1

NCMB 312 LECTURE clinical manifestations are: mild-diarrhea that becomes

voluminous; rice-watery stool (pathognomonic sign);
WEEK 13 washer woman’s hands; effortless vomiting; cramping of the
extremities (hypokalemia) and signs of severe
dehydration. In these people, rapid loss of body fluids leads to
dehydration and shock. Without treatment, death can occur
CHOLERA within hours. The three (3) deficits during Cholera: (1)
Severe dehydration and ECF volume deficit; (2)
Cholera is an acute, diarrheal illness caused by infection of Hypokalemia; and (3) Metabolic acidosis. The diagnostic tests
the intestine with the toxigenic bacterium and etiologic are: stool or vomitus culture; serum electrolytes; and dark
agent Vibri coma or Vibrio cholerae serogroup. An field or phase microscopy. To test for cholera, doctors must
estimated 2.9 million cases and 95,000 deaths occur each year take a stool sample or a rectal swab and send it to a laboratory
around the world. The infection is often mild or without to look for the cholera bacterium.
symptoms, but can sometimes be severe. Approximately one
in 10 (10%) infected persons will have severe disease Cholera can be simply and successfully treated by
characterized by profuse watery diarrhea, vomiting, and leg immediate replacement of the fluid and salts lost through
cramps. In these people, rapid loss of body fluids leads to diarrhea. Patients can be treated with oral rehydration
dehydration and shock. Without treatment, death can occur solution (ORS), a prepackaged mixture of sugar and salts to
within hours. Waldemar Haffkine was a Russian-Jewish be mixed with 1 liter of water and drunk in large
bacteriologist developed the first cholera vaccine in July amounts. This solution is used throughout the world to
1892. Filippo Pacini (1854) - V. cholerae was first isolated treat diarrhea. Severe cases also require intravenous fluid
as the cause of cholera by Italian anatomist. John Snow is replacement. With prompt appropriate rehydration, fewer than
widely considered to be the father of modern epidemiology. 1% of cholera patients die. Antibiotics shorten the course and
But it was not until 1854 that the physician John Snow diminish the severity of the illness, but they are not as
(1813-1858) made a major contribution to fighting cholera important as receiving rehydration. Persons who develop
when he was able to demonstrate a link between cholera and severe diarrhea and vomiting in countries where cholera
the contaminated drinking water through his pioneering occurs should seek medical attention promptly. The
studies. For his persistent efforts to determine how cholera was medical management are to correct of dehydration and
spread and for the statistical mapping methods he initiated. fluid imbalance and antibiotics of tetracycline as drug of
choice. The nursing management are: (1) assess patient for
Cholera is a bacterial disease usually spread through seven Fs signs of dehydration and complications; (2) observe enteric
– foods, fluids, fingers, feces, fomites, fields, flies. Cholera is precautions (feces); and (3) increase oral fluid intake.
spread the way many diarrheal diseases are spread, through
The disease is not likely to spread directly from one
the (1) Fluid/Water: By drinking water that has been person to another; therefore, casual contact with an infected
contaminated by feces and has not been treated (disinfected). person is not a risk for becoming ill. The risk for cholera is very
(2) Fingers: By getting hands in one’s mouth, when hands low for people visiting areas with epidemic cholera. When
are not washed after using the toilet or after contact with simple precautions are observed, contracting the disease is
feces on the ground (which is especially common for young unlikely. All people (visitors or residents) in areas where
children who are crawling). (3) Flies: Because flies sit on cholera is occurring or has occurred should observe the
feces and then land on food. (4) Food: By eating food that following recommendations: (1) Drink only bottled, boiled,
has been contaminated (made dirty) by fingers, flies, or or chemically treated water and bottled or canned
water that have come in contact with feces. (5) carbonated beverages. (2) When using bottled drinks, make
Fields/Floors: The soil where food is grown can contain sure that the seal has not been broken. (3) To disinfect the
feces when cholera-infected people or animals feces on the water to drink: boil for 1 minute or filter the water and add 2
ground or near water sources instead of using latrines or drops of household bleach or ½ an iodine tablet per liter of
burying the feces. Hands that have been working in water. (4) Avoid tap water, fountain drinks, and ice cubes. (5)
the soil can pass microbes like cholera on when hand washing Wash the hands often with soap and clean water. (6) If no
is not done afterwards. Floors that get contaminated with water and soap are available, use an alcohol-
animal or human feces can also end up contaminating fingers based hand cleaner (with at least 60% alcohol). (7) Clean the
that end up in mouths. (6) Fomites: inanimate objects that hands especially before eating or preparing food and after
can become contaminated with infectious agents and serve as using the bathroom. (8) Eat foods that are packaged or
a mechanism for transfer between hosts. The classic example that are freshly cooked and served hot. (9) Do not eat raw or
of a fomite is a park water fountain from which many people undercooked meats and seafood, or raw or undercooked fruits
drink. Infectious agents deposited by one person can and vegetables unless they are peeled. (10) Dispose of
potentially be transmitted to a subsequent drinker. (7) Feces: feces in a sanitary manner to prevent contamination of water
The cholera bacterium is usually found in water or food and food sources
sources that have been contaminated by feces (poop) from
a person infected with cholera. Cholera is most likely to be The FDA recently approved a single-dose live oral cholera
found and spread in places with inadequate water treatment, vaccine called Vaxchora® (lyophilized CVD 103-HgR) for adults
poor sanitation, and inadequate hygiene. 18 – 64 years old who are traveling to an area of active
cholera transmission with toxigenic Vibrio cholerae (the
Cholera is also known as El Tor and Violent Dysentery. bacteria strain that most commonly causes cholera). The
The incubation period is from a few hours to 5 days vaccine is not routinely recommended for most travelers from
(average of 3 days). It can take anywhere from a few the United States, as most people do not visit areas of active
hours to 5 days for symptoms to appear after infection. cholera transmission. No cholera vaccine is 100% protective
Symptoms typically appear in 2-3 days. The period of and vaccination against cholera is not a substitute for
communicability is as long as microorganisms are present in standard prevention and control measures, including
the bowel excreta. precautions for food and water.
Cholera infection is often mild or without symptoms, but can
sometimes be severe. Approximately one in ten (10%)
infected persons will have severe disease characterized by
profuse watery diarrhea, vomiting, and leg cramps. The
2

personal hygiene. This includes thorough handwashing with

soap and water after using the toilet, after changing
DYSENTERY diapers, and before handling or preparing food.
Bacillary Dysentery
Amoebic Dysentery
Bacillary Dysentery also known as Shigella infection
Amoebic dysentery, also known as Amoebiais is caused by the (shigellosis) or Bloody Flux is an intestinal disease caused by a
protozoan parasite Entamoeba histolytica. It is transmitted in family of bacteria known as shigella. The main sign of shigella
areas where poor sanitation allows contamination of infection is diarrhea, which often is bloody. Kiyoshi Shiga
drinking water and food with feces. In these areas, up to (1897) - a Japanese Scientist discovered Shigella bacteria
40% of people with diarrhea may have amoebic dysentery. causing dysentery.
E. histolytica infection can occur when a person: (1) Puts
anything into their mouth that has touched the feces (poop) of Diarrhea and bloody diarrhea can result from a number of
a person who is infected with E. histolytica. (2) Swallows diseases. Confirming shigellosis involves taking a sample of
something, such as water or food, that is contaminated your stool to be tested in a laboratory for the presence of
with E. histolytica. (3) Swallows E. histolytica cysts (eggs) shigella bacteria or their toxins. Shigella can be passed through
picked up from contaminated surfaces or fingers. Only direct contact with the bacteria in the stool. For example, this
about 10% to 20% of people who are infected with E. can happen in a child care setting when staff members
histolytica become sick from the infection. Those people don't wash their hands well enough after changing diapers or
who do become sick usually develop symptoms within 2 to helping toddlers with toilet training. Shigella bacteria also can
4 weeks, though it can sometimes take longer. The causal be passed in contaminated food or b ydrinking or swimming in
agent, Entamoeba histolytica, was discovered in Russia in 1873 contaminated water. Children under age 5 are most likely
by Friedrich Losch. His early observations came from the case to get shigella infection, but it can occur at any age. A mild
of a young farmer who had been suffering from chronic case usually clears up on its own within a week. When
dysentery. treatment is needed, doctors generally prescribe antibiotics of
cotrimoxazole as drug of choice.
The symptoms are often quite mild and can include +/-
fever, +/- vomiting, abdominal pain, diarrhea with tenesmus Signs and symptoms of shigella infection usually begin a day or
and muco-purulent blood streaked loose stool (poop), and two after contact with shigella, but may take up to a week to
stomach cramping. Rarely, E. histolytica invades the liver and develop. Signs and symptoms may include: Diarrhea (often
forms an abscess (a collection of pus). In a small number of containing blood or mucus), Abdominal pain or cramps,
instances, it has been shown to spread to other parts of the with or without fever, with or without vomiting. Although
body, such as the lungs or brain, but this is very uncommon. some people have no symptoms after they've been infected
Although anyone can have this disease, it is more common with shigella, their feces may still be contagious up to a few
in people who live in tropical areas with poor sanitary weeks. The incubation period is 1 to 4 days. The mode of
conditions. In the United States, amebiasis is most common transmission is same as cholera with 7 Fs. Infection occurs
in: (1) People who have traveled to tropical places that when the patient accidentally swallow shigella bacteria
have poor sanitary conditions, (2) Immigrants from tropical (Shigella dysenteriae) that comes in three (3) strains
countries that have poor sanitary conditions. (3) People who Shigella flexneri, Shigella boydii, and Shigella sonnei.
live in institutions that have poor sanitary conditions. (4). Men
who have sex with men. But in the Philippines, most Shigella infection usually runs its course in five to seven
common is unsanitary conditions and poor hygiene in days. Replacing lost fluids from diarrhea may be all the
preparation of foods. treatment you need, particularly if your general health is good
and your shigella infection is mild. Avoid drugs intended to
Diagnosis of amebiasis can be very difficult. One problem is that treat diarrhea, such as loperamide (Imodium) or atropine
other parasites and cells can look very similar to E. histolytica (Lomotil), because they can make your condition worse.
when seen under a microscope. Therefore, sometimes people For severe shigella infection, antibiotics may shorten the
are told that they are infected with E. histolytica even duration of the illness. However, some shigella bacteria
though they are not. Entamoeba histolytica and another have become drug resistant. So it's better not to take
ameba, Entamoeba dispar, which is about 10 times more antibiotics unless shigella infection is severe. Antibiotics
common, look the same when seen under a microscope. may also be necessary for infants, older adults and people who
Unlike infection with E. histolytica, which sometimes makes have HIV infection, as well as in situations where there's a high
people sick, infection with E. dispar does not make people risk of spreading the disease replacement. For generally
sick and therefore does not need to be treated. If the patient healthy adults, drinking water may be enough to counteract
have been told that he is infected with E. histolytica but are the dehydrating effects of diarrhea. Children may benefit from
feeling fine, the patient might be infected with E. dispar instead. an oral rehydration solution, such as Pedialyte, available in
drugstores. Many pharmacies carry their own brands.
Unfortunately, most laboratories do not yet have the tests Children and adults who are severely dehydrated need
that can tell whether a person is infected with E. histolytica treatment in a hospital emergency room, where they
or with E. dispar. Until these tests become more widely can receive salts and fluids through a vein (intravenously),
available, it usually is best to assume that the parasite is E. rather than by mouth. Intravenous hydration provides the
histolytica. The healthcare provider will ask the patient to body with water and essential nutrients much more quickly
submit fecal samples. Because E. histolytica is not always than oral solutions do.
found in every stool sample, the patient may be asked to
submit several stool samples from several different days. Risk factors are: (1) Age. Children under age 5 are most likely
A blood test is also available but is only recommended to get shigella infection, but it can occur at any age. (2) Living
when the healthcare provider thinks that the infection may arrangements and activities. Close contact with other people
have spread beyond the intestine (gut)to some other organ of spreads the bacteria from person to person. Shigella outbreaks
the body, such as the liver. However, this blood test may not be are more common in child care centers, community wading
helpful in diagnosing the current illness because the test can be pools, nursing homes, jails and military barracks. (3) Time
positive if you had amebiasis in the past, even if the patients are spent in areas that lack sanitation. People who live or travel in
not infected now. But the risk of spreading infection is low developing countries are more likely to contract shigella
if the infected person is treated with antibiotics of infection. (4) Men who have sex with men. Men who have sex
metronidazole as drug of choice and practices good with men are at higher risk because of direct or indirect oral-
3

anal contact. Shigella infection usually clears up without

complications, although it may take weeks or months before A diagnosis of typhoid fever can usually be confirmed by
your bowel habits return to normal. The complications may analyzing samples of blood, stools or urine for culture. These
include: (1) Dehydration. Persistent diarrhea can cause will be examined under a microscope for the Salmonella typhi
dehydration. Symptoms include lightheadedness, dizziness, bacteria that cause the condition. The bacteria aren't always
lack of tears in children, sunken eyes and dry diapers. detected the first time, so the patient may need to have a series
Severe dehydration can lead to shock and death. (2) of tests.
Seizures. Some children who run high fevers with a shigella
infection have seizures. It's not known whether the convulsions A complete blood count (CBC) will show a high number of
are a result of the fever or the shigella infection itself. If the white blood cells. A blood culture during the first week of the
child has a seizure, contact the doctor immediately. (3) fever can show S typhi bacteria. Other tests that can help
Rectal prolapse. In this condition, straining during bowel diagnose this condition include Fluorescent antibody study to
movements may cause the mucous membrane or lining of the look for substances that are specific to S typhi bacteria. If the
rectum to move out through the anus. (4) Hemolytic uremic Widal test range is more than or equal to 1:160 titre for
syndrome. This rare complication of shigella, more antigen O and antigen H, then it indicates typhoid infection.
commonly caused by bacteria called E. coli, can lead to a For the diagnosis of a Widal blood test, 1:20, 1:40, 1:60,
low red blood cell count (hemolytic anemia), low platelet 1:80, 1:160, and 1:200 titres need to be included in the
count (thrombocytopenia) and acute kidney failure. (5) Toxic diagnosis to obtain the typhoid test report. The Widal test is
megacolon. This rare complication occurs when the colon positive if TO antigen titer is more than 1:160 in an active
becomes paralyzed, preventing from having a bowel infection, or if TH antigen titer is more than 1:160 in past
movement or passing gas. Signs and symptoms include infection or in immunized persons. A single Widal test is of
abdominal pain and swelling, fever, and weakness. If don't little clinical relevance due to the high number of cross-
receive treatment for toxic megacolon, the colon may break reacting infections, including malaria.
open (rupture), causing peritonitis, a life-threatening
infection requiring emergency surgery. (6) Reactive arthritis. The medical management are: (1) Antibiotics:
Reactive arthritis develops in response to an infection. Signs chloramphenicol – drug of choice. (2) IVF to correct
and symptoms include joint pain and inflammation, usually in dehydration or fluid imbalance. (3) Paracetamol for the fever.
the ankles, knees, feet and hips; redness, itching and discharge (4) Oral therapy rehydration (oresol, hydrites). Antibiotic
in one or both eyes (conjunctivitis); and painful therapy is the only effective treatment for typhoid fever.
urination(urethritis). Commonly prescribed antibiotics include: (1) Ciprofloxacin
(Cipro). In the United States, doctors often prescribe this for
Although researchers continue their work to develop a non-pregnant adults. Another similar drug called ofloxacin also
shigella vaccine, nothing is available yet. To prevent the may be used. Unfortunately, many Salmonella typhi bacteria
spread of shigella: (1) Wash hands frequently and are no longer susceptible to antibiotics of this type,
thoroughly. (2) Supervise small children when they wash their particularly strains acquired in Southeast Asia. (2)
hands. (3) Dispose of soiled diapers properly. (3) Disinfect Azithromycin (Zithromax). This may be used if a person is
diaper-changing areas after use. (4) Don't prepare food for unable to take ciprofloxacin or the bacteria is resistant to
others if you have diarrhea. (5) Keep children with diarrhea ciprofloxacin. (3) Ceftriaxone. This injectable antibiotic is an
home from child care, play groups or school. (6) Avoid alternative in more-complicated or serious infections and for
swallowing water from ponds, lakes or untreated pools. (7) people who may not be candidates for ciprofloxacin, such as
Avoid sexual activity with anyone who has diarrhea or who children. These drugs can cause side effects, and long-term
recently recovered from diarrhea. use can lead to the development of antibiotic-resistant
strains of bacteria. Three typhoid vaccines are currently
TYPHOID FEVER recommended by WHO for control of endemic and epidemic
typhoid fever: (1) an injectable typhoid conjugate vaccine
Typhoid fever, also known as enteric fever, is a potentially (TCV), consisting of Vi polysaccharide antigen linked to
fatal multisystemic illness caused primarily by Salmonella tetanus toxoid protein licensed for children from 6 months of
enterica serotype typhi and, to a lesser extent, S enterica age and adults up to 45 years of age; (2) an injectable
serotypes paratyphi A, B, and C. The terms typhoid and unconjugated polysaccharide vaccine based on the purified Vi
enteric fever are commonly used to describe both major antigen (known as Vi-PS vaccine) for persons aged two years
serotypes. Karl Joseph Eberth was the first to describe the and above; and (3) an oral live attenuated Ty21a vaccine in
bacillus that was suspected to cause typhoid in 1880. Four capsule formulation for those over six years of age.
years later, Georg Gaffky was a pathologist that confirmed
this link, naming the bacillus Eberthella typhi, which is known The nursing management are: (1) Enteric isolation, (2) Vital
today as Salmonella enterica. British bacteriologist Almroth signs must be recorded accurately. (3) Intake and output
Edward Wright first developed an effective typhoid vaccine must be accurately measured. (3) Concurrent disinfection.
at the Army Medical School in Netley, Hampshire. It was (4) Increase oral fluid intake
introduced in 1896 and used successfully by the British during
the Boer War in South Africa. HEPATITIS

The simple etiologic agent is Salmonella typhi. The Hepatitis refers to an inflammatory condition of the liver.
incubation period varies, usually 1 – 3 weeks, average of It’s commonly caused by a viral infection, but there are other
2weeks. The period of communicability is as long as the bacilli possible causes of hepatitis. These include autoimmune
appears in the excreta. The mode of transmission is fecal – oral hepatitis and hepatitis that occurs as a secondary result of
route with iIngestion of contaminated food and water through medications, drugs, toxins, and alcohol. Autoimmune
7 F’s – fingers, feces, flies, food, fomites, fluids and fields. hepatitis is a disease that occurs when the body makes
The clinical manifestations are: Gradual onset of A-norexia and antibodies against the liver tissue. Other name for Hepatitis A
abdominal pain, B-radycardia, C-onstipation D-iarrhea, D- are Infectious hepatitis and Catarrhal-jaundice hepatitis,
evelop skin eruptions on the abdomen, back and chest Hepatitis B is Serum Hepatitis and Hepatitis C is Post-
(ROSE SPOTS) which is the pathognomic sign, E-nlarged transfusion hepatitis.
spleen, F-ever and chills, G-eneralized body weakness, and
H-eadache. The three (3) cardinal signs of Pyrexial stage of The liver is located in the right upper area of the abdomen. It
Typhoid Fever are: Rose Spots, Enlargement of the Spleen performs many critical functions that affect metabolism
(Splemomegaly and Fever (REF). throughout the body, including: (1) bile production, which is
4

essential to digestion; (2) filtering of toxins from the body; It’s three times more common in women than in men.
(3) excretion of bilirubin (a product of broken-down red Hepatitis signs and symptoms typically don't appear until
blood cells), cholesterol, hormones, and drugs; (4) breakdown the patient had the virus for a few weeks. Hepatitis signs
of carbohydrates, fats, and proteins; (5) activation of and symptoms can include: fatigue (up 2-4 months),
enzymes, which are specialized proteins essential to body sudden nausea and vomiting, abdominal pain or discomfort,
functions; (6) storage of glycogen (a form of sugar), minerals, especially on the upper right side beneath the lower ribs
and vitamins (A, D, E, and K) synthesis of blood proteins, such (hepatomegaly), clay-colored bowel movements (excretion of
as albumin; and (7) synthesis of clotting factors. conjugated bilirubin into the intestines is decreased), loss of
appetite (encourage high calorie and low fat diet), low-grade
The hepatitis B virus was discovered in 1965 by Dr. Baruch fever, dark urine (increase bilirubin), joint pain, yellowing of
Blumberg who won the Nobel Prize for his discovery. the skin (jaundice) and the whites of the eyes (icteric sclera)
Originally, the virus was called the "Australia Antigen" because and intense itching and It is believed that pruritus in hepatitis
it was named for an Australian aborigine's blood sample that is caused by an accumulation of toxins that the liver
reacted with an antibody in the serum of an American cannot eliminate. Instead of the toxins being removed by
hemophilia patient. According to the Centers for Disease the liver, they accumulate in the bloodstream and cause
Control and Prevention (CDC), approximately 4.4 million jaundice and severe itching. Bilirubin is one of those toxins
Americans are currently living with chronic hepatitis B and C. that cause pruritus. These symptoms may be relatively mild
Many more people don’t even know that they have hepatitis. and go away in a few weeks. Sometimes, however, hepatitis A
infection results in a severe illness that lasts several months. If
Treatment options vary depending on which type of the patient has infectious forms of hepatitis that are chronic,
hepatitis the patient have. A patient can prevent some like hepatitis B and C, patient may not have symptoms in
forms of hepatitis through immunizations and lifestyle the beginning. Symptoms may not occur until the damage
precautions. The five (5) types of viral hepatitis are affects liver function. Chronic hepatitis develops slowly, so
classified as hepatitis A, B, C, D, and E. A different virus is these signs and symptoms may be too subtle to notice.
responsible for each type of virally transmitted hepatitis.
Hepatitis A is always acute, short-term disease caused by an The nurse may assist in taking history and physical
infection with the hepatitis A virus (HAV). The virus is one examination, to diagnose hepatitis, first the doctor will take the
of several types of hepatitis viruses that cause inflammation history to determine any risk factors that the patient may have
and affect the liver's ability to function. This type of hepatitis for infectious or noninfectious hepatitis. During a physical
is most commonly transmitted by consuming food or water examination, the doctor may press down gently on the
contaminated by feces from a person infected with hepatitis abdomen to see if there’s pain or tenderness. The doctor may
A or from close contact with a person or object that's also feel to see if the liver is enlarged. If the skin or eyes are
infected. It can be fecal-oral or oral-anal route of transmission. yellow, the doctor will note this during the exam. Liver function
Mild cases of hepatitis A don't require treatment. Most people
who are infected recover completely with no permanent tests (SGOT/SGPT – serum transaminase) use blood samples to
liver damage. Hepatitis B is most likely to become ongoing determine how efficiently the liver works. Abnormal results of
and chronic and transmitted through contact with infectious these tests may be the first indication that there is a problem,
body fluids, such as blood, vaginal secretions, or semen, especially if the patient doesn’t show any signs on a physical
containing the hepatitis B virus (HBV). Injection drug use, exam of liver disease. High liver enzyme levels may indicate
having sex with an infected partner, or sharing razors with an that the liver is stressed, damaged, or not functioning properly.
infected person increase the risk of getting hepatitis B. It’s If the liver function tests are abnormal, the doctor will likely
estimated by the CDC that 1.2 million people in the United order other blood tests to detect the source of the problem.
States and 350 million people worldwide live with this chronic These tests can check for the viruses that cause hepatitis.
disease. Hepatitis C comes from the hepatitis C virus They can also be used to check for antibodies that are common
(HCV). Hepatitis C is transmitted through direct contact with in conditions like autoimmune hepatitis. An abdominal
infected body fluids, typically through injection drug use ultrasound uses ultrasound waves to create an image of the
and sexual contact. HCV is among the most common blood organs within the abdomen. This test allows the doctor to
borne viral infections in the United States. Approximately 2.7 take a close at the liver and nearby organs. It can reveal:
to 3.9 million Americans are currently living with a chronic fluid in the abdomen, liver damage or enlargement, liver
form of this infection. Hepatitis D is also called delta tumors, abnormalities of the gallbladder; and sometimes the
hepatitis, hepatitis D is a serious liver disease caused by the pancreas shows up on ultrasound images as well. This can be
hepatitis D virus (HDV). HDV is contracted through direct a useful test in determining the cause of the abnormal
contact with infected blood. Hepatitis D is a rare form of liver function. A liver biopsy is an invasive procedure that
hepatitis that only occurs in conjunction with hepatitis B involves the doctor taking a sample of tissue from the liver. It
infection. The hepatitis D virus can’t multiply without the can be done through the skin with a needle and doesn’t
presence of hepatitis B. It’s very uncommon in the United require surgery. Typically, an ultrasound is used to guide the
States. Hepatitis E is a waterborne disease caused by the doctor when taking the biopsy sample. Hemorrhage is a
hepatitis E virus (HEV). Hepatitis E is mainly found in areas common complication od liver biopsy and need to check if
with poor sanitation and typically results from ingesting fecal there is a prolonged prothrombin time. This test allows the
matter that contaminates the water supply. This disease is doctor to determine how infection or inflammation has affected
uncommon in the United States. However, cases of hepatitis your liver. It can also be used to sample any areas in the liver
E have been reported in the Middle East, Asia, Central that appear abnormal.
America, and Africa, according to the CDC. Causes of
noninfectious hepatitis are excessive alcohol consumption can The Nursing Interventions: (1) Practicing good hygiene
cause liver damage and inflammation. This is sometimes including washing hands is one of the best way to protect
referred to as alcoholic hepatitis. The alcohol directly injures against hepatitis A; (2) Bed rest; (3) small frequent
the cells of the liver. Over time, it can cause permanent damage feeding, high in carbohydrates, in severe cases spare protein;
and lead to liver failure and cirrhosis, a thickening and scarring (4) Avoid alcohol and OTC drugs; (5) Implement Standard
of the liver. Other toxic causes of hepatitis include overuse precaution; and (6) prevention is vaccination. Hepatitis B
or overdose of medications and exposure to poisons. As in vaccination @ 0, 6, 14 weeks 0.5 cc IM. Vaccines are available
the case of autoimmune system response, in some cases, for people most at risk. Getting a hepatitis A vaccine or an
the immune system mistakes the liver as a harmful object injection of immunoglobulin (an antibody) within two
and begins to attack it. It causes ongoing inflammation that weeks of exposure to hepatitis A may protect the patient
can range from mild to severe, often hindering liver function. from infection.
5

---------------------------------------------------------------------------------
Hepatitis A usually doesn’t require treatment because it’s a
short-term illness. Bed rest may be recommended if symptoms
cause a great deal of discomfort. If the patient experience
vomiting or diarrhea, the nurse may encourage the patient to LEPROSY
follow the doctor’s orders for hydration and nutrition. Acute
hepatitis B doesn’t require specific treatment. Chronic Hansen’s disease (also known as leprosy) is an infection caused
hepatitis B is treated with antiviral medications. This form of by bacteria called Mycobacterium leprae. These bacteria
treatment can be costly because it must be continued for grow very slowly and it may take up to 20 years to
several months or years. Treatment for chronic hepatitis B develop signs of the infection. It can also be called Hansenosis
also requires regular medical evaluations and monitoring to and Lepra. It is chronic disease of the skin, peripheral nerves
determine if the virus is responding to treatment. Hepatitis B and nasal mucosa, when contracted they called “Living
can be prevented with vaccination. The CDC recommends dead”, and was perceived to be caused by sin. In 1873, Dr.
hepatitis B vaccinations for all newborns. The series of three Gerhard Henrik Armauer Hansen of Norway was the first
vaccines is typically completed over the first six months of person to identify the germ that causes leprosy under a
childhood. The vaccine is also recommended for all microscope. Hansen's discovery of Mycobacterium leprae
healthcare and medical personnel. Antiviral medications are proved that leprosy was caused by a germ, and was thus not
used to treat both acute and chronic forms of hepatitis C. hereditary, from a curse, or from a sin. The mode of
People who develop chronic hepatitis C are typically treated transmission are: (1) droplet, and (2) intimate skin to skin
with a combination of antiviral drug therapies. They may also contact (inoculation through the skin break). It is not known
need further testing to determine the best form of exactly how Hansen’s disease spreads between people.
treatment. People who develop cirrhosis (scarring of the liver) Scientists currently think it may happen when a person with
or liver disease as a result of chronic hepatitis C may be Hansen’s disease coughs or sneezes, and a healthy person
candidates for a liver transplant. Currently, there is no breathes in the droplets containing the bacteria. Prolonged,
vaccination for hepatitis C. No antiviral medications exist for close contact with someone with untreated leprosy over many
the treatment of hepatitis D at this time. According to a months is needed to catch the disease. In the southern
2013 study, a drug called alpha interferon (medication for United States, some armadillos are naturally infected with the
chronic hepatitis) can be used to treat hepatitis D, but it only bacteria that cause Hansen’s disease in people and it may be
shows improvement in about 25 to 30 percent of people. possible that they can spread it to people. However, the
Hepatitis D can be prevented by getting the vaccination for risk is very low and most people who come into contact with
hepatitis B, as infection with hepatitis B is necessary for armadillos are unlikely to get Hansen’s disease.
hepatitis D to develop. Currently, no specific medical
therapies are available to treat hepatitis E. Because the There are two (2) types: (1) multibacillary (MB) –
infection is often acute, it typically resolves on its own. infectious, malignant, numerous macules, papules and
People with this type of infection are often advised to get nodules, and (2) paucibacillary (PB) – hypopigmented macule.
adequate rest, drink plenty of fluids, get enough nutrients, and Hansen’s disease can be recognized by appearance of
avoid alcohol. However, pregnant women who develop this patches of skin that may look lighter or darker than the
infection require close monitoring and care. normal skin. Sometimes the affected skin areas may be reddish.
Loss of feeling in these skin patches is common. The disease
Tips to prevent hepatitis such as: (1) Hygiene; (2) Practicing can affect the nerves, skin, eyes, and lining of the nose
good hygiene is one key way to avoid contracting hepatitis A (nasal mucosa). The bacteria attack the nerves, which can
and E. If the patient is traveling to a developing country, become swollen under the skin. This can cause the affected
patient should avoid: local water, ice, raw or undercooked areas to lose the ability to sense touch and pain, which can lead
shellfish and oysters, raw fruit and vegetables. Hepatitis B, C, to injuries, like cuts and burns. Usually, the affected skin
and D contracted through contaminated blood can be changes color and either becomes: lighter or darker, often
prevented by: not sharing drug needles, not sharing razors, dry or flaky, with loss of feeling, or reddish due to
not using someone else’s toothbrush, and not touching inflammation of the skin. If left untreated, the nerve damage
spilled blood. Hepatitis B and C can also be contracted can result in paralysis of hands and feet. In very advanced
through sexual intercourse and intimate sexual contact. cases, the person may have multiple injuries due to lack of
Practicing safe sex by using condoms and dental dams can help sensation, and eventually the body may reabsorb the affected
decrease the risk of infection. The use of vaccines is an digits over time, resulting in the apparent loss of toes and
important key to preventing hepatitis. Vaccinations are fingers. Corneal ulcers and blindness can also occur if
available to prevent the development of hepatitis A and B. facial nerves are affected. Other signs of advanced Hansen’s
Experts are currently developing vaccines against hepatitis C. disease may include loss of eyebrows (madarosis), inability to
A vaccination for hepatitis E exists in China, but it isn’t available close eyelids (lagopthalmos) and saddle-nose deformity
in the United States. People with chronic hepatitis B and C are resulting from damage to the nasal septum as leonine face as
encouraged to avoid alcohol because it can accelerate liver pathognomonic sign and gynecomastia. Since Hansen’s
disease and failure. Certain supplements and medications can disease affects the nerves, loss of feeling or sensation can
also affect liver function. If patient have chronic hepatitis B occur. When loss of sensation occurs, injuries such as burns
or C, check with the doctor before taking any new may go unnoticed. Because patient may not feel the pain that
medications. can warn patient of harm to the body, take extra caution to
ensure the affected parts of the body are not injured.
Complications of hepatitis are chronic liver disease, cirrhosis,
and liver cancer. When the liver stops functioning normally, To confirm the diagnosis, the doctor will take a sample of the
liver failure can occur. Complications of liver failure skin or nerve (through a skin or nerve biopsy) to look for the
include: bleeding disorders, a buildup of fluid in the bacteria under the microscope and may also do tests to rule out
abdomen, known as ascites, increased blood pressure in other skin diseases. Slit Skin smear – to demonstrate M. leprae.
portal veins that enter the liver, known as portal If the number of lesions = 2-5 PB and > 5 MB with (-) in all
hypertension, kidney failure, hepatic encephalopathy, which site = Paucibacillary and (+) in all sites = Multibacillary.
can involve fatigue, memory loss, and diminished mental Also, doctor perform lepromin test to detedt hypersensitivity to
abilities due to the buildup of toxins, like ammonia, that leprosy. Early diagnosis and treatment usually prevent
affect brain function, hepatocellular carcinoma, which is a disability that can result from the disease, and people with
form of liver cancer and even death. Hansen’s disease can continue to work and lead an active life.
Once treatment is started, the person is no longer contagious.
6

However, it is very important to finish the entire course of usually between 3 days to 3 weeks in adult and 3 days to
treatment as directed by the doctor. Any individual cannot get 30 days in newborn or a period of 3-4 weeks. However, it
leprosy from a casual contact with a person who has Hansen’s may range from one day to several months, depending on
disease like: (1) shaking hands or hugging, (2) sitting next to the kind of wound. Most cases occur within 14 days. In
each other on the bus, (3) sitting together at a meal, and (4) general, doctors see shorter incubation periods with more
Hansen’s disease is also not passed on from a mother to her heavily contaminated wounds, more serious disease and a
unborn baby during pregnancy and it is also not spread worse outcome (prognosis).
through sexual contact.Hansen’s disease is treated with a
combination of antibiotics. Typically, 2 or 3 antibiotics are Signs and symptoms of tetanus appear anytime from a few
used at the same time. These are dapsone with rifampicin, and days to several weeks after tetanus bacteria enter your
clofazimine is added for some types of the disease. This is body through a wound. Common signs and symptoms of
called multidrug therapy (MDT) – RA4073. This strategy tetanus include: spasms and stiffness in the jaw muscles
helps prevent the development of antibiotic resistance by (trismus), stiffness of neck muscles, difficulty swallowing,
the bacteria, which may otherwise occur due to length of stiffness of abdominal muscles, painful body spasms lasting
the treatment. Paucibacillary form – 2 antibiotics are used for several minutes, typically triggered by minor
at the same time, daily dapsone (100mg) OD (6-9 mos) and occurrences, such as a draft, loud noise, physical touch or
rifampicin (600mg) once per month. Multibacillary form – light, risus sardonicus (sardonic smile) – pathognomonic
daily clofazimine is added to rifampicin and dapsone. Day 1: R- sign, opisthotonus, low grade fever, diaphoresis and for
600 D-100 C-300 once month and Day 2-28: Dapsone 100 OD, tetanus neonatorum as difficulty sucking as the first sign
Clofazimine (Lamprine) 50 mg OD. Treatment usually lasts and excessive crying later leading to a strangled soundless and
between one to two years. The illness can be cured if voiceless noise.
treatment is completed as prescribed. Antibiotics used
during the treatment will kill the bacteria that cause
leprosy. But while the treatment can cure the disease and
prevent it from getting worse, it does not reverse nerve damage
or physical disfiguration that may have occurred before the
diagnosis. Thus, it is very important that the disease be
diagnosed as early as possible, before any permanent nerve
damage occurs.

Health education by the nurse on Sulfone therapy like

Dapsone that cause cutaneous eruptions, and iritis, orchitis.
Lamprine can cause brownish black skin discoloration,
dryness and flakiness that need to explain to the patient.
Skin care to prevent injury. Separate newborns from leprous The diagnostic tests are clinical manifestations, history of
mothers and report cases and suspects of leprosy. BCG wound, immunization status, blood culture and tetanus
vaccine and education on mode of transmission. Nursing antibody test. Tetanus is a medical emergency requiring:
Diagnosis of altered body image and social stigma. (1) care in the hospital; (2) immediate treatment with
medicine called human tetanus immune globulin (TIG), ATS,
TAT as passive immunization and TT and DPT as active
TETANUS immunization; (3) aggressive wound care; (4) drugs to control
muscle spasms and sedative (Diazepam); (5) Antibiotics (Pen G,
Tetanus is a serious disease caused by a bacterial toxin Metronidazole); (6) Emergency equipment at bedside
that affects your nervous system, leading to painful muscle tracheostomy set, ET tube and mechanical ventilator.
contractions, particularly of your jaw and neck muscles.
Tetanus can interfere with your ability to breathe and can The following nursing managements are: (1) preventing
threaten your life. Tetanus is commonly known as "lockjaw." seizure by keeping the room dim and quiet. Avoid stimuli of
The disease tetanus extends all the way back to the fifth spasm. Avoid unnecessary handling. Close monitoring of v/s
century BC. However, it was not until the late 1800s that and muscle tone. Raise side rails. Promote rest. (2) Provide
Arthur Nicolaier discovered the toxins that caused tetanus adequate airway by inhalation of oxygen as per doctor’s
which have the ability to infect several species and that order. (3) Monitor for possible complications like aspiration
protection could be provided by passive transfer of an pneumonia and cardiac dysrhhythmias.
antitoxin. Tetanus is an infection caused by a bacterium
called Clostridium tetani which is commonly found in soil, Serious health problems that can happen because of tetanus
saliva, dust, and manure. Clostridium tetani is an anaerobic, include: (1) uncontrolled/involuntary tightening of the vocal
gram (+), toxigeni, spore forming bacteria and has two (2) cords (laryngospasm); (2) broken bones (fractures); (3)
types of toxin: tetanospasmin referring to toxin impairs the infections gotten by a patient during a hospital visit (hospital-
nerves that control your muscles (motor neurons). acquired infections); (4) blockage of the main artery of the
The toxin can cause muscle stiffness and spasms — the major lung or one of its branches by a blood clot that has
signs and symptoms of tetanus (muscle contraction) The travelled from elsewhere in the body through the bloodstream
toxin tetanolysin referring to breakdown of RBC. The (pulmonary embolism); (5) pneumonia, a lung infection, that
bacteria generally enter through a break in the skin such as a develops by breathing in foreign materials (aspiration
cut or puncture wound by a contaminated object. They produce pneumonia). Breathing difficulty, possibly leading to death (1
toxins that interfere with normal muscle contractions. The to 2 in 10 cases are fatal)
spores develop into bacteria when they enter the body.
Being up to date with the tetanus vaccine is the best tool
The common ways tetanus gets into the body is direct to prevent tetanus. Protection from vaccines, as well as a
inoculation or break into the skin such as stepping on nails or prior infection, do not last a lifetime. This means that if you had
other sharp objects is one way people are exposed to the tetanus or got the vaccine before, still need to get the
bacteria that cause tetanus. These bacteria are in the vaccine regularly to keep a high level of protection against
environment and get into the body through breaks in the skin. this serious disease. CDC recommends tetanus vaccines for
Wounds contaminated with dirt, and feces, burns, crush people of all ages, with booster shots throughout life. The
injuries, surgical procedures, and dental infections. The tetanus vaccine usually is given to children as part of the
incubation period — time from exposure to illness — is diphtheria and tetanus toxoids and acellular pertussis
7

(DTaP) vaccine. This vaccination provides protection against bacterium is another leading cause of bacterial meningitis.
three diseases: a throat and respiratory infection These bacteria commonly cause an upper respiratory
(diphtheria), whooping cough (pertussis) and tetanus. As infection but can cause meningococcal meningitis when they
prevention of tetanus neonatorum, active immunization of enter the bloodstream. This is a highly contagious infection
pregnant mother with TT1 to TT5, strict asepsis during that affects mainly teenagers and young adults. It may
delivery and licensing of health professional like the midwives cause local epidemics in college dormitories, boarding schools
and nurses. and military bases. A vaccine can help prevent infection.

Haemophilus influenzae (haemophilus). Haemophilus

MENINGITIS influenzae type b (Hib) bacterium was once the leading
cause of bacterial meningitis in children. But new Hib vaccines
Meningitis, also known as cerebrospinal fever is an have greatly reduced the number of cases of this type of
inflammation of the membranes (meninges) surrounding the meningitis. Listeria monocytogenes (listeria). These bacteria
brain and spinal cord. The swelling from meningitis can be found in unpasteurized cheeses, hot dogs and
typically triggers symptoms such as headache, fever and a lunchmeats. Pregnant women, newborns, older adults and
stiff neck. Most cases of meningitis in the United States are people with weakened immune systems are most susceptible.
caused by a viral infection, but bacterial, parasitic and fungal Listeria can cross the placental barrier, and infections in
infections are other causes. Some cases of meningitis improve late pregnancy may be fatal to the baby.
without treatment in a few weeks. Others can be life
threatening and require emergency antibiotic treatment. The Viral meningitis is usually mild and often clears on its own.
etiologic agents of meningitis are Neisseria meningitides, Most cases in the United States are caused by a group of viruses
Streptococcus pneumonia, Haemophilus influenza, known as enteroviruses, which are most common in late
Streptococcus agalactae and Listeria monocytogenes. The summer and early fall. Viruses such as herpes simplex virus,
first definitive description of the disease was by Gaspard HIV, mumps, West Nile virus and others also can cause viral
Vieusseux in Switzerland in 1805. The bacterium was first meningitis.
identified in the spinal fluid of patients by Weichselbaum in
1887. Neisseria meningitidis is a leading cause of bacterial Chronic meningitis is a slow-growing organisms (such as fungi
meningitis and sepsis in the United States and in the and Mycobacterium tuberculosis) that invade the membranes
Philippines. The first evidence that linked bacterial infection and fluid surrounding your brain cause chronic meningitis.
as a cause of meningitis was written by Austrian Chronic meningitis develops over two weeks or more. The
bacteriology Anton Vaykselbaum who described meningococcal signs and symptoms of chronic meningitis — headaches, fever,
bacteria in 1887. vomiting and mental cloudiness — are similar to those of acute
meningitis.
The mode of transmissions are respiratory droplets
through nasopharyngeal mucosa, direct invasion through Fungal meningitis is relatively uncommon and causes
otitis media and may result after a skull fracture, chronic meningitis. It may mimic acute bacterial meningitis.
penetrating head wound. The incubation period is 3 – 6 Fungal meningitis isn't contagious from person to person.
days and the period of communicability is as long as the Cryptococcal meningitis is a common fungal form of the disease
microorganism is present in the discharges. Early meningitis that affects people with immune deficiencies, such as AIDS. It's
symptoms may mimic the flu (influenza). Symptoms may life-threatening if not treated with an antifungal medication.
develop over several hours or over a few days. Possible signs
and symptoms in anyone older than the age of 2 include: Meningitis can also result from noninfectious causes, such
sudden high fever, petecchial/purpuric rashes (sometimes, as chemical reactions, drug allergies, some types of cancer
such as in meningococcal meningitis), signs of increased and inflammatory diseases such as sarcoidosis.
ICP - severe frontal headache, altered level of consciousness
(confusion or difficulty concentrating and sleepiness or Risk factors for meningitis include: (1) Skipping vaccinations.
difficulty waking), restlessness, projectile vomiting, blurring of Risk rises for anyone who hasn't completed the recommended
vision; papilledema; diplopia, seizures, sensitivity to light, childhood or adult vaccination schedule. (2) Age. Most cases of
no appetite or thirst. Signs of meningeal irritation as viral meningitis occur in children younger than age 5. Bacterial
kernig’s sign, nuchal rigidity – pathognomonic sign, meningitis is common in those under age 20. (3) Living in a
opisthotonus and brudzinski’s sign with late signs of community setting. College students living in dormitories,
decerebration and decortications. Signs in newborns and personnel on military bases, and children in boarding
infants may show these signs: high fever, constant crying, schools and child care facilities are at greater risk of
excessive sleepiness or irritability, inactivity or sluggishness, meningococcal meningitis. This is probably because the
poor feeding, bulge in the soft spot on top of a baby's head bacterium is spread by the respiratory route, and spreads
(fontanel), stiffness in a baby's body and neck. Infants with quickly through large groups. (4) Pregnancy. Pregnancy
meningitis may be difficult to comfort, and may even cry increases the risk of listeriosis — an infection caused by
harder when held. Bacterial meningitis is serious, and can listeria bacteria, which may also cause meningitis. Listeriosis
be fatal within days without prompt antibiotic treatment. increases the risk of miscarriage, stillbirth and premature
Delayed treatment increases the risk of permanent brain delivery. (5) Compromised immune system. AIDS,
damage or death. alcoholism, diabetes, use of immunosuppressant drugs and
other factors that affect your immune system also make
Bacterial meningitis - bacteria that enter the bloodstream you more susceptible to meningitis. Having your spleen
and travel to the brain and spinal cord cause acute bacterial removed also increases your risk, and anyone without a spleen
meningitis. But it can also occur when bacteria directly invade should get vaccinated to minimize that risk.
the meninges. This may be caused by an ear or sinus
infection, a skull fracture, or, rarely, after some surgeries. The family doctor or pediatrician can diagnose meningitis
Several strains of bacteria can cause acute bacterial based on a medical history, a physical exam and certain
meningitis, most commonly: Streptococcus pneumoniae diagnostic tests. During the exam, the doctor may check for
(pneumococcus). This bacterium is the most common cause signs of infection around the head, ears, throat and the skin
of bacterial meningitis in infants, young children and adults in along the spine. The child may undergo the following
the United States. It more commonly causes pneumonia or diagnostic tests: (1) Blood cultures. Blood samples are placed
ear or sinus infections. A vaccine can help prevent this in a special dish to see if it grows microorganisms, particularly
infection. Neisseria meningitidis (meningococcus). This bacteria. A sample may also be placed on a slide and stained
8

(Gram's stain), then studied under a microscope for antibiotics; (9) Position carefully to prevent joint stiffness;
bacteria. (2) Imaging. Computerized tomography (CT) or (10) Maintain adequate nutrition and elimination; and (11)
magnetic resonance imaging (MRI) scans of the head may show Follow strict aseptic technique with head wounds and skull
swelling or inflammation. X-rays or CT scans of the chest fractures.
or sinuses also may show infection in other areas that may
be associated with meningitis. (3) Spinal tap (lumbar Common bacteria or viruses that can cause meningitis can
puncture). For a definitive diagnosis of meningitis, a spinal spread through coughing, sneezing, kissing, or sharing eating
tap to collect cerebrospinal fluid (CSF). In people with utensils, a toothbrush or a cigarette. These steps can help
meningitis, the CSF often shows a low sugar (glucose) level prevent meningitis: (1) Avoid mode of transmission. (2)
along with an increased white blood cell count and Prophylactic treatment of Rifampicin with alternative of
increased protein. CSF analysis may also help the doctor Ciprofloxacin. (3) Wash hands. Careful hand-washing helps
identify which bacterium caused the meningitis. If the prevent the spread of germs. Teach children to wash their
doctor suspects viral meningitis, he or she may order a hands often, especially before eating and after using the toilet,
DNA-based test known as a polymerase chain reaction spending time in a crowded public place or petting animals.
(PCR) amplification or a test to check for antibodies against Show them how to vigorously and thoroughly wash and rinse
certain viruses to determine the specific cause and determine their hands. (4) Practice good hygiene. Don't share drinks,
proper treatment. The treatment depends on the type of foods, straws, eating utensils, lip balms or toothbrushes
meningitis the patient has. with anyone else. Teach children and teens to avoid sharing
these items too. (5) Stay healthy. Maintain the immune
Meningitis complications can be severe. The longer you or your system by getting enough rest, exercising regularly, and
child has the disease without treatment, the greater the risk of eating a healthy diet with plenty of fresh fruits, vegetables
seizures and permanent neurological damage, including: (1) and whole grains. (6) Cover the mouth. When need to
hearing loss, (2) memory difficulty, learning disabilities, brain cough or sneeze, be sure to cover the mouth and nose. (7)
damage, gait problems, seizures, (3) respiratory problems If the patient is pregnant, take care with food. Reduce the
(bronchitis and pneumonia), (4) otitis media and risk of listeriosis by cooking meat, including hot dogs and deli
mastoiditis, (5) blindness, (6) hydrocephalus, (7) kidney meat, to 165 F (74 C). (8) Avoid cheeses made from
failure, (8) shock, and (9) death. With prompt treatment, unpasteurized milk. Choose cheeses that are clearly labeled
even patients with severe meningitis can have good recovery. as being made with pasteurized milk. (9) Immunizations -
some forms of bacterial meningitis are preventable with the
The medical treatments are antibiotic with Penicillin G as a following vaccinations: Haemophilus influenzae type b (Hib)
drug of choice with alternative of chlorampenicol, vaccine. Children in the United States routinely receive this
ampicillin, ceftraxiazone and aminoglycosides, Diuretics vaccine as part of the recommended schedule of vaccines,
(Mannitol) to revent cerebral edema, CNS stimulant starting at about 2 months of age. Here in the Philippines, EPI
(Pyrentinol/Encephabol), Anticonvulsant (Diazepam, is the sources. The vaccine is also recommended for some
Phenytoin (Dilantin) to reduce restlessness and convulsion, adults, including those who have sickle cell disease or AIDS
Corticosteroid (Prednisone/Dexamethasone), Digitalis and those who don't have a spleen. Pneumococcal conjugate
glycoside (Digoxin) to control arrhythmias, and vaccine (PCV13). This vaccine also is part of the regular
Acetamenophen to relieve fever and pain. Acute bacterial immunization schedule for children younger than 2 years in
meningitis must be treated immediately with intravenous the United States. Additional doses are recommended for
antibiotics and sometimes corticosteroids. This helps to children between the ages of 2 and 5 who are at high risk of
ensure recovery and reduce the risk of complications, such pneumococcal disease, including children who have chronic
as brain swelling and seizures. The antibiotic or heart or lung disease or cancer. Pneumococcal
combination of antibiotics depends on the type of bacteria polysaccharide vaccine (PPSV23). Older children and adults
causing the infection. The doctor may recommend a broad- who need protection from pneumococcal bacteria may
spectrum antibiotic until he or she can determine the exact receive this vaccine. The Centers for Disease Control and
cause of the meningitis. The doctor may drain any infected Prevention recommends the PPSV23 vaccine for all adults
sinuses or mastoids — the bones behind the outer ear that older than 65; for younger adults and children age 2 and older
connect to the middle ear. Viral meningitis - antibiotics who have weak immune systems or chronic illnesses such as
can't cure viral meningitis, and most cases improve on their heart disease, diabetes or sickle cell anemia; and for anyone
own in several weeks. Treatment of mild cases of viral who doesn't have a spleen. Meningococcal conjugate
meningitis usually includes: bed rest, plenty of fluids, over- vaccine. The Centers for Disease Control and Prevention
the-counter pain medications to help reduce fever and relieve recommends that a single dose be given to children ages 11
body aches. The doctor may prescribe corticosteroids to to 12, with a booster shot given at age 16. If the vaccine is first
reduce swelling in the brain, and an anticonvulsant given between ages 13 and 15, the booster is recommended
medication to control seizures. If a herpes virus caused the between ages 16 and 18. If the first shot is given at age 16 or
meningitis, an antiviral medication is available. Treatment for older, no booster is necessary. This vaccine can also be
chronic meningitis is based on the underlying cause. given to children between the ages of 2 months and 10 years
Antifungal medications treat fungal meningitis, and a who are at high risk of bacterial meningitis or who previously
combination of specific antibiotics can treat TB meningitis. unvaccinated people who have been exposed in outbreaks.
However, these medications can have serious side effects, so
treatment may be deferred until a laboratory can confirm that POLIOMYELITIS
the cause is fungal. Non-infectious meningitis due to
allergic reaction or autoimmune disease may be treated Polio is a contagious viral illness that in its most severe
with corticosteroids. In some cases, no treatment may be form causes nerve injury leading to paralysis, difficulty
required because the condition can resolve on its own. breathing and sometimes death. Also known as Infantile
Cancer-related meningitis requires therapy for the specific paralysis and Heine Medin Disease. In the U.S., the last case
cancer. of naturally occurring polio was in 1979. Today, despite a
worldwide effort to wipe out polio, poliovirus continues to
The nursing management are: (1) Respiratory Isolation: 24 affect children and adults in parts of Asia and Africa. Karl
hours after onset of antibiotic therapy; (2) Provide non- Landsteiner and Erwin Popper discovered poliovirus in
stimulating environment; (3) Initiate seizure precaution; (4) 1908 by proving that it was not a bacterium that caused
Avoid factors that increase ICP; (5) Assess for signs of the paralysis, but a much smaller entity—a virus. The
increased ICP; (6) Watch out for deterioration of condition; disease was given its first clinical description in 1789 by
(7) Monitor fluid balance; (8) Watch out for reactions of the British physician Michael Underwood, and recognized as
9

a condition by Jakob Heine in 1840. The first modern Because no cure for polio exists, the focus is on increasing
epidemics were fuelled by the growth of cities after the comfort, speeding recovery and preventing complications.
industrial revolution. On March 26, 1953, American medical Supportive treatments include: pain relievers (aspirin and
researcher Dr. Jonas Salk announces on a national radio show codeine), sedatives (phenobarbital), ventilator supports to
that he has successfully tested a vaccine against poliomyelitis, assist breathing (O2 therapy, tracheostomy and mechanical
the virus that causes the crippling disease of polio. Albert Bruce ventilation), and moderate exercise (physical therapy) to
Sabin was a Polish American medical researcher, best known prevent deformity and loss of muscle function.
for developing the oral polio vaccine, which has played a key
role in nearly eradicating the disease. The nursing management are (1) strict isolation, enteric
precaution, (2) CBR / Firm and non-
The predisposing factors are (1) Age. About 60% of patient are sagging bed, (3) rest, (4) ROM exercises, (5) Relief of
under 10 years of age. (2) Sex. Males are more prone to the muscle spasm with analgesics / hot
disease than females. Death rate is proportionately higher moist compress, (6) protective devices like hand roll for
in males. (3) Heredity. Not heredity. (4) Environment and claw hand, trochanter roll for outer
hygienic condition. The rich are more often spared than the rotation of the femur and footboard, (7) monitor for
poor. Excessive work, strain and marked overexertion are possible complications like respiratory
also factors causing the disease. The causative agent is paralysis and hypertension, and (8) promote rehabilitation by
polio virus/filterable virus Legio debilitans with Type I – referring to physical and
Brunhilde: permanent immunity; most paralytogenic; Type occupational therapy for braces and orthopedic shoes.
II – Lansing: temporary immunity; and Type III – Leon:
temporary immunity. Polio mainly affects children younger than 5. However, anyone
who hasn't been vaccinated is at risk of developing the
The mode of transmissions are fecal-oral through saliva, disease. Paralytic polio can lead to temporary or permanent
vomitus and feces, direct contact from one person to muscle paralysis, disability, bone deformities and death. Of the
another and ingestion through of contaminated food (fecal- 3 strains of wild poliovirus (type 1, type 2 and type 3), wild
oral route). Inhalation of oropharyngeal secretions. People poliovirus type 2 was eradicated in 1999 and no case of wild
carrying the poliovirus can spread the virus for weeks in their poliovirus type 3 has been found since the last reported case in
feces. People who have the virus but don't have symptoms can Nigeria in November 2012. Both strains have officially been
pass the virus to others. The incubation period is 7 – 14 certified as globally eradicated. As at 2020, wild poliovirus
days and period of communicability is not accurately type 1 affects two countries: Pakistan and Afghanistan. The
known. Polio virus can be found in throat secretions as early as strategies for polio eradication work when they are fully
36 hours and in the feces 72 hours after exposure to infection. implemented. This is clearly demonstrated by India’s success in
Risk of spreading the microorganism is highest during the stopping polio in January 2011, in arguably the most
prodromal period. technically challenging place, and polio-free certification of
the entire WHO Southeast Asia Region in March 2014.
Some types of poliomyelitis are bulbar with respiratory
paralysis, spinal with paralysis of the upper and lower There are two vaccines for polio: Oral Polio Vaccine (OPV) and
extremities and intercostal muscles and bulbospinal with the Inactivated Polio Vaccine (IPV). In the Philippines still
involvement of neurons both in brainstem and the spinal cord. using OPV, IPV does not replace the OPV vaccine, but is used
with OPV to strengthen a child's immune system and
Signs and symptoms, inapparent/ subclinical stage where protect them from polio. IPV Salk are killed formulized
some patient are in asymptomatic stage (90-95%). Abortive virus, given SC or MI, include circulating antibodies but not
(Minor Illness Stage) – fever, sore throat, GI symptoms local (intestinal immunity), prevents paralysis but does not
(vomiting), low lumbar backache/ cervical stiffness on ante- prevent re-infection, difficult to manufacture and costly and
flexion of spine, headache, pain or stiffness in the arms or not useful with controlling epidemics. OPV Sabin are live
legs, muscle weakness or tenderness. Major Illness Stage - attenuated virus, given orally, immunity is both humoral
non-paralytic/ pre-paralytic or meningitic type with and intestinal, induces antibody quickly, prevents paralysis
recurrence of fever, poker spine (stiffness of the back), and prevent re-infection, easy to manufacture and cheaper
tightness and spasm of hamstring, hypersensitiveness of the and can be effectively use in controlling epidemics
skin, deep reflexes are exaggerated and paresis. Paralytic polio
is the most serious form of the disease is rare. Initial signs and The most effective way to prevent polio is vaccination.
symptoms of paralytic polio, such as fever and headache, Most children in the United States receive four doses of
often mimic those of nonparalytic polio. Within a week, inactivated poliovirus vaccine (IPV) at the following ages: two
however, other signs and symptoms appear, including: with monthsfour months, between 6 and 18 months, Between ages 4
paralysis depending on the part affected, positive hoyne’s and 6 when children are just entering school. IPV is safe for
sign (head drop), (+) kernig’s and brudzinki signs, loss of people with weakened immune systems, although it's not
reflexes, severe muscle aches or weakness, loose and certain just how protective the vaccine is in cases of severe
floppy limbs (flaccid paralysis), muscle wasting (atrophy), immune deficiency. Common side effects are pain and redness
breathing or swallowing problems, sleep-related breathing at the injection site. Allergic reaction to the vaccine - IPV
disorders, such as sleep apnea, and decreased tolerance of can cause an allergic reaction in some people. Because the
cold temperatures. Post-polio syndrome is a cluster of vaccine contains trace amounts of the antibiotics streptomycin,
disabling signs and symptoms that affect some people years polymyxin B and neomycin, it shouldn't be given to anyone
after having polio. who's reacted to these medications. Signs and symptoms of an
allergic reaction usually occur within minutes to a few hours
The diagnostic tests are blood and throat culture, lumbar after the shot. Watch for: difficulty breathing, weakness,
tap (pandy’s test), EMG and stool exam with culture and hoarseness or wheezing, rapid heart rate, hives, dizziness and
sensitivity. Doctors often recognize polio by symptoms, get medical help immediately.
such as neck and back stiffness, abnormal reflexes, and
difficulty swallowing and breathing. To confirm the diagnosis, a The Centers for Disease Control and Prevention (CDC)
sample of throat secretions, stool or a colorless fluid that advises taking precautions to protect the people from polio
surrounds your brain and spinal cord (cerebrospinal fluid) is if traveling anywhere there's a risk of polio. Adults who
checked for poliovirus. have been vaccinated who plan to travel to an area where
polio is occurring should receive a booster dose of
10

inactivated poliovirus vaccine (IPV). Immunity after a booster conclude whether control methods are feasible, applicable and
lasts a lifetime. advisable due to lack of knowledge on the side effects of
those methods and research studies are needed to validate the
methods.

The seafoods are unsafe to eat from waters affected by red tide
RED TIDE POISONING are filter-feeding shellfish which include clams, cockles,
oyster, mussels and scallops from red tide affected coastal
A "red tide" is a common term used for a harmful algal bloom. areas are unsafe to eat. Shellfish are particularly prone to toxin
Harmful algal blooms, or HABs, occur when colonies of algae— contamination as they feed by filtering microscopic food out of
simple plants that live in the sea and freshwater—grow out of the water, and if toxic planktonic organisms are present, they
control while producing toxic or harmful effects on people, fish, are filtered from the water along with other nontoxic foods.
shellfish, marine mammals, and birds. The human illnesses Whelks, moon snails and other univalves can also
caused by HABs, though rare, can be debilitating or even fatal. accumulate dangerous levels of toxin during red tide as
they feed on contaminated shellfish. Acetes or alamang from
While many people call these blooms 'red tides,' scientists red tide affected waters are also not safe for consumption. Fish,
prefer the term harmful algal bloom. One of the best known squids, crabs and shrimps can be eaten during a red tide
HABs in the nation occurs nearly every summer along because the toxin is not absorbed in the edible tissues of these
Florida’s Gulf Coast. This bloom, like many HABs, is caused animals, however, the gills, viscera and internal organs of fish
by microscopic algae that produce toxins that kill fish and must be removed before cooking. Eating distressed or dead
make shellfish dangerous to eat. The toxins may also make fish, and other aquatic animals in areas affected by red tide
the surrounding air difficult to breathe. As the name suggests, is discouraged because the reason for the animal’s strange
the bloom of algae often turns the water red. behavior or death cannot be absolutely known. It could be
something unrelated to red tide.
Red tide is a term used to describe coastal phenomenon in
which the water is discolored by high algal biomass or Diseases that may affect humans include: (1) Paralytic Shellfish
concentration of algae. The discoloration may not necessarily Poisoning (PSP) - this disease is caused by the production of
be red in color but it may also appear yellow, brown, green, saxitoxin by the Alexandrium species. It is common along
blue or milky, depending on the organisms involved. It may the Atlantic and Pacific coasts in the US and Canada. Poisoning
either be harmful or harmless. Some red tides are considered occurs when one ingests shellfish contaminated with PSP
harmless when there is no harmful impact on the toxins causing disruption of nerve function and paralysis.
environment, living organism and humans as well. Almost Extreme cases may result in death by asphyxiation by
always red tides are harmful since they cause harm to the respiratory paralysis. (2) Diarrhetic Shellfish Poisoning
environment, living organisms and to humans. Some cause (DSP) - This disease is caused by the Dinophysis species. It
mass mortality of fish or fish kills and some produce potent generally occurs in Japan and Europe, but it has also been
toxins that are of public significance. found in other countries such as Canada, the US, Chile, New
Zealand, and Thailand. Symptoms of DSP include diarrhea,
Red tide occurs when an algae rapidly increases in numbers to nausea, vomiting, abdominal pain, and cramps. DSP is
the extent that it dominates the local planktonic or benthic generally not lethal. (3) Amnesic Shellfish Poisoning (ASP) -
community. Such high abundance can result from explosive this disease, which has been found along the eastern
growth, caused, for example, by a metabolic response to a Canadian coast, is caused by domoic acid producing
particular stimulus (e.g., nutrients or some environmental planktonic and benthic algae. It can also be found in soft
condition like a change in water temperature), or from the shell clams and blue mussels infected by Pseudo-nitzschia
physical concentration of a species in a certain area due to local delicatissima. Gastric and neurological symptoms include
patterns in water circulation. Blooms are caused by dizziness, disorientation and memory loss.
environmental conditions that promote explosive growth.
Factors that are favorable to the rapid increase include In the Philippines, the most common shellfish poisoning
warm sea surface temperatures, and high nutrient content. syndrome is paralytic shellfish poisoning (PSP). Eating toxin
The similarity of these alga and heterotrophs often makes contaminated-shellfish can cause paralytic shellfish
it difficult to identify the precise cause of a harmful algal poisoning (PSP) in humans. PSP is caused by saxitoxin, which is
bloom, and to predict its impact on the affected ecosystem. produced by toxic dinoflagellates, and is one of the most
potent toxins. After ingestion, this poison immediately
Red tide is a global phenomenon. However, since the affects the nervous system, with symptoms usually occurring
1980s harmful red tide events have become more frequent within 30 minutes. Severity depends on the amount of toxin
and widespread. Detection of a spread is thought to be ingested. Initial reactions are tingling of the lips and tongue,
influenced by higher awareness of red tide, better which spreads to the face, neck, fingertips and toes. Headache,
equipment for detecting and analyzing red tide, and dizziness and nausea follow. These symptoms maybe
nutrient loading from farming and industrial runoff. mistaken for drunken conditions and are further aggravated by
Countries affected by red tide events include: Argentina, alcohol consumption. In severe cases, muscular paralysis and
Australia, Brazil, Canada, Chile, Denmark, England, France, respiratory difficulty may occur within five (5) to twelve
Guatemala, Hong Kong, India, Ireland, Italy, Japan, the (12) hours. Fatalities from respiratory paralysis have been
Netherlands, New Zealand, Norway, New Guinea, Peru, the reported. The most common human health problemsassociated
Philippines, Romania, Russia, Scotland, Spain, Sweden, with red tides and other harmful algae blooms are various
Thailand, the United States, and Venezuela (WHO, 2007, CDC, types of gastrointestinal, respiratory, and neurological
2012). In the Philippines, the known species of PSP toxin- disorders.
producing dinoflagellates are: (1) Pyrodinium bahamense var.
compressum; (2) Gymnodinium catenatum; (3) Alexandrium There is no antidote and direct treatment forPSP.Treatment
tamiyavanichii; and (4) Alexandrium minutum but the most is symptomatic and varies with the severity of symptoms,
notable one is due to Pyrodinium bahamense var. compressum. which include pumping the stomach, inducing vomiting and
charcoal hemoperfusion (a process involving the pumping of
Currently, red tides cannot be predicted, but researchers arterial blood through an activated charcoal filter to remove
are investigating the possibility. At present, methods to the poison). Alkaline fluids such as sodium bicarbonate are
control red tides are still limited in scope and remain also thought to be helpful in treating symptoms, as the
largely untested in major blooms since it is premature to
11

toxin is unstable in alkaline conditions. Artificial respiration abrupt onset of remittent fever, chills, headache, anorexia,
may be required if patients exhibit respiratory stress. abdominal pain, severe prostration, respiratory distress and
fever subsides by lysis. (2) Immune or Toxic stage – iritis,
Individuals should pay close attention to Red Tide Advisory headache, meningeal manifestations, disorientation,
and under no circumstances should individuals harvest, convulsions with CSF findings of aseptic meningitis, oliguria
market and consume shellfish from any areas under and anuria with progressive renal failure, shock, coma, and
shellfish ban due to red tides. Toxic shellfish taste and congestive heart failure are also seen in severe cases. (3)
appear no different from nontoxic shellfish and cooking Convalescent Stage - at this stage, relapse may occur during
does not destroy the red tide toxin. Testing is the only the 4th to 5th week. Many of these symptoms can be
way to determine if shellfish contain unsafe levels of toxin. mistaken for other diseases. In addition, some infected persons
Swimming is safe for most people. However, red tide can cause may have no symptoms at all.
some people to suffer from skin irritation and burning
eyes. Use common sense. If you are particularly susceptible The diagnostic tests are: Blood urea-nitrogen and urea,Enzyme
to irritation from plant products, avoid red tide water. If you Link Immuno-sorbent Assay (Elisa), Liver function test,
experience irritation, get out of the water and wash Leptospira Antigen-antibody test (LAAT) and Leptospira
thoroughly. Do not swim among dead fish because they can Antibody Test (LAT) are the confirmatory tests. Medical
be associated with harmful bacteria. Treatment of leptospirosis is geared toward: suppressing
the causative agent and fighting possible complications.
Red Tide Monitoring Program has been in placed to Leptospirosis is treated with antibiotics which should be
determine toxicity in shellfish and toxic algae in seawater given early in the course of the disease. Intravenous
samples. The Bureau of Fisheries and some Local antibiotics may be required for persons with more severe
Government Units conduct regular monitoring of the coastal symptoms. Persons with sympt oms suggestive of leptospirosis
waters of the country. Toxin levels in shellfish are analyzed should contact a health care provider.Penicillin G is a drug
by mouse bioassay method. The Philippines’ regulatory of choice with ampicillin, amoxicillin and sometimes
level for PSP toxin is forty (40) microgram per 100 grams of streptomycin as alternative if allergy topenicillin. For
shellfish meat. When shellfish toxicity exceeds the regulatory prophylaxis doxycycline is prescribed. Patient who have
level, BFAR Director issues shellfish advisory, which declares been infected with leptospirosis should not donate blood for
shellfish, ban in red tide affected areas. During shellfish ban at least 12 months after the recovery. Administration of fluid
harvesting, marketing and consumption of shellfish are and electrolyte and blood as indicated. Peritoneal Dialysis is the
prohibited. Concerned LGUs and government agencies last resort to save the kidney. The complications if not
coordinate and collaborate in the implementation of the ban treated are meningitis, respiratory distress, rnal interstitial
thus preventing contaminated shellfish from reaching the tubular necrosis that result to renal failure (Weil’s disease), and
market. When blooms subside, shellfish purify themselves of cardiovascular problems.
the toxin, and when testing indicates a return to safe levels,
the areas are reopened. BFAR Director also issues bimonthly The nursing management are: (1) Isolate the patient, urine
Shellfish Bulletin, which provides information on the status of must be properly disposed of. (2) Darken patient’s room. (3)
the coastal waters of the country with regards to toxic red tide. Observe meticulous skin care. (4) Keep clients under close
surveillance. (5) For home care, clean near dirty places,
--------------------------------------------------------------------------------- pools, and stagnant water. (6) Facilitate health education on
LEPTOSPIROSIS the modes of transmission of the disease. (7) Encourage
oral fluid intake.
Leptospirosis is a bacterial disease that affects both humans
and animals. Leptospirosis (from Greek leptos, meaning Prevention and Control Sanitation in homes, workplaces, and
"fine," and speira, meaning "a coil") is a zoonosis, which farms is a must. There is a need for proper drainage system and
was first discovered as a disease of sewer workers by control of rodents (40 to 60 percent infected). Animals must be
Landouzy in 1883. However, Adolf Weil of Heidelberg vaccinated (cattle, dogs, cats, and pigs). The risk of
reported the clinical entity of fever, jaundice, hemorrhage, and acquiring leptospirosis can be greatly reduced by not
renal failure in 1886. The other names of leptospirosis are swimming or wading in water that might be contaminated with
Weil’s disease, Canicola Fever, Mud Fever, Hemorrhagic animal urine, or eliminating contact with potentially infected
jaundice and Swineherd’s Disease. A spirochete of genus animals. Protective clothing or footwear should be worn by
Leptospira (Leptospira interrogans) is the etiologic agent. those exposed to contaminated water or soil because of
The incubation period is 6-15 days. Leptospira is found in their job or recreational activities. Leptospirosis occurs
the urine between 10 to 20 days after the onset. Ingestion worldwide, but is most common in temperate or tropical
or contact with the skin and mucous membrane of the climates. It is an occupational hazard for many people who
infected urine or carcasses of wild and domestic animals. work outdoors or with animals, such as: farmers, mine
workers, sewer workers, slaughterhouse workers,
The mode of transmission through the mucous membrane veterinarians and animal caretakers, fish workers, dairy
of the eyes, nose, and mouth, and through a break on the farmers, and military personnel. The disease has also
skin, direct human to human transmission is rare. Humans been associated with swimming, wading, kayaking, and
become infected through direct contact with the urine of rafting in contaminated lakes and rivers. As such, it is a
infected animals or with a urine-contaminated environment. recreational hazard for campers or those who participate
The bacteria enter the body through cuts or abrasions on the in outdoor sports. The risk is likely greater for those who
skin, or through the mucous membranes of the mouth, nose participate in these activities in tropical or temperate
and eyes. Drinking contaminated water can also cause climates. In addition, incidence of Leptospirosis infection
infection. Many different kinds of wild and domestic animals among urban children appears to be increasing.
carry the bacterium. These can include, but are not limited to
cattle, pigs, horses, dogs, rodents, and wild animals. When DENGUE FEVER
these animals are infected, they may have no symptoms of the
disease. Infected animals may continue to excrete the bacteria Dengue fever is a mosquito-borne disease that occurs in
into the environment continuously or every once in a while for tropical and subtropical areas of the world. Also known as
a few months up to several years. Breakbone fever, Dandy fever, Infectious Thrombocytopenic
purpura and H-fever. Millions of cases of dengue infection
The clinical manifestation are: (1) Septic Stage - this stage occur worldwide each year. Dengue fever is most common
is marked with febrile lasting for four to seven days and in Southeast Asia and the western Pacific islands, but the
12

disease has been increasing rapidly in Latin America and person infected with a dengue virus, the virus enters the
the Caribbean. Researchers are working on dengue fever mosquito. When the infected mosquito then bites another
vaccines. For now the best prevention is to reduce person, the virus enters that person's bloodstream. After
mosquito habitat in areas where dengue fever is common. In patient recovered from dengue fever, patient has immunity
1779-1780, the first confirmed, reported outbreak of dengue to the type of virus that infected the patient — but not to
fever occurred almost simultaneously in Asia, North the other three dengue fever virus types. The risk of
America, and Africa. In 1789, the American physician developing severe dengue fever, also known as dengue
Benjamin Rush published an account of a probable dengue hemorrhagic fever, actually increases if the patient infected a
fever epidemic that had occurred in Philadelphia in 1780. In second, third or fourth time.
1943, Ren Kimura and Susumu Hotta first isolated the
dengue virus. These two scientists were studying blood Diagnosing dengue fever can be difficult, because its signs
samples of patients taken during the 1943 dengue epidemic and symptoms can be easily confused with those of other
in Nagasaki, Japan. A year later, Albert B. Sabin and Walter diseases — such as malaria, leptospirosis and typhoid fever.
Schlesinger independently isolated the dengue virus. The doctor will likely ask about the medical and travel history.
Be sure to describe international trips in detail, including the
The etiologic agents are Dengue virus - Arbovirus (I, II, III, IV, countries visited and the dates, as well as any contact that
V), Chikungunya virus, Onyong-yong virus and Flavi virus. may have had with mosquitoes.Certain laboratory tests can
The mode of transmission is a bite of infected female detect evidence of the dengue viruses, but test results
AEDES AEGYPTI mosquito and serve as a vector. Some usually come back too late to help direct treatment
characteristic of the female mosquito are day biting, low flying, decisions.The diagnostic test are tourniquet test is a
stagnant water, with buzzing sound, urban (DLSU). The presumptive diagnosis; detects capillary fragility. Platelet
incubation period is 3 – 14 days. Many people, especially Count: Confirmatory test with result of <100,000 cells/mm3.
children and teens, may experience no signs or symptoms Hemoconcentration with increase in 20% hematocrit count.
during a mild case of dengue fever. When symptoms do Also, can be diagnosed with Dengue NS1 Ag and Dengue
occur, they usually begin four to seven days after bitten by Duo, viral isolation and serologic test (ELISA).
an infected mosquito. The clinical manifestations are base
on grading: Grade I: Symptomatic and Supportive with fever No specific treatment for dengue fever exists. The doctor
(hot stage – cold stage – wet stage), headache, malaise, may recommend that the patient needs to drink plenty of
anorexia, chills, pain (abdominal, bone and joint, and ocular), fluids to avoid dehydration from vomiting and a high fever
and rashes – (+) Herman’s Sign: Flushing of the skin and (+) because the important management for dengue fever is
Tourniquet Test (Rumple Leeds Test). correction of dehydration and fluids and electrolytes.
Antipyretic/ Analgesic: Do not administer NSAID for Fever.
Give codeine instead of aspirin. Calamine lotion for itchiness.
Intravenous Fluid Therapy - Protocol for Fluid correction
with NO SHOCK as IVF Crystalloids- D5LR or D5 0.9 NaCl or
PLR at 5-7 ml/kg/hr Protocol for fluid correction with SHOCK
with IVF Crystalloids- PLR or P 0.9 NSS at 20ml/KBW IV bolus
in <20 minutes if no improvement be given with Colloids-
Dextran, Haemacel, Haesteril at 10ml/kg bolus in <10
minutes. If still no improvement - Fresh Frozen Plasma at
15cc/kg in 2 hours and start inotropes Dopamine
7-15ug/kg/m. Blood pressure monitoring and transfusion to
replace blood loss. While recovering from dengue fever,
watch for signs and symptoms of dehydration. Call the doctor
or inform the nurse right away if develop any of the following:
Grade II: Manifestations of grade I plus spontaneous decreased urination, few or no tears, dry mouth or lips,lethargy
bleeding (epistaxis, gingival bleeding, petechiae or or confusion, cold or clammy extremities.
ecchymosis, gastro intestinal bleeding (ground coffee colored
vomitus, hematemesis, melena and hematochezia) – BED REST. The nursing management are (1) complete bed rest, (2) ice
Grade III: Manifestations of Grade II plus Beginning symptoms packs on the forehead and abdomen, (3) prevent and control
of circulatory failure - monitor vital signs (V/S) and watch bleeding, (4) TSB and increase fluid intake, (5) diet of DAT
out for complication of shock, hypotension & narrowing of except dark colored foods with modification on low fat,
pulse pressure, weak and thready pulse, cold, clammy skin, low fiber, non irritating and high in Vitamin C. (6) health
and restlessness. GRADE IV: Manifestations of Grade III education on 5S as search and destroy, self protection
plus Shock (undetected BP and pulse) - PROPERPOSITIONING. measures, seek early consultation, say no to indiscriminate
Most people recover within a week or so. In some cases, fogging and stay hydrated.
symptoms worsen and can become life-threatening. Blood
vessels often become damaged and leaky. And the number of If an individual are living or traveling in tropical areas
clot-forming cells (platelets) in your bloodstream drops. This where dengue fever is common, these tips may help reduce
can cause a severe form of dengue fever, called dengue the risk of mosquito bites: (1) Stay in air-conditioned or
hemorrhagic fever, severe dengue or dengue shock syndrome. well-screened housing. The mosquitoes that carry the dengue
The Classifications of Dengue Fever are (1) Mild DHF: slight viruses are most active from dawn to dusk, but they can also
fever, with or without petechial hemorrhage. Mild dengue fever bite at night. (2) Wear protective clothing. When going into
causes a rash, and muscle and joint pain. (2) Moderate DHF: mosquito-infested areas, wear a long-sleeved shirt, long
high fever, but less hemorrhage, no shock. Severe DHF: pants, socks and shoes. (3) Use mosquito repellent.
frank type: flushing, sudden high fever, severe hemorrhage, Permethrin can be applied to the clothing, shoes, camping gear
followed by sudden drop of temperature, shock and and bed netting. An indi vidual can also buy clothing made
terminating in recovery or death. The complications of Dengue with permethrin already in it. (4) Reduce mosquito habitat.
Fever are Thrombocytopenia and Hypovolemic Shock. If The mosquitoes that carry the dengue virus typically live in
severe, dengue fever can damage the lungs, liver or heart. and around houses, breeding in standing water that can
Blood pressure can drop to dangerous levels, causing shock collect in such things as used automobile tires. It can help
and, in some cases, death. Dengue fever is caused by any one of lower mosquito populations by eliminating habitats where they
four types of dengue viruses spread by mosquitoes that thrive lay their eggs. At least once a week, empty and clean
in and near human lodgings. When a mosquito bites a containers that hold standing water, such as planting
13

containers, animal dishes and flower vases. Keep standing (swelling that generally occurs in one of arms or legs or both
water containers covered between cleanings and have an arms or both legs swell). The complications of filariasis are
aquarium with gold fish as zooprophylaxis. renal involvement and super-infection.

Factors that put every individual at greater risk of developing Although the parasite damages the lymph system, most
dengue fever or a more severe form of the disease include: infected people have no symptoms and will never develop
(1) Living or traveling in tropical areas. Being in tropical clinical symptoms. These people do not know they have
and subtropical areas increases the risk of exposure to the lymphatic filariasis unless tested. A small percentage of
virus that causes dengue fever. Especially high-risk areas are persons will develop lymphedema. This is caused by fluid
Southeast Asia, the western Pacific islands, Latin America and collection because of improper functioning of the lymph
the Caribbean. (2) Prior infection with a dengue fever virus. system resulting in swelling. This mostly affects the legs, but
Previous infection with a dengue fever virus increases the risk can also occur in the arms, breasts, and genitalia. Most
of having severe symptoms if infected again. people develop these symptoms years after being infected.
The swelling and the decreased function of the lymph
One dengue fever vaccine, Dengvaxia, is currently approved for system make it difficult for the body to fight germs and
use in those ages 9 to 45 who live in areas with a high incidence infections. These people will have more bacterial infections in
of dengue fever. The vaccine is given in three doses over the the skin and lymph system. This causes hardening and
course of 12 months. The vaccine is approved only for thickening of the skin, which is called elephantiasis. Many
older children because younger vaccinated children appear to bacterial infections can be prevented with appropriate skin
be at increased risk of severe dengue fever and hospitalization hygiene as well as skin and wound care. People with the
two years after receiving the vaccine. But this dengue fever disease can suffer from lymphedema and elephantiasis and
vaccine created an impact and big problems in the health care in men, swelling of the scrotum, called hydrocele. Lymphatic
industry. The World Health Organization stresses that the filariasis is a leading cause of permanent disability worldwide.
vaccine is not an effective tool, on its own, to reduce Communities frequently shun and reject women and men
dengue fever in areas where the illness is common. disfigured by the disease. Affected people frequently are
Controlling the mosquito population and human exposure is unable to work because of their disability, and this harms their
still the most critical part of prevention efforts. families and their communities. Adult worms nest in the
lymphatic vessels and disrupt the normal function of the
FILIARIARIS lymphatic system. The worms can live for approximately 6–8
years and, during their life time, produce millions of
Lymphatic filariasis, considered globally as a neglected microfilariae (immature larvae) that circulate in the blood.
tropical disease (NTD), is a parasitic disease caused by Mosquitoes are infected with microfilariae by ingesting blood
microscopic, thread-like worms. The adult worms only live when biting an infected host. Microfilariae mature into infective
in the human lymph system. The lymph system maintains larvae within the mosquito. When infected mosquitoes bite
the body’s fluid balance and fights infections. Lymphatic people, mature parasite larvae are deposited on the skin from
filariasis is spread from person to person by mosquitoes. Also, where they can enter the body. The larvae then migrate to the
known as elephantiasis. The etiologic agents are Wuchereria lymphatic vessels where they develop into adult worms, thus
bancrofti which is responsible for 90% of the cases, Brugia continuing a cycle of transmission.
malayi which causes most of the remainder of the cases, Brugia
timori which also causes the disease and Loa loa, an African The diagnostic are nocturnal blood exam and
eye worm and is passed on to humans through the repeated Immunochromatographic test (ICT). The standard method for
bites of deerflies. Lymphatic filariasis is caused by infection diagnosing active infection is the identification of microfilariae
with parasites classified as nematodes (roundworms) of the in a blood smear by microscopic examination. The microfilariae
family Filariodidea. that cause lymphatic filariasis circulate in the blood at night
(called nocturnal periodicity). Blood collection should be
The Mode of transmission is a bite of female Aedes done at night to coincide with the appearance of the
poecilius, Anopheles Minimus Flavirostis and Culex microfilariae, and a thick smear should be made and
Quenquefastiatus. The characteristic of female aedes stained with Giemsa or hematoxylin and eosin. For increased
poecillius are dirty water, abaca area, rural and night biting. sensitivity, concentration techniques can be used. Serologic
The incubation period is 8-16 months.Lymphatic filariasis is techniques provide an alternative to microscopic detection
transmitted by different types of mosquitoes for example by of microfilariae for the diagnosis of lymphatic filariasis.
the Culex mosquito, widespread across urban and semi-urban Patients with active filarial infection typically have elevated
areas, Anopheles, mainly found in rural areas, and Aedes, levels of antifilarial IgG4 in the blood and these can be detected
mainly in endemic islands in the Pacific. using routine assays. Because lymphedema may develop
many years after infection, lab tests are most likely to be
Lymphatic filariasis infection involves asymptomatic, acute, negative with these patients.
and chronic conditions. The majority of infections are
asymptomatic, showing no external signs of infection while The medical management is Diethylcarbamazine (DEC) is the
contributing to transmission of the parasite. These drug of choice in the Philippines and the United States. The
asymptomatic infections still cause damage to the lymphatic drug kills the microfilariae and some of the adult worms. DEC
system and the kidneys, and alter the body's immune has been used world-wide for more than 50 years. Because
system. The clinical manifestations: (1) Acute stage – this infection is rare in the U.S., the drug is no longer
Lymphadenitis (enlargement in one or more lymph nodes, approved by the Food and Drug Administration (FDA) and
usually due to infection), Lymphangitis (an infection of the cannot be sold in the U.S. Physicians can obtain the
lymphatic channels that occurs as a result of infection), medication from CDC after confirmed positive lab results.
Funiculitis (inflammation of the spermatic cord), Orchitis CDC gives the physicians the choice between 1 or 12-day
inflammation of one or both of the testicles),and treatment of DEC (6 mg/kg/day). One day treatment is
Epididymitis (inflammation of the epididymis which is a generally as effective as the 12-day regimen. DEC is
tube located at the back of the testicles that stores and generally well tolerated. Side effects are in general limited and
carries sperm). (2) Chronic Stage – Hydrocele (swelling in depend on the number of microfilariae i n the blood. The most
the scrotum that occurs when fluid collects in the thin sheath common side effects are dizziness, nausea, fever, headache,
surrounding a testicle), Elephantiasis (obstruction of the or pain in muscles or joints. DEC should not be administered
lymphatic system, which results in the accumulation of a fluid to patients who may also have onchocerciasis as DEC can
called lymph in the affected areas), and Lymphedema worsen onchocercal eye disease. In patients with loiasis, DEC
14

can cause serious adverse reactions, including encephalopathy The clinical manifestations are early signs of anemia:
and death. The risk and severity of the adverse reactions are repeated chronic symptoms of pallor, easy fatigability and
related to Loa loa microfilarial density. The doctor can also dizziness, malaise, splenomegaly and hepatomegaly. The
prescribed Albendazole (Albenza) and steroids. Surgical diagnostic tests are peripheral blood smear/malarial smear:
management is done to correct chronic signs and symptoms. confirmatory test. It detects malaria parasite best done
during the height of fever. The (quantitative) thick blood smear
The nursing management are teach patient about personal determines the presence and percentage of parasite in the
hygiene (wash affected areas with soap and water, elevate and blood (number of protozoa), while the (qualitative) thin blood
exercise affected part, and assist in mass treatment in endemic smear determines the specific species in the blood (type of
communities. protozoa). Quantitative Buffy Coat (QBC)/ Rapid Diagnostic
Test (RDT), detects malarial antigen and taken anytime, the
The best way to prevent lymphatic filariasis is to avoid faster test.
mosquito bites. The mosquitoes that carry the microscopic
worms usually bite between the hours of dusk and dawn. If an In most cases, malaria deaths are related to one or more
individual live in an area with lymphatic filariasis: (1) sleep serious complications, including: (1) Cerebral malaria
under a mosquito net between dusk and dawn, (2) wear (common in falciparum) - If parasite-filled blood cells block
long sleeves and trousers, and (3) use mosquito repellent small blood vessels to the brain (cerebral malaria), swelling
on exposed skin. Another approach to prevention includes of the brain or brain damage may occur. Cerebral malaria
giving entire communities medicine that kills the may cause seizures and coma. (2) Black water, also called
microscopic worms — and controlling mosquitoes. Annual malarial hemoglobinuria, one of the less common yet most
mass treatment reduces the level of microfilariae in the blood dangerous complications of malaria. The distinctive color of
and thus, diminishes transmission of infection. This is the basis the urine (dark) is due to the presence of large amounts
of the Global Programme to Eliminate Lymphatic Filariasis. of hemoglobin, released during the extensive destruction of the
patient's red blood cells by malarial parasites that leads to
MALARIA kidney failure. (3) Breathing problems - accumulated fluid in
the lungs (pulmonary edema) can make it difficult to
Malaria is a disease caused by a parasite. The parasite is breathe. (4) Organ failure - malaria can cause the kidneys
transmitted to humans through the bites of infected or liver to fail, or your spleen to rupture. Any of these
mosquitoes. People who have malaria usually feel very sick, conditions can be life-threatening. (5) Anemia - malaria
with a high fever and shaking chills. The difference of fever in damages red blood cells, which can result in anemia. (6) Low
malaria and dengue, the fever in malaria is cold stage with blood sugar - severe forms of malaria itself can cause low
chills, chatter teeth, shakes and shivering, followed by hot stage blood sugar (hypoglycemia), as can quinine — one of the
with high fever and headache and wet stage with diaphoresis. most common medications used to combat malaria. Very low
Other signs and symptoms may include: nausea and blood sugar can result in coma or death. (7) Disseminated
vomiting, muscle pain and fatigue, chest or abdominal pain, and Intravascular Coagulation.
cough. Some people who have malaria experience cycles of
malaria "attacks." An attack usually starts with shivering and The following preventive control
chills, followed by a high fever, followed by sweating and a measures:CHEMOPROPHYLAXIS- Doxycycline: 1 day before
return to normal temperature. Malaria signs and symptoms going and 4 weeks after leaving malaria endemic area,
typically begin within a few weeks after being bitten by an Chloroquine: 1 week before going and 4 weeks after
infected mosquito. However, some types of malaria parasites leaving malaria endemic area, Mefloquine: 2-3 weeks before
can lie dormant in your body for up to a year. Each year, going and 4 weeks after leaving malaria endemic area.
approximately 210 million people are infected with malaria, ZOOPROPHYLAXIS - Typing of domestic animals to divert
and about 440,000 people die from the disease. Most of the attention of mosquitoes. Chemically-treated mosquito nets,
people who die from the disease are young children in Africa. larvae-eating fish (tilapia), Environmental Sanitation, Anti-
In 2018, there were an estimated 228 million cases of mosquito soap and Natural anti-mosquito plants. If an
malaria worldwide. The estimated number of malaria deaths individual live in or are traveling to an area where malaria
stood at 405 000 in 2018. In 2018, P. falciparum accounted is common, take steps to avoid mosquito bites. Mosquitoes
for 99.7% of estimated malaria cases in the WHO African are most active between dusk and dawn. To protect yourself
Region 50% of cases in the WHO South-East Asia Region, 71% from mosquito bites, you should: (1) Cover the skin. Wear
of cases in the Eastern Mediterranean and 65% in the Western pants and long-sleeved shirts. (2) Apply insect repellant to skin
Pacific. Other names of malaria are “AGUE”, marsh fever, and clothing. Sprays on skin and sprays containing permethrin
and King of Tropical and Sub-tropical Diseases. Charles Louis are safe to apply to clothing. (3) Sleep under a net. Bed nets,
Alphonse Laveran discovered that malaria was caused by a particularly those treated with insecticide, help prevent
protozoan parasite in 1880. mosquito bites while you are sleeping.

Malaria is caused by a type of microscopic parasite Use of anti-malarial drug (Class: Aminoquinolones) – these
(plasmodial species). The parasite is transmitted to humans drugs are schizonticidal (chloroquine, quinine, primaquine,
most commonly through mosquito bites, through blood and sulfadoxine). Quinine is given in emergency situation
transfusion, contaminated needles and syringes and congenital (IV) but watch out for symptoms of neurologic toxicity like
transmission (RARE). The etiologic agent are (1) Plasmodium confusion, twitching, delirium, convulsions, and coma. For
falciparum – most common causative agent in the P.Vivax – Chloroquine, Primaquine, for P.Facipanum –
Philippines and the most serious type of malaria, malignat Pyrimethamine, Primaquine and for mixed causative agents –
tertian, malaria, incubation period of 7-14 days, (2) Quinine, Primaquine. Chloroquine is the drug of choice and can
plasmodium vivax – benign tertian malaria with incubation be given to pregnant. Primaquine – prevents relapse
period of 12 to 17 days with relapse up to 3 years, (3) Pyrimethamine – good for pregnant mother but used with
plasmodium ovale – ovale tertian malaria with incubation more folic acid. Primaquine under class Sulfadoxine use for
period of 9 to 18 days with relapse up to 20 years, (4) resistant P. falciparum strains. Treatment of malaria
plasmodium malariae – quartan malaria with 13 to 40 days depends on many factors including disease severity, the
incubation period, (5) plasmodium knowlesii. Thecharacteristic species of malaria parasite causing the infection, and the part of
of of female anopheles mosquito are night biting, high the world in which the infection was acquired. The latter two
flying, free flowing water, no buzzing sound, and rural. characteristics help determine the probability that the
organism is resistant to certain anti-malarial drugs. Additional
factors such as age, weight, and pregnancy status may limit the
15

available options for malaria treatment. Some prescribed first comforted, and body stiffness. Encephalitis can be life-
line drug of Artemether-lumefantrine combination tablet threatening, but this is rare. Mortality depends on a number of
and second line of Chloroquine, Primaquine Pyrimethamine factors, including the severity of the disease and age. Younger
and Sulfadoxine. The antimalarials that can be used in patients tend to recover without many ongoing health issues,
pregnancy include: chloroquine, amodiaquine, quinine, whereas older patients are at higher risk for complications and
azithromycin, sulfadoxine-pyrimethamine, mefloquine, mortality. Encephalitis is more likely to affect children, older
dapsone chlorproguanil, artemisinin derivatives, atovaquone- adults, individuals with weakened immune systems, and
proguanil and lumefantrine. For Complicated Malaria: Multi people who live in areas where mosquitoes and ticks that
drug resistant Falciparum: *Artemether 20mg/ Lumefantrine spread specific viruses are common.
120mg (C0-Artem) and Erythrocyte Exchange Transfusion.
The medical management is symptomatic and supportive
The biggest risk factor for developing malaria is to live in or to management. Treatment for encephalitis focuses on
visit areas where the disease is common. There are many alleviating symptoms. There are only a limited number of
different varieties of malaria parasites. The variety that causes reliably tested specific antiviral agents that can help, one of
the most serious complications is most commonly found in: which is acyclovir; success is limited for most infections
(1) African countries south of the Sahara Desert, (2) The except when the condition is due to herpes simplex.
Asian subcontinent, (3) New Guinea, the Dominican Republic Corticosteroids may be administered to reduce the brain’s
and Haiti Risks of more-severe disease, and (4) People at inflammation, especially in cases of post-infectious
increased risk of serious disease include: young children and (secondary) encephalitis. If the patient has severe
infants, older adults, travelers coming from areas with no symptoms, they may need mechanical ventilation to help
malaria, pregnant women and their unborn children and them breathe and other supportive treatment. Anticonvulsants
poverty, lack of knowledge, and little or no access to health are sometimes given to patients who have seizures.
care also contribute to malaria deaths worldwide. Sedatives can be effective for seizures, restlessness, and
irritability. For patients with mild symptoms, the best
Scientists around the world are trying to develop a safe and treatment is rest, plenty of fluids, and Tylenol (paracetamol) for
effective vaccine for malaria. As of yet, however, there is still no fever and headaches.
malaria vaccine approved for human use.
The nursing management are (1) Provide comfort – keep
ENCEPHALITIS patient in a quiet, well ventilated room; encourage oral
hygiene and bed bath. (2) Prevent from complications – turn
Encephalitis, slso, known as brain fever is an acute the patient at least every 2 hours, encourage increase oral
inflammation (swelling) of the brain usually resulting from fluid intake, encourage high caloric diet, moisten lips with
either a viral infection or due to the body’s own immune mineral oil. (3) Monitor intake and output. The prevention are
system mistakenly attacking brain tissue. In medicine, “acute” identification of vectors and eliminating breeding grounds,
means it comes on abruptly and develops rapidly; it usually destruction of larvae, screening homes, and use of repellants.
requires urgent care. The most common cause is a viral
infection. The brain becomes inflamed as a result of the body’s
attempt to fight off the virus. Encephalitis occurs in 1 in every
1,000 cases of measles. The causative agent is Culex
trieantorhynchus and the mode of transmission is a bite of
an infected mosquito. There are two main types of TERMINOLOGIES
encephalitis: primary and secondary. Primary encephalitis
occurs when a virus directly infects the brain and spinal cord. Cholera – is an infectious disease that causes severe
Secondary encephalitis occurs when an infection starts watery diarrhea, which can lead to dehydration and even
elsewhere in the body and then travels to the brain. death if untreated. It is caused by eating food or drinking
Encephalitis can develop as a result of a direct infection to the
water contaminated with a bacterium called Vibrio cholerae.
brain by a virus, bacterium, or fungus, or when the immune
system responds to a previous infection; the immune system
mistakenly attacks brain tissue. Primary (infectious) Dysentery – is an intestinal inflammation, primarily of the
encephalitis can be split into three main categories of viruses: colon. It can lead to mild or severe stomach cramps and
(1) Common viruses, including HSV (herpes simplex severe diarrhea with mucus or blood in the feces. Without
virus) and EBV (Epstein-Barr virus); (2) Childhood viruses, adequate hydration, it can be fatal. Infection with the
including measles and mumps, (3) Arboviruses (spread by Shigella bacillus, or Entamoeba hystolica are the most
mosquitoes, ticks, and other insects), including Japanese
common cause.
encephalitis, West Nile encephalitis, and tick-borne
encephalitis. Secondary encephalitis: could be caused by a
complication of a viral infection. Symptoms start to appear days Typhoid Fever – is a systemic infection caused by
or even weeks after the initial infection. The patient’s immune Salmonella Typhi, usually through ingestion of contaminated
system treats healthy brain cells as foreign organisms and food or water. The acute illness is characterized by prolonged
attacks them. We still do not know why the immune system fever, headache, nausea, loss of appetite, and constipation
malfunctions in this way. The incubation period is 4 to 21 days. or sometimes diarrhea. Symptoms are often non-specific and
clinically non-distinguishable from other febrile illnesses.
Japanese Encephalitis generally begins with fever, nausea,
chills, and headache, vomiting with stiffness/ neurologic
manifestations within 24 hours, dizziness, conjunctivitis, Hepatitis – is an inflammation of the liver that can cause a
athralgia, myalgia and decreased IQ and serious brain damage. range of health problems and can be fatal. There are five main
The symptoms rapidly worsen, with signs and symptoms of strains of the hepatitis virus, referred to as types A, B, C, D and
rigidity, ataxia, speech difficulties, ocular palsy, flaccid E.
paralysis and there may be seizures (fits), confusion, and loss
of consciousness, and even coma. Initially, encephalitis is Leprosy – also known as Hansen's disease, is a chronic
harder to detect in young children and babies. Parents or infectious disease caused by Mycobacterium leprae. The
guardians should look out for vomiting, a bulging fontanel disease mainly affects the skin, the peripheral nerves,
(the soft area on the top center of the head), persistent crying mucosal surfaces of the upper respiratory tract and the
that does not get better when the baby is picked up and
16

eyes. Leprosy is known to occur at all ages ranging from

early infancy to very old age.

Tetanus – is also called lockjaw, is a serious infection

caused by Clostridium tetani. This bacterium produces a
toxin that affects the brain and nervous system, leading to
stiffness in the muscles. If Clostridium tetani spores are
deposited in a wound, the neurotoxin interferes with nerves
that control muscle movement.

Meningitis – is an inflammation (swelling) of the protective

membranes covering the brain and spinal cord. A bacterial or
viral infection of the fluid surrounding the brain and spinal
cord usually causes the swelling. However, injuries, cancer,
certain drugs, and other types of infections also can cause
meningitis.

Poliomyelitis – is a highly infectious viral disease that largely

affects children under 5 years of age. The virus is transmitted
by person-to-person spread mainly through the fecal-oral
route or, less frequently, by a common vehicle (e.g.
contaminated water or food) and multiplies in the intestine,
from where it can invade the nervous system and cause
paralysis.

Red Tide Poisoning – also known as Paralytic Shellfish

Poisoning, or PSP, is a life-threatening syndrome, and the
onset of symptoms is rapid, usually within two hours of
consumption. Symptoms include tingling, burning, numbness,
drowsiness, incoherent speech, and respiratory paralysis.

Leptospirosis – is a bacterial disease that affects humans

and animals. It is caused by bacteria of the genus Leptospira.
In humans, it can cause a wide range of symptoms, some of
which may be mistaken for other diseases. Some infected
persons, however, may have no symptoms at all.

Dengue Fever – is a mosquito-borne tropical disease caused by

the dengue virus. Symptoms typically begin three to fourteen
days after infection. These may include a high fever,
headache, vomiting, muscle and joint pains, and a characteristic
skin rash.

Filiariasis – is a parasitic disease caused by an infection with

roundworms of the Filarioidea type. These are spread by
blood-feeding insects such as black flies and mosquitoes.
They belong to the group of diseases called helminthiases. Eight
known filarial worms have humans as a definitive host.

Malaria – is a life-threatening disease caused by parasites

that are transmitted to people through the bites of infected
female Anopheles mosquitoes. It is preventable and curable.
is caused by Plasmodium parasites. The parasites are spread
to people through the bites of infected female called
"malaria vectors." There are 5 parasite species that cause
malaria in humans, and 2 of these species – P. falciparum and
P. vivax – pose the greatest threat.

Encephalitis – is an uncommon but serious condition in

which the brain becomes inflamed (swollen). It can be life
threatening and requires urgent treatment in hospital.
Anyone can be affected, but the very young and very old
are most at risk. Encephalitis sometimes starts off with flu-
like symptoms, such as a high temperature and headache