAN Technique
Brugia malayi (primarily) Presence of microfilariae Physical examination, history taking, observation
Other names: Brugia timori Aedes flavivostris in the blood but no of major and minor signs and symptoms Use of mosquito repellents
Elephantiasis (secondary) clinical signs and Anytime fumigation
– nematode parasites symptoms of disease Laboratory examinations Wear a long sleeves, pants
Endemic in 45 out Incubation period: Nocturnal Blood Examination (NBE) – blood are and socks
of 78 provinces 8 – 16 months Acute Stage: taken from the patient at his residence or in
Lymphadenitis hospital after 8:00 pm
Highest Lymphangitis Immunochromatographic Test (ICT) – rapid
prevalence rates: Affectation of male assessment method; an antigen test that can be
Regions 5, 8, 11 genitalia done at daytime
and CARAGA
Chronic Stage: (10-15 Treatment:
years from onset of first Drug-of-Choice: Diethylcarbamazine Citrate
attack) (DEC) or Hetrazan
Hydrocele
Lymphedema
Elephantiasis
3. Shistosomiasis Schistosoma mansoni Contact with the Diarrhea Diagnostic Test: Dispose the feces properly
S. haematobium infected freshwater with Bloody stools (on and off COPT or cercum ova precipitin test (stool exam) not reaching body of water
Other Names: S. japonicum (endemic in cercaria and penetrates dysentery) Use molluscides
Snail Fever the Philippines) the skin Enlargement of abdomen Treatment: Prevent exposure to
Bilharziasis Splenomegaly Drug-of-Choice: PRAZIQUANTEL (Biltracide) contaminated water (e.g.
Vector: Oncomelania Hepatomegaly use rubber boots)
Endemic in 10 Quadrasi Anemia / pallor Oxamniquine for S. mansoni Apply 70% alcohol
regions and 24 weakness Metrifonate for S. haematobium immediately to skin to kill
provinces surface cercariae
*Death is often due to hepatic complication Allow water to stand 48-72
High prevalence: hours before use
Regions 5, 8, 11

ROBERT C. REÑA, BSN

REFERENCES:
 THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN
 CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION
 DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph
 CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov
 18
DISEASE CAUSATIVE AGENT
1. Leptospirosis Leptospira interrogans –
bacterial spirochete
Other Names:
- Weil’s Disease RAT is the main host.
- Mud Fever Although pig, cattle,
- Trench Fever rabbits, hare, skunk, and
- Flood Fever other wild animals can
- Spirochetal also serve as reservoir
Jaundice
- Japanese Occupational disease
Seven Days affecting veterinarians,
fever miners, farmers, sewer
workers, abattoir workers,
etc
2. Rabies Rhabdovirus of the genus
lyssavirus
Other Names:
Lyssa Degeneration and necrosis
Hydrophobia of brain – formation of
Le Rage negri bodies
Two kinds of Rabies:
a. Urban or canine –
transmitted by dogs
b. Sylvatic – disease of
wild animals and bats
which sometimes spread
to dogs, cats, and livestock
VI. DISEASES TRANSMITTED BY ANIMALS
MODE OF PATHOGNOMONIC
TRANSMISSION SIGN
Through contact of the Leptospiremic Phase
skin, especially open - leptospires are present in
wounds with water, blood and CSF
moist soil or vegetation - onset of symptoms is
infected with urine of abrupt
the infected host - fever
- headache
Incubation Period: - myalgia
7-19 days, average of - nausea
10 days - vomiting
- cough
- chest pain
Immune Phase
- correlates with the
appearance of circulating
IgM
Bite or scratch (very Sense of apprehension
rare) of rabid animal Headache
Fever
Non-bite means: Sensory change near site
leaking, scratch, organ of animal bite
transplant (cornea), Spasms of muscles of
inhalation/airborne deglutition on attempts to
(bats) swallow
Source of infection: Fear of
saliva of infected water/hydrophobia
animal or human Paralysis
Delirium
Incubation period: Convulsions
2 – 8 weeks, can be
years depending on “FATAL once signs and
severity of wounds, site symptoms appear”
of wound as distance
from brain, amount of
Communicable Disease Nursing
MANAGEMENT/TREATMENT PREVENTION
Diagnosis Protective clothing,
Clinical manifestations boots and gloves
Culture of organism Eradication of rats
Examination of blood and CSF during the first Segregation of domestic
week of illness and urine after the 10th day animals
Leptospira agglutination test Awareness and early
diagnosis
Treatment: Improved education of
Penicillins and other related B-lactam antibiotics people
Tetracycline (Doxycycline)
Avoid wading or
Erythromycin
swimming in water
contaminated with urine
Most common complication: kidney failure
of infected animals.
Concurrent disinfection
of articles soiled with
urine.
Diagnosis: Have pet immunized at 3
history of bite of animal months of age and every
culture of brain of rabid animal year thereafter
demonstration of negri bodies
Never allow pets to roam
Management: the streets
*Wash wound with soap immediately. Antiseptics
e.g. povidone iodine or alcohol may be applied Take care of your pet
*Antibiotics and anti-tetanus immunization
*Post exposure treatment: local wound National Rabies
treatment, active immunization (vaccination) and Prevention and Control
passive immunization (administration of rabies Program
immunoglobulin) Goal: Human rabies is
*Consult a veterinarian or trained personnel to eliminated in the
observe the pet for 14 days Philippines and the
country is declared rabies-
*Without medical intervention, the rabies victim free
would usually last only for 2 to 6 days. Death is
 19 Communicable Disease Nursing

virus introduced, and often due to respiratory paralysis.

protection provided by
clothing
3. Bubonic Bacteria (Yersinia pestis) Direct contact with the Fever and lyphadenitis Streptomycin, tetracycline, chloramphenicol Environmental Sanitation
Plague infected tissues of
Vector: rat flea rodents

VII. DISEASES OF THE SKIN

MODE OF
DISEASE CAUSATIVE AGENT PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION
1. Leprosy Mycobacterium leprae Airborne-droplet Early signs: Diagnostic Test: Avoid prolonged skin-to-
Change in skin color – either Slit Skin Smear - determines the presence of M. skin contact
Other names: Prolonged skin-to- reddish or white leprae; optional and done only if clinical diagnosis
Hansenosis skin contact Loss of sensation on the skin is doubtful to prevent misclassification and wrong BCG vaccination –
Hansen’s disease lesion treatment practical and effective
Loss of sweating and hair growth Lepromin Test – determines susceptibility to preventive measure
-an ancient Thickened and painful nerves leprosy against leprosy
disease and is a Muscle weakness or paralysis or
leading cause of extremities Treatment: Good personal hygiene
permanent Pin and redness of the eyes Ambulatory chemotherapy through use of MDT
physical disability Nasal obstruction or bleeding Domiciliary treatment as embodied in RA 4073 Adequate nutrition
among the Ulcers that do not heal which advocates home treatment
communicable Health education
diseases Late Signs: PAUCIBACILLARY (tuberculoid and
Madarosis indeterminate); noninfectious type Major activity of leprosy
Loss of eyebrows Duration of treatment: 6 to 9 months control program:
Inability to close eyelids Procedure: casefinding and treatment
(lagophthalmos) Supervised: Rifampicin and Dapsone once a month with effective drugs
Clawing of fingers and toes on the health center supervised by the rural health
Contractures midwife Prevent deformities by
MDT Facts: Chronic ulcers Self-administered: Dapsone (side effect: itchiness of self-care, exercise, and
It reduces communicability period of leprosy in Sinking of the nosebridge the skin) everyday at the client’s house physical therapy.
4-6 weeks time. Enlargement of the breast
It prevents development of resistance to drugs. (gynecomastia) MULTIBACILLARY (lepromatous and
It shortens the duration of treatment. borderline); infectious type
Duration of treatment: 24-30 months
Procedure:
Supervised: Rifampicin, Dapsone, and Lamprene
 20 Communicable Disease Nursing

(Clofazimine; side effect: dryness or flaking of the

skin) once a month on the health center supervised
by the rural health midwife
Self-administered: Dapsone and Lamprene
everyday at the client’s house
2. Anthrax Bacillus anthracis Contact with 1. Cutaneous form – most Treatment: Penicillin Proper handwahing
a. tissues of common
Other names: animals (cattle, - itchiness on exposed part Immunize with cell-free
Malignant pustule sheep, goats, - papule on inoculation site vaccine prepared from
Malignant edema Incubation period: horses, pigs, etc.) - papule to vesicle to eschar culture filtrate containing
Woolsorter few hours to 7 days dying of the disease - painless lesion the protection antigen
disease most cases occur within b. biting flies that
Ragpicker disease 48 hours of exposure had partially fed on 2. Pulmonary form – Control dust and proper
Charbon such animals contracted from inhalation of B. ventilation
c. contaminated anthracis spores
hair, wool, hides or - at onset, resembles common
products made URTI
from them e.g. - after 3-5 days, symptoms
drums and brushes become acute, with fever, shock,
d. soil associated and death
with infected
animals or 3. Gastrointestinal anthrax –
contaminated bone contracted from ingestion of
meal used in meat from infected animal
gardening - violent gastroenteritis
- vomiting
- bloody stools
3. Scabies Sarcoptes scabiei Direct contact with Itching Diagnosis: Personal hygiene
- An itch mite infected individuals Appearance of the lesion Avoid playing with dogs
parasite When secondarily infected: Intense itching Laundry all clothes and
Incubation Skin feels hot and burning Finding of causative mite iron
Period: Maintain the house clean
24 hours When large and severe: fever, Treatment: (limited entirely to the skin) Environmental sanitation
headache, and malaise Examine the whole family before undertaking Eat the right kind of food
treatment Regular changing of clean
Benzyl benzoate emulsion (Burroughs, Welcome) – clothing, beddings and
cleaner to use and has more rapid effect towels
Kwell ointment
 21 Communicable Disease Nursing

4. Pediculosis Pediculosis Direct contact Itchiness of the scalp Kwell shampoo Proper hygiene
Capitis (head lice)
Other name: Corporis (body lice) Common in school One tbsp water + one tbsp vinegar
Phthipiasis Pubis (crab lice) age

VIII. INTESTINAL PARASITISM

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Ascariasis Ascaris lumbricoides Fecal-oral route Pot-bellied Diagnostic Test: Fecalysis Proper handwahing
Voracious eater
Other names: (nematode) 5 Fs: Finger, Foods, Thin extremities Treatment:
Roundworm Feces, Flies, Fomites Antihelminthic: Mebendazole / Pyrantel Pamoate
Giant worms
2. Taeniasis Taenia solium – pork Eating inadequately Muscle soreness Diagnostic Test: Fecalysis Proper handwahing
Taenia saginata – beef cooked pork or beef Scleral hemorrhage
Other name: Dyphyllobotruim latum – Treatment: Cook pork and beef
Tape worm fish 5 Fs: Finger, Foods, Antihelminthic: Mebendazole / Pyrantel Pamoate adequately
Feces, Flies, Fomites

3. Capillariasis Trichuris trichuria Eating inadequately Abdominal pain Diagnostic Test: Fecalysis Proper handwahing
cooked seafood Diarrhea
Other name: Capillararia borborygmi Treatment: Cook seafoods adequately
Whip worm Philippinensis 5 Fs: Finger, Foods, Antihelminthic: Mebendazole / Pyrantel pamoate
Feces, Flies, Fomites
4. Enterobiasis Enterobium vermicularis Inhalation of ova Nocturnal anal itchiness Diagnostic Test: Fecalysis / tape test Proper handwahing
Toilet seat
Other name: Infected bedsheets Treatment: Proper disinfection of
Pinworm Antihelminthic: Mebendazole / Pyrantel pamoate beddings
5 Fs: Finger, Foods,
Feces, Flies, Fomites
5. Ancyloclos- Ancyclostoma duodenal Walking barefooted Dermatitis Diagnostic Test: Fecalysis Proper handwahing
tomiasis
Necatur americanus 5 Fs: Finger, Foods, Anemia Treatment: Avoid walking barefooted
Other name: Feces, Flies, Fomites Antihelminthic: Mebendazole / Pyrantel pamoate
Hookworm Black fishy stool
ROBERT C. REÑA, BSN
 22 Communicable Disease Nursing

IX. OTHER COMMUNICABLE DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Pneumonia Bacteria: Droplet Rusty sputum Diagnosis: Avoid mode of
Pneumococcus, Fever and chills Based on signs and symptoms transmission
Types: streptococcus Incubation Period: Chest pain Dull percussion on affected lung
a. Community pneumoniae, 2 – 3 days Chest indrawing Sputum examination – confirmatory Build resistance
Acquired staphylococcus aureus, Rhinitis/common cold Chest x-ray
Pneumonia (CAP) Klebsiella pneumonia Productive cough Turn to sides
b. Hospital / (Friedlander’s bacilli) Fast respiration Management:
Nosocomial Vomiting at times Bedrest Proper care of influenza
c. Atypical Virus: Convulsions may occur Adequate salt, fluid, calorie, and vitamin intake cases
Haemophilus influenzae Flushed face Tepid sponge bath for fever
Dilated pupils Frequent turning from side to side
Fungi: Pneumonocystis Highly colored urine with Antibiotics based on CARI of the DOH
carinii pneumonia reduced chlorides and
increased urates Oxygen inhalation
Suctioning
Expectorants / mucolytics
Bronchodilators
Oral/IV fluids
CPT
2. Mumps Mumps virus, a member Direct contact Painful swelling in front Supportive and symptomatic MMR vaccine
of family of the ear, angle of the
Other name: Paramyxoviridae Source of infection: jaws and down the neck Sedatives – to relieve pain from orchitis Isolate mumps cases
Epidemic Parotitis Secretions of mouth and Fever Cortisone – for inflammation
nose Malaise
Loss of appetite Diet: Soft or liquid as tolerated
Incubation Period: Swelling of one or both
12 to 26 days, usually testicles (orchitis) in some Support the scrotum to avoid orchitis, edema, and
18 days boys atrophy

Dark glasses for photophobia

3. Influenza Influenza virus Direct contact Sudden onset Supportive and symptomatic Avoid use of common
A – most common Droplet infection or by Fever with chills towels, glasses, and eating
Other name: B – less severe articles freshly soiled Headache Keep patient warm and free from drafts utensils
La Grippe C – rare with nasopharyngeal Myalgia / arthralgia TSB for fever Cover mouth and nose
discharges Boil soiled clothing for 30 minutes before during cough and sneeze
 23 Communicable Disease Nursing

Period of Airborne laundering Immunization:

Communicability: Flujob/Flushot – effective
Probably limited to 3 days Incubation Period: for 6 months to 1 year
from clinical onset Short, usually 24 – 72
hours
4. Streptococcal Group A beta hemolytic Droplet Sudden onset Diagnosis: Avoid mode of
sore throat streptococcus High grade fever with Throat swab and culture transmission
Complication: chills
Other name: Other diseases: Rheumatic Heart Enlarged and tender Treatment: erythromycin
Pharyngitis Scarlet fever Disease cervical lymph nodes
Tonsillitis St. Anthony fire Inflamed tonsils with Care:
Puerperal sepsis mucopurulent exudates Bed rest
Imoetigo Headache Oral hygiene with oral antiseptic or with saline
Acute glomerulonephritis dysphagia gargle (1 glass of warm water + 1 tsp rock salt)
Rheumatic Heart Disease Ice collar
5. Meningitis Meningococcus Direct (Droplet) A. Sudden Onset Diagnostic Test: Respiratory Isolation
Neisseria meningitides - high fever accompanied
Other name: Incubation Period: by chills Lumbar puncture or Lumbar tap - reveals CSF
Cerebrospinal 2 - 10 days - sore throat, headache, WBC and protein, low glucose; contraindicated
fever prostration (collapse) for increased ICP for danger of cranial herniation

B. entrance into the Hemoculture – to rule out meningococcemia

bloodstream leading to
septicemia
(meningococcemia)
a. rash, petchiae, purpura
C. Symptoms of menigeal
irritation
- nuchal rigidity (stiff
neck) – earliest sign
- Kernig’s sign – when
knees are flexed, it cannot
be extended
- Brudzinski signs – pain
on neck flexion with
automatoc flexion of the
knees
- convulsion
Treatment:
Osmotic diuretic (Mannitol) – to reduce ICP and
relieve cerebral edema; Alert: fastdrip to prevent
crystallization
Anti-inflammatory (Dexamethasone) – to relieve
cerebral edema
Antimicrobial (Penicillin)
Anticonvulsany (Diazepam / Valium)
Complications:
Hydrocephalus
Deafness (Refer the child for audiology testing)
and mutism
Blindness
 24 Communicable Disease Nursing

- poker soine (poker face /

flat affect)
- Increased ICP
(Cushing’s triad:
hypertension,
bradycardia, bradypnea)
and widening pulse
pressure

IX. KILLER DISEASES OF THE NEW MILLENNIUM

CAUSATIVE MODE OF PATHOGNOMONIC

DISEASE MANAGEMENT/TREATMENT PREVENTION
AGENT TRANSMISSION SIGN
1. Meningococcemia Neisseria meningitides Direct contact with High grade fever in the Respiratory isolation within 24 hours Universal precaution
respiratory droplet from first 24 hours
nose and throat of Hemorrhagic rash – Drug-of-Choice: Penicillin Chemoprophylaxis with
infected individuals petechiae Rifampicin to protect
nuchal rigidity exposed individual from
Incubation Period: Kernig’s sign developing the infection
2 – 10 days Brudzinski sign
Shock Proper hand washing
Death
2. Severe Acute Coronavirus Close contact with Prodromal Phase: No specific treatment Utilize personal protective
Respiratory respiratory droplet Fever (>38 0C) equipment (N95 mask)
Syndrome / SARS secretion from patient Chills PREVENTIVE MEASURES and CONTROL
Malaise 1. Establishment of triage Handwashing
Earliest case: Incubation Period: Myalgia 2. Identification of patient
Guangdong Province, 2 – 10 days Headache 3. Isolation of suspected probable case Universal Precaution
China in November Infectivity is none to low 4. Tracing and monitoring of close contact The patient wears mask
2002 5. Barrier nursing technique for suspected Isolation
Respiratory Phase: and probable case
Global outbreak: Within 2-7 days, dry
March 12, 2003 nonproductive cough
progressing to respiratory
First case in the distress
Philippines:
April 11, 2003
 25 Communicable Disease Nursing

3. Bird Flu Influenza Virus H5N1 Contact with infected Fever Control in birds: Isolation technique
birds Body weakness and body 1. Rapid destruction (culling or stamping out of all Vaccination
Other Name: malaise infected or exposed birds) proper disposal of Proper cooking of poultry
Avian Flu Incubation Period: Cough carcasses and quarantining and rigorous
3 days, ranges from 2 – Sore throat disinfection of farms
4 days Dyspnea 2. Restriction of movement of live poultry
Sore eyes
In humans:
1. Influenza vaccination
2. Avoid contact with poultry animals or migratory
birds
4. Influenza A Influenza Virus A Exposure to droplets - similar to the symptoms Diagnostic: - Cover your nose and
(H1N1) H1N1 from the cough and of regular flu such as Nasopharyngeal (throat) swab mouth when coughing and
sneeze of the infected • Fever Immunofluorescent antibody testing – to sneezing
Other Name: This new virus was person • Headache distinguish influenza A and B - Always wash hands with
Swine Flu first detected in people • Fatigue soap and water
in April 2009 in the Influenza A (H1N1) is • Lack of appetite - Use alcohol- based hand
May 21, 2009 – first United States. not transmitted by • Runny nose Treatment: sanitizers
confirmed case in the eating thoroughly • Sore throat Antiviral medications may reduce the severity and - Avoid close contact with
Philippines Influenza A (H1N1) is cooked pork. • Cough duration of symptoms in some cases: sick people
fatal to humans - Vomiting or nausea Oseltamivir (Tamiflu) - Increase your body's
June 11, 2009 - The The virus is killed by - Diarrhea or zanamivir resistance
WHO raises its cooking temperatures of - Have at least 8 hours of
Pandemic Alert Level 160 F/70 C. sleep
to Phase 6, citing - Be physically active
significant Incubation Period: - Manage your stress
transmission of the 7 to 10 days - Drink plenty of fluids
virus. - Eat nutritious food

ROBERT C. REÑA, BSN

REFERENCES:
 THE ROYAL PENTAGON REVIEW SPECIALISTS, INC NOTE-TAKING GUIDE FOR COMMUNICABLE DISEASE NURSING by DANIEL JOSEPH E. BERDIDA, RM, RN
 CHAPTER VII: COMMUNICABLE DISEASE PREVENTION and CONTROL, PUBLIC HEALTH NURSING IN THE PHILIPPINES, 10th EDITION
 DEPARTMENT OF HEALTH OFFICIAL WEBSITE: www.doh.gov.ph
 CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) OFFICIAL WEBSITE: www.cdc.gov