Communicable Dis.

by TRA Jesse Daclis; PHN White Book

**Communicable Dis.**

→ can be transmitted from one person to another

→ (+) Causative Agent

* *pano mo malalaman if communicable dis. siya?* ***CA***

→ **Stages of Infection: (**`IPACR`**)**

* ***“IPA-CR mo”***

**COVID-19**

→ CA: Beta Corona Virus

**Incubation Period**

→ first stage of infection

→ duration: entry until first s/sx appeared

→ Asymptomatic

**Prodromal Period**

→ (+) non-specific s/sx

* example: flu-like s/sx

**Acute Period**

→ (+) specific signs & symptoms

→ __**Pathognomonic Signs**__

* **Rabies**: Hydrophobia
* **Dengue**: petechiae & Herman’s sign (flushing of the skin)
* **Leprosy**: Leonile Appearance (a lion-like appearance)

**Convalescence Period**

→ s/sx start to disappear

**Resolution Period**

→ last stage

**IMMUNITY**

* **Antigen**
* foreign bodies
* **“AntigENEMY”**
* from Sir Kenneth

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* **Antibody**
* “papatayin ang mga antigen”
* CHON (protein)
* destroy familiar antigen

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**Immunoglobulin (GAMED)**

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**Ig**__**M**__: first Ab → “__Mauna__ ako”

* first to respond

**Ig**__**G**__: 2nd Ab → “__Gagi__ sunod ako”

**Immunity General Types**

* **Natural Immunity**
* inherent in the body
* from the word natural

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* **Acquired Immunity**
* **acquired when exposed to the environment**

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**Active Acquired Immunity**
* Antibodies are __*produced by the individual itself*__
* !! LONG-TERM PROTECTION
* “Active Acquired = AKO”

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**Passive Acquired Immunity**
* Antibodies are __*given*__ to the individual
* !! SHORT-TERM PROTECTION

**Active Acquired Immunity (ANTIGEN)**

* **Natural Active Immunity**
* stimulus: exposed to antigen
* `NARS - natural active nagrecover ka sa sakit`

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* **Artificial Active Immunity (**`LIT`**)**
* vaccine → laman ay Antigen
* **L**ive Attenuated → buhay na pinahina na mikrobyo; bawal for immunocompromised
* **I**nactivated → killed; pwede sa immunocompromised
* **T**oxoid (modified toxins)

**Passive Acquired (IMMUNOGLOBULIN)**

* **Natural Passive Immunity**
* transplacental → IgG
* breastfeeding → IgA

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* **Artificial Passive Immunity**
* post-exposure
* immunoglobulin na iniinject

**Mode of Transmission** (`CAVEVE`)

1. **Contact**


1. **Direct** → physical touch
2. **Indirect** → contaminated object
3. **Droplet**


1. respiratory secretions → __large particles__ → within 3 ft.
2. use surgical mask

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2. **Airborne (**`MTV`**)**


1. respiratory secretions → __fine particles__ → greater than 3 ft.
2. use N95
3. **“MTV”**


1. measles
2. tuberculosis
3. varicella

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3. **Vehicle T.**


1. taga-bitbit lamang ng mikrobyo (carrier)
2. non-living → water, food

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4. **Vector T.**


1. living


1. mosquito
2. fly

**RABIES (Lyssa)**

CA: **Rhabdo Virus** → bullet shape virus

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* KAPAG NASA EXTREMETIES
* (-) s/sx
* (-) contagious
* (-) death

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* KAPAG NASA __**BRAIN**__
* (+) contagious
* (+) s/sx
* (+) death

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**Mode of Transmission:**

* animal bite
* scratch
* tissue transplant

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\***RA 7170: Organ Donation Act**

**Rabies: Signs & Symptoms**

1. **Invasive Stage**


1. Prodromal s/sx → nonspecific
2. fever, photophobia, headache, numbness

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2. **Excitement Stage**


1. Acute


1. Hydrophobia (laryngospasm)
2. Aerophobia (fear of flying)
3. Maniacal behavior (like a wild animal)

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3. **Paralytic Stage**


1. Generalized Paralysis


1. Respiratory Paralysis → cause of death

**Rabies: Diagnostics**

1. Brain Biopsy
2. **Fluorescent Rabies Antibody Test (FRAT)**


1. confirmatory test

**Rabies: Immunization (preventing the virus from reaching the brain)**

**First Aid**: Wash with soap & water + betadine

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**Tetanus Toxoid: Prophylaxis**

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**Artificial Active (Vaccine)**

* **Verorab / Imurab**
* inactivated virus
* stimulate immune system to produce antibodies
* 5 doses
* IM
* ID (cost-effective)
* Day 0, 3, 7, 14, 28

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**Artificial Passive (Immunoglobulin)**

* **Rabies Ig (Rabuman)**
* laman ay antibodies
* immediate effect
* half is injected on the wound site; half is injected IM
* depends on the weight of the pt

**Rabies: Palliative Care**

For patients na nasa brain na ang rabies:

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1. Strict Isolation → Use all PPE
2. Nonstimulating Environment
3. Use of Restraints
4. No any sense of fluids
5. Cover IVF

**Rabies: Responsible Pet Ownership**

→ prevention

→ Dog Immunization: 3 months; Booster yearly

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\***RA No. 9482: Anti-Rabies Act of 2007**

* “Ninenay Four Dog Eight 2”
* “Nanay poor dog ito”

**Dengue vs. Malaria vs. Filariasis**

* **Dengue - H-fever**
* CA: Dengue Virus 1, 2, 3, 4 or Chikungunya virus
* Vector: Aedes Aegypti or the common household mosquito
* Peak Age of Susceptibility: 5-9 yrs
* Peak Months: September & October

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* **Malaria - Marsh Fever**
* CA: protozoal parasite → plasmodium
* Vector: Anopheles
* Plasmodium
* P. vivax
* P. orale
* P. malaria
* P. Falciparum - fatal; common in the Phil.

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* **Filariasis - Elephantiasis**
* Vector: Aedes Poecillus
* Roundworms
* Wuchereria bancrofti
* Brugia Malayi
* Brugia timori

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**Mode of Transmission**

* Mosquito Bite

**Dengue: Grade 1**

→ Fever (High) → 2-4 days

→ Pattern: Biphasic/ Saddleback

* will remain elevated for 2-4 days, then okay for 1-2 days, then will elevate again
* \*BEQ: low fever of dengue = low platelet → bleeding

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* Bradykinin
* Prostaglandin
* Histamine
* → after producing → releasing fever

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**S/sx**

* Herman’s sign (flushing of the skin)
* Petechiae

**Dengue: Grade II**

**S/sx** of Grade 1 + Spontaneous Bleeding

* Platelets less than 50, 000
* Epistaxis
* Hematemesis
* Melena

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**MGT**

* bawal ang dark-colored food & drinks

**Dengue: Grade III Shock**

(+) Plasma Leakage

→ Hypotension

→ tachycardia

→ tachypnea

→ Narrow Pulse Pressure

**Dengue: Grade IV Profound Shock**

→ undetectable BP/pulse

→ DSS: Dengue Shock Syndrome

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**Warning Signs**

* abdominal pain → damaged liver
* persistent vomiting
* clinical fluid accumulation → pleural effusion; ascites
* inc HCT → plasma leakage

**Dengue: Diagnostics**

1. **Tourniquet Test / Rumpel Lead Test**


1. screening test → assesses the vascular resistance
2. not for dehydration or bleeding


1. link: (https://youtu.be/LSpo9fJOz0c?si=4DrN45_heMNEb9Dm)

__STEPS:__


1. Check BP
2. Solve Mid Systolic Diastolic Pressure


1. Add the systole and diastole divided by 2
3. Reinflate the BP Cuff until the answer for no. 2 for at least 5 mins
4. Observe Petechiae: 1 inch or 2.5 cm square


1. normal: 1-2 petechiae
2. positive: 20 or more petechiae

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5. **CBC**


1. Platelet: low
2. HCT: high (concentrated)

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3. **Serological test** → (+) Antibody


1. **Elisa / EIA: Enzyme Immunosorbent Assay**


1. Confirmatory Test

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4. **Dengue Duo**


1. rapid test


1. (+) NS1 Antigen Test (Viral Particle)
2. (+) Ab → IgM; IgG

**Dengue: Palliative Management**

* Paracetamol
* NO aspirin (platelet inhibitor)

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**NSG Management:**

* Rest
* Fluid Replacement
* Oral Rehydration Solution (ORS) → Most Important for Dengue
* 2-3 L for adults
* IVF → LR NSS
* Ice Pack → for bleeding
* Diet: No colored foods & drinks

**MALARIA**

→ protozoal parasite

→ Sporozoites

* immature protozoa → will live in liver → hepatomegaly

→ Merozoites

* matured merozoites → will exit liver into the RBC → Anemia
* (+) Severe anemia: Malarial Cachexia

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S/sx every 2-3 days


1. Cold Stage (10-15 mins)


1. chills
2. clatter teeth
2. Hot Stage Stage 4-6 hrs


1. high fever
2. headache
3. malaise
3. Diaphoretic Stage


1. wet stage
2. mag-papawis

Diagnostics Test

1. Blood Smear → “Peak”

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MGT

**Artemether Lumefrantine** → first-line

Primaquine - ff-up drug; 3-14 days

Chloroquine → prophyliactic drug; P. Virax

Quinine IM/IV

* supine for 1 hr
* wof dizziness

Filariasis

Stages

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1. Asymptomatics S. → 8-16 months
2. Acute Stqge


1. Lymphdenitis
2. Lymphangitis
3. Funiculitis → spermatic cord
4. Orchitis → testes
5. Epididymitis
3. Chronic S. (10-15 years)


1. Hydrocele
2. Elephantiasis
3. Lyphmedema

Diagnostics

1. Nocturnal Blood Exam

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MGT

DEC _> diethyl carbamezapine (hetrazan)

4 S

Search & destroy

Self-protection

Say No to indiscriminate fogging

Seek Early Consultation

Tuberculosis

CA: mycobacterium tubercle

MOT: airborne droplet → cough

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LatenT

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Acrive

Afternoon low-grade fever

blood in sputum (hemoptysis)

Cough (less than 2 wks)

ddec in weight

eevening sweat (night sweats)

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extrapulmonary tb

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RIPES OF TB

* Rifampicin
* S/E: red-orange body fluids
* A/E: hepatotoxic
* bawal alak &

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Inad Vit. B6 (Pyridoxine) → peripheral neuritis

No to tyramine foods → HPN crisis

Hepatotoxic

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* Pyrazinamine
* A
* I
* N
* → inhibit the excretion of uric acid → Inc. fluid intake, NSAIDs, Allopurinol

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* Ethambutol
* Eyes → Optic Neuritis → Blindness
* Not for children 6 yo and below

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* Streptomycin
* aminoglycoside
* Nephrotoxicity
* Ototoxicity

Leprosy: Hansen’s Disease

C.A. Mycobacterium Leprae

MOT: Airborne-Droplet

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Skin

Mucuos-Membrane

Peripheral nerve

Testes

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early

* Loss of skin sensation
* extremities paralysis
* painful/thick nerves
* redness eyes
* obstruction nose
* skin color changes → reddish / white
* your ulcer do not heal

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late

* large breast in male
* achronic ulcer contracture
* toes & fingers clawing
* eyebrows loss (madarosis)
* eyelids can’t close completely

**Leprosy: Types**

* Paucibacillary (Tuberculoid & Intermediate)
* Tx: Rifampicin & Isoniazid

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* Multibacillary (Lepromatous & Borderline)
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