Understanding & Managing Infectious and Communicable Diseases

Infection

is the invasion and multiplication of pathogenic microorganisms, such as bacteria, viruses, fungi, or parasites, within a host organism. This can lead to tissue damage and trigger an immune response.

can vary greatly in severity, from mild conditions that resolve on their own to serious illnesses that require medical intervention.

Sporadic

Epidemic

Pandemic

Endemic

Incidence of Diseases

EPIDEMIC

is a disease that affects a large number of people within a community, population, or region.

PANDEMIC

is an epidemic that’s spread over multiple countries or continents.

ENDEMIC

is something that belongs to a particular people or country.

OUTBREAK

is a greater-than-anticipated increase in the number of endemic cases. It can also be a single case in a new area. If it’s not quickly controlled, an outbreak can become an epidemic.

Agent - Reservoir - Portal of Exit - Mode of Transmission - Portal of Entry - Susceptible Host

Chain of Infection

Contact Transmission

Airborne Transmission

Vehicle Transmission

Vector borne Transmission

FOUR MODES OF TRANSMISSION

Direct Contact

Indirect Contact

Droplet Spread

Contact Transmission

negative pressured private room

A patient with highly transmissible or epidemiologically important microorganisms is placed in a ___________________________ with handwashing and toilet facilities and personal protective equipment to reduce opportunities for transmission of microorganisms.

Isolation precautions

create barriers between people and germs. These types of precautions help prevent the spread of germs in the hospital

Standard Precaution

Measures used for all patients, regardless of diagnosis, to prevent the spread of infection.
Includes: hand hygiene, use of PPE as needed (gloves, gowns, masks), safe injection practices, proper handling of equipment/ linen, and environmental cleaning.

Droplet Precaution

Used for infections spread through large respiratory droplets (travel about 3 feet).
Requires: surgical mask when within 3 ft of the patient, patient wearing a mask during transport, and placing patient in a private room.
Examples: influenza, pertussis.

Airborne Precaution

Used for infections spread through small aerosolized particles that can stay in the air longer.
Requires: N95 respirator, negative-pressure room, and limiting patient transport.
Examples: TB, measles, chickenpox.

Contact Precaution

Used for infections spread through direct or indirect contact with the patient or their environment. Requires: gloves and gown upon entry, dedicated equipment, and strict hand hygiene.

Examples: C. difficile, MRSA, VRE.

Acquired Immune Deficiency Syndrome (AIDS)

• Caused by HIV (Human Immunodeficiency Virus) that damages cellular immunity

• Attacks Body’s immune system – T4 cells

• Period between infection and appearance of AIDS can take place from 7 to 12 years

Signs and Symptoms for AIDS

Minor Signs

• Persistent cough for 1 month

• Generalized pruritic dermatitis

• Recurrent Herpes zoster

• Oropharyngeal candidiasis

• Fever, sweats (particularly at night)

• Chronic disseminated Herpes Simplex

• Generalized Lymphadenopathy

Major Signs:

• Loss of weight

• Chronic Diarrhea for more than 1 month

• Prolonged fever for 1 month

Pneumocystis carinii pneumonia

Oral Candidiasis

Toxoplasma gondii

Chronic Diarrhea

CANCERS

Common Opportunistic Infections in AIDS Patients

Pneumocystis carinii pneumonia

Attacks the lungs, making it difficult to breathe. Symptoms include a cough that doesn't go away, fever and trouble breathing

Oral Candidiasis (Candida Albicans)

causes inflammation and a thick white coating on the mucous membranes of your mouth, tongue can also be present on the esophagus or vagina

Toxoplasmosis (Toxoplasma gondii)

Acquired by touching mouths with hands after changing cat litter or by eating raw or undercooked meat

Pulmonary tuberculosis

Most common opportunistic infection associated with HIV and a leading cause of death among people living with AIDS

Kaposi’s Sarcoma (human herpesvirus 8)

– affects small blood vessels and internal organs causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat or in other vital organs (e.g lungs).

Cervical cancer (Human Papilloma Virus)

sexually transmitted virus; usually through oral sex; also causes common warts

Non-Hodgkin’s Lymphoma

cancerous tumor of the lymph nodes

Progressive multifocal leukoencephalopathy (PML)

an extremely serious brain infection caused by the human polyomavirus JCV. Signs and symptoms vary.

Sexual Intercourse 

BT and sharing of infected needles 

Organ donation

Accidental exposure in hospitals or clinics

Perinatal transmission

AIDS Modes of Transmission

one in seven

An unborn baby has about a _____________ chance of catching HIV if the mother is HIV positive.

Enzyme Linked Immunosorbent assay

Particle agglutination test (PA test)

Western Blot analysis

Immunofluorescent test

Radioimmunoprecipitation assay (RIPA)

AIDS Diagnostic Examinations

Antiretroviral Drugs

work by inhibiting the reproduction of the virus

Compliance, Counseling, Condoms, and Contact (Partner) Management

4C’s in the management of AIDS

Amoebiasis (Entamoeba histolytica)

Protozoan infection initially involves the colon but may spread to soft tissues, most commonly to the liver or lungs

Source: Human Excreta

Incubation Period: three days in severe infection - several months for acute and chronic form

Period of Communicability: entire duration of the illness

Fecal-oral route (direct contact or indirect contact)

Amoebiasis Mode of Transmission

Signs and symptoms of Amoebiasis

❑Pain on the RQ with the tenderness of the liver

❑Jaundice

❑Weight loss and anorexia

❑Onset is gradual

❑Diarrhea increases and stool becomes bloody and mucoid

❑Stool exam

❑Blood Exam

❑Sigmoidoscopy/ Proctoscopy

Diagnostic Tests Amoebiasis

❑ Metronidazole (Flagyl/Dazomet)

❑ Tetracycline

❑ Ampicillin

❑ Streptomycin

❑ Fluid and electrolyte replacements

Amoebiasis Treatment

CHOLERA (Vibrio cholerae)

An acute bacterial enteric disease of the small intestine with severe vomiting and diarrhea leading to dehydration

Incubation period: ❑ from few hours to 5 day

Complications ❑ Acidosis ❑ Circulatory collapse

CHOLERA Signs and Symptoms

❑ Rice watery stools (pathognomonic sign)

❑ painless watery stools without blood or mucus

❑ Occasional vomiting

❑ Rapid dehydration

❑ Oliguria even anuria

❑ Direct transmission

❑ Indirect Transmission

Modes of Transmission CHOLERA

❑Prompt fluid therapy

❑Tetracycline and other antimicrobial agents

❑Monitoring of serum electrolytes, Intake and Output

CHOLERA Modalities of Treatment

rapid intravenous rehydration with balance multi-electrolyte solution. (K, Na, )

Intervention for client on Shock - CHOLERA

Salmonellosis (Salmonella typhimurium, Salmonella enteritidis)

Infestation of the digestive system by bacteria of Genus Salmonella Gastroenteritis

Reservoir: Domestic and wild animals

Modes of Transmission: Foodborne

Incubation Period: 16-72 hours, usually 12-36 hours

Treatment -  ❑Rehydration and electrolyte replacement Antibiotic

Nursing Management = ❑Isolate the patient ❑Restrict food until Nausea and Vomiting subsides ❑Offer clear liquids

Shigellosis (Shigella dysenteriae)

An acute bacterial disease that involves the large and small intestines

is an acute enteric infection caused by shigellae, a facultative gram-negative, anaerobic bacillus.

Incubation Period - 1-3 days up to 1 week

Mode of Transmission - fecal-oral

Treatment - Antibiotics

Nursing Management - ❑Isolate the patient ❑Maintain fluid and electrolyte balance

❑Fever and Headache

❑Cramping abdominal pain

❑Persistent diarrhea

❑Nausea and vomiting

❑Tenesmus

Shigellosis Signs and Symptoms

❑During acute illness: enteric precaution

❑Adequate sewage disposal

❑Detection and treatment of carriers

Methods of Prevention Shigellosis

ANTHRAX (Bacillus anthracis)

Spores of B. anthracis can survive for years in dry soil

Treatment - ❑ Antibiotic Therapy

Nursing Management -

❑ Care history taking

❑ Thorough physical examination

❑ Skin Care, physiological and emotional support

❑Direct Transmission

❑Indirect Transmission

❑Airborne Transmission

Modes of Transmission ANTHRAX

1. Anthrax Meningitis

2. Anthrax Sepsis

Complications ANTHRAX

❑Parenteral Penicillin G

❑Erythromycin, Tetracycline or Chloramphenicol

Treatment ANTHRAX

ASCARIASIS (Ascaris lumbricoides)

Most common in the tropical regions, especially in poorly sanitized areas

Nursing Interventions :

❑Isolation

❑Handwashing

❑Proper food sanitation

❑Availability of toilet facilities

❑Importance of personal hygiene

❑Biliary tract obstruction

❑Hepatic Abscess and cholangitis

❑Intestinal obstruction ❑Malnutrition

Complications ASCARIASIS

❑Stool for Ova

❑Abdominal X-ray

❑Routine Blood Counts

Diagnostic test  ASCARIASIS

❑Albendazole or Mebendazole

❑Piperazine Citrate

❑Pyrantel Pamoate

Treatment ASCARIASIS

Chicken Pox (Varicella-zoster Virus (VZV))

Highly contagious disease characterized by a maculopapular rash with vesicular scabs in multiple stages of healing Usually benign in children (2-8 yrs old), in adults.

Reservoir - ❑Man

Modes of Transmission -  ❑By direct Contact ❑Airborne

Period of Communicability - ❑1-2 days before the onset of fever or 1 day before the lesion appears

Nursing Management:

❑Respiratory isolation until all vesicles are crusted

❑Cool baths with bacterial soaps

❑Cut the nails

❑Diversional activities

❑Provide general hygiene care

Active immunization: Live attenuated varicella vaccine

Methods of Prevention Chicken Pox

❑Oral Acyclovir

❑Antihistamine

Treatment: Chicken Pox

Smallpox (Variola Virus)

An acute infectious disease with an exanthem

Possible Complications: Nephritis Pneumonia

Modes of Transmission:  ❑Direct Contact ❑Indirect Contact

Period of Communicability: from development of the earliest lesion until the disappearance of all the scabs

Nursing Care : Primarily supportive/ palliative

❑ Fever

❑ Malaise

❑ Headache

❑ Severe backache

❑ Rashes that is more abundant on face and extremities

Signs and symptoms Smallpox

Measles

Highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough and KOPLIK’S SPOT

Mode of Transmission: ❑ Direct contact ❑ Air droplets ❑ Transplacental

Period of communicability: 3 days before rashes appears and about 5 days after rashes began

Modes of Prevention: Heath education: modes of transmission and receiving of vaccine

Treatment: ❑Supportive care

❑ Otitis media

❑ Bronchopneumonia

❑ Encephalitis

Possible Complications: Measles

Nursing Management: Measles

❑Manage fever

❑Bed rest

❑Dim the lights

❑Force fluids

❑Assess for symptoms of complications

❑Keep fingernails trimmed

German Measles (Rubella virus)

“Rubella, 3-day measles” Acute systemic viral disease that produces distinctive 3-day rash and lymphadenopathy

Occurrence: World Wide

Modes of transmission: Direct contact Air droplets Transplacental

Incubation Period: 16-18 days

Period of Communicability: Approx. 1 week before the rash to about 5 days after the rash began

❑Encephalitis

❑Neuritis

❑Arthritis

❑Teratogenic effect

Possible Complications:

a. Health education

b. Prevent exposure of pregnant women to infected person

Preventive Methods es

a. Bed rest

b. Darken the room

c. Irrigate eyes with warm normal saline

Nursing Management German Measle

RABIES (Rhabdovirus)

Fatal acute viral disease of the CNS that affects all warm blooded animals and is usually transmitted to man by a bite of an infected domestic and wild animal

Mode of Transmission: close contact with saliva from infected animals

Incubation Period: Usually 2-8 weeks occasionally as short as 5 days or as long as 1 year

Period of Communicability: 3-10 days in dogs and cats before the onset of clinical signs

Nursing Care:

❑Wash and flush w/ water and soap immediately

❑rabies immune globulin (RIG) and/or vaccines as indicated

❑Isolate the client

❑Keep the patient as comfortable as possible

Signs and Symptoms RABIES

❑Fever, Headache, Pain and paresthesia on the bitten area

❑Dilation of the pupils

❑Sense of apprehension

❑Sore throat ❑Increased salivation

❑Unusual sensitivity to sound, light and changes in temperature

❑Convulsions

❑Episodes of irrational excitement alternating with periods of alert alarm

❑Severe and painful throat spasms when patient attempts to swallow or even view liquid

❑Violent spasms of inspiratory muscles

❑Death due to cardiac and respiratory failure

❑Pet vaccination

❑Observation of pet for 10days after biting someone

❑If the animal dies w/ suspected rabies, bring the intact head for viral antigen testing

Prevention  RABIES

Negri bodies

are aggregates of viral proteins that are most easily detected in the Ammon horn (hippocampus) and in the Purkinje cells in the cerebellum (pathognomonic sign)

TUBERCULOSIS (Mycobacterium tuberculosis)

Reportable, communicable, inflammatory disease that can occur in any part of the body most frequent site-pulmonary

 ❑Persistent cough lasting three or more weeks

❑Chest pain (specially in breathing and coughing

❑Fatigue and weakness

❑Weight loss

❑Loss of appetite

❑Night sweats and fever

Symptoms of Tuberculosis

LEPTOSPIROSIS (Leptospira bacteria)

More common in tropical and subtropical regions and can cause a range of symptoms from mild flu-like illness to severe complications such as liver or kidney failure.

Treatment: ❑Antibiotic

Nursing Management:

❑Early detection

❑Infection control

❑Monitoring and support

❑Patient education

Schistosomiasis (Schistosoma flukes (worms))

Common in tropical and subtropical regions, especially in areas with poor sanitation.

Treatment: ❑Antiparasitic ❑Supportive Care

Nursing Management: ❑Education on Prevention ❑Monitoring for Symptoms ❑Management of Chronic Symptoms ❑Encouraging Compliance with Treatment

bloody stool

lethargy and fever

abdominal pain

headache

Schistosomiasis S&S

Kato-Katz technique

The eggs of intestinal schistosomiasis can be detected in fecal specimens through a technique using methylene blue-stained cellophane soaked in glycerin or glass slides

TETANUS (Clostridium tetani)

Serious bacterial infection found in soil, dust, and animal feces.

Treatment:

❑Wound Care

❑Antitoxin

❑Antibiotic

❑Muscle Relaxants and Sedation ❑

Ventilatory Support

Nursing Management:

❑Pain & Muscle Spasm Management

❑Respiratory Monitoring

❑Infection Control

❑Patient & Family Education

❑Vaccination Awareness

Severe Hyperextension and spasticity

caused by neurotoxin of C. tetani

HEPATITIS

inflammation of the liver, commonly caused by viral infections, but it can also result from other factors such as alcohol use, toxins, drugs, or autoimmune conditions.

Nursing Management:

❑Education on Prevention

❑Symptom Management

❑Dietary Management

❑Monitoring

Hepatitis A (HAV)

• Transmission: Fecal–oral (contaminated food/water), poor hygiene

• Onset: Acute, self-limiting

• Chronicity: No chronic infection

• Vaccine: Yes

• Key Points: Common in outbreaks; handwashing is the best prevention.

• Treatment: Generally supportive, focusing on symptom relief, as these infections are usually self-limiting.

Hepatitis B (HBV)

Transmission: Blood and body fluids

• Sexual contact

• Needles

• Perinatal (mother → baby)

• Chronicity: Can become chronic

• Complications: Cirrhosis, liver cancer

• Vaccine: Yes

• Key Points: More infectious than HIV; screening needed for pregnant women.

• Treatment: Antiviral medications

Hepatitis C (HCV)

• Transmission: Blood (needle sharing, transfusions before screening)

• Chronicity: Most likely to become chronic (70–85%)

• Vaccine: None

• Complications: Chronic liver disease, cirrhosis, hepatocellular carcinoma

• Key Points: Often asymptomatic for years; curable with antivirals.

• Treatment: Direct-acting antivirals

Hepatitis D (HDV)

• Transmission: Blood

• Special Feature: Requires Hepatitis B to replicate

• Chronicity: High risk of chronic infection

• Vaccine: No direct vaccine, but HBV vaccine prevents HDV

• Key Points: Co-infection with HBV makes disease more severe.

• Treatment: Interferon therapy

Hepatitis E (HEV)

• Transmission: Fecal–oral (water contamination)

• Chronicity: Usually acute only

• Vaccine: None (except in China)

• Key Points: Severe in pregnant women (esp. 3rd trimester) → high mortality.

• Treatment: Generally supportive, focusing on symptom relief, as these infections are usually self-limiting

General Symptoms of Hepatitis

❑Fatigue

❑Nausea and vomiting

❑Abdominal pain, particularly in the upper right quadrant (liver area)

❑Loss of appetite

❑Jaundice (yellowing of skin and eyes)

❑Dark urine and pale stools

❑Joint pain