Terminologies

• Communicable Disease – Illness caused by an infectious agent of its toxins

• Infection – Implantation and successful replication of an organism within the body causing immunologic response

• Contact

• Carrier

• Contagious Disease – Disease that is easily transmitted

• Infectious Disease – Requires direct inoculation through a break on the skin or mucous membrane

• Host

• Reservoir

• Disinfection – Destruction of pathogens outside the body by physical or chemical mean

• Concurrent Disinfection – When patient is still the cause of infection

• Terminal Disinfection – Patient is no longer the source of infection

• Isolation – Separation of person with communicable disease

• Reverse Isolation – Separation of immunocompromised person at risk of communicable disease

• Quarantine – Limitation of freedom within the longest incubation period of the disease

Epidemiology

• Epidemiologic Triangle

  • Agent

    • Bacteria

    • Viruses

    • Fungi

    • Protozoa

    • Prions

    • Helminths

  • Host

  • Environment

• Patterns of Occurrence and Distribution

  • Endemic

  • Sporadic

  • Epidemic

  • Pandemic

Chain of Infection

• Causative Agent

• Reservoir

• Portal of Exit

• Mode of Transmission

• Portal of Entry

• Susceptible Host

Agent

• Infectivity – Ability to invade and replicate

• Virulence – Strength of the agent to cause a disease

• Pathogenicity – Ability to cause a disease

• Antigenicity – Ability to stimulate antibody production

• Invasiveness– Ability to live outside the body

Mode of Transmission

• Direct Contact

• Indirect Contact

• Droplet Spread

• Air-borne Transmission

• Vehicle-borne Transmission

• Vector-borne Transmission

Acquisition

• Community acquired
  Nosocomial

• Iatrogenic

Stages of Infection

• Incubation – Infection —> 1st SSx

• Prodromal – 1st SSx —> Pathognomonic signs

• Illness or Fastigial – All SSx

• Convalescence or Defervescence – Subsiding SSx and recovery

Immunity

• Natural Immunity

  • Active

  • Passive

• Artificial immunity

  • Active

  • Passive

• Types of Antigen

  • Inactive

    • not long lasting

    • multiple doses

    • booster needed

  • Attenuated

    • single dose only

    • long lasting immunity

Isolation

• Strict Isolation

• Contact Isolation

• Respiratory Isolation

• Enteric isolation

• Drainage/Secretion Isolation

• Universal Precaution

  

Integumentary Diseases

Chicken Pox

• Agent: HHV3 or Varicella-Zoster Virus

• MOT

  • Airborne

  • Direct Contact

  • Contact with contaminated fomites

• Incubation Period: 11 to 21 Days

• Period of Communicability – 5 days before onset of rash and 5 days after first crop of vesicles

• SSx

  • Itchy maculovesiculopapular lesions

  • Earliest complication: Encephalitis

  • Late complication: Herpes Zoster

• Dx

  • Tszank Smear

  • Lesion: Center —> Periphery

  • 

• MGT

  • Strict Isolation

  • Fever: NO ASPIRIN

  • Pruritus

    • Calamine Lotion

    • Oatmeal bath

    • Cornstarch bath

    • Antihistamine

    • Cut nails or use mittens

• DOC: Acyclovir/Zovirax

Rubeola

• Measles, 1st Disease, English Disease, 7 day rash

• Agent: Paramyxoviridae

• MOT:

  • Airborne

  • Direct Contact

  • Indirect Contact

• Incubation Period: 7-14 days

• Period of Communicability: Just before the prodrome until 4 days after the rash appears

• Koplik’s Spots (ENANTHEM) – pathognomonic sign

• 

• Pre-eruptive Stage

  • Fever

  • Catarrhal symptoms

  • Stimson’s line

• Eruptive Stage

  • Maculo-papular rash (EXANTHEM)

  • High grade fever

  • Anorexia and Irritability

• Convalesnce Stage

  • Rashes fade away

  • Fever subsides

  • Desquamation begins

  • Symptoms subsides

• MGT

  • Supportive and Symptomatic

    • Fever – TSB

    • Koplik Spots – Gentian violet, water and salt–

  • Vitamin A

    • <1 yr – 100,000 IU

    • >1yr – 200,000 IU

    • Pregnant – 10,000 IU

  • Dim light and use Shades

• Complication: Bronchopneumonia

• Prevention: Immunization

  • Anti-measles: 9 months

  • MMR

    • 1st dose at 15 months

    • 2nd dose at 12 years old

Rubella

• German measles, 3 Day Rash

• Togaviridae

• MOT

  • Droplet

  • Direct contact of respiratory secretions

  • Transplacental Transmission

• Incubation period: 2 to 3 day

  

• Prodromal Period

  • Low grade fever

  • Headache

  • Malaise

  • Mild coryz

  • Conjunctivitis

  • Cervical lymphadenopathy

• Eruptive Period

  • Forchheimer’s Spot — Pathognomonic

    • 

  • Rash – last for 1 to 5 days

  • Orchitis

  • Transient polyarthritis

• Congenital Rubella

  • IUGR– IUFD

  • Cleft palate

  • Cardiac Defects

  • Eye defects

  • Ear defects

  • Mental retardation

• Prevention

  • MMR: 2 doses

  • Rubella titer <1:8 - Not immune

  • Immune serum globulin within one week after exposure

Scabies

• The Itch

• Sarcoptes scabiei

• MO

  • Direct inoculation

  • Skin to skin contact

  • Indirect contact with fomites

• IP: 4 to 6 weeks

• Signs and Symptoms

  • Linear burrow

  • Anaphylactic reaction

  • Acropustulosis

    • Pustules

    • Blisters

    • Ulceration

      

• MGT

  • Kwell lotion (Gamma benzene hexachloride)

  • Crotamiton (Eurax)

  • DOC: IVERMECTIN: Single dose

• Prevention

  • Good personal hygiene

  • Avoid direct contact with infected persons

  • All members of the household should be treated

Neurologic Diseases

Rabies

• Hydrophobia, Lyssa

• Rhabdovirus

• All warm blooded animals are susceptible

• MOT

  • Bite or scratch of rabid animal

  • Transplant of infected organ

• IP: 9 days to 7 years

• SSx

  • Numbness at site

  • Salivation

  • Fever

  • Headache

  • Malaise

  • Hydrophobia/Aerophobia

  • Hallucination

  • Confusion or Restlessness

  • Respiratory paralysis

• Dx: Flourescent Antibody Test

• 

• MGT

  • Wash wound for 5 minutes

  • Observe the dog for 10 to 14 days

  • Do not rub garlic on wound

  • Hospital: assess for

    • Severity

    • Site (Proximity)

    • Numbness

    • Duration

    • Give Tetanus Immunoglobulin

  • Rabies Immunoglobulin

    • Bayrab

    • Verorab

    • Rabipur

    • Imogam

  • Human Diploid Cell vaccine (HDCV)

    • Imovax

• When symptoms are already present

  • IVF – cover

  • Sedation

  • Restraint

• Prevention – Responsible pet ownership

Leprosy

• Lepra, Hansenosis, Hansen’s Disease

• Mycobacterium leprae

• MOT

  • Droplet

  • Skin to skin contact

• 3 Distinct Forms

  • Lepromatous leprosy

  • Tuberculoid leprosy

  • Borderline leprosy

Lepromatous

• Multibacillary

• Lepromin test negative

• Large amount of bacilli in skin lesion

• 24-30 months treatment

• Rifampicin, Dapsone, Lamprene(Clofazimine)

Tuberculoid

• Paucibacillary

• Lepromin test positive

• Organism rarely isolated on skin lesion

• 6-9 months treatment

• Rifampicin, Dapsone

Early SSx

• Change in skin color

• Loss of sensation

• Decreased/absent sweating and hair growth

• Thickened or painful nerves

• Muscle weakness or paralysis

• Nasal obstruction

• Pain or redness of eyes

• Non healing ulcer

Late SSx

• Gynecomastia

• Madarosis

• Lagopthalmos

• Leonine facies

• Contractures

• Clawing

• Sinking nose bridge

• Chronic ulceration

Dx:

• Slit Skin Smear

Prevention:

• Report all cases and suspects of leprosy

• BCG vaccine

• Health education

Tetanus

• Lock jaw

• Clostridium tetani

• MOT:

  • Direct Inoculation

• IP:– 3 to 21 days

• SSx

  • Hemolysis — Tetanolysin

  • Spasms – Tetanospasmin

  • Opisthotonus

  • Trismus

  • Risus sardonicus

• MGT

  • Wash wound area

  • Hospital: Antitetanus Serum (ATS)

  • Spasms

    • Dilantin

    • Diazepam

  • DOC

    • Metronidazole

    • Penicillin (GABA Antagonist)

• Prevention:

  • TT: 5 doses

  • DPT

Meningitis

• Neisseria gonorrhea

• MOT

  • Droplet

• SSx

  • Increased ICP

  • Kernig’s Sign

  • Brudzinki’s Sign

• Dx

  • Lumbar Tap

    • Cloudy

    • Yellowish

    • Decreased glucose

    • Increased protein

• MGT

  • Respiratory Isolation

  • N95 mask

  • DOC:

    • Penicillin G

    • Mannitol

    • Steroids – cerebral edema

• Prevention

  • Avoid contact with infected person

Poliomyelitis

• Infantile paralysis, Acute flaccid paralysis (AFP)

• Agent:

  • Poliovirus 1,2,3

  • Legio Debilitans

    • Brunhilde

    • Leon

    • Lansing

• MOT

  • Feco-oral transmissionPoliomyelitis

• SSx

  • Poker Spine — destruction of anterior horn cells of spine

  • Hoyne’s Sign

  • Tripod Sign

  • Muscle tenderness, weakness, and spasms

  • Asymmetrical Paralysis of the extremities

  • Loss of superficial and deep reflexes

• Dx: Pandy’s Test

• MGT

  • Enteric isolation

  • ROM exercises

  • Trochanter rolls and foot board are indicated

  • Physical Therapy

• Prevention

  • SALK: Inactivated Polio Vaccine (IPV)

  • SABIN: Oral Polio Vaccine (OPV)

Vector-Borne Diseases

Dengue

• H Fever, Dandy’s Fever, Breakbone fever, Infectious Thrombocytopenic Purpura

• Agents

  • Dengue virus 1,2,3,4

  • Arbovirus

  • Chikungunya virus

• MOT

  • Vector-borne: Aedes Egypti

• GRADE 1

  • Dengue fever

  • Fever: 39 degrees Celsius

  • Abd. Pain and vomiting

  • Petechial rash

• Grade 2

  • Dengue hemorrhagic fever

  • Bleeding

• Grade 3

  • Circulatory collapse•

• Grade 4

  • Shock, coma, and death

• Dx: Presumptive

  • Tourniquet test

  • Rumple-lead test

  • Capillary fragility test

• Dx: Confirmatory

  • CBC

  • Platelet count

• MGT

  • Supportive and symptomatic

    • Fever: Analgesics, NO ASPIRIN

    • Increase fluid intake

    • Oresol

    • IVF

    • Blood transfusion

• Prevention

  • Sanitation

  • Treated mosquito nets

  • On-stream seeding

  • On-stream clearing

  • Wear covered clothing

  • Planting Neem trees

  • Zooprophylaxis

Malaria

• Marsh Fever, Ague

• Agents:

  • Plasmodium falciparum

  • Plasmodium vivax

  • Plasmodium malariae

  • Plasmoidium ovale

• MOT

  • Vector: Anopheles mosquito

  • Blood transfusion

  • Transplacental

• SSx

  • Paroxysms with shaking chills

  • Rapid rising fever with severe headache

  • Profuse sweating

  • Myalgia

  • Splenomegaly

  • Hepatomegaly

• Dx: Malarial Smear

• MGT

  • Chemoprophylaxis: Chloroquine

  • DOC

    • Arthimeter

    • Quinine

    • Primaquine

• Prevention

• Sanitation

• Treated mosquito nets

• On-stream seeding

• On-stream clearing

• Wear covered clothing

• Planting Neem trees

• Zooprophylaxis

• Avoid outdoor night activities (9PM to 3AM)

Filariasis

• Elephantiasis

• Agent:

  • Wuchereria bancrofti

  • Brugia malayi

  • Brugia timori

• MOT:

• Vector:

  • Aedes Poecellus

  • Culex quinquefasciatus

  • Anopheles Minimus

  • 

• S/Sx:

  • 1. Acute-Inflammation

    • 1. Lymphadenitis

    • 2. Lympharyngitis

    • 3. Epidydimitis

  • 2. Chronic

    • 1. Lymphedema

    • 2. Hydrocele

    • 3. Elephantiasis

• Dx:

  • 1. Nocturnal Blood Smear-8PM above

  • 2. Immunochromatographic Test

  • 3. Bentonite Flocculation Test

• DOC:

  • DEC (Diethyl Carbamazipine Citrate)

  • Hetrazan/BeltrazanFilariasis

• Prevention:

  • 1. Fumigation/Fogging

  • 2. Proper garbage disposal

  • 3. Avoid over hanging of clothes

  • 4. Seeding: larva eating fishes

  • 5. Cleaning: exposure to sunlight

  • 6. Zooprophyaxis

  • 7. Plant: Neem Trees (sampaguita)

  • 8. Stock: cover/put salt

Respiratory Diseases

Diphteria

• 

  Agent:

  • Klebs-Loeffler Bacillus

  • Corynebacterium Diphteria•

• MOT:

  • Droplet

• S/Sx:

  • 1. Nasal – Foul smelling nasal discharge

  • 2. Pharyngeal – Pseudomembrane, bull-neck

  • 3. Laryngeal – Stridor

• Dx:

  • 1. Confirmatory: Nasal and Throat Swab

  • 2. Schick’s Test – Susceptibility

  • 3. Maloney’s Test - HypersensitivityDiphteria

• Mgt:

  • 1. Do not remove the pseudomembrane

  • 2. Anti-Diphteria Serum

  • 3. Tracheostomy set at bedside

  • 4. DOC:

    • 1. Penicillin

    • 2. Erythromycin

Pertusis

• Whooping cough

• Agent:

• Bordotella pertussis

  • Haemophilus pertussis

  • Bordet-Gengou Bacillus

• MOT:

  • Droplet

  • Direct contact of respiratory dischargesPertussis

• S/Sx:

  • A. Catarrhal Stage - Highly communicable

    • 1. Cough

    • 2. Sneezing

    • 3. Teary eyes

    • 4. Fever

  • B. Paroxysmal Stage - Frequent coughing ending in inspiratory whoop.

• Dx:

  • 1. Nasal and Throat Swab

• MGT:

  • DOC: Erythromycin

  • Supportive Therapy

    • Fluid and Electrolytes replacement

    • Adequate nutrition

    • Oxygen therapy

Pneumonia

• Consolidation of the lungs

• Agent: Streptococcus Pneumoniae

• MOT: Droplet

• S/Sx: Rusty Sputum

• DOC: 1st Amoxicillin2nd Cotrimoxazole (Hepatotoxic)

Tuberculosis

• Consumption disease/ Poor Man’s Disease/ Phi

• Agent:

  • M. Tuberculosis

  • M. Africanum

  • M. Bovis

• MOT:

  • Airborne

• IP: 6-8 weeks

• S/Sx:

  • 1. Cough for 2 weeks or more

  • 2. Afternoon fever

  • 3. Night sweats

  • 4. Chest pain, back pain

  • 5. Anorexia

  • 6. Weight loss

  • 7. Fatigue

• Dx:

  • 1. Presumptive:

    • Mantoux Test

    • Tuberculin

    • PPD test

• IP: 48-72°

• Induration:

  • Immunocompromise: >5mm

  • With risk: >10mm

  • Without risk: >15mmTuberculosis

• Dx:

  • DSSM (Direct Sputum Smear Microscopy)

    • 1. Sputum Test

    • 2. AF Bacilli Test

  • 3. Chest Xray

• MGT: DOTS

  • Category I

    • New patient

    • DSSM (+)

    • Serious

  • Category II

    • Default

    • Relapse

    • Failure

  • Category III

    • Children

    • DSSM (-)

    • Less serious

  • Category IV

    • Chronic

    • MDR

• Drugs:

  • 1. Rifampicin

    • Nephrotoxic

    • Discoloration of secretions

  • 2. Isoniazid (INH)

    • Hepatotoxic (SGPT, SGOT, ALT)

    • Peripheral neuritis

  • 3. Pyrazinamide (PZA)

    • Hyperuricemia

    • Gout

  • 4. Ethambutol

    • Opthotoxic (-) 6y/o and below

  • 5. Streptomycin

    • Ototoxic

    • vertigo, deafness

• Prevention: BCG Vaccination

Gastrointestinal Diseases

Schistosomiasis

• Snail fever

• Katayama diseas

• Bilhariasis

• Agent:

  • Schistosoma japonicum

  • Schistosoma haematobium

  • Schistosoma mansoni

• Reservoir: Oncomelania quadrasi

• MOT: Direct inocculation

• S/Sx:

  • Fever

  • Hepatosplenomegaly

  • Eosinophilia

  • Cough

• Dx: Katokatz test

• DOC: Praziquantel

• Prevention:

  • 1. Boots

  • 2. Molluscicides

Cholera

• “El Tor”

• MOT: Feco-oral

• Agent:

  • Vibrio Cholerae

  • Vibrio El TorCholera

• S/Sx:

  • 1. Rice water stool

  • 2. Washer woman’s hands

  • 3. Vomiting

  • 4. Diarrhea

  • 5. Oliguria

• Mgt:

  • 1. Tetracycline

  • 2. Nalidixic Acid

Amoebiasis

• Amoebic Dysentery

  • Mucoid

  • Blood

• Agent:

  • Protozoa: Entamoeba Hystolytica (cyst) - resistant to chlorine

• S/Sx: Bloody mucoidal stool

• DOC: Metronidazole (Flagyl)

Leptospirosis

• Weil’s disease

• Canicola fever

• Trench fever

• Mild fever

• Canefield fever

• Swineherd’s fever

• Nanukayami disease

• Flood Fever

• Spirochetal Jaudice DiseaseLeptospirosis

• Agent:

  • Spirochete

  • Leptospira interrogans

• MOT:

  • Vector — Rodents

  • irect contact to skin on open wounds

• S/SX:

  • GI

  • Fever

  • Jaundice

  • Conjunctival suffusion

  • Renal interstitial tubular necrosis

  • Nausea and vomiting

  • Meningeal irritation

  • Headache

  • MyalgiaLeptospirosis

• Dx:

  • MAT (Microscopy Agglutination Test)

  • LAT (Leptospira Antigen-Antibody Test)

• DOC:

  • Penicillin

• Prophylaxis:

  • Doxycycline

• Prevention:

  • Eradication of Rodents

Typhoid Fever

• Enteric Fever

• Agent:

  • Salmonella Typhii

  • Typhoid bacillus

• MOT: Feco-oral

• S/SX:

  • Rose spots/Red spots

  • Ladder-like fever

  • Splenomegaly

• Dx:

  • Typhidot

  • Widal test

• DOC: Chloramphenicol

Parasitism

• Ascariasis

  • Ascaris lumbrecoides (giant round worm)

• Ancylostomiasis

  • Ancyclostoma duodenale (hookworm)

  • Necator americanus

• Trichuriasis

  • Trichuris trichuria (whipworm)

• Enterobiasis

  • Enterobium vermicularis (pinworm)

• Taeniasis and Cystiscercosis

  • Taenia solium (flat/tapeworm)

  • Taenia saginata

• Trichinosis

  • Trichinosis spiralis

• DOC: Mebendazole

Reproductive Tract Diseases

Sexually Transmitted Diseases

1. Gonorrhea–

   • N. gonorrhea

   • Purulent discharge

   • Penicillin

2. Candidiasis

   • Candida albicans

   • Cheese-like/curd like secretions

   • Mycostatin (Nystatin)

3. Herpes Simplex

   • HSV

   • Blisters

   • Antiviral/not curable

4. Syphillis

   • Spirochete: Treponema palidum

   • VDRL (Venereal Disease Research Lab Test)

   • RPR (Rapid Plasma Reagin)

   • Penicillin G

5. Chlamydia

   • Chlamydia trachomatis

   • Azithromycin

6. Trichomoniasis/Vaginitis

   • Trichomonas vaginalis

   • Frothy/bubble-like discharge

   • Metronidazole

7. Condyloma accuminata lata

   • Genital warts

   • HPV

   • Cauliflower-like lesions