Communicable Dis.

by TRA Jesse Daclis; PHN White Book

Communicable Dis.

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

• Antibody

  • “papatayin ang mga antigen”

  • CHON (protein)

    • destroy familiar antigen

Immunoglobulin (GAMED)

IgM: first Ab → “Mauna ako”

• first to respond

IgG: 2nd Ab → “Gagi sunod ako”

Immunity General Types

• Natural Immunity

  • inherent in the body

  • from the word natural

• Acquired Immunity

  • acquired when exposed to the environment

  Active Acquired Immunity

  • Antibodies are produced by the individual itself

  • !! LONG-TERM PROTECTION

  • “Active Acquired = AKO”

  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

• Artificial Active Immunity (LIT)

  • vaccine → laman ay Antigen

    • Live Attenuated → buhay na pinahina na mikrobyo; bawal for immunocompromised

    • Inactivated → killed; pwede sa immunocompromised

    • Toxoid (modified toxins)

Passive Acquired (IMMUNOGLOBULIN)

• Natural Passive Immunity

  • transplacental → IgG

  • breastfeeding → IgA

• 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

2. Airborne (MTV)

   1. respiratory secretions → fine particles → greater than 3 ft.

   2. use N95

   3. “MTV”

      1. measles

      2. tuberculosis

      3. varicella

3. Vehicle T.

   1. taga-bitbit lamang ng mikrobyo (carrier)

   2. non-living → water, food

4. Vector T.

   1. living

      1. mosquito

      2. fly

RABIES (Lyssa)

CA: Rhabdo Virus → bullet shape virus

• KAPAG NASA EXTREMETIES

  • (-) s/sx

  • (-) contagious

  • (-) death

• KAPAG NASA BRAIN

  • (+) contagious

  • (+) s/sx

  • (+) death

Mode of Transmission:

• animal bite

• scratch

• tissue transplant

*RA 7170: Organ Donation Act

Rabies: Signs & Symptoms

1. Invasive Stage

   1. Prodromal s/sx → nonspecific

   2. fever, photophobia, headache, numbness

2. Excitement Stage

   1. Acute

      1. Hydrophobia (laryngospasm)

      2. Aerophobia (fear of flying)

      3. Maniacal behavior (like a wild animal)

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

Tetanus Toxoid: Prophylaxis

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

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:

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

*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

• Malaria - Marsh Fever

  • CA: protozoal parasite → plasmodium

  • Vector: Anopheles

  • Plasmodium

    • P. vivax

    • P. orale

    • P. malaria

    • P. Falciparum - fatal; common in the Phil.

• Filariasis - Elephantiasis

  • Vector: Aedes Poecillus

  • Roundworms

    • Wuchereria bancrofti

    • Brugia Malayi

    • Brugia timori

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

• Bradykinin

• Prostaglandin

• Histamine

• → after producing → releasing fever

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

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

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

5. CBC

   1. Platelet: low

   2. HCT: high (concentrated)

3. Serological test → (+) Antibody

   1. Elisa / EIA: Enzyme Immunosorbent Assay

      1. Confirmatory Test

4. Dengue Duo

   1. rapid test

      1. (+) NS1 Antigen Test (Viral Particle)

      2. (+) Ab → IgM; IgG

Dengue: Palliative Management

• Paracetamol

  • NO aspirin (platelet inhibitor)

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

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”

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

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

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

LatenT

Acrive

Afternoon low-grade fever

blood in sputum (hemoptysis)

Cough (less than 2 wks)

ddec in weight

eevening sweat (night sweats)

extrapulmonary tb

RIPES OF TB

• Rifampicin

  • S/E: red-orange body fluids

  • A/E: hepatotoxic

  • bawal alak &

Inad Vit. B6 (Pyridoxine) → peripheral neuritis

No to tyramine foods → HPN crisis

Hepatotoxic

• Pyrazinamine

• A

• I

• N

• → inhibit the excretion of uric acid → Inc. fluid intake, NSAIDs, Allopurinol

• Ethambutol

  • Eyes → Optic Neuritis → Blindness

  • Not for children 6 yo and below

• Streptomycin

  • aminoglycoside

  • Nephrotoxicity

  • Ototoxicity

Leprosy: Hansen’s Disease

C.A. Mycobacterium Leprae

MOT: Airborne-Droplet

Skin

Mucuos-Membrane

Peripheral nerve

Testes

early

• Loss of skin sensation

• extremities paralysis

• painful/thick nerves

• redness eyes

• obstruction nose

• skin color changes → reddish / white

• your ulcer do not heal

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

• Multibacillary (Lepromatous & Borderline)