COMMUNICABLE DISEASESCommunicable disease- (synonym: infectious disease) An illness due to a specific infectious agent or its toxic products that arises through transmission of that agent or its products from an infected person, animal or inanimate source to a susceptible host; either directly or indirectly through an intermediate plant or animal host, through a vector, or through contact with the inanimate environment.

Common communicable diseases found in the Philippines are discussed according to the different systems which they affect and in the following order, if specified: Important information/Description Also known as(aka) Causative agent Predisposing factors Incubation period Period of communicability Mode of transmission Diagnostic/Laboratory exams Signs and symptoms Complications Management Prevention Treatment Medical Care Nursing Care

DISEASES AFFECTING THE INTEGUMENTARY SYSTEMI. LEPROSY

A. Important Information1. Chronic infectious and communicable disease. No new case of leprosy arises without previous contact; usually prolonged and intimate, with an open case.2. Majority is contracted in childhood, will show manifestations by 15 years of age and definitely diagnosed by age 20.3. It is not hereditary.4. No other disease shows these cardinal signs:4.1 Presence of Hansens bacilli in stained smears or biopsy material4.2 Presence of localized areas of anesthesia5. Does not cross placental tissues and therefore does not affect the fetus. Pregnancy women with leprosy cannot be treated because the drugs are teratogenic.

B. AKA: Hansens Disease, Hansenosis, Lepra

C. Causative Agent: Mycobacterium leprae or Hansens bacilli thrives best in reticuloendothelial cells

D. Incubation Period - varies from 1 to 5 years

E. Period of communicability as long as there are open lesionsChildren below 12 years old are more susceptible

F. Mode of transmission:1. (Not exactly known) Skin to skin contact with untreated leprosy patient2. Respiratory tract: Droplet infection (nasopharyngeal secretions)G. Diagnostic/Laboratory exams:1. Skin smear test

A skin smear is a test in which a sample of material is collected from a tiny cut in the skin and then stained for M. leprae, an acid-fast bacillus.

2. Skin lesion biopsy

A skin biopsy is the removal of a small portion of abnormal skin. The removed skin is tested to see why it is not normal.

3. Lepromin Test- tissue is removed from the earlobe or from large soft nodules thoroughly dried and ground into powder as the basic lepromin stock. The usual dose is 0.2 ml, just enough to produce a wheal when injected intradermally at the flexor surface of the forearm. A (+) result develops a nodule at the site of injection on the 1st-3rd week and gradually increase in size.Size of the wheal

3 mm. wheal1+

3-5 mm. wheal2+

>5mm. wheal3+

If nodule suppurates4+

H. Types1. Polar1.1 Lepromatous or malignant Many microorganisms are found Open or infectious cases Negative reaction to lepromin test Tendency to form globi in the skin, mucous membranes, peripheral nerves1.2 Tuberculoid or benign Only few organisms are found Usually closed or noninfectious Positive reaction to lepromin test

2. Indeterminate- unestablished lesion; usually noninfectious3. Borderline- s/sx of tuberculoid and lepromatousI. S/Sx:CARDINAL SIGNS1) Peripheral nerve enlargement2) Loss of sensation3) Positive smear test

EARLY STAGE Skin changes color Alopecia- hair loss Muscle weakness and paralysis of the extremities

Pain and redness in the eyes

Loss of sensation(anesthesia) Epistaxis nose bleeding

Skin ulcers which do not heal even when treated Anhydrosis loss of sweating Skin lesions varying from bronze, purple or light red macules, 1-10 cm in diameter; yellow or brown infiltrated nodules, 1-5 cm in diameter; confluent nodulesLATE STAGE Clawing of the fingers and toes due to contractures

Lagophthalmos inability to close the eyes

Leoning face pathognomonic sign - skin becomes so thickened and nodular

Earlobes are thickened and nodular Sinking of the nose bridge(saddle nose deformity) due to absorption of the small bones

Severe neuritis: neuralgic pains, most severe in the arms Trophic ulcers on the hands, feet, fingers or toes contract because of bone absorption and big blisters or bullae appear on the trunk Gynecomastia- enlargement of male breast Madarosis loss of hair, then thickening of eyebrows

FINAL STAGE Injury of the eye Involvement of the 5th and 7th cranial nerves Gangrene of fingers or toes which may require amputation

J. ManagementPREVENTION Separate infants from lepromatous parents at birth BCG immunization Avoid contactMEDICAL CAREDomiciliary treatment as embodies in R.A. 4073 which advocated home treatment Multidrug therapy (MDT): sulfone drugs are given in combination with other drugs to prevent drug resistance, hasten recovery and lessen the period of communicabilityPaucibacillary (few organisms)- given for 6-9 mos. or until negative Rifampicin once a month Dapsone once a dayMultibacillary (many organisms)- given for 24-30 mos./2 years Rifampicin once a month Dapsone once a day Lamprene once a day(causes blackish discoloration of the skin)

Adverse ReactionRIFAMPICIN Discoloration of body fluids Rashes Muscle soreness Anuria (nephrotoxicity) Thrombocytopenia- relative decrease of platelets in blood Jaundice DAPSONE Causes increase in the numbers of lesions Treated symptomatically, needs referralLAMPRENE Skin discoloration Dryness and flakiness of the skin (hot soak to improve circulation)TREATMENT COMPLETION PB regimen- should take 6 blister packs within 9 mos. MB regimen- should take 12 blister packs within 18 mos. At the end of this duration, the patient should be considered as Treatment Completed (TC)

NURSING CARE Emotional support Skin and Meticulous eye care Balanced diet, exercises and rest hygiene Adequate information regarding drug therapy

II. MEASLES & III. GERMAN MEASLESMeasles

German Measles

A. Important Information

1. An extremely contagious exanthematous disease of acute onset.2. Essential a disease of childhood.3. Signs and symptoms are preferable to the upper respiratory passages.4. It is endemic and may occur at any time of the year.5. Breastfed babies of mothers who have measles possess a relative immunity for the first 3 months of life.6. The greatest incidence occurs during 3 years of age.7. Second attacks are not impossible.8. The most common complication is otitis media.9. The most serious complications are bronchopneumonia and encephalitis.

1. An acute contagious disease2. Essentially a mild childhood disease, the danger actually being congenital defects in the newborn if a pregnant woman suffers from it or exposed to someone with the disease. 2.1 Mirocephaly 2.2 Congenital heart defect; cataract; deafness and mutism

B. Also known as Rubeola; Morbilli; Little Red Disease; hard Measles, 7-day measles; 9-day measles

Rubella, 3-day measles

C. Causative agent filterable Paramyxovirus, rubeola/measles virus

Pseudoparamyxovirus, Rubella/ Toga virus

D. Incubation period usually 10-12 days (8-20 days) usually 14-21 days

E. Period of communicability about 9 days (4 days before to 5 days after the appearance of rash). It is most communicable at the height of the rash 4-7 days after the onset of catarrhal symptoms ( 7 days before and 4 days after the appearance of rash)

F. Mode of transmission

Spread by direct (droplet/airborne; nasopharyngeal secretions) or indirect contact (airborne) Same with measles, mother to infant (transplacental)

G. Signs & symptomsPRE-ERUPTIVE/PRODROMAL STAGE 3 Cs: Coryza, Cough, Conjuctivitis

Photophobia- fear of light Pathognomonic sign : Kopliks spot whitish spots in the inner cheeks, appear 3 days before rashes start

ERUPTIVE/ SKIN RASH STAGE Usually seen on the fourth day Maculopapular rashes redisn in color and blotchy in appearance-Cephalocaudal appearance: from face to trunk to extremities

High grade intermittent fever Anorexia(loss of appetite), pruritus(itching), and irritability Tonsillitis(inflamma-tion of the tonsils)

CONVALESCENT STAGE Cephalocaudal disappearance of the rashes Desquamation of the skin

PRE-ERUPTIVE/PRODROMAL STAGE Starts with low grade fever Mild catarrhal symptoms Malaise, stiffness of the neck, and anorexia Mild conjunctivitis and sore throat Most earliest and prominent characteristic sign: Lymphadenopathy

ERUPTIVE STAGE Pathognomonic sign: Forscheimers spot pinkish rash on the soft palate extending to mucous membrane

Pinkish maculopapular rash begins on the face and spreads to trunk, limbs, fades rapidly lasting about 2-3 days No pigmentation or desquamation Testicular pain in adults Transient polyarthralgia(joint pains) & polyarthritis( pain affecting 5 or more joints) Enlargement of lymph nodes- subocciptal, pastauricular and poscervical

POST-ERUPTIVE STAGE Lymph nodes subsides Rashes disappear on the 3rd day

H. Diagnosis/ Diagnostic test Clinical observation Nose & Throat Swabbing- laboratory test done to isolate and identify organisms that may cause infection in the throat

Leukopenia or leukocytosis Confirmatory test: Complement fixation or hemagglutinin an immunological test that is used to detect presence of specific antigen/antibody produced by microorganism

Same as measles

I. Immunity/Prevention Measles vaccine at 9 months old

MMR (measles, mumps, and rubella) vaccine-1st dose at 15 months old-2nd dose at 11 to years MMR vaccine Pregnant women should be vigilant preventing exposure Immunoglobulin one week after exposure of high risk individuals-Immune serum globulin (20 ml)- given to pregnant woman in their 1st trimester

J. Complications Bronchopneumonia- acute or chronic inflammation of the lungs Abdominal pain Secondary skin infections Otitis media Encephalomyelitis- inflammation of the brain and spinal cord Subacute sclerosing panencephalitis (SSPE) Encephalitis Neuritis Arthritis Athralgia Congenital rubella syndrome

I. ManagementNURSING CARE: Isolate in a well-ventilated room with subdued light Tepid Sponge Bath (TSB)-for fever

Skin care; daily cleansing bed bath Oral hygiene (for tonsillitis) Position patient where direct glare of light is avoided Care of ears Increase Oral Fluid Intake and provide adequate nutrition, increase Vitamin C Avoid exposure to draft. Never sponge with cold water

MEDICAL CARE: No therapy is indicated for uncomplicated measles Supportive & Symptomatic Antipyretics Antibiotics for secondary infections Immune Globulin prophylaxisNURSING CARE: Isolate in a well-ventilated room with subdued light Bed rest TSB (for fever)

Ear and eye care

TREATMENT: Symptomatic

IV. CHICKEN POX & V. HERPES ZOSTERChicken Pox

Herpes Zoster

A. Important Information

1. Most highly contagious childhood disease2. Affects adults more severely than children3. One attack confers lifelong immunity4. Not all viruses may leave the body; they just become dormant and live in the nerves which, when weakened by low resistance, may lead to Herpes Zoster5. Charcaterized by vesicular eruptions on the skin and mucous membrane6. Mild self-limiting disease

1. Caused by the same virus that causes chickenpox2. A dormant type of chickenpox3. More often attacks adults than children4. Uncommon under age 105. Appears in clusters6. Acute viral infection of the nerve structure occurring in a partially immune individual due to a previous varicella infection7. Extremely painful because it affects the sensory nerve

B. Also known as Varicella zoster

Shingles; Acute Posterior Ganglionitis; Zota

C. Causative agent Varicella Zoster virus; Herpes virus varicella; Human Haemophilus virus 3 Same as chicken pox

D. Incubation period From 10 to 21 days (mean: 14 days) Unknown; believed to be 13 to 17 days

E. Period of communicability 1 day before the eruption of the first lesion up to five days after the appearance of the last crop A day before appearance of rash until 5 to 6 days after last crust

F. Mode of transmission

Direct contact Indirect contact (linen or fomites) Airborne/droplet infection Same as chicken pox

G. Signs & symptomsPRE-ERUPTIVE/PRODROMAL STAGE Mild fever and malaise

ERUPTIVE/ SKIN RASH STAGE Rashes start from the trunk (unexposed area) then spread to other parts of the body

In older children, lesions may widespread and more severe Rapid progression Very pruritic

STAGES

MACULE flat red lesion PAPULE elevated lesion

VESICLE fluid-filled papule