ASSESSING HEALTH • Values and beliefs

Introduction: 2. Head –to- Toe Framework. This system

of collecting data starts from the head and
A comprehensive health assessment
proceeds systematically to the toes.
encompasses the physical, psychological,
social and spiritual dimensions of a • General: General health state, Vital
person. - Physical health includes basic signs and weight, nutritional status
functions such as breathing, eating, and
• Head: hair, scalp, eyes, ears, oral
walking.
cavity, cranial nerves
- Psychological health includes intellect,
self-concept, emotions and behaviors. • Neck
- Social dimensions of health involve
relationships and interactions among family • Chest
members, friends and co- workers. • Abdomen
- Spiritual health encompasses belief in a
higher being, personal interpretation of the • Extremities
meaning of life, and attitudes toward moral
• Genitals
decisions and personal conduct.
• Rectum

Framework for health Assessment

3. Body Systems Framework. This may be
1. Functional health framework. Evaluate
used during focused assessment especially
the effects of mind, body and environment
among acutely or critically ill clients.
in relation to a person’s ability to perform
the tasks of daily living. This health • Respiratory
assessment framework organizes data
collection in terms of Gordon’s 11 functional • Cardiovascular
health patterns: • Musculoskeletal
• Health perception and health • Gastrointestinal
management
• Integumentary
• Activity and exercise
• Endocrine
• Nutrition and metabolism
• Genitourinary
• Elimination
• Reproductive
• Sleep and rest
• Neurologic
• Cognition and perception
• Sensory
• Self-perception and self-concept
• Psychosocial
• Roles and relationships
• Coping and stress tolerance
• Sexuality and reproduction
 the rate of cellular metabolism.
These in turn increase body
Assessing Vital Signs temperature.
The vital signs or cardinal signs are body 5. Increased temperature of body
cells (fever). Increases the rate of
temperature, pulse, respiration and
cellular metabolism. “Fever further
blood pressure (TPRBP). causes fever”.

BODY TEMPERATURE Processes Involved in Heat Loss are as

follows:
The balance between the heat
produced and the heat lost from the body. a. Radiation. The transfer of
heat from the surface of one
Types of body temperature object to the surface of
another without contact
1. Core temperature. It is the between the two objects.
temperature of the deep tissues of E.g., it feels warm in a
the body. Measured by taking oral crowded room.
and rectal temperature. b. Conduction. The transfer of
2. Surface temperature. It is the heat from one surface to
temperature of the skin, another. It requires
subcutaneous tissue and fat. temperature difference
Measured by taking axillary between the two surfaces.
temperature. E.g., application of moist
Body heat is primarily produced by wash-cloth over the skin.
metabolism. c. Convection. The dissipation
of heat by air currents. E.g.,
The heat regulating center is found in
exposure of the skin towards
the hypothalamus. the electric fan.
Factors affecting the Body’s heat d. Evaporation. The
production are as follows. continuous vaporization of
moisture from the skin, oral
1. Basal Metabolic Rate (BMR). The mucous, respiratory tract.
younger the person, the higher the E.g., tepid sponge bath
BMR; the older the person, the lower increases peripheral
the BMR. Therefore, the older circulation, thereby
persons have lower body increasing heat loss by
temperature than the younger evaporation.
persons.
2. Muscle Activity (exercise,
swimming). Increases cellular Factors affecting Temperature are as
metabolic rate. Therefore, exercise follows:
increases body heat production. 1. Age. The infant’s body temperature
3. Thyroxine output. Increases is greatly affected by the
cellular metabolic rate (chemical temperature of the environment.
thermogenesis). Hyperthyroidism is Elder people are at risk of
characterized by increased body hypothermia due to decreased
temperature. thermoregulatory controls,
4. Epinephrine, norepinephrine and decreased subcutaneous fat,
sympathetic stimulation. Increase
 inadequate diet and sedentary 4. Constant fever. Body temperature
activity. is consistently high.
2. Diurnal variations. Highest • Very high temperatures (41-420C)
temperature is usually reached cause irreversible brain cell
between 8:00 PM to 12MN; and the damage.
lowest temperature is reached
between 4:00 and 6:00 AM.
3. Exercise. Strenuous exercise
increases metabolic rate thus the Decline of fever
body temperature. 1. Crisis or flush or effervescent
4. Hormones (e.g., progesterone, stage. The sudden declined of
thyroxine, norepinephrine, and fever. This indicates impairment of
epinephrine increase body function of hypothalamus.
temperature; estrogen decreases 2. Lysis. The gradual decline of
body temperature. fever. This indicates that the body is
5. Stress. Sympathetic nervous able to maintain homeostasis. This
system stimulation increases the is the desired decline of fever.
production of epinephrine and
norepinephrine, thereby increasing
the metabolic rate and heat Clinical signs of fever
production.
a. Onset (cold or chill stage) of fever
• increased heat rate
Alterations in Body Temperature
• increased respiratory rate and depth
1. Pyrexia. It is the body temperature
above normal range. (hyperthermia, • shivering
fever) • pale, cold skin
2. Hyperpyrexia. Very high fever, 410C
(105.8F) and above. • cyanotic nail bed
3. Hypothermia. Sub-normal core
body temperature. This maybe • complains of feeling cold
caused by excessive heat loss,
• “goose flesh” appearance of the skin
inadequate heat production or
impaired hypothalamic function. • cessation of sweating
• rise in body temperature
Types of fever
1. Intermittent Fever. The temperature
fluctuates between periods of fever b. Course of fever
and periods of normal/subnormal • absence of chills
temperature.
2. Remittent fever. The temperature • skin that feels warm
fluctuates within a wide range over • feeling of being neither hot nor cold
the 24-hour period but remains
above normal range. • increased pulse and respiratory rates
3. Relapsing fever. The temperature is
elevated for few days, alternated • increased thirst
with 1 or 2 days of normal
• mild to severe dehydration
temperature.
 • drowsiness, restlessness, delirium and return to the heart, decrease BP,
convulsions therefore increase in the heart rate.

• herpetic lesions of the mouth (fever

blisters) Pulse Sites.

• loss of appetite 1. Temporal. Over the temporal bone

of the head; superior and lateral to
• malaise, weakness and aching the eye.
muscles 2. Carotid. At the lateral aspect of the
neck; below the ear lobe.
c. Defervescence (fever abatement) 3. Apical. At the left mid-clavicular line
• skin that appears flushed and feels (MCL) fifth intercostals space (ICS),
warm use stethoscope.
4. Brachial. At the inner aspect of the
• sweating
upper arm (Biceps muscles) or
• decreased shivering medially at the antecubital space.
5. Radial. On the thumb side of the
• possible dehydration inner aspect of the wrist.
6. Femoral. Alongside the inguinal
ligament.
PULSE 7. Posterior Tibial. At the medial
aspect of the ankle, behind the
It is a wave of blood created by the medial malleolus.
contraction of the left ventricle of the heart. 8. Popliteal. At the back of the knee.
9. Pedal (Dorsalis Pedis). At the
The pulse rate is regulated by the dorsum of the foot.
autonomic nervous system (ANS). • Use the middle two to three
fingertips to palpate the pulse. Do
Factors affecting the Pulse rate are as
not use the thumb. The normal pulse
follows:
is detected readily, obliterated by the
1. Age. Younger persons have higher strong pressure.
pulse rate than older persons.
2. Sex/Gender. After puberty, females
have higher pulse rate than the Assessment of the Pulse
males.
3. Exercise. Increases metabolic rate, 1. Rate. Then normal pulse rates per
thereby increasing the pulse rate. minute are as follows:
4. Fever. Increases metabolic rate, Newborn to 1 month: 80-180 beats/min
therefore the pulse rate increases.
5. Medications. Digitalis, beta-blockers 1 year 80-140 beats/min
decrease pulse rate; epinephrine,
2 years 80-130 beats/min
atropine sulfate increase pulse rate.
6. Hemorrhage. Increases pulse rate 6 years 75-120 beats/min
as compensatory mechanism for
blood loss. 10 years 60-90 beats/min
7. Stress. Sympathetic nervous
stimulation increases the activity of Adult 60-100 beats/min
the heart. • Tachycardia. Pulse rate above the
8. Position stage. In sitting or standing 100 beats/min (Adult)
position there is decreased venous
 • Bradycardia. Pulse rate below the 2. Diaphragmatic (abdominal). Involves
60 beats/min (Adult) movement of the abdomen.
Respiratory Centers
2. Rhythm- is the pattern and intervals
of beats. Dysrhythmia is irregular 1. Medulla oblongata is the primary
rhythm. respiratory center.
3. Volume. (Amplitude). The strength 2. Pons contains the following:
of the pulse. • Pneumotach center- responsible
• A normal pulse can be felt with for the rhythmic quality of breathing.
moderate pressure.
• Apneustic center- responsible for
• Full or bounding pulse. It can be deep, prolonged inspiration.
obliterated only by great pressure.
3. Carotid and aortic bodies contain
• Thready pulse. It can be easily be peripheral chemoreceptors. These
obliterated (also weak, feeble). take up the work of breathing when
central receptors in the medulla
4. Arterial wall elasticity. The artery oblongata are damaged. Respond to
feels straight, smooth, soft, and low oxygen concentration in the
pliable. blood. Respond to pressures. If the
5. Presence/Absence of bilateral BP is elevated, the respiratory rate
equality. Absence of bilateral becomes slow. (Hypertension leads
equality indicates cardiovascular to respiratory acidosis.) If the BP is
disorder. decreased, the respiratory rate is
rapid. (Hypotension leads to
respiratory alkalosis.) the primary
RESPIRATION chemical stimulation for breathing is
The act of breathing high carbon dioxide level in the
blood.
Three processes: 4. Muscle and joints contain
proprioceptors
• Ventilation. The movement of • Proprioceptors. Exercise
gases in and out of the lungs increases respiratory rate.
Inhalation (Inspiration) Assessing Respiration
Exhalation (Expiration) •Rate. Normal is 12-20
• Diffusion. The exchange of gases breaths/minute in adult.
from an area of higher pressure to • Depth. Observe the movement of
an area of lower pressure. It occurs the chest. It may be normal, deep or
at the alveolo-capillary membrane. shallow.
• Perfusion. The availability and • Rhythm. Observe for regularity of
movement of blood for transport of exhalations and inhalations.
gases, nutrients and metabolic
waste products. • Quality or character. Refer to
respiratory effort and sound of breathing.
Two types of breathing
Major factors affecting Respiratory Rate
1. Costal (thoracic). Involves (RR)
movement of the chest.
1. Exercise. Increases RR
 2. Stress. Increases RR The difference between the systolic and
3. Environment. Increased temperature diastolic pressures (S – D = PP) normal is
of the environment decreases RR; 30-40 mm Hg
decreased temperature, increases
RR. Hypertension
4. Increased altitude. Increases RR.
5. Medications. (e.g. narcotics It is an abnormally high blood pressure over
decreases RR) 140 mm Hg systolic or above 90 mm Hg
diastolic for at least two consecutive
readings.
• Eupnea. Normal respiration that is quiet,
rhythmic and effortless. Hypotension

• Tachypnea. Rapid respiration, above 20 It is an abnormally low blood pressure,

breaths per minute in an adult systolic pressure below 100/60 mm Hg.

• Bradypnea. Slow breathing, less than 12 Determinants of Blood Pressure

breaths per minute in an adult. 1. Blood Volume. Hypervolemia raises
• Hyperventilation. Deep, rapid ventilation, BP. Hypovolemia lowers BP.
carbon dioxide is excessively exhaled 2. Peripheral Resistance.
Vasoconstriction elevates BP.
(respiratory acidosis).
Vasodilation lowers BP.
• Hypoventilation. Slow, shallow 3. Cardiac Output. When the pumping
respiration, carbon dioxide is excessively action of the heart is weak
retained (respiratory alkalosis). (Decreased CO), BP decreases.
4. Elasticity or Compliance of Blood
• Dyspnea. Difficult and labored breathing Vessels. In older people, elasticity of
blood vessels decreases thereby
• Orthopnea. Ability to breath only in an increasing BP.
upright position 5. Blood Viscosity (viscosity
increases markedly when the
• Apnea. Absence of respiration hematocrit (Hct) is more than 60-
BLOOD PRESSURE 65%). Increased blood viscosity
increases BP.
Is the measure of the pressure exerted by
the blood as it pulsates through the arteries Factors affecting Blood Pressure

BP = Cardiac Output x Total Peripheral 1. Age. Older people have a higher BP

resistance or C.O. x TPR due to decreased elasticity of blood
vessels.
Systolic Pressure 2. Exercise. Increases the cardiac
output, hence the BP.
The pressure of blood as a result of the 3. Stress. Sympathetic Nervous
contraction of the ventricles (100-140 mm System stimulation causes
Hg) increased BP.
4. Race. Hypertension is one of the ten
Diastolic Pressure
leading causes of death among
The pressure of blood when the ventricles Filipinos.
are at rest (60-90 mm Hg) 5. Obesity. BP is generally elevated
among overweight and obese
Pulse Pressure people.
 6. Sex/Gender. After puberty and 11. The sound during BP taking is
before age 65 years, males have Korotkoff sound.
higher BP. After age 65 years, 12. The systolic pressure in the
females have higher BP due to popliteal artery is usually 10-40
hormonal variations in menopause.
mm Hg higher than that of the
7. Medications. Some medications may
increase or decrease BP.
brachial artery. The diastolic
8. Diurnal Variations. BP is lowest in pressure is usually the same.
the morning and highest in the late
afternoon or early evening.
9. Disease Process. Diabetes Mellitus,
Renal failure, Hyperthyroidism,
Cushing’s disease cause increase in
BP.

ASSESSING BLOOD PRESSURE

1. Ensure that the client is rested.

2. Allow 30 minutes to pass if the
client had engaged in exercise or
had smoked or ingested caffeine
before taking the BP. These
factors tend to increase BP.
3. Use appropriate size of the BP
cuff. Too narrow cuff causes false
high reading. Too wide cuff
causes false low reading.
4. Position the client in sitting or
supine position.
5. Position the arm at the level of
the heart, with the palm of the
hand facing up. The left arm is
preferably because it is nearer
the heart.
6. Apply Bp cuff snuggly, 1 inch
above the antecubital space.
7. Determine palpatory BP before
auscultatory BP to prevent
auscultatory gap.
8. Use the bell of the stethoscope
since the blood pressure is a low
frequency sound.
9. Inflate and deflate Bp cuff slowly,
2-3 mm Hg at a time.
10. Wait 1-2 minutes before making
further determinations.
 COMMUNICABLE DISEASE CHAIN OF INFECTION

 Communicable diseases are often

1
the leading causes of illnesses in the
country today. Most often they afflict Etiologic agent
the most vulnerable, the young and
the elderly. They have numerous
economic, psychological, disabling
and disfiguring effects to the afflicted 6 2
individuals, families and Susceptible host Reservoir
communities. What is doubly
threatening is the emergence of
newly discovered diseases and the
re-emergence of old ones.
5 3
 Communicable diseases are readily
Portal of entry to Portal of exit from
transferred from one infected person
the susceptible reservoir
to a susceptible and uninfected
person and maybe caused by
microorganisms.

Types of microorganisms causing 4

infections:
Method of
transmission

1. Bacteria – the most

common infection- Etiologic Agent
causing
microorganisms The extent to which any
2. Viruses – consist microorganisms is capable of producing an
primarily of nucleic infectious process depends on the number
acid and therefore of microorganisms (pathogenicity), the
must enter living cells ability of the microorganisms to enter the
in order to reproduce. body, the susceptibility of the host, and the
3. Fungi – include
ability of the microorganisms to live in the
yeasts and molds
4. Parasites – live on host’s body.
other living organisms Reservoir
There are many reservoirs, or
sources of microorganisms. Common
sources are other humans, the client’s own
microorganisms, plants, animals, or the
general environment. People are the most
common source of infection for others and
for themselves.
Portal of Exit from the Reservoir occur by injecting salivary
fluid during biting or by
Before an infection can establish depositing feces or other
itself in a host, the microorganisms must materials on the skin through
leave the reservoir. the bite wound or a
traumatized skin area.
Method of Transmission
After the microorganism leaves its Portal of Entry to the Susceptible Host
source or reservoir, it requires a means of
transmission to reach another person or Before a person can become
host through a receptive portal of entry. infected, microorganisms must enter the
These are the three mechanisms: body. The skin is a barrier to infectious
agents; however, any break in the skin can
1. Direct transmission – involves readily serve as portal of entry. Often,
immediate and direct transfer of
microorganisms enter the body of the host
microorganisms from person to person
through touching, biting, kissing, or by the same route they used to leave the
sexual intercourse. Droplet spread is source.
also a form of direct transmission but Susceptible Host
can occur only if the source and the host
are within 3 feet of each other. A susceptible host is any person
Sneezing, coughing, spitting, singing, or who is at risk for infection. A compromised
talking can project droplet spray into the host is a person “at increased risk”, an
conjunctiva or onto the mucous individual who for one or more reasons is
membranes of the eyes, nose, or mouth more likely than others to acquire an
of another person.
infection. Impairment of the body’s natural
2. Indirect transmission – Indirect
defenses and a number of other factors can
transmission may either vehicle-borne
or vector-borne. affect susceptibility to infection.
a. Vehicle-borne transmission. Disease cycle maybe broken down by
A vehicle is any substance these factors:
that serves as an
intermediate means to 1. Increasing host resistance
transport and introduce an 2. Destruction of the source and
infectious agent into a reservoir of infection
susceptible host through a 3. Destruction of the agent in the
suitable portal of entry. environment
Fomites (inanimate materials 4. Avoidance of exposure
or objects), such as
handkerchiefs, toys, soiled
clothes, cooking or eating Handwashing
utensils, and surgical
The most important procedure for
instruments or dressings, can
act as vehicles. preventing the transfer of microorganisms,
b. Vector-borne transmission. A and therefore nosocomial infection, is
vector is an animal or flying correct and frequent handwashing. Proper
or crawling insect that serves handwashing protects the patient, your co-
as an intermediate means of worker, you, and your family.
transporting the infectious
agent. Transmission may Handwashing should be done in all of the
following instances:
 • At the beginning of every work shift
• Before and after prolonged contact
with a patient Specific Protection against Disease
• Before invasive procedure I. IMMUNIZATION
• Before contact with especially
susceptible patients  Is the process of introducing vaccine
• Before and after touching wounds into the body to produce antibodies
• After contact with body substances, that will protect our body against a
even when gloves are worn specific infectious agent
• Anytime you are in doubt about the  Most vaccines are given more than
necessity for doing so once since the first dose gives only
• At the end of every shift before half of the protection the body
leaving the health care facility needs. A second shot or “booster” is
needed to give the body full
protection against the disease
Gloves
Gloves are worn for three reasons:
Immunization against communicable
First, they protect the hands when the
diseases
health worker is likely to handle any body
substances, e.g. blood, urine, feces, 1. For infants
sputum, mucous membranes, and non- 2. Following exposure
intact skin. Second, gloves reduce the like 3. For all persons in endemic areas
hood of health workers transmitting their 4. For person subject to unusual
own endogenous microorganisms to risk
individuals receiving care. Third, gloves 5. For known cases
reduce the chance that the health worker’s
hands will transmit microorganisms from Vaccines available for routine
one client or a fomite to another client. In all immunization
situations, gloves are changed between
client contacts. 1. DPT (Diphtheria, Pertussis and
Tetanus) vaccine. An early start
with DPT reduces the chance of
severe pertussis.
Diphtheria – caused by Corynebacterium
diphtheriae
Pertussis – caused by Bordetella pertussis
Tetanus – caused by Clostridium tetani

2. OPV (Oral Polio Vaccine). The

extent of protection against polio
is increased the earlier the OPV
is given.
Poliomyelitis – caused by Polio Virus
 3. MMR (Measles, Mumps, Rubella) TUBERCULOSIS
vaccine
Measles – caused by Measles virus  A highly contagious bacterial
infection usually affecting the lungs
Mumps – caused by Mumps virus but can also affect other organs of
the body like brain, kidney, intestines
German Measles – caused by Rubella virus and bones
 Considered as the world’s deadliest
4. Hib (H. influenzae type B) disease and remains as a major
Polysaccharide vaccine public health problem in the
Meningitis – caused by Hemophilus Philippines
influenza  It often occurs in children of under
developed and developing countries
5. Hepatitis B vaccine. An early start
in the form of primary complex
of Hepatitis B reduces the chance especially after a bout of a
of being infected and becoming a debilitating childhood disease such
carrier. as measles
 In the Philippines, TB ranks sixth in
the leading cause of morbidity
6. BCG (Bacillus of Calmette and
(2004) and mortality (2004). The
Guerin). BCG given at the estimated incidence of all TB cases
earliest possible age protects in the Philippines is 243/100,00
against the possibility of infection population (2006)
from other family members.
Tuberculosis – caused by Mycobacterium
tuberculosis Causative agent:

7. CDT (Cholera, Dysentery and Mycobacterium tuberculosis

Typhoid) Mode of Transmission:
Cholera – caused by Vibrio cholerae
Inhalation of the infective droplets present in
Dysentery – caused by Shigella dysentery the air
Typhoid – caused by Salmonella typhi Signs and Symptoms:

 Cough of two weeks or more

II. CHEMOPROPHYLAXIS  Fever
 Chest or back pains not referable to
 Administration of drugs to prevent any Musculo-skeletal disorders
occurrence of infection  Hemoptysis or recurrent blood-
 E.g. Penicillin for gonorrhea, streaked in the sputum
chloroquine for malaria, INH for  Significant weight loss
tuberculosis  Other signs and symptoms such as
sweating, fatigue, body malaise and
shortness of breath
III. MECHANICAL PROPHYLAXIS

 Placing mechanical barriers between

Period of Communicability:
the sources of agent and host such
as use of mosquito nets, masks or  As long as viable tubercle bacilli are
glove being discharged in the sputum.
Some untreated or inadequately
 treated patients maybe sputum- LEPROSY
positive intermittently for years
 The degree of communicability  Is an ancient disease and is a
depends on the number of bacilli leading cause of permanent physical
discharged, the virulence of the disability among the communicable
bacilli, adequacy of ventilation, diseases.
exposure of the bacilli to sun or UV  It is a chronic mildly communicable
light and opportunities for disease that mainly affects the skin,
aerosolization by coughing, the peripheral nerves, the eyes and
sneezing, talking or singing. mucosa of the URT
 Children with primary complex are
generally not infectious Causative agent:
Mycobacterium leprae
Treatment:
Modes of transmission:
No. of No. of
tablets tablets per 1. Airborne – inhalation of droplet/spray
DRUGS from coughing and sneezing of
per day day
untreated patient
Intensive Continuation 2. Prolonged skin-to-skin contact
Phase Phase
Signs and Symptoms:
(2 (4 months)
months) 1. Early signs and symptoms
a. Change in skin color – either
Isoniazid 1 1 reddish or white
b. Loss of sensation on the skin
Rifampicin 1 1
lesion
Pyrazinamide 2 c. Decrease/loss of sweating
and hair growth over the
Ethambutol 2 lesion
d. Thickened and/or painful
nerves
Preventive Measures: e. Muscle weakness or
paralysis of extremities
1. Prompt diagnosis and treatment of f. Pain and redness of the eyes
infectious cases g. Nasal obstruction or bleeding
2. BCG vaccination of newborn, infants, h. Ulcers that do not heal
grade 1/school entrants 2. Late signs and symptoms
3. Educate the public in mode of spread a. Loss of eyebrow – madarosis
and methods of control and the b. Inability to close eyelids –
importance of early diagnosis lagophthalmos
4. Improve social conditions, which c. Clawing of fingers and toes
increase the risk of becoming infected, d. Sinking of the nose bridge
such as overcrowding e. Enlargement of the breasts in
5. Make available medical, laboratory and males – gynecomastia
x-ray facilities for examination of f. Chronic ulcers
patients, contacts and suspects.
Susceptibility:
Children especially 12 years and below are
more susceptible
Prevention:
1. Avoidance of prolonged skin-to-skin
contact especially with a
lepromatous case
2. Children should avoid close contact
with active, untreated leprosy case
3. BCG vaccination
4. Good personal hygiene
5. Adequate nutrition
6. Health education

Treatment:
Ambulatory chemotherapy through use of
Multi Drug Therapy (MDT)
SCHISTOSOMIASIS (Bilharziasis or snail Methods of Control:
fever)
1. Preventive measures
 Also known as the Bilharziasis or a. Educate the public in
Snail Fever has long been one of the endemic areas regarding the
important tropical diseases in our mode of transmission and
country. methods of protection
 It is caused by a blood fluke that is b. Proper disposal of feces and
transmitted by a tiny snail urine
Oncomelania hupensi quadrasi. c. Improve irrigation and
 Since it affects mostly farmers and agriculture practices: reduce
their families in the rural area it snail habitats by removing
results in manpower losses and vegetation
lessened agricultural productivity. d. Treat snail-breeding sites
 There is a high prevalence of with molluscicides
Schistosomiasis in Region 5 (Bicol), e. Prevent exposure to
Region 8 (Samar and Leyte) and contaminated water
Region 11 (Davao) f. Provide water for drinking,
bathing and washing clothes
from sources free of cercaria
Causative Agents: or treatment to kill them
g. Treat patients in endemic
Schistosoma japonicum areas to prevent disease
progression
Schistosoma mansoni
h. Travelers visiting in endemic
Schistosoma haematobium areas should be advised of
the risk and informed about
Signs and Symptoms: preventive measures
2. Control of Patient, contacts and the
 Diarrhea environment
 Bloody stool a. Report to local health
 Enlargement of the abdomen authority
 Splenomegaly b. No need for isolation and
 Weakness quarantine to infected people
 Anemia and those who are at risk
 Inflamed liver c. Concurrent disinfection:
sanitary disposal of feces
and urine
Mode of Transmission: 3. Investigation of contacts and source
of infection
Infection occurs when the skin comes in
a. Epidemic measure: examine
contact with contaminated fresh water in for Schistosomiasis and treat
which certain types of snails that carry all who are infected but
schistosomes are living. It is a free- especially those with
swimming larval form (cercaria) of the moderate to heavy infection,
parasite that penetrates the skin. pay particular to children
b. Motivate people in these
Fresh water becomes contaminated when areas to have annual stool
infected people urinate or defecate in water. exam
Treatment: Modes of Transmission:
Praziquantel is the drug of choice against all 1. Ingestion of raw or insufficiently
species. Alternative drugs are Oxamniquine cooked infected crabs
for S. mansoni and Metrifonate for S. 2. Contamination of food or utensil with
haematobium metacercaria during food
preparation
PARAGONIMIASIS 3. Drinking of water contaminated with
infective larvae
 It is a chronic parasitic infection, Signs and Symptoms:
which greatly reduces human
productivity and quality of life.  Cough of long duration
 It is frequently encountered in  Hemoptysis
communities where eating of fresh  Chest/back pain
or inadequately cooked crabs is a  PTB-like symptoms not responding
practice. to anti-TB medications
 The manifestations closely resemble Diagnosis:
PTB that most often it is
misdiagnosed for this disease in  Sputum examination
endemic areas  Immunology
 Cerebral Paragonimiasis –
Endemic areas identified: Eosinophilia in CSF
The provinces of Mindoro, Camarines Sur,
Camarines Norte, Sorsogon, Samar, Leyte, Prevention and Control:
Negros Islands, Albay, Cebu, Basilan
 Treatment of infected person
 Commonly patients with  Sanitary disposal of excreta
Paragonimiasis are misdiagnosed to  Education of the public regarding the
have PTB and are treated as PTB signs and symptoms and the modes
patients. In fact, a study by Dr. of transmission of the parasite
Vicente Belizario Jr. et al, revealed  Avoid eating insufficiently or raw
that 56% of his subjects were cooked crabs
nonresponsive to a multi-drug
therapy for PTB but were positive for
Paragonimiasis Treatment:
Praziquantel is the drug of choice given 25
Causative Agent: mg./kg body weight three times daily for
three days. Bithionol is the alternative drug.
Paragonimus westermani (Lung Fluke) is
the most common important causative
agent in Asia
Intermediate Hosts (vector):
1. First IH – Fresh water snail
a. Antemelania asperata
2. Second IH – Small, fresh water crab
a. Sundathelpusa philippina
b. Varona litterata
SOIL TRANSMITTED HELMINTHIASES Prevention and Control:
(STH)
1. Health education
 It is the third most prevalent infection a. Good personal hygiene –
worldwide, second only to the thorough washing of hands
diarrheal disease and tuberculosis before eating and after using
 The prevalence of STH among the 2 toilet
to 5 years old is lesser but they b. Keeping fingernails short and
suffer the greatest impact of the clean
disease when they get infected c. Use of footwear
 The three major causes of intestinal d. Use of sanitary facilities like
parasitic infections in the Philippines toilets
are: e. Sanitary disposal of feces
Ascaris lumbricoides (Giant intestinal
roundworm) 2. Early diagnosis and treatment
Trichuris trichiura (Whipworm) a. Laboratory examination of
stool (fecalysis)
Hookworm b. Ensure proper dosage of
medication and completion of
- Ancylostoma duodenale (Old world treatment
hookworm) Treatment:
- Necator americanus (New world Piperazine citrate, pyrantel pamoate,
hookworm) mebendazole, albendazole, levimazole
 They are classified as soil depends on what parasite is present
transmitted helminthes because their
major development takes place in
the soil. Geofactors like temperature,
humidity, wind etc. are the primary
factors which determine their
distribution
 With unsanitary disposal of human
stool, eggs from these parasites
develop in the soil and can
mechanically infect humans when
fingers, food or water are
contaminated with parasite eggs
from the soil where they became
infective or when the infective larva
of hookworms in the soil penetrate
skin of barefooted individuals
Signs and Symptoms:

 Anemia
 Malnutrition
 Stunted growth in height and body
size
 Decreased physical activities
 Impaired mental development and
school performance
MEASLES CHICKEN POX (Varicella)

 An acute highly communicable  An acute infectious disease of

infection characterized by fever, sudden onset with slight fever, mild
rashes and symptoms referable to constitutional symptoms and
upper respiratory tract; the eruption eruption which are maculo-papular
is preceded by about 2 days of for a few hours, vesicular for 3-4
coryza, during which stage grayish days and leaves granular scabs
pecks (Koplik spots) may be found  Lesions are more on covered than
on the inner surface of cheeks on exposed parts of the body and
 Death is due to complication (ex. may appear on scalp and mucous
Secondary to pneumonia, usually in membrane of URT
children under 2 years old)
 Measles is severe among
malnourished children with fatality of Causative Agent: Varicella-Zoster Virus
95-100% Source of Infection:
Secretion of respiratory tract of infected
Causative Agent: persons. Lesions of skin are of little
Measles Virus consequence. Scabs themselves are not
infective.
Source of Infection:
Mode of Transmission:
Secretion of nose and throat of infected
person Direct contact or droplet spread. Indirect
through articles freshly soiled by discharges
Mode of Transmission: of infected persons. One of the most readily
By droplet spread or direct contact with communicable diseases, especially in the
infected persons, or indirectly through early stages of eruption
articles freshly soiled with secretions of Incubation Period: 2-3 weeks
nose and throat
Susceptibility, Resistance and
Incubation Period: Occurrence:
10 days from exposure to appearance of  Universal among those not
fever, and about 14 days until rash appears previously attacked. Severe in
adults. An attack confers long
Methods of Prevention and Control:
immunity
 Avoid exposing children to any  Second attacks are rare
person with fever or with acute  Not common in early infancy
catarrhal symptoms Methods of Prevention and Control:
 Isolation of cases from diagnosis
about 5-7 days after onset of rash  Case over 15 years of age should be
investigated to eliminate possibility
 Disinfection of all articles soiled with
of smallpox
secretion of nose and throat
 Isolation of infected person,
 Live attenuated and inactivated
measles virus vaccines (MMR)  Concurrent disinfection of throat and
nose discharge
 Exclusion from school for 1 week
after eruption first appears
  Avoid contact with susceptible swelling have been absent for at
MUMPS (Epidemic Parotitis) least four days because of the
danger of glandular complications
 An acute contagious disease
characterized by the swelling of one
or both parotid (salivary) glands, In males, the scrotum should be
usually occurring in epidemic form supported by a properly fitted
suspensory, pillow or a sling
Causative Agent: between the thighs, thus relieving
the pull of gravity on the testes and
Mumps Virus, a member of the family
blood vessels and minimizing the
Paramyxoviridae
dangers of orchitis
Source of infection:
Secretion of the mouth and nose
Mode of Transmission:

 Direct contact with a person who has

the disease or by contact with
articles in his immediate
environment which have become
freshly soiled with secretion from the
nasopharynx

Incubation Period:
12 to 26 days, usually 18 days
Signs and Symptoms:

 Painful swelling in front of ear, angle

of jaws and down the neck
 Painful particularly when swallowing
 Fever
 Malaise
 Loss of appetite
 Swelling of one or both testicles
(orchitis) in some boys

Treatment:

 Prophylactic. A vaccine exists for the

active immunization of patients
against mumps (MMR)
 Active treatment. The average case
before the age puberty requires little
attention
 After the age of puberty. All patients,
particularly adults, should remain
quiet in bed until all fever and
DIPHTHERIA WHOOPING COUGH (PERTUSSIS)

 Acute febrile infection of the tonsil,  Acute infection of respiratory tract. It

throat, nose, larynx or a wound begins as an ordinary cold, which in
marked by a patch or patches of a typical case increasingly severe,
grayish membrane from which the and after the second week is
diphtheria bacillus is readily cultured attended by paroxysms of cough
ending in a characteristic whoop as
the breath is drawn in
Causative Agent: Corynebacterium
diphtheriae (Klebs-Loeffler Bacillus) Causative Agent:
Source of Infection: Bordetella pertussis (Haemophilus
Discharges and secretions from mucus pertussis, Bordet-Gengou Bacillus)
surface of nose and nasopharynx and from Source of Infection:
skin and other lesions
Discharges from laryngeal and bronchial
Mode of Transmission: mucous membrane of infected persons
Contact with patient or carrier or with Mode of Transmission:
articles soiled with discharges of infected
persons. Milk has served as a vehicle Direct spread through respiratory and
salivary contacts. Crowding and close
Period of Communicability: association with patients facilitate spread
Variable until virulent bacilli has
disappeared from secretions and lesions
Susceptibility, Resistance and
Susceptibility, Resistance and Occurrence:
Occurrence:
Susceptibility is general, predominantly in
 Infants born of mothers who had childhood disease, the incidence being
diphtheria infection are relatively highest under 7 years of age and mortality
immune but the immunity disappears highest in infants particularly under 6
before 6th month months of age. One attack confers definite
 Recovery from attack of diphtheria is and prolonged immunity.
usually but not necessarily followed
by persistent immunity Methods of Prevention and Control:
 Two-thirds or more of the urban
cases are in children under 10 years Routine DPT immunization of all infants
of age which can be started at 1 ½ months of life
Methods of Prevention and Control and given at monthly intervals in 3
consecutive months. Booster dose is
 Active immunization of all infants usually given at the age of 2 years and
and children with 3 doses of DPT again at 4 to 5 years of age
toxoid administered at 4 to 6 weeks
intervals and then booster doses
following year after the last dose of
primary series and another dose on
the 4th or 5th year of age
 Pasteurization of milk
 Education of parents
TETANUS NEONATORUM AND TETANUS INFLUENZA
AMONG OLDER AGE GROUP
 Highly communicable disease
 Acute disease induced by toxin of characterized by abrupt onset with
Tetanus bacilli growing anaerobically fever which last 1 to 6 days, chilly
in wounds and at the site of sensation or chills, aches or pain in
umbilicus among infants. the back and limbs with prostrations.
Characterized by muscle Respiratory symptoms include
contractions coryza, sore throat and cough
Causative Agent:
Causative Agent:
Influenza Virus A, B, C
Clostridium tetani (Tetanus bacillus)
Source of Infection:
Source of Infection:
Discharges from the mouth and nose of
Immediate source of infection is soil, street infected person
dust, animal and human feces
Modes of Transmission:
Mode of Transmission:
By direct contact, through droplet infection,
Usually occurs through contamination of the or by articles freshly soiled with discharge of
unhealed stump of the umbilical cord nose and throat of infected person, airborne
Susceptibility, Resistance and Period of Communicability:
Occurrence:
Probably limited to 3 days from clinical
Susceptibility is general. An important cause onset
of death in many countries in Asia, Africa
Susceptibility, Resistance and
and South America especially in rural
Occurrence:
tropical areas.
Resistance – immunity is induced by  Universal but of varying degrees as
shown by frequent unapparent and
tetanus toxoid anti-toxin
typical infection during epidemics
 Occurrence is variable, in
pandemics, local epidemics, and as
Methods of Prevention and Control: sporadic cases, often unrecognized
by reason of indefinite clinical
 Pregnant women should be actively symptoms
immunized in regions where tetanus
 Infection produces immunity of
neonatorum is prevalent
unknown duration to the type and
 Health education of mothers, relative subtype of infecting virus
and attendants in the practice of Methods of Prevention and Control:
strict aseptic methods of umbilical
care in the newborn  Education of the public as to sanitary
hazard from spitting, sneezing and
coughing
 Avoid use of common towels,
glasses, and eating utensils
 Active immunization with influenza
vaccine provided prevailing strain of
 virus matches antigenic component
of vaccine
PNEUMONIAS CHOLERA (El Tor)

 An acute serious illness

 An acute infectious disease of the characterized by sudden onset of
lungs usually caused by the acute and profuse colorless
pneumococcus resulting in the diarrhea, vomiting, severe
consolidation of one or more lobes dehydration, muscular cramps,
of either one or both lungs cyanosis and in severe cases
collapse
Causative Agents: Causative Agent:

 Majority of cases due to Vibrio cholerae (El Tor)

Streptococcus pneumoniae Source of Infection:
(Diplococcus pneumoniae)
 Occasionally Klebsiella pneumoniae Vomitus and feces of infected persons and
 Viruses feces of convalescent or healthy carriers
Predisposing Causes:
Mode of Transmission:
 Fatigue
 Overexposure to inclement weather Food and water contaminated with vomitus
(extreme hot or cold) and stool of patients and carrier
 Exposure to pollutes air Susceptibility, Resistance and
 Malnutrition Occurrence:
Signs and Symptoms:
 Susceptibility and resistance general
Rhinitis/common cold - Pain over affected although variable. Frank clinical
area attacks confer a temporary immunity
Rusty sputum - Highly colored urine which may afford some protection,
for several years
Productive cough - Severe chill, in young  Immunity artificially induced by
children vaccine is of variable and uncertain
duration
Fast respiration - High fever  Appears occasionally in epidemic
form in the Philippines
Vomiting at times - Dilated pupils
Convulsion may occur
Methods of Prevention and Control:
Management:
 Bring patient to hospital for proper
 Bed rest isolation and prompt and competent
 Adequate salt, fluid, calorie and medical care
vitamin intake. Water requirement  Other preventive measures are the
increases because of high fever, same as those of Typhoid and
sweating and increased respiratory Dysentery
rate  All contacts should submit
 Tepid sponge for fever themselves for stool examination
 Frequent turning from side to side and be treated accordingly if found
 Antibiotics based on Care of Acute positive
Respiratory Infection (CARI) of DOH
  Isolation of patient during acute
illness

BACILLARY DYSENTERY (Shigellosis) TYPHOID

 An acute bacterial infection of the  Systemic infection characterized by
intestine characterized by diarrhea, continued fever, malaise, anorexia,
fever, tenesmus and in severe cases slow pulse, involvement of lymphoid
bloody mucoid stools tissue, Splenomegaly, rose spots on
 Severe infections are frequent in trunks and diarrhea.
infants and in elderly debilitated  Many mild typical infections are
persons often unrecognized
Causative Agent:
Shigella, there are four main groups: Causative Agent:
Shigella boydii Shigella sonnei Salmonella typhi
Shigella flexneri Shigella dysenterae Source of Infection:
Source of Infection: Feces and urine of infected person. Family
Feces of infected persons, many in contacts may be transient carrier. Carrier
apparent mild and unrecognized infection state is common among person over 40
years of age especially females
Mode of Transmission:
Mode of Transmission:
Eating contaminated foods or drinking
contaminated water and by hand to mouth Direct or indirect contact with patient or
transfer of contaminated materials; by flies, carrier. Principal vehicles are food and
by objects soiled with feces of a patient or water. Contamination is usually by hands of
carrier carrier. Flies are vectors

Susceptibility, Resistance and Period of Communicability:

Occurrence: As long as typhoid bacilli appear in excreta,
Disease is more common and more severe usually from appearance of prodormal
in children than in adults symptoms from first week throughout
convalescent
Methods of Prevention and Control:
Susceptibility, Resistance and
 Sanitary disposal of human feces Occurrence:
 Sanitary supervision of processing,
preparation and serving of food Susceptibility is general although many
particularly those eaten raw adults appear to acquire immunity through
 Adequate provision for safe washing unrecognized infections
facilities
Methods of Prevention and Control:
 Fly control and screening to protect
foods against fly contamination  Same as preventive and control
 Protection of purified water supplies measures as in Dysentery in
 Control of infected individual addition, immunization with vaccine
contacts and environment of high antigenicity
  Education of the general public and  Washing hands very well before
particularly the food handlers eating and after using the toilet
 Separate and proper cleaning of
articles used by patient

HEPATITIS A (Infectious hepatitis, PARALYTIC SHELLFISH POISONING

Epidemic hepatitis, Catarrhal jaundice) (PSP 1 Red Tide Poisoning)
 A form of hepatitis occurring either  A syndrome of characteristic
sporadically or in epidemics and symptoms predominantly neurologic
caused by virus introduced by fecally which occur within minute or several
contaminated water or food hours after ingestion of poisonous
 Young people especially school shellfish
children are most frequently affected Causative Organism:
Single-celled organism called
Causative Agent: Dinoflagellates; it is commonly referred as
Hepatitis Virus A Plankton

Predisposing factors: The organism that causes red tide in the

seas around Manila Bay, Samar, Bataan
 Poor sanitation and Zambales is the Pyromidium
 Contaminated water supplies bahamense var. compressum
 Unsanitary method of preparing and
serving of food Mode of Transmission:
 Malnutrition Ingestion of raw or inadequately cooked
 Disaster and war time condition seafood usually bi-valve shellfish or mollusk
Signs and Symptoms:
during red tide season
 Influenza-like symptom like
Signs and Symptoms:
headache
 Malaise and easy fatigability  Numbness of face especially around
 Anorexia and abdominal discomfort the mouth
 Nausea and vomiting  Vomiting and dizziness
 Fever  Headache
 Lymphadenopathy  Tingling sensation and eventually
 Jaundice paralysis of hands and feet
 Bilirubinemia with clay colored stool  Floating sensation and weakness
Management:  Rapid pulse
 Difficulty of speech (ataxia) and
 Prophylaxis – IM injection of gamma difficulty in swallowing (dysphagia)
globulin  Total muscle paralysis with
 Complete bed rest respiratory arrest and death occurs
 Low fat diet but high in sugar in severe cases
Prevention and Control: Management and Control:
 Ensure safe water for drinking  No definite medication indicated
 Sanitary method in preparing,  Induce vomiting
handling and serving food  Drinking pure coconut milk and
 Proper disposal of urine and feces sodium bicarbonate solution
 weakens the toxic effect of red tide.
It is advised to take these solutions
in early stage of poisoning only
 Shellfish affected by red tide must
not be cooked with vinegar as the
toxin of Pyromidium increases when
mixed with acid
 Toxin of red tide is not totally Treatment:
destroyed upon cooking hence
 Penicillin and other B-lactam
consumers must be educated to
antibiotics
avoid bi-valve mollusk such as
 Tetracycline
tahong, talaba, halaan, kabiya when
red tide warning has been issued by  Erythromycin
proper authority
Prevention and Control:
LEPTOSPIROSIS  Improved education of people at
(Weil’s disease, Mud fever, Trench fever, particular risk
Flood fever, Spiroketal jaundice, Japanese  Use of protective clothing boots and
seven days fever) gloves especially by workers with
occupational hazards
 It is a worldwide zoonotic disease.  Rat and other potential hosts control
Rat is the main host of the disease  Investigation of contacts and source
although pigs, cattle, rabbits and of infection
other wild animals can also serve as
reservoir hosts
 It is an occupational disease
affecting veterinarians, miners,
farmers, sewer workers, abattoir
workers, etc
Causative Agent:
Leptospira interrogans. There are about 200
serovars, var icterohemmorhagiae thought
to be more virulent and causes leptospirosis
Mode of Transmission:
Through contact of the skin, especially open
wounds with water, moist soil or vegetation
contaminated with urine of infected host
Signs and Symptoms:
1. Leptospiremic phase – leptospires
present in blood and CSF. Onset of
symptoms are abrupt with fever,
headache, myalgia, nausea,
vomiting, cough and chest pain
2. Immune phase – correlates with the
appearance of circulating IgM
RABIES (Hydrophobia, Lyssa)  Delirium and convulsion
 Is an acute viral encephalomyelitis
caused by the rabies virus, a Without medical intervention, the rabies
rhabdovirus of the genus Lyssavirus victim would usually last only for 2 to 6
 It is fatal once signs and symptoms days. Death is often due to respiratory
appear paralysis
 There are two kinds urban or canine
rabies is transmitted by dogs while Management and Prevention:
sylvatic rabies is a disease of wild
animals and bats which sometimes  The wound must be immediately and
spread to dogs, cats, and livestock thoroughly washed with soap and
water. Antiseptic such as povidone
 Rabies remains a public health
iodine or alcohol may be applied
problem in the Philippines.
Approximately 300 to 600 Filipinos  The patient must be given antibiotics
die of rabies every year and anti-tetanus immunization
 Philippines has the highest  Post-exposure treatment is given to
prevalence rate of rabies in the persons who are exposed to rabies.
whole world It consists of local wound treatment,
Mode of Transmission: active immunization and passive
immunization
Usually by bites of a rabid animal whose a. Active immunization
saliva has the virus. The virus may also be aims to induce the
introduced into a scratch or in fresh breaks body to develop
in the skin (very rare). Transmission from antibodies against
rabies up to 3 years
man to man is possible
b. Passive
Incubation Period: immunization is
given in order to
The usual incubation period is 2 to 8 weeks. provide immediate
It can be as long as a year or several years protection against
depending on the severity of wounds, site of rabies which should
the wound as distance from the brain, be administered
amount of virus introduced and protection within the first
provided by clothing seven days of
active
Susceptibility and Resistance: immunization. The
effect of the
All warm-blooded mammals are susceptible. immunoglobulin is
Natural Immunity in man is unknown only short term
Signs and Symptoms:  Consult a veterinarian or trained
personnel to observe your pet for 14
 Sense of apprehension days for sign of rabies
 Headache  Be a responsible pet owner
 Fever  Consult for rabies diagnosis and
 Sensory change near the site of surveillance of the area
animal bite  Mobilize for community participation
 Spasm of muscles or deglutition on
attempt to swallow (fear of water)
 Paralysis
NATIONAL RABIES PREVENTION AND Signs and Symptoms:
CONTROL PROGRAM
 Itching
Goal: Human rabies is eliminated in the  Minor discomfort – skin may feel hot
Philippines and the country is declared and burning
rabies-free  When large areas are involved and
secondary infection is severe, there
General Objectives: will be fever, headache and malaise
 Secondary dermatitis is common
 To reduce the incidence of human
rabies from 7 per million to 1 per
million population by 2010 and Diagnosis:
eliminate human rabies by 2015
 To reduce the incidence of canine  Appearance of the lesion, and the
rabies from 70 per 100,000 to 7 per intense itching and finding the
100,000 dogs by 2010, and causative mite
eliminate canine rabies by 2015  Scraping from its burrow with a
hypodermic needle or curette, and
then examined under low power
SCABIES objective or hard lens
 A communicable disease of the skin
characterized by the eruptive lesions Treatment:
produced by the burrowing of the
female parasite into the skin  The whole family must be examined
before undertaking treatment, as
long as one member of the family
Causative Organism: remains infected, other members will
Sarcoptic scabiei, itch mite. The female get the disease
parasite is easily is easily visible with a  Treatment is limited entirely to the
skin
magnifying glass. She burrows beneath the
 Benzyl benzoate emulsion to clean
epidermis to lay her eggs, and set up an
the lesion and it has a more rapid
intense irritation effect
Mode of Transmission:
The disease is transmitted by direct contact
with infected individuals or their clothing or Prevention and Control:
bedding.
 Good personal hygiene – daily bath,
Predisposing factors: washing of hands before and after
1. Close crowding as in tenement eating and after using the toilet,
districts cutting of fingernails
2. Lack of personal cleanliness  Regular changing of clean clothing
beddings and towel
 Eating the right kind of food and
taking plenty of fluids
 Keeping the house clean
  Improving sanitation of the  Contracted by inhalation of
surroundings spores of Bacillus anthracis
ANTHRAX (Malignant pustule, Malignant  At the onset of illness, the
edema, Woolsorter’s disease) symptoms are mild and
resemble that of common
 An acute bacterial disease usually upper respiratory tract
affecting the skin but which may vary infection
rarely involves the oropharynx.  The symptoms become
Lower respiratory tract, mediastinum acute, with fever, shock and
or intestinal tract. death results
3. Gastrointestinal anthrax
Causative Agent:  Contracted by ingestion of
meat from infected animals
Bacillus anthracis and is manifested as violent
gastroenteritis with vomiting
Modes of Transmission: and bloody stools
 Cutaneous infection is by contact
with tissues of animals (cattle, Methods of Control:
sheep, goats, horses, pigs) dying of
the disease; possibly by biting flies Immunize high-risk persons
that had partially fed on such
animals;  Educate employees handling
 Contaminated hair, wool, hides or potentially contaminated articles
about modes of anthrax
products made from them such as
transmission
drums or brushes;
 Personal cleanliness
 Contact with soil associated with
infected animals  Control dusts and proper ventilation
in hazardous industries especially
those that handle raw animal
Signs and Symptoms: materials

There are 3 forms of anthrax

1. Cutaneous anthrax
 Most common and is
contracted by contact with
infected animals
 The exposed part of the skin
begins to itch and a papule
appears in the inoculation
site.
 This papule becomes a
vesicle and then evolves into
depressed black eschars
 The lesion is not painful and
often untreated which will
result to septicemia and
death when not treated early
2. Pulmonary anthrax
MENINGOCOCCEMIA risk of exposure particularly among
children and elderly
 The disease is usually sporadic “BIRD FLU” or AVIAN INFLUENZA
(cases occur alone or may affect
household members with intimate  Influenza is recognized both as
contact) emerging and re-emerging viral
 Although primarily a disease of infection and is described as an
children, it may occur among adult unvarying disease caused by a
especially in condition of forced varying virus. The virus mutates but
overcrowding such as institution, jail its burden on health, lives and
and barracks manpower is consistently
 There is an increased rate in overwhelming
smokers, overcrowded households  It is an infectious disease of birds
and military recruits. ranging from mild to severe form of
illness. All birds are thought to be
susceptible to infection with avian
Causative Agent: influenza, though some species are
more resistant than others.
Neisseria meningitides
 Some forms of bird flu infections can
Source of Infection: cause illness to humans. It is due to
highly pathogenic influenza virus
Respiratory droplets from nose and throat of H5N1. It is the subtype that can be
infected persons transmitted from infected poultry to
human
Mode of Transmission: Source of Infection:
Direct contact with respiratory droplets from Viruses that normally infect only birds and
nose and throat of infected persons. Carrier less commonly pigs
may exist without cases of meningitis.
Signs and Symptoms:
Signs and Symptoms:
 Fever
 High grade fever for first 24 hours  Body weakness and muscle pain
 Weakness, joint and muscle pain  Cough
 Hemorrhagic rash, progressing from  Sore throat
few petechiae to widespread  May have difficulty in breathing in
purpura severe cases
 Meningeal irritation like headache,  Sore eyes
nausea and vomiting, stiff neck, Control Measure in Birds:
seizure or convulsion and sensorial
changes  Rapid destruction, proper disposal of
Methods of Prevention and Control carcasses and rigorous disinfection
of farms
 Respiratory isolation of patients for
 Restriction on the movement of live
the first 24 hours upon admission to
poultry
prevent exposure of hospital staff
Preventive Measures in Human:
 Protective clothing for hospital staff
with patient suspected of  All workers directly or indirectly
meningococcemia involved in handling live poultry
 Public should be educated to avoid should be given the current season’s
overcrowded places to reduce the influenza vaccine to reduce the
 possibility of dual infection with  Common findings include
human and influenza viruses hypoxia, dullness on
 Yearly vaccination of poultry workers percussion and decreased
with regular of periodic direct contact breath sounds on physical
with poultry examination
 Infectivity is highest during
this phase
SARS (Severe Acute Respiratory
Syndrome)
Preventive Measures and Control
 It is a newly recognized form of a
typical pneumonia that had been  Establishment of triage
described in patients in Asia, North  Identification of patients
America and Europe. The earliest  Isolation of susceptible probable
known cases were identified from case
Guangdong Province, China in  Tracing and monitoring of close
November 2002. contact
 The WHO issued the global alert on
the outbreak on March 12, 2003 and
instituted worldwide surveillance.

Causative Agent:
It is a novel human coronavirus based on
serological and molecular tests done on
specimens from SARS patients
Modes of Transmission:

 Close contact with respiratory

droplet secretion from SARS patient
 Transmission occurs when another
person’s mucous membrane is
exposed to droplet secretions when
a SARS patient coughs, sneezes or
talks
Signs and Symptoms:
1. Prodromal phase
 Body temperature of more
than 38 degrees Celsius
sometimes with chill, malaise
and headache
 During this stage the
infectivity is none to low
2. Respiratory phase
 Within 2 to 7 days the illness
may proceed to this stage
characterized by dry non-
reproductive cough with or
without respiratory distress
FILARIASIS Laboratory Examinations:

 Public Health concern in many  Blood Examination – thick blood

endemic areas (45 out of 78 smear about the size of 25 centavo
provinces are endemic) coin, blood is taken from the patient
 Chronic parasitic infection caused by 10pm to 2am for Wuchereria and
nematode parasite anytime for Brugia but more
- Washeterias preferred at night. (due to parasite’s
Bancroft periodicity)
- Brugia malayi
and/or Brugia timori Treatment:
The drug of choice is Diethylcarbamazine
Mode of Transmission: The disease is (DEC)
transmitted to a person through bites from
an infected female mosquito
Vectors: Supportive care for Filariasis:

Wuchereria – Aedes poecilus, Anopheles Patients are advised to observed personal

minismus flavirostris hygiene by washing the affected areas with
soap and water at least twice a day or
Brugia – Mansonia bonnaea, Mansonia prescribed antibiotics or anti-fungal for
uniformis super infection
Asymptomatic stage: Prevention and control:
1. Characterized by the presence of A. Measures aimed to control the
microfilariae in the peripheral blood vector
2. No clinical signs and symptoms of 1. Environmental sanitation such as
the disease proper drainage and cleanliness
Acute stage: of the surroundings
1. Lymphadenitis – inflammation of the 2. Use of insecticides
lymph nodes B. Measures aimed to protect the
2. Lymphangitis – inflammation of people in endemic areas
lymph vessels 1. Use of mosquito nets
3. In some cases, the male genitalia is 2. Application of insect repellants
affected 3. Screening of houses
4. Health education

Chronic stage – developed 10-15 years

from the onset of first attack
1. Hydrocoele – swelling of the scrotum
2. Lymphedema – swelling of the upper
and lower extremities
3. Elephantiasis – enlargement or
thickening of the skin of the lower
and/or upper extremities, scrotum,
breast
MALARIA

 Continues to be a major public Treatment:

health concern having an annual
parasite incidence of 5.1 per 1000 Drug of choice is Chloroquine.
population Pyrimethamine/sulfoxide combination
maybe used in areas with high levels of
resistance to chloroquine
Infectious agents:
Chemoprophylaxis:
Plasmodium falciparum
Only chloroquine should be given. It must
Plasmodium malariae be taken at weekly intervals starting from 1-
Plasmodium vivax 2 weeks before entering endemic areas

Plasmodium ovale Prevention and control:

Sustainable preventive and vector control
 The severity and characteristic
manifestation of the disease are  Insecticide – treatment of mosquito
governed by the infecting species nets
 House spraying
Mode of transmission:  Protective clothing
 Educate the people in endemic
Through the bite of an infected female areas
mosquito or directly from one person to  Chemoprophylaxis
another by passage of blood containing
erythrocytic parasites

Signs and symptoms:

 Recurrent chills
 Fever
 Profuse sweating
 Anemia
 Hepatomegaly
 Splenomegaly

Laboratory Examinations:

 Thick and thin blood smear – look

for the presence of malarial parasite
 Para Sight F test – dipstick test for
simple and rapid diagnosis of
Plasmodium falciparum
 Serological test – IHA (Indirect
Hemagglutination)
ELISA (Enzyme-linked Immunosorbent
Assay)
DENGUE HEMORRHAGIC FEVER (H- Control measures:
Fever)
 Vector elimination
o Changing water and
scrubbing sides of lower
Etiologic agents: vases once a week
Dengue Virus Types 1, 2, 3 and 4 o Destroy breeding places of
mosquito
Source of infection: o Keep water container clean
and covered
Immediate source is a vector mosquito, the  Avoid too many hanging clothes
Aedes aegypti or the common household inside the house
mosquito  Spray with insecticides
Mode of transmission:  Health education of the public

Through bite of infected female mosquito

Signs and symptoms:
An acute febrile infection of sudden onset
with clinical manifestation of 3 stages:

 First 4 days – invasive stage starts

abruptly as high fever, abdominal
pain and headache
 4th to 7th days – toxic or hemorrhagic
stage – lowering of temperature,
severe abdominal pain, vomiting,
frequent bleeding. Death may occur
 7th to 10th day – convalescent or
recovery stage

Diagnostic test:

 Torniquet test (Rumpel Leads Test)

 Platelet count

Supportive and symptomatic treatment:

 Paracetamol, analgesic for fever,

muscle pain or headache. DON’T
GIVE ASPIRIN
 Rapid replacement of body fluids
SEXUALLY TRANSMITTED INFECTIONS I. BACTERIAL STI

 Sexually Transmitted Infections (STI) a. Gonorrhea

and their complications belong to the
top five categories for which adults Causative agent:
seek health care in the developing Neisseria gonorrhoeae
countries
 Many STIs can be treated and cured Mode of transmission:
relatively easily and cheaply if
diagnosed early enough. From Sexual contact in adult, transmission in
among the STI, the most common neonates is during birth
treatable are: Chlamydia,
Signs and symptoms:
Gonorrhea, Trichomoniasis, and
Syphilis Genital (penis or cervix), anus throat, and
eyes can be infected.
Primary Prevention of STI  Males – burning urination and pus
1. Modification of sexual activity – this discharges from infection of urethra
would decrease the like hood of  Females – vaginal discharge
exposure to or contact with Treatment:
infectious agents Ceftriaxone for uncomplicated cases. If
a. Engage in mutually
resistant, spectinomycin is used
monogamous relationship
b. Limit the number of Prevention:
sexual partners
c. Inspect and question new No drug or vaccine. Condoms offer
partners protection. Trace contacts and treat to
d. Avoid certain sexual interrupt transmission
practices involving anal or fecal contact
2. Barrier methods of contraception
(use of condoms, diaphragms and
b. Syphilis
spermicides)
3. The only STI that can be prevented Causative agent:
with vaccine is HBV infection
4. Prophylactic antibiotics taken before Treponema pallidum
and after exposure should not be
done because: Mode of transmission:
a. No single antibiotic Sexual contact and from mother to fetus
covers all potential STIs across the placenta
b. Allergic reaction may
occur Signs and symptoms:
c. They may lead to
mergence or resistant  Primary syphilis (Chancre) –
organism painless sore at the site of entry of
germs, swollen glands
 Secondary syphilis (Condylomas) –
maculopapular rash notably on the
palms and soles, or as moist
papules on the skin and mucous
 membranes. Moist lesion of the
genitals
 Tertiary syphilis (Gummas) – varies II. PARASITIC STI
from no symptoms to indication of
damage to body organs such as
brain, heart and liver a. Trichomoniasis
Causative agent:
Treatment:
Trichomonas vaginalis
Penicillin is effective in all stages of syphilis
Mode of transmission:
Prevention:
Usually passed by direct sexual contact.
Same as other bacterial STI. No vaccine Can be transmitted through contact with wet
available. Benzathine penicillin given to objects such as towels, wash clothes, etc.
contact’s
Signs and symptoms:

 Males – slight itching of the penis,

c. Chlamydia painful urination, clear discharge
from penis
Causative agent:
 Females – white or greenish-yellow
Chlamydia trachomatis odorous discharge, vaginal itching,
painful urination
Mode of transmission: Treatment:
Through sexual contact and birth Metronidazole for both partners
Signs and symptoms: Prevention:
 In males – discharge from penis, Condoms limit transmission
burning and itching of the urethral
opening, burning sensation during
urination
 In females – slight vaginal
discharge, itching and burning of
vagina, painful intercourse,
abdominal pain
Treatment:
Tetracycline or Erythromycin
Prevention:
No vaccine is available. Erythromycin is
effective in infected mother to prevent
neonatal disease