COMMUNICABLE DISEASES

Disease Etiologic Agent Classification Drug of Choice

RESPIRATORY
Pertussis Bordetella pertussis Bacteria erythromycin
(whooping cough)
Pneumonia Streptococcus pneumioniae Bacteria Amoxicillin

Pulmonary tuberculosis Mycobacterium tuberculosis Bacteria RIPES

Influenza Influenza virus Virus oseltamivir

Diptheria Corynebacterium diptheriae Bacteria penicillin

Meningitis Neisseria meningitidis Bacteria ceftriaxone

VIRAL EXANTHEMS
Varicella chicken pox Varicella Zoster Virus VZV Virus acyclovir

Rubeola Measles Morbili virus virus x

Rubella German Toga virus virus x
Measles Rubi virus
GASTRIC INTERAL TRACT

Typhoid Salmonella typhii Bacteria Ciprofloxacin

Cholera Vibrio cholerae Bacteria Tetracycline

Poliomyelitis Legio debilitans virus x

Hep A & E Hep A, E Virus x
Ascariasis Ascaris lumbricoides virus mebendazole
Amoebiasis Entamoeba histolytica Parasite metronidazole

GUT/STD’s
Gonorrhea Neisseria gonorrheae bacteria ceftriaxone
AIDS HIV virus
Syphilis Treponema pallidum bacteria Penicillin
Chancroid Haemophilus ducreyi bacteria erythromycin
Chlamydia trachomatis C. trachomatis bacteria erythromycin
infection
SWIMMING IN CONTAMINATED WATER

Schistosomiasis Schistosoma japonicum Parasite Praziquantel

Leptospirosis Leptospira interrogans bacteria Pen G
MOT THRU SKIN: VECTOR BORNE
Chikungunya Chikungunya virus Virus X
 Zika Zika virus virus X
Malaria Plasmodium Parasite Co – artem
Dengue Flavi/Arbo Virus X
Filariasis Wuchereria Bancrofti Parasite Hetrazan
Japanese Encephalitis Jap B virus virus x
OTHERS
Rabies Rhabdo virus virus vaccine
Tetanus Clostridium tetani bacteria metronidazole

COMMUNICABLE DISEASE
MOT: by agency, vector or fomites

Types of Communicable Diseases

1. Contagious – spread by direct contact with infectious agents causing disease

- Easily transmitted from 1 person to another through direct or indirect means
2. Infectious – requires direct inoculation of organism through a break on skin or mucous
membrane

RULE: All contagious are infectious, BUT not all infectious are contagious.

Classification of Diseases: Based on occurrence

1. Sporadic – intermittent occurrence of few isolated unrelated cases in given locality

- disease occurs occasionally, irregularly, no specific pattern
2. Endemic – contributes occurrence throughout a period of time, of usual number of cases in a
given locality
- Constantly present in population, community or country
3. Epidemic – occurrence is of unusually large number of cases in a relatively short period of time
4. Pandemic – epidemic disease that occurs worldwide

Types of Infection

1. Recurrent – reappearance of symptoms after infectious disease has been treated or subsided
- Renewed presence of same infectious agent
2. Reinfection – after an initial infectious agent has been eliminated, a new infection occurs caused
by same organism or by another strain of same species
3. Superinfection – during the illness, additional infection occurs by another infectious agent
4. Autoinfection – the infected person is his own self direct source of re-exposure

Disease according to source of infection

1. Exogenous – source of microorganism from outside of body

2. Endogenous – source of infection inside the body
3. Fulminant – infection that results in the death of the patient over a short period of time
4. Nosocomial – hospital acquired infection

According to severity or duration of infectious disease

1. Acute – occurs over short period of time

2. Chronic – occurs over long period of time
3. Latent disease – causative organism remains inactive for a time but can become active
&produce symptoms of disease

According to source of infection

1. Incidence – refers to number of people in population who developed a disease during a specific
period of time
2. Prevalence – number of people in population who developed disease at particular time

Patterns of Infection (Course of Infectious Process)

1. Incubation Period – from entry of microorganism to body to onsent of nonspecific signs and
symptoms
2. Prodromal Period – extends from onset of nonspecific to appearance of specific signs &
symptoms
3. Illness Period – host experiences maximum impact of infectious process
 4. Convalescent period – manifestation subside

Chain of Infection

 Causative Agent – virus, bacteria, fungi, parasite

 Reservoir – Inanimate object, humans, animals
 Portal of Exit
 Mode of transmission – easiest link to break
a. Contact Transmission – refers to spread of microorganism through direct and indirect
contact
 Direct Contact – aka person to person transmission
- Involves direct transmission by ____ contact between the source of infection &
susceptible host

Ex. common colds, respiratory tract infections, _____, syphilis, gonorhea

 Indirect Contact – refers to transmission of causative agent from its reservoir to a

susceptible host through an inanimate object (fomites)
Ex. common fomites: handkerchief, towels, spoons, toys
 Droplet – organism is spread in droplet nuclei travel only short distances usually <1
meter from the reservoir to the host
 Airborne – refers to spread of pathogens by droplet nuclei in dust that travles >1 meter
from the reservoir to the host
Ex. measles, tuberculosis
 Vector borne – carry organism from one host to another
- insects (arthropods) are the most important group of vectors

Ex. vector borne diseases: Malaria, Dengue, Chikungunya, Jap B, Filariasis, Zika

 Portal of Entry – usually this path is same as the portal of exit

 Susceptible host – final and most important link in chain of infection

Control Measure in the Spread of Infection

1. Isolation - separation of infected person

2. Quarantine – limitation movement of susceptible host

Sterilization – process of completely destroying all microbial forms on a non-living object spore

Disinfection – process by which most microbial forms in a non-living object are destroyed without
necessarily bacterial spores

Antisepsis – use of chemical agent on living tissue (skin) to prevent spread of microorganisms either by
inhibiting their growth or destroying them

CONCEPTS OF IMMUNOLOGY

 Immunology – the study of the immune system and the immune response
 Immunogen – any substance capable of inducing immune response, whether humoral cellular or
both
 Antigen – substance that is recognized by a particular antibody or T cells and serves the target of
the immune response

LINES OF DEFENSE

 1st Line of Defense

- Intact skin and mucous membrane
 - Enzymes in tears in body secretions
- Normal flora
 2nd Line of Defense
- Innate arm of immune system
- Interferon natural killer cells (kills virus – infected cells)
- Neutrophils and macrophages (phagocytes)
 3rd Line of Defense
- Adaptive arm of immune system
- B cells & T cells

IMMUNE SYSTEM

Main function: To protect the host against infection caused by virus, bacteria, fungi, parasites

Cells involved:

 B lymphocyte or B cell
 T lymphocyte or T cell

Lymphocytes: produce in primary (central)lymphoid organs

1. Thymus
2. Bone marrow

B cells – remain in bone marrow to reach maturity

T cells – need to migrate in the thymus where they mature

Upon maturation, B and T cells enter blood stream, migrate to secondary lymphoid organs

Secondary or Peripheral lymphoid organs

 Lymph node spleen

 Mucosa-associated lymphoid tissue
1. Tonsils
2. Appendix
3. Peyer’s patches of small intestine
- Sites where antigen from organism entering body or present on body surface are trapped

B lymphocytes (B cells)

 Differentiate into antibody producing plasma cells

 Produces immunoglobulin/antibodies
 Antigen presenting cells
 Possesses cell memory, with immunoglobulins on its surface (IgD & IgM)

T lymphocytes (T cells) have 2 main subsets:

 CD4+ T cells – helper T cells

- Promote inflammation & antibody production
 CD8 T cells – cytotoxic T cells
- Recognize and kill virus infected cells, tumor cells & foreign cells
- Also possess immunologic memory

TYPES OF IMMUNITY

1. Innate Immunity (Natural Immunity)

- Exist from the time of birth prior to exposure to antigen
 - Non-specific
- Includes host barriers (1st line of defense)
- Phagocytosis & inflammation (2nd line of defense)
2. Acquired (Adaptive Immunity)
- Occurs after exposure to antigen, improves upon repeated exposure
- Specific
- Responsible for conferring lifetime protective immunity to re-exposure with same pathogen
- Mediated by B (antibody formation) and T cells

Maybe:

 Active Immunity
- is resistance induced upon contact with foreign antigens
- Long term resistance
- Slow onset
 Passive Immunity
- is resistance based on antibodies performed in another host
- Forms of passive immunity:
a. IgG – passed from mother to fetus during pregnancy
b. IgA – passed from mother to newborn during breastfeeding
 Humoral Immunity
- involve mainly activities of different cells & involve in both primary & secondary
responses

Antibodies – are globulin proteins (immunoglobulins) that react with specific antigen that stimulated their
production

5 MAIN CLASSES OF ANTIBODIES

1. IgG – predominant antibody secondary response

- Major defense against fungi & viruses/bacteria
- Only antibody to cross the placenta
- Most abundant antibody in the newborns
- Main immunoglobulin in chronic infections
2. IgM – largest immunoglobulin
- Main immunoglobulin produced by early in primary response
- Predominant immunoglobulin in acute infections
3. IgD – immunoglobulin with no antibody function
4. IgE – immunoglobulin that mediates immediate (anaphylactic) or severe allergy reaction
5. IgA – main immunoglobulin in secretions (colostrum, saliva, tears, resp, intestinal, secretions)

FORMS OF ISOLATION

 Strict Isolation – for highly transmissible or dangerous pathogens

 Contact Isolation – to prevent the spread of diseases that can be spread through contact with
open wounds
 Respiratory Isolation – is used that are spread through particles that are exhale
 Reverse Isolation – to prevent patient in a compromise health situation from being contaminated
by other people or object
 Enteric Isolation – prevent infections transmitted by direct or indirect contact with fece
Ex. typhoid, cholera & polio
 Blood & Fluid Precautions – when communicable diseases found in patient’s body fluid
 MOT THRU SKIN: VECTOR BORNE

Vector: mosquito

Causes: virus

ZIKA VIRUS INFECTION CHIKUNGUNYA

Mode of Transmission - Mosquito bite - Mosquito bites
- Sexual transmission
- Pruritic Maculopapular rash
- Maculopapular rash Conjunctival infection
- Trunk to lower body Arthralgia
- Microcephaly
- Conjunctival infection
- Arthralgia (joint pain)
Mgt:
- Symptomatic & supportive
- No vaccine

JAPANESE ENCEPHALITIS

: Significant viral encephalitis

 Vector: culex mosquitoes

 IP: 5 – 15 days
 Have vaccine
 No rash
 Can cause brain damage

S/sx:

 nonspecific febrile illness

 NV, diarrhea, cough
 Acute flaccid paralysis
 Severe encephalitis

Vaccine:

 2 IM
  28 days apart
 1 week prior to travel

Vesiculopapular lesions – variola

DENGUE

 Etiology/cause: virus
 Aedes aegypti: female
- Low flying, day biters
- In rainy season
- Lay eggs in stagnant water
- Mot: bite of infected mosquitoes

Causes: Flavi virus – Arbo (under family of flavi) (main reason)

Rash: Maculopapular rash

Herman’s rash

Spreads: Trunk to sideward (centrifugal)

Warning signs:

- Persistent vomiting
- Rapid decrease platelet
- Inc hematocrit (dehydration)
- Mucosal bleed (epistaxis)
- Abdominal pain
- Liver enlargement, lethargy

Priorities:

- Fluid volume deficit

- Prevent hypovolemic shock

Fluid: Plain LR

DX:

 Torniquet Test: Presumptive diagnosis; detects capillary fragility

 Platelet Count: Confirmatory test – Result: <100,000 cells/mm3
 Hemoconcentration: Increase 20% Hct

Complication: Shock to Death

Treatment

 Antipyretic/ Analgesic: Do not administer NSAID for fever:

- Mefenamic
- Ibuprofen
 - Naproxen
- Dicloperac
- Celecoxib
 Paracetamol – can only be given

Preventive Measures:

 Search & destroy breeding places

 Secure self- protection
 Seek early consultation
 Support spraying to prevent impending outbreak

MALARIA

Cause/ Etiology: Parasite

- Protozoal (plasmodium)
- unicellular

Vector: Anopheles

- does not bite humans in motion

- high flying
- Night biter
- Clear stagnant water
- Larger
- Brown
 Sexual Cycles (Sporogony) Mosquitos
 Asexual Cycle (Schizogony) Humans
Intermediate Host

Destroy: RBC (anemia)

Iron Deficiency Anemia: spoon shaped nails

Causative Agents:

1. Plasmodium Falciparum
- Common in Philippines
- Fatal (nakakamatay)
- Black water fever
- Cerebral malaria
- Malignant tertian malaria
2. Plasmodium Ovale
- Rarely seen in Philippines
- Benign tertian
- Vivax (both) (most common)
- Ovale
3. Plasmodium Vivax
- Benign tertian malaria
- Fever occurs every 48 hrs on 3rd day
4. Plasmodium Malariae
- Quartan malaria
- Fever & chills every 72 hrs on 4th day

MOT:
 - Bite of infected female Anopheles mosquito
- Blood transfusion (vehicle borne)
- Transplacental

S/SX: 3 STAGES

- Cold – chills
- Hot – fever
- Wet – sweat

Clinical Management:

- Malaise (general weakness)

- Splenomegaly
- Hepatomegaly
- Hypoglycemia

Diagnostics:

 Malarial Smear: Confirmatory test

- Detects malaria paraise
- Best done during the height of fever
 Quantitative Buffy Coat (QBC) / Rapid Diagnostic Test (RTD)
- Detects malarial antigen
- Take anytime, the faster tes

DOC: Co- artem, Chloroquine

Management:

- With chills: add blanket to keep warm

- For fever: antipyretics, TSB
- Keep patient dry; avoid drafts or exposure to air

Prevention:

 Zooprophylaxis – typing of domestic animals to divert attention of mosquitos

 Stream Seeding – constructions of ponds for larvae eating fishes (dengue: gold fish; malaria:
tilapia)
 Stream Clearing – eradication of breeding places

FILARIASIS

Etiology/ Causative Agent: worm

- Worm Wuchereria Bancrofti

- Brugia malayii
(round worm inside mosquito)

Vector: Mosquito

(round worm inside mosquito)

- Elephantiasis
- Bite of mosquito
- Metazoa:

Mode of Entry:
  Culex, Aedes – carries of W. bancrofti
 Mansonia mosquitoes – carriers of B. Malayii

IP: 3 to 12 months

Drug of Choice: Diethylcarbamazine (Hetrazan)

S/Sx:

 Acute – local inflammation skin, lymph nodes, N/V, fever, edema

 Chronic- massive swelling of legs arms, genetalia, kidney – renal failure – dialysis

Diagnostics

- Microfilariae in blood, fluid or urine

- Immunochromatographic Test (ICT)

Complications

- Tissue necrosis, Kidney damage

- Gross disfigurement
- Disturbed Body Image

Preventive

- Avoid mosquito bites

- Apply mosquito repellent
- Wear protective clothing

Aerosol Generating Procedure

- Infection Control
- N95
 Bronchoscopy
 Airway suctioning
 Sputum induction
 Intubation, extubation
 CPR, Ventilation (manual, non-invasive-bipap, cpap)

Medical Waste

- Waste that has been generated during the course of care and contaminated or visibly soiled
- Blood or other potential infectious materials
- Urine, feces, suctioned fluids
- Irrigating solutions, excretions, secretions

General Waste

- Not soiled with body fluid or blood

Color coding scheme used in health care facilities for medical waste mgt:

 Red – sharps, scalpels

 Orange - radioactive waste
 Yellow – infectious mateials (with blood and body fluids)
 Black – non-infectious, dry waste
 Green – non-infectious, wet waste
PRIMARY LYMPHOID ORGANS

- Bone marrow (B cells are made)

- thymus

SECONDARY OR PEIPHERAL LYMPHOID ORGANS

- Lymph nodes
- Spleens

Mucosa associated lymphoid tissue

- Tonsils
- Appendix
- Peyer’s patches

INFECTION CONTROL BASIC

- Hand hygiene
- Isolation precaution
 Reverse - chemo
 Resp - covid
 Enteric - typhoid
 Strict - HIV
- Decontamination
- Disinfection
- Sterilization
- Environmental care
- Healthcare Waste management
- Healthcare workers protection
 Gloves
 Gowns
 Goggles
 Mask

TRIVIA:

 Hematochezia – bloody stool

 Melena - black stool
 Macroglossia – enlargement of tongue
 Cephalocaudal – Head to toe spread – German Measles & Rubeola
 Doc in MI – morphine
 Angina – nitroglycerine
 Standard Precaution
- Nose & mouth are covered when coughing or sneezing
- Handwashing
- Needles placed in a puncture-resistant container
- Avoid use of artificial nails
 Quarantine – Incubation period