EPI DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Tuberculosis Mycobacterium Airborne-droplet 1. Usually asymptomatic Diagnostic test: • Respiratory precautions
tuberculosis 2. Low-grade afternoon • Sputum examination or the Acid-fast bacilli • Cover the mouth and
Other names: Direct invasion fever (AFB) / sputum microscopy nose when sneezing to
Koch’s Disease TB bacillus through mucous 3. Night sweating 1. Confirmatory test avoid mode of
Consumption Koch’s bacillus membranes and 4. Loss of appetite 2. Early morning sputum about 3-5 cc transmission
Phthisisperiod for development
Most hazardous Mycobacterium bovis
of clinical breaks in the skin 5. Weight loss 3. Maintain NPO before collecting sputum • Give BCG
disease isWeak
the first 6-12 months after infection
lungs (very rare) 6. Easy fatigability – due 4. Give oral care after the procedure • Improve social
Highest risk of developing disease(rod-shaped)
is children under to increased oxygen 5. Label and immediately send to laboratory conditions
3years old Incubation period : demand 6. If unknown when was the sputum collected,
4 – 6 weeks 7. Temporary amenorrhea discard
TREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS;
8. Productive dry cough • Chest X-ray is used to:
Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S) 9. Hemoptysis 1. Determine the clinical activity of TB, whether
CATEGORY 1: 6 CATEGORY 2: 8 it is inactive (in control) or active (ongoing)
months SCC CATEGORY 3: 4 SIDE EFFECTS: 2. To determine the size of the lesion:
months SCC
months SCC Rifampicin a. Minimal – very small
Indications: Indications: SIDE EFFECTS:
Indications: • body fluid
> new (+) smear > treatment failure b. Moderately advance – lesion is < 4 cmEthambutol
discoloration
> (-) smear PTB with > relapse > new (-) smear PTB c. Far advance – lesion is > 4 cm • Optic neuritis
• hepatotoxic
extensive > return after default with minimal lesions • Tuberculin Test – purpose is to determine the• Blurring of vision
• nephrotoxic
parenchymal lesions Intensive Phase:3 mos on CXR history of exposure to tuberculosis
R&I 1 tab each; P&E 2
• permanent (Not to be givento
on CXR Same meds with discoloration of Other names:
tabs each children below 5 y.o. due
> Extrapulmonary TB Category 1 contact lenses Mantoux Test – used for single screening, result
Streptomycin – 1 to inability to complain
> severe concominant Intensive Phase: 2 Isoniazid interpreted after 72 hours
vial/day IM for first 2 blurring of vision)
HIV disease months • Peripheral Tine test – used for mass screening read after •48 Inability to recognize
mos = 56 vials (if R&I 1 tab each; P&E neuropathy
Intensive Phase: 2 hours green from blue
given for > 2mos can 2 tabs each (Give Vit
months Interpretation: Streptomycin
cause hepato- and Continuation Phase: 2 B6/Pyridoxine)
R&I : 1 tab each; P&E nephrotoxixity 0 - 4 mm induration – not significant
months • hepatotoxic • Damage to 8th CN
2 tabs each Continuation Phase: 5 5 mm or more – significant in individuals who
R&I 1 tab each • nephrotoxic • Ototoxic
Continuation Phase: 4 months are considered at risk; positive for patients who
are HIV-positive or have HIV risk factors and •areTinnitus
Pyrazinamide
months R&I : 1 tab each CATEGORY 4: • hyperuricemia /gouty
R&I : 1 tab each E : 2 tabs Chronic (*Referral of unknown HIV status, those who are close • nephrotoxic
arthritis (increase fluid
needed) intake) contacts with an active case, and those who have
chest x-ray results consistent with tuberculosis.
10 mm or greater – significant in individuals
who have normal or mildly impaired immunity

NATIONAL TB CONTROL PROGRAM: s
Vision: A country where TB is no longer a public health problem
Mission: Ensure that TB DOTS Services are available, accessible, and
affordable to the communities in collaboration with LGUs and others
Goal: To reduce prevalence and mortality from TB by half by the year 2015
(Millennium Development Goal)
Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered
2. Detect at least 70% new sputum smear (+) TB cases
Objectives: 1. Improve access to and quality of services
2. Enhance stakeholder’s health-seeking behavior
3. Increase and sustain support for TB control activities
4. Strengthen management of TB control activities at all levels
KEY POLICIES:
*Case finding:
- DSSM shall be the primary diagnostic tool in NTP case finding
- No TB Dx shall be made based on CXR results alone
- All TB symptomatic shall be asked to undergo DSSM before treatment
- Only contraindication for sputum collection is hemoptysis
- PTB symptomatic shall be asked to undergo other tests (CXR and culture),
only after three sputum specimens yield negative results in DSSM
- Only trained med techs / microscopists shall perform DSSM
- Passive case finding shall be implemented in all health stations

*Treatment: Domiciliary treatment – preferred mode of care

DSSM – basis for treatment of all TB cases
*Hospitalization is recommended: massive hemoptysis, pleural effusion,
military TB, TB meningitis, TB pneumonia, & Sx is needed or with Cx
*All patients undergoing treatment shall be supervised
*National & LGUs shall ensure provision of drugs to all smear (+) TB cases
*Quality of fixed-dose combination (FDC) must be ensured
*Treatment shall be based on recommended category of treatment regimen
DOTS Strategy – internationally-recommended TB control strategy
Five Elements of DOTS: (RUSAS)
Recording & reporting system enabling outcome assessment of all patients
Uninterrupted supply of quality-assured drugs
Standardized SCC for all TB cases
Access to quality-assured sputum microscopy
Sustained political commitment MANAGEMENT OF CHILDREN WITH TUBERCULOSIS - for TB symptomatic children
*a TB symptomatic child with either known or
Prevention: BCG immunization to all infants (EPI) unknown exposure to a TB case shall be referred
for tuberculin testing
Casefinding: * (+) contact but (-) tuberculin test and unknown
- cases of TB in children are reported and identified in 2 contact but (+) tuberculin test shall be referred for
instances: (a) patient was screened and was found symptomatic CXR examination
of TB after consultaion (b) patient was reported to have been *(-) CXR, repeat tuberculin test after 3 months
exposed to an adult TB patient * INH chemoprophylaxis for three months shall be

2. Diphtheria Corynebacterium Droplet especially Pseudomembrane – Diagnostic test: DPT immunization
diphtheria secretions from mycelia of the oral mucosa Pasteurization of milk
Types: mucous membranes causing formation of white • Nose/throat swab Education of parents
> nasal Klebbs-loffler of the nose and membrane on the • Moloney’s test – a test for hypersensitivity to
> pharyngeal – nasopharynx and oropharynx diphtheria toxin
most common from skin and other • Schick’s test – determines susceptibility to
> laryngeal – lesions Bull neck bacteria
most fatal due to Dysphagia
proximity to Milk has served as a Dyspnea Drug-of-Choice:
epiglottis vehicle Erythromycin 20,000 - 100,000 units IM once only

Incubation Period:
2 – 5 days
3. Pertussis Bordetella pertussis Droplet especially Catarrhal period: 7 days Diagnostic: DPT immunization
Hemophilus pertussis from laryngeal and paroxysmal cough Booster: 2 years and 5-5
Whooping cough Bordet-gengou bacillus bronchial secretions followed by continuous • Bordet-gengou agar test years
Tusperina Pertussis bacillus nonstop accompanied by Patient should be
No day cough Incubation Period: vomiting Management: segregated until after 3
7 – 10 days but not 1. DOC: Erythromycin or Penicillin 20,000 - weeks from the appearance
exceeding 21 days Complication: abdominal 100,000 units of paroxysmal cough
hernia 2. Complete bed rest
(because if more 3. Avoid pollutants
than 21 days, the 4. Abdominal binder to prevent abdominal hernia
cough can be related
to TB or lung
cancer)
4. Tetanus Clostridium tetani – Indirect contact – Risus sardonicus (Latin: No specific test, only a history of punctured wound DPT immunization
anaerobic spore-forming inanimate objects, “devil smile”) – facial
Other names: heat-resistant and lives in soil, street dust, spasm; sardonic grin Treatment: Tetanus toxoid
Lock jaw soil or intestine animal and human Antitoxin immunization among
feces, punctured Opisthotonus – arching of antitetanus serum (ATS) pregnant women
wound back tetanus immunoglobulin (TIG)
Neonate: umbilical cord Pen G Licensing of midwives
Children: dental caries For newborn: Diazepam – for muscle spasms
Adult: punctured wound; 1. Difficulty of sucking Health education of
after septic abortion Incubation Period: 2. Excessive crying Note: The nurse can give fluid provided that the mothers
Varies from 3 days 3. Stiffness of jaw patient is able to swallow. There is risk of aspiration.
to 1 month, falling 4. Body malaise Check first for the gag reflex
between 7 – 14 days

5. Poliomyelitis Legio debilitans Fecal – oral route Paralysis Diagnostic test: OPV vaccination
Polio virus Muscular weakness Frequent hand washing
Other name: Enterovirus Incubation period: Uncoordinated body • CSF analysis / lumbar tap
Infantile paralysis 7 – 21 days movement • Pandy’s test
Attacks the anterior horn Hoyne’s sign – head lag
of the neuron, motor is after 4 months Management:
affected Rehabilitation involves ROM exercises
Man is the only reservoir (!Safety)
6. Measles RNA containing Droplet secretions 1. Koplik’s spots – No specific diagnostic test Measles vaccine
paramyxovirus from nose and throat whitish/bluish pinpoint Disinfection of soiled
Other names: patches on the buccal Management: articles
Morbilli Incubation period: cavity Supportive and symptomatic Isolation of cased from
Rubeola 10 days – fever 2. cephalocaudal diagnosis until about 5-7
14 days – rashes appearance of days after onset of rash
appear maculopapular rashes
3. Stimson’s line –
Period of bilateral red line on the
Communicability: lower conjunctiva
4 days before and 5
days after the
appearance of rash
7. Hepatitis B Hepatitis B virus Blood and body 1. Right-sided Abdominal Diagnostic test: -Hepatitis B immunization
fluids pain -Wear protected clothing
Other names: Placenta 2. Jaundice • Hepatitis B surface agglutination (HBSAg) test -Hand washing
Serum Hepatitis 3. Yellow-colored sclera -Observe safe-sex
Incubation period: 4. Anorexia Management: -Sterilize instruments used
45 – 100 days 5. Nausea and vomiting > Hepatitis B Immunoglobulin in minor surgical-dental
6. Joint and Muscle pain procedures
7. Steatorrhea Diet: high in carbohydrates -Screening of blood
8. Dark-colored urine products for transfusion
9. Low grade fever

Hepatitis A – infectious hepatitis; oral-fecal

Hepatitis B – serum hepatitis; blood and body fluids
Hepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluids
Hepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis B
Hepatitis E – oral-fecal

II. DISEASES TRANSMITTED THROUGH FOOD AND WATER



MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Cholera Vibrio cholera Fecal-oral route Rice watery stool Diagnostic Test: Proper handwashing
Vibrio coma Stool culture Proper food and water
Other names: Ogawa and Inaba bacteria 5 Fs Period of sanitation
El tor Communicability: Treatment: Immunization of Chole-vac
Incubation Period: 7-14 days after onset, Oral rehydration solution (ORESOL)
Few hours to 5 days; occasionally 2-3 months IVF
usually 3 days Drug-of-Choice: tetracycline (use straw; can cause
staining of teeth)
2. Amoebic Entamoeba histolytica Fecal-oral route • Abdominal cramping Treatment: Proper handwashing
Dysentery • Bloody mucoid stool Proper food and water
Protozoan (slipper-shaped • Tenesmus - feeling of Metronidazole (Flagyl) sanitation
body) incomplete defecation * Avoid alcohol because of its Antabuse effect can
(Wikipedia) cause vomiting
3. Shigellosis Shigella bacillus Fecal-oral route • Abdominal cramping Drug-of-Choice: Co-trimoxazole Proper handwashing
• Bloody mucoid stool Proper food and water
Other names: Sh-dysenterae – most 5 Fs: Finger, Foods, • Tenesmus - feeling of Diet: Low fiber, plenty of fluids, wasily digestible sanitation
Bacillary infectious Feces, Flies, incomplete defecation foods Fly control
dysentery Sh-flesneri – common in Fomites (Wikipedia)
the Philippines
Sh-connei Incubation Period:
Sh-boydii 1 day, usually less
than 4 days
4. Typhoid fever Salmonella typhosa Fecal-oral route • Rose Spots in the Diagnostic Test: Proper handwashing
(plural, typhi) abdomen – due to Typhi dot – confirmatory test; specimen is feces Proper food and water
5 Fs bleeding caused by Widal’s test – agglutination of the patient’s serum sanitation
perforation of the
Incubation Period: Peyer’s patches Drug-of-Choice: Chloramphenicol
Usual range 1 to 3
weeks, average 2 • Ladderlike fever
weeks
5. Hepatitis A Hepatitis A Virus Fecal-oral route • Fever Prophylaxis: “IM” injection of gamma globulin Proper handwashing
• Headache Hepatitis A vaccine Proper food and water
Other names: 5 Fs • Jaundice Hepatitis immunoglobulin sanitation
Infectious • Clay-colored stool Proper disposal of urine
Hepatitis / Incubation Period: • Lymphadenopathy Complete bed rest – to decrease metabolic needs of and feces
Epidemic 15-50 days, • Anorexia liver Separate and proper

Hepatitis / depending on dose, Low-fat diet; increase carbohydrates (high in sugar) cleaning of articles used by
Catarrhal Jaundice average 20-30 days patient
6. Paralytic Dinoflagellates Ingestion of raw of • Numbness of face Treatment: 1. Avoid eating shellfish
Shellfish inadequately cooked especially around the 1. No definite treatment such as tahong, talaba,
Poisoning (PSP I Phytoplankton seafood usually mouth 2. Induce vomiting halaan, kabiya, abaniko
Red tide bivalve mollusks • Vomiting and dizziness 3. Drink pure coconut milk – weakens the during red tide season
poisoning) during red tide • Headache toxic effect 2. Don’t mix vinegar to
season • Tingling 4. Sodium bicarbonate solution (25 grams in ½ shellfish it will increase
sensation/paresthesia and glass of water) toxic effect 15 times
Incubation Period: eventful paralysis of Advised only in the early stage of illness greater
30 minutes to hands because paralysis can lead to aspiration
several hours after • Floating sensation and NOTE: Persons who survived the first 12 hours after
ingestion weakness ingestion have a greater chance of survival.
• Rapid pulse
• Dysphonia
• Dysphagia
• Total muscle paralysis
leading to respiratory
arrest and death

III. SEXUALLY TRANSMITTED DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Syphilis Treponema pallidum Direct contact Primary stage: painless Diagnostic test: Abstinence
(a spirochete) Transplacental chancre at site of entry Dark field illumination test – most effective if Be faithful
Other names: Buboes moist lesions are present Condom
Sy Incubation Period: Condylomata Fluorescent treponemal antibody absorption test
Bad Blood 10 days to 3 months Gumma VDRL slide test
The pox (average of 21 days) CSF analysis
Lues venereal Kalm test
Morbus gallicus Wasseman test

Treatment:
Drug of Choice: Penicillin

Primary and secondary sores will go even without treatment but the germs continue

2. Gonorrhea Neiserria gonorrheae Direct contact – Thick purulent yellowish Diagnostic test: Abstinence
genitals, anus, discharge Culture of urethral and cervical smear Be faithful
Other names: mouth Burning sensation upon Gram staining Condom
GC, Clap, Drip, urination / dysuria
Stain, Gleet, Incubation Period: Treatment:
Flores Blancas 2 – 10 days Drug of Choice: Penicillin
3. Trichomoniasis Trichomonas vaginalis Direct contact Females: Diagnostic Test: Abstinence
white or greenish-yellow Culture Be faithful
Other names: Incubation Period: odorous discharge Condom
Vaginitis 4 – 20 days; average vaginal itching and Treatment:
Trich of 7 days soreness Drug of Choice: Metronidazole (Flagyl) Personal Hygiene
painful urination
Males:
Slight itching of penis
Painful urination
Clear discharge from penis
4. Chlamydia Chlamydia trachomatis Direct contact Females: Diagnostic Test: Abstinence
(a rickettsia) Asymptomatic Culture Be faithful
Incubation Period: Dyspareunia Condom
2 to 3 weeks for Fishy vaginal discharge Treatment:
males; usually no Drug of Choice: Tetracycline
symptoms for Males:
females Burning sensation during
urination
Burning and itching of
urethral opening
(urethritis)
5. Candidiasis Candida albicans Direct contact White, cheese-like vaginal Diagnostic Test: Abstinence
discharges Culture Be faithful
Other names: Curd like secretions Gram staining Condom
Moniliasis
Candidosis Treatment:
Nystatin for oral thrush
Cotrimazole, fluconazole for mucous membrane
and vaginal infection
Fluconazole or amphotericin for systemic infection
6. Acquired Retrovirus Direct contact 1. Window Phase Diagnostic tests: Abstinence
immune (Human T-cell Blood and body a. initial infection Enzyme-Linked Immuno-Sorbent Assay (ELISA) Be faithful
deficiency lymphotrophic virus 3 or fluids b. lasts 4 weeks to 6 - presumptive test Condom

syndrome (AIDS) HTLV 3) Transplacental months Western Blot – confirmatory
c. not observed by present Sterilize needles, syringes,
Attacks the T4 cells: T- Incubation period: laboratory test (test should Treatment: and instruments used for
helper cells; T- 3-6 months to 8-10 be repeated after 6 1. Treatment of opportunistic infection cutting operations
lymphocytes, and CD4 years months) 2. Nutritional rehabilitation
lymphocytes 3. AZT (Zidovudine) – retards the replication Proper screening of blood
Variable. Although 2. Acute of retrovirus donors
the time from a. short, symptomatic 4. PK 1614 - mutagen
infection to the period Rigid examination of blood
development of b. flu-like symptoms and other blood products
detectable antibodies c. ideal time to undergo
is generally 1-3 screening test (ELISA) Avoid oral, anal contact
months, the time and swallowing of semen
from HIV infection 3. Asymptomatic HIV
to diagnosis of Infection Avoid promiscuous sexual
AIDS has an a. with antibodies against contact
observed range of HIV but not protective
less than 1 year to b. lasts for 1-20 years HIV/AIDS Prevention
15 years or longer. depending upon factors and Control Program:
(PHN Book)
4. ARC (AIDS Related Goal: Contain the
Complex) transmission of HIV /AIDS
a. a group of symptoms and other reproductive tract
indicating the disease is infections and mitigate
likely to progress to AIDS their impact
b. fever of unknown origin
c. night sweats
d. chronic intermittent
diarrhea
e. lymphadenopathy
f. 10% body weight loss

5. AIDS
a. manifestation of severe
immunosuppression
b. CD4 Count: <200/dL
c. presence of variety of
infections at one time:

oral candidiasis

leukoplakia
AIDS dementia complex
Acute encephalopathy
Diarrhea, hepatitis
Anorectal disease
Cytomegalovirus
Pneumonocystis carinii
pneumonia (fungal)
TB
Kaposi’s sarcoma (skin
cancer; bilateral purplish
patches)
Herpes simplex
Pseudomonas infection
Blindness
Deafness

IV. ERUPTIVE DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Chickenpox Human (alpha) herpes Droplet spread Vesiculo-pustular rashes No specific diagnostic exam Case over 15 years of age
virus 3 (varicella-zoster should be investigated to
Other names: virus), a member of the Direct contact Centrifugal appearance of Treatment is supportive and symptomatic; eliminate possibility of
Varicella Herpesvirus group rashes infection viral in origin, and therefore is self- smallpox.
Indirect through articles limiting Report to local authority
freshly soiled by Pruritus Isolation
discharges of infected Drug-of-choice: Concurrent disinfection of
Period of persons Acyclovir (orally to reduce the number of lesions; throat and nose discharges
Communicability: topically to lessen the pruritus) Exclusion from school for
Not more than one day Incubation Period: 1 week after eruption first
before and more than 6 2-3 weeks, commonly appears
days after appearance of 13 to 17 days Avoid contact with
the first crop of vesicles susceptibles

2. German Rubella virus or RNA- Droplet Forscheimer spots – red Diagnostic Test: MMR vaccine (live
Measles containing Togavirus pinpoint patches on the Tubella Titer (Normal value is 1:10) attenuated virus)
Incubation Period: oral cavity - Derived from
Other Names: Three (3) days chick embryo
Rubella Maculopapular rashes - Given in divided
Three-day Headache or fractionated
Measles Low-grade fever doses
Sore throat Contraindication:
- Allergy to eggs
If necessary, epinephrine
should be at the bedside.
3. Herpes Zoster Herpes zoster virus Droplet Painful vesiculo-pustular Treatment is supportive and symptomatic Avoidance of mode of
(dormant varicella zoster Direct contact from lesions on limited portion transmission
Other names: virus) secretion of the body (trunk and Acyclovir to lessen the pain
Shingles shoulder)
Cold sores
Low-grade fever
4. Dengue Dengue virus 1, 2, 3, and Bite of infected Classification (WHO): Diagnostic Test: 4 o’clock habit
Hemorrhagic 4 and Chikungunya virus mosquito (Aedes
Fever Aegypti) Grade I: Torniquet test (Rumpel Leads Test / capillary Chemically treated
Period of a. flu-like symptoms fragility test) – PRESUMPTIVE; positive when 20 mosquito net
Other names: communicability: Daytime biting b. Herman’s sign or more oetechiae per 2.5 cm square or 1 inch Larva eating fish
H-fever Unknown. Presumed to Low flying c. (+) tourniquet sign square are observed Environmental sanitation
be on the 1st week of Stagnant clear water Antimosquito soap
illness up to when the Urban Grade II: Platelet count – CONFIRMATORY; (Normal is Neem tree (eucalyptus)
virus is still present in the a. manifestations of Grade 150 - 400 x 103 / mL)
blood Incubation Period: I plus spontaneous Eliminate vector
Uncertain. Probably 6 bleeding Treatment: Avoid too many hanging
Occurrence is sporadic days to 1 week b. e.g. petechiae, Supportive and symptomatic clothes inside the house
throughout the year ecchymosis purpura, gum Paracetamol for fever Residual spraying with
Manifestations: bleeding Analgesic for pain insecticide
Epidemic usually occur
during the rainy seasons First 4 days: Grade III: Rapid replacement of body fluids – most important
(June to November) Febrile/Invasive Stage a. manifestations of Grade treatment
- starts abruptly as fever II plus beginning of
Peak months: September - abdominal pain circulatory failure ORESOL
and October - headache b. hypotension,
- vomiting tachycardia, tachypnea Blood tansfusion
- conjunctival infection
-epistaxis Grade IV: Diet: low-fat, low-fiber, non-irritating, non-

a. manifestations of Grade carbonated. Noodle soup may be given. ADCF
th th
4 – 7 days: III plus shock (Dengue (Avoid Dark-Colored Foods)
Toxic/Hemorrhagic Shock Syndome)
Stage ALERT! No Aspirin
- decrease in
temperature
- severe abdominal pain
- GIT bleeding
- unstable BP (narrowed
pulse pressure)
- shock
- death may occur

7th – 10th days:

Recovery/Convalescent
Stage
- appetite regained
- BP stable

V. VECTOR-BORNE DISEASES

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Malaria Plasmodium Parasites: Bite of infected Cold Stage: severe, Early Diagnosis and Prompt Treatment *CLEAN Technique
Vivax anopheles mosquito recurrent chills (30 Early diagnosis – identification of a patient with *Insecticide – treatment of
Falciparum (most fatal; minutes to 2 hours) malaria as soon as he is seen through clinical mosquito net
most common in the Night time biting and/or microscopic method *House Spraying (night
Philippines) High-flying Hot Stage: fever (4-6 Clinical method – based on signs and symptoms time fumigation)
Ovale Rural areas hours) of the patient and the history of his having visited a *On Stream Seeding –
Malariae Clear running water malaria-endemic area construction of bio-ponds
Wet Stage: Profuse Microscopic method – based on the examination for fish propagation (2-4
sweating of the blood smear of patient through microscope fishes/m2 for immediate
(done by the medical technologist) impact; 200-400/ha. for a

- intermittent chills and delayed effect)
sweating QBC/quantitative Buffy Coat – fastest *On Stream Clearing –
- anemia / pallor Malarial Smear – best time to get the specimen is cutting of vegetation
- tea-colored urine at height of fever because the microorganisms are overhanging along stream
- malaise very active and easily identified banks
- hepatomegaly
- splenomegaly Chemoprophylaxis *Avoid outdoor night
- abdominal pain and Only chloroquine should be given (taken at weekly activities (9pm – 3am)
enlargement intervals starting from 1-2 weeks before entering *Wearing of clothing that
- easy fatigability the endemic area). In pregnant women, it is given covers arms and legs in the
throughout the duration of pregnancy. evening
*Use mosquito repellents
NURSING CARE: Treatment: *Zooprophylaxis – typing
1. TSB (Hot Stage) Blood Schizonticides - drugs acting on sexual of domestic animals like
2. Keep patent warm blood stages of the parasites which are responsible the carabao, cow, etc near
(Cold Stage) for clinical manifestations human dwellings to
3. Change wet clothing 1. QUININE – oldest drug used to treat deviate mosquito bites
(Wet Stage) malaria; from the bark of Cinchona tree; from man to these animals
4. Encourage fluid intake ALERT: Cinchonism – quinine toxicity
5. Avoid drafts 2. CHLOROQUINE Intensive IEC campaign
3. PRIMAQUINE
4. FANSIDAR – combination of
pyrimethamine and sulfadoxine
2. Filariasis Wuchereria bancrofti Bite of Aedes poecillus Asymptomatic Stage: Diagnosis CLEAN Technique
Brugia malayi (primarily) Presence of microfilariae Physical examination, history taking, observation
Other names: Brugia timori Aedes flavivostris in the blood but no of major and minor signs and symptoms Use of mosquito repellents
Elephantiasis (secondary) clinical signs and Anytime fumigation
– nematode parasites symptoms of disease Laboratory examinations Wear a long sleeves, pants
Endemic in 45 out Incubation period: Nocturnal Blood Examination (NBE) – blood are and socks
of 78 provinces 8 – 16 months Acute Stage: taken from the patient at his residence or in
Lymphadenitis hospital after 8:00 pm
Highest Lymphangitis Immunochromatographic Test (ICT) – rapid
prevalence rates: Affectation of male assessment method; an antigen test that can be
Regions 5, 8, 11 genitalia done at daytime
and CARAGA
Chronic Stage: (10-15 Treatment:
years from onset of first Drug-of-Choice: Diethylcarbamazine Citrate
attack) (DEC) or Hetrazan
Hydrocele
Lympedema

Elephantiasis

3. Shistosomiasis Schistosoma mansoni Contact with the Diarrhea Diagnostic Test: Dispose the feces properly
S. haematobium infected freshwater with Bloody stools COPT or cercum ova precipitin test not reaching body of water
Other Names: S. japonicum (endemic in cercaria and penetrates Enlargement of abdomen Use molluscides
Snail Fever the Philippines) the skin Splenomegaly Treatment: Prevent exposure to
Bikharziasis Hepatomegalu Drug-of-Choice: PRAZIQUANTEL (Biltracide) contaminated water (e.g.
Vector: Oncomelania Anemia use rubber boots)
Endemic in 10 Quadrasi weakness Oxamniquine for S. mansoni Apply 70% alcohol
regions and 24 Metrifonate for S. haematobium immediately to skin to kill
provinces surface cercariae
Allow water to stand 48-
High prevalence: 72 hours before use
Regions 5, 8, 11

VI. DISEASES TRANSMITTED BY ANIMALS

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Leptospirosis Leptospira interrogans – Through contact of the Leptospiremic Phase Diagnosis Protective clothing, boots
bacterial spirochete skin, especially open - leptospires are present in Clinical manifestations and gloves
Other Names: wounds with water, blood and CSF Culture of organism
- Weil’s Disease RAT is the main host. moist soil or vegetation - onset of symptoms is Examination of blood and CSF during the first Eradication of rats
- Mud Fever Although pig, cattle, infected with urine of abrupt week of illness and urine after the 10th day
- Trench Fever rabbits, hare, skunk, and the infected host - fever Leptospira agglutination test Segregation of domestic
- Flood Fever other wild animals can - headache animals
- Spirochetal also serve as reservoir Incubation Period: - myalgia Treatment:
Jaundice 7-19 days, average of - nausea Penicillins and other related B-lactam antibiotics Awareness and early
- Japanese Occupational disease 10 days - vomiting Tetracycline (Doxycycline) diagnosis
Seven Days affecting veterinarians, - cough Erythromycin
fever miners, farmers, sewer - chest pain Improved education of
workers, abattoir workers, people
etc Immune Phase

- correlates with the
appearance of circulating
IgM

2. Rabies Rhabdovirus of the genus Bite or scratch (very Sense of apprehension Diagnosis: Have pet immunized at 3
lyssavirus rare) of rabid animal Headache history of bite of animal months of age and every
Other Names: Fever culture of brain of rabid animal year thereafter
Lyssa Degeneration and necrosis Non-bite means: Sensory change near site demonstration of negri bodies
Hydrophobia of brain – formation of leaking, scratch, organ of animal bite Never allow pets to roam
Le Rage negri bodies transplant (cornea), Spasms of muscles of Management: the streets
inhalation/airborne deglutition on attempts to *Wash wound with soap immediately. Antiseptics
Two kinds of Rabies: (bats) swallow e.g. povidone iodine or alcohol may be applied Take care of your pet
a. Urban or canine – Source of infection: Fear of *Antibiotics and anti-tetanus immunization
transmitted by dogs saliva of infected water/hydrophobia *Post exposure treatment: local wound National Rabies
animal or human Paralysis treatment, active immunization (vaccination) and Prevention and Control
b. Sylvatic – disease of Delirium passive immunization (administration of rabies Program
wild animals and bats Incubation period: Convulsions immunoglobulin) Goal: Human rabies is
which sometimes spread 2 – 8 weeks, can be *Consult a veterinarian or trained personnel to eliminated in the
to dogs, cats, and livestock years depending on “FATAL once signs and observe the pet for 14 days Philippines and the
severity of wounds, site symptoms appear” country is declared rabies-
of wound as distance *Without medical intervention, the rabies victim free
from brain, amount of would usually last only for 2 to 6 days. Death is
virus introduced, and often due to respiratory paralysis.
protection provided by
clothing
3. Bubonic Bacteria (Yersinia pestis) Direct contact with the Fever and lyphadenitis Streptomycin, tetracycline, chloramphenicol Environmental Sanitation
Plague infected tissues of
Vector: rat flea rodents

VII. DISEASES OF THE SKIN

MODE OF
DISEASE CAUSATIVE AGENT PATHOGNOMONIC SIGN MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION
1. Leprosy Mycobacterium leprae Airborne-droplet Early signs: Diagnostic Test: Avoid prolonged skin-to-
Change in skin color – either Slit Skin Smear - determines the presence of M. skin contact
Other names: Prolonged skin-to- reddish or white leprae; optional and done only if clinical diagnosis BCG vaccination –
Hansenosis skin contact Loss of sensation on the skin is doubtful to prevent misclassification and wrong practical and effective
Hansen’s disease lesion treatment preventive measure

Loss of sweating and hair growth Lepromin Test – determines susceptibility to against leprosy
-an ancient Thickened and painful nerves leprosy Good personal hygiene
disease and is a Muscle weakness or paralysis or Adequate nutrition
leading cause of extremities Treatment: Health education
permanent Pin and redness of the eyes Ambulatory chemotherapy through use of MDT
physical disability Nasal obstruction or bleeding Domiciliary treatment as embodied in RA 4073
among the Ulcers that do not heal which advocates home treatment
communicable
diseases Late Signs: PAUCIBACILLARY (tuberculoid and
Madarosis indeterminate); noninfectious type
Loss of eyebrows Duration of treatment: 6 to 9 months
Inability to close eyelids Procedure:
(lagophthalmos) Supervised: Rifampicin and Dapsone once a month
Clawing of fingers and toes on the health center supervised by the rural health
Contractures midwife
Chronic ulcers Self-administered: Dapsone everyday at the client’s
Sinking of the nosebridge house
Enlargement of the breast
(gynecomastia) MULTIBACILLARY (lepromatous and
borderline); infectious type
Duration of treatment: 24-30 months
Procedure:
Supervised: Rifampicin, Dapsone, and Lamprene
(Clofazimine) once a month on the health center
supervised by the rural health midwife
Self-administered: Dapsone and Lamprene
everyday at the client’s house

2. Anthrax Bacillus anthracis Contact with 1. Cutaneous form – most Treatment: Penicillin Proper handwahing
a. tissues of common
Other names: animals (cattle, - itchiness on exposed part Immunize with cell-free
Malignant pustule sheep, goats, - papule on inoculation site vaccine prepared from
Malignant edema Incubation period: horses, pigs, etc.) - papule to vesicle to eschar culture filtrate containing
Woolsorter few hours to 7 days dying of the disease - painless lesion the protection antigen
disease most cases occur within b. biting flies that
Ragpicker disease 48 hours of exposure had partially fed on 2. Pulmonary form – Control dust and proper
Charbon such animals contracted from inhalation of B. ventilation
c. contaminated anthracis spores
hair, wool, hides or - at onset, resembles common
products made URTI
from them e.g. - after 3-5 days, symptoms
drums and brushes become acute, with fever, shock,
d. soil associated and death
with infected
animals or 3. Gastrointestinal anthrax –
contaminated bone contracted from ingestion of
meal used in meat from infected animal
gardening - violent gastroenteritis
- vomiting
- bloody stools
3. Scabies Sarcoptes scabiei Direct contact with Itching Diagnosis: Personal hygiene
- An itch mite infected individuals Appearance of the lesion Avoid playing with dogs
parasite When secondarily infected: Intense itching Laundry all clothes and
Incubation Skin feels hot and burning Finding of causative mite iron
Period: Maintain the house clean
24 hours When large and severe: fever, Treatment: (limited entirely to the skin) Environmental sanitation
headache, and malaise Examine the whole family before undertaking Eat the right kind of food
treatment Regular changing of
Benzyl benzoate emulsion (Burroughs, Welcome) – clean clothing, beddings
cleaner to use and has more rapid effect and towels
Kwell ointment

4. Pediculosis Pediculosis Direct contact Itchiness of the scalp Kwell shampoo Proper hygiene
Capitis (head lice)
Other name: Corporis (body lice) Common in school One tbsp water + one tbsp vinegar
Phthipiasis Pubis (crab lice) age

VIII. INTESTINAL PARASITISM

MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Ascariasis Ascaris lumbricoides Fecal-oral route Pot-bellied Diagnostic Test: Fecalysis Proper handwahing
Voracious eater
Other names: (nematode) 5 Fs: Finger, Foods, Thin extremities Treatment:
Roundworm Feces, Flies, Fomites Antihelminthic: Mebendazole / Pyrantel Pamoate
Giant worms
2. Taeniasis Taenia solium – pork Eating inadequately Muscle soreness Diagnostic Test: Fecalysis Proper handwahing
Taenia saginata – beef cooked pork or beef Scleral hemorrhage
Other name: Dyphyllobotruim latum – Treatment: Cook pork and beef
Tape worm fish 5 Fs: Finger, Foods, Antihelminthic: Mebendazole / Pyrantel Pamoate adequately
Feces, Flies, Fomites

3. Capillariasis Trichuris trichuria Eating inadequately Abdominal pain Diagnostic Test: Fecalysis Proper handwahing
cooked seafood Diarrhea
Other name: Capillararia borborygmi Treatment: Cook seafoods adequately
Whip worm Philippinensis 5 Fs: Finger, Foods, Antihelminthic: Mebendazole / Pyrantel pamoate
Feces, Flies, Fomites
4. Enterobiasis Enterobium vermicularis Inhalation of ova Nocturnal anal itchiness Diagnostic Test: Fecalysis / tape test Proper handwahing
Toilet seat
Other name: Infected bedsheets Treatment: Proper disinfection of
Pinworm Antihelminthic: Mebendazole / Pyrantel pamoate beddings
5 Fs: Finger, Foods,
Feces, Flies, Fomites
5. Ancyloclos- Ancyclostoma duodenal Walking barefooted Dermatitis Diagnostic Test: Fecalysis Proper handwahing
tomiasis
Necatur americanus 5 Fs: Finger, Foods, Anemia Treatment: Avoid walking barefooted
Other name: Feces, Flies, Fomites Antihelminthic: Mebendazole / Pyrantel pamoate
Hookworm Black fishy stool

IX. OTHER COMMUNICABLE DISEASES


MODE OF PATHOGNOMONIC
DISEASE CAUSATIVE AGENT MANAGEMENT/TREATMENT PREVENTION
TRANSMISSION SIGN
1. Pneumonia Bacteria: Droplet Rusty sputum Diagnosis: Avoid mode of
Pneumococcus, Fever and chills Based on signs and symptoms transmission
Types: streptococcus Incubation Period: Chest pain Dull percussion on affected lung
a. Community pneumoniae, 2 – 3 days Chest indrawing Sputum examination – confirmatory Build resistance
Acquired staphylococcus aureus, Rhinitis/common cold Chest x-ray
Pneumonia (CAP) Klebsiella pneumonia Productive cough Turn to sides
b. Hospital / (Friedlander’s bacilli) Fast respiration Management:
Nosocomial Vomiting at times Bedrest Proper care of influenza
c. Atypical Virus: Convulsions may occur Adequate salt, fluid, calorie, and vitamin intake cases
Haemophilus influenzae Flushed face Tepid sponge bath for fever
Dilated pupils Frequent turning from side to side
Fungi: Pneumonocystis Highly colored urine with Antibiotics based on CARI of the DOH
carinii pneumonia reduced chlorides and
increased urates Oxygen inhalation
Suctioninh
Expectorants / mucolytics
Bronchodilators
Oral/IV fluids
CPT
2. Mumps Mumps virus, a member Direct contact Painful swelling in front Supportive and symptomatic MMR vaccine
of family of the ear, angle of the
Other name: Paramyxoviridae Source of infection: jaws and down the neck Sedatives – to relieve pain from orchitis Isolate mumps cases
Epidemic Parotitis Secretions of mouth and Fever Cortisone – for inflammation
nose Malaise
Loss of appetite Diet: Soft or liquid as tolerated
Incubation Period: Swelling of one or both
12 to 26 days, usually testicles (orchitis) in some Support the scrotum to avoid orchitis, edema, and
18 days boys atrophy

Dark glasses for photophobia

3. Influenza Influenza virus Direct contact Sudden onset Supportive and symptomatic Avoid use of common
A – most common Droplet infection or by Fever with chills towels, glasses, and eating
Other name: B – less severe articles freshly soiled Headache Keep patient warm and free from drafts utensils
La Grippe C – rare with nasopharyngeal Myalgia / arthralgia TSB for fever Cover mouth and nose
discharges Boil soiled clothing for 30 minutes before during cough and sneeze
Period of Airborne laundering
Communicability:
Probably limited to 3 days Incubation Period:

from clinical onset Short, usually 24 – 72
hours
4. Streptococcal Group A beta hemolytic Droplet Sudden onset Diagnosis: Avoid mode of
sore throat streptococcus High grade fever with Throat swab and culture transmission
Complication: chills
Other name: Other diseases: Rheumatic Heart Enlarged and tender Treatment: erythromycin
Pharyngitis Scarlet fever Disease cervical lymph nodes
Tonsillitis St. Anthony fire Inflamed tonsils with Care:
Puerperal sepsis mucopurulent exudates Bed rest
Imoetigo Headache Oral hygiene with oral antiseptic or with saline
Acute glumerulonephritis dysphagia gargle (1 glass of warm water + 1 tsp rock salt)
Rheumatic Heart Disease Ice collar
5. Meningitis Meningococcus Direct (Droplet) A. Sudden Onset Diagnostic Test: Respiratory Isolation
Neisseria meningitides - high fever accompanied
Other name: Incubation Period: by chills Lumbar puncture or Lumbar tap - reveals CSF
Cerebrospinal 2 - 10 days - sore throat, headache, !WBC and protein, low glucose; contraindicated
fever prostration (collapse) for increased ICP for danger of cranial herniation

B. entrance into the Hemoculture – to rule out meningococcemia

bloodstream leading to
septicemia Treatment:
(meningococcemia) Osmotic diuretic (Mannitol) – to reduce ICP and
a. rash, petchiae, purpura relieve cerebral edema; Alert: fastdrip to prevent
crystallization
C. Symptoms of menigeal Anti-inflammatory (Dexamethasone) – to relieve
irritation cerebral edema
- nuchal rigidity (stiff Antimicrobial (Penicillin)
neck) – earliest sign Anticonvulsany (Diazepam / Valium)
- Kernig’s sign – when
knees are flexed, it cannot
be extended
- Brudzinski signs – pain
on neck flexion with
automatoc flexion of the
knees
- convulsion
- poker soine (poker face /
flat affect)
- Increased ICP
(Cushing’s triad:

hypertension,
bradycardia, bradypnea)
and widening pulse
pressure

IX. KILLER DISEASES OF THE NEW MILLENNIUM

CAUSATIVE MODE OF PATHOGNOMONIC

DISEASE MANAGEMENT/TREATMENT PREVENTION
AGENT TRANSMISSION SIGN
1. Meningococcemia Neisseria meningitides Direct contact with High grade fever in the Respiratory isolation within 24 hours Universal precaution
respiratory droplet from first 24 hours Chemoprophylaxis
nose and throat of Hemorrhagic rash – Drug-of-Choice: Penicillin Proper hand washing
infected individuals petechiae
nuchal rigidity
Incubation Period: Kernig’s sign
2 – 10 days Brudzinski sign
Shock
Death
2. Severe Acute Coronavirus Close contact with Prodromal Phase: No specific treatment Utilize personal protective
Respiratory respiratory droplet Fever (>38 0C) equipment (N95 mask)
Syndrome / SARS secretion from patient Chills PREVENTIVE MEASURES and CONTROL
Malaise 1. Establishment of triage Handwashing
Earliest case: Incubation Period: Myalgia 2. Identification of patient
Guangdong Province, 2 – 10 days Headache 3. Isolation of suspected probable case Universal Precaution
China in November Infectivity is none to low 4. Tracing and monitoring of close contact The patient wears mask
2002 5. Barrier nursing technique for suspected Isolation
Respiratory Phase: and probable case
Global outbreak: Within 2-7 days, dry
March 12, 2003 nonproductive cough
progressing to respiratory
First case in the distress
Philippines:
April 11, 2003
3. Bird Flu Influenza Virus H5N1 Contact with infected Fever Control in birds: Isolation technique
birds Body weakness and body 1. Rapid destruction (culling or stamping out of all Vaccination
Other Name: malaise infected or exposed birds) proper disposal of Proper cooking of poultry
Avian Flu Incubation Period: Cough carcasses and quarantining and rigorous
3 days, ranges from 2 – Sore throat disinfection of farms
4 days Dyspnea 2. Restriction of movement of live poultry

Sore eyes
In humans:
1. Influenza vaccination
2. Avoid contact with poultry animals or migratory
birds
4. Influenza A Influenza Virus A Exposure to droplets - similar to the symptoms Diagnostic: - Cover your nose and
(H1N1) H1N1 from the cough and of regular flu such as Nasopharyngeal (throat) swab mouth when coughing and
sneeze of the infected • Fever Immunofluorescent antibody testing – to sneezing
Other Name: This new virus was person • Headache distinguish influenza A and B - Always wash hands with
Swine Flu first detected in people • Fatigue soap and water
in April 2009 in the Influenza A (H1N1) is • Lack of appetite - Use alcohol- based hand
May 21, 2009 – first United States. not transmitted by • Runny nose Treatment: sanitizers
confirmed case in the eating thoroughly • Sore throat Antiviral medications may reduce the severity and - Avoid close contact with
Philippines Influenza A (H1N1) is cooked pork. • Cough duration of symptoms in some cases: sick people
fatal to humans - Vomiting or nausea Oseltamivir (Tamiflu) - Increase your body's
June 11, 2009 - The The virus is killed by - Diarrhea or zanamivir resistance
WHO raises its cooking temperatures of - Have at least 8 hours of
Pandemic Alert Level 160 F/70 C. sleep
to Phase 6, citing - Be physically active
significant Incubation Period: - Manage your stress
transmission of the 7 to 10 days - Drink plenty of fluids
virus. - Eat nutritious food