Communicable diseases

COMMUNICABLE DISEASES

INTRODUCTION

DEFINITION:-

A communicable disease is an illness

caused by an infectious agent or toxic

product and is transmitted by direct or

indirect contact between the reservoir,

host and the susceptible individual.

CHICKEN POX:CAUSATIVE AGENT:-

• Varicella- Zoster virus ( VZT).

INCUBATION PERIOD:-

• 10-21 days.

PERIOD OF COMMUNICABILITY:-

• Transmitted one to two days before onset of rash.

METHOD OF TRANSMISSION:-

• Air borne – droplet infection.

• Person-to-person transmission.

• Indirect contact with articles soiled by an infected

patient.

EARLY SIGNS AND SYMPTOMS:-

– A sudden onset of mild fever, Malaise.

– Itchy rash progresses to vesicular lesions that last three to four days

before scabbing.

– Papules, Vesicles, Generalized lymphadenopathy.

PREVENTION:

– Hospitalization (28 days if varicella-zoster immune globulin is used).

– Disinfect the soiled linens.

– Childhood immunization.

– Check with the local health department about vaccine availability.

Varicella-zoster immune globulin (VZIG) given within 96 hours of

exposure.

NURSING CARE MANAGEMENT:

– Isolate high risk children from infected children.

– Administer skin care, give bath and change clothes and linens

daily.

– Administer topical calamine lotion.

– Keep child’s finger nails clean and cut short.

– Avoid use of aspirin.(reye syndrome).

–Oral acyclovir can be given to healthy children.

20mg/kg(maximum 800 mg per dose) four times a day given

for five days.

– Foscarnet is the new drug.

– Antihistamines may also reduce itching.

COMPLICATIONS:

–Abscess, cellulitis, sepsis.

–Encephalitis,

–Thrombocytopenia,

–Haemorrhagic varicella,

–Pneumonia.

MEASLES ( RUBEOLA):

AGENT :-

– virus.

SOURCE:-

– respiratory tract secretions, blood, and urine of infected person.

TRANSMISSION:-

– Direct contact with droplets of infected person, primarily in the winter.

– Airborne by droplets and contaminated dust.

INCUBATION PERIOD:-

– 10-20 days.

PERIOD OF COMMUNICABILITY:-

– From 4 days before to 5 days after rash appears, but mainly during

prodromal( catarrhal) stage.

CLINICAL MANIFESTATION:-

Prodromal ( catarrhal) stage:-

–Fever and malaise.

–Coryza, cough and conjunctivitis ( followed in 24 hours).

–Koplik spots ( small, irregular red spots with a minute).

–Bluish white center first seen on buccal mucosa opposite

molars 2 days before rash.

–Rash- appears 3-4 days after onset of prodromal stage.

–Anorexia, Abdominal pain, Malaise.

–Lymphadenopathy.

THERAPEUTIC MANAGEMENT:-

• Preventive- childhood immunization ( vitamin A

immunization).

• Supportive- Bed rest during febrile period.

• Antipyretics, Antibiotics to prevent secondary bacterial

infection in high risk children.

COMPLICATIONS:-

• Otitis media.

• Pneumonia ( bacterial).

• Obstructive laryngitis.

• Laryngotracheitis.

• Encephalitis.

MUMPS ( INFECTIOUS PAROTITIS):

CAUSATIVE AGENT:-

– Paramyxovirus.

SOURCE:-

– Saliva of infected persons.

TRANSMISSION:-

– Direct contact with or droplet spread from an infected person.

INCUBATION PERIOD:-

– 14-21 days.

PERIOD OF COMMUNICABILITY:-

– Most communicable immediately before and after swelling begins. 1-6

days before first symptoms.

CLINICAL MANIFESTATIONS:-

Prodromal stage:-

– Fever, Headache, Malaise.

– Anorexia for 24 hours, followed by ‘ear ache’ that is aggravated by

chewing.

Parotitis:-

By third day,

– Parotid gland enlarges and reaches maximum size in 1-3 days, accompanied

by pain and tenderness.

THERAPEUTIC MANAGEMENT:-

– Childhood immunization, Symptomatic and supportive.

-Analgesics for pain and Antipyretics for fever.

-Intravenous fluid for child who refuses to drink or vomits because of

meningoencephalitis.

COMPLICATIONS:-

– Sensoneural deafness, Post infectious encephalitis.

– Myocarditis, Arthritis.

– Hepatitis, Epididymoorchitis, Oopharitis.

NURSING MANAGEMENT:-

• Maintain isolation during period of communicability.

• Institute droplet and contact precautions during hospitalization.

• Encourage rest and decreased activity during prodromal phase until

swelling subsides.

• Give analgesics for pain. Encourage fluids and soft & bland foods,

avoid food requiring chewing.

• To relieve orchitis, provide warmth and local support with tight-

fitting underpants.

POLIOMYELITIS:AGENT:-

– Enterovirus.

THREE TYPES:-

– Type 1. Most frequent cause of paralysis, both epidemic and endemic.

– Type 2. Least frequently associated with paralysis.

– Type 3. Second most frequently associated with paralysis.

SOURCE:-

– Feces and oropharyngeal secretions of infected persons especially young children.

TRANSMISSION:-

– Direct contact with persons with apparent or inapparent active infection.

– Spread via fecal-oral and pharyngeal – oropharyngeal routes.

– Vaccine – acquired paralytic polio may occur as a result of the live oral polio

vaccination.

INCUBATION PERIOD:-

– Usually 7-14 days, with range of 5-35 days.

PERIOD OF COMMUNICABILITY:-

• Not exactly known; virus present in throat and feces shortly after

infection and persists for about 1 week in throat and 4-6 weeks in

feces.

CLINICAL MANIFESTATIONS:-

• May be manifested in three different forms;

ABORTIVE OR INAPPARENT - fever, uneasiness, sore throat,

headache, anorexia, vomiting, abdominal pain lasts a few hours to a few

days.

NON PARALYTIC – same manifestations as abortive, but more severe,

with pain and stiffness in neck, back, and legs.

PARALYTIC – initial course similar to nonparalytic type, followed by

recovery and signs of central nervous system paralysis.

THERAPEUTIC MANAGEMENT:-

Preventive:-

– childhood immunization.

– Complete bed rest during active phase.

– Mechanical or assisted ventilation in case of respiratory paralysis.

– Physical therapy for muscles after acute phase.

COMPLICATIONS:-

– Permanent paralysis, Respiratory arrest, Hypertension.

– Kidney stones from demineralization of bones.

NURSING MANAGEMENT:-

• Administer mild sedatives. Participate in physiotherapy procedures

• Position child to maintain body alignment and prevent contractures or skin breakdown, use footboard.

• Promote early ambulation with assistive devices.

• Provide high protein diet and bowel management for prolonged immobility.

• Observe for respiratory paralysis, difficulty in talking, ineffective cough, inability to hold breatth.

PERTUSSIS (WHOOPING COUGH):

AGENT:-

– Bordetella pertussis.

SOURCE :-

– Discharge from respiratory tract of infected persons.

INCUBATION PERIOD:-

– 7-10 days.

COMMUNICABILITY PERIOD:-

– 4-6 weeks from onset.

MODE OF TRANSMISSION:-

– Direct contact.

– Air borne by droplet spread from infected person.

CLINICAL MANIFESTATIONS:-

– Coryza, Dry cough which is worse at night.

– Dyspnea and fever, Vomiting after coughing.

– Lymphocytosis, Sneezing, Lacrimation, Hacking cough becomes more severe.

TREATMENT:-

Preventive measures:-

– Immunization, Antimicrobial therapy – (Eg:- Erythromycin, Clarithromycin,

Azithromycin).

– Adequate fluids, children who are dehydrated.

– Intensive care and mechanical ventilation, if needed for infants <6 months.

COMPLICATIONS:-

• Pneumonia, Seizures, Marasmus. Hemorrhage( sclera, conjuctival, epistaxis).

• Weight loss and dehydration. Hernias( umbilical and inguinal).

NURSING MANAGEMENT:-

• Obtain nasopharyngeal culture for diagnosis.

• Encourage oral fluids, offer small amount of fluids frequently.

• Ensure adequate oxygenation.

• Provide humidified oxygen, suction as needed to prevent choking

on secretions.

• Observe for signs of airway obstruction.

• Use standard precautions and mask in health care workers

exposed to children with persistent cough and high suspicion of

pertussis.

ACQUIRED IMMUNO DEFICIENCY SYNDROME:

Introduction:

Epidemiology:

– 2.3 million children are living with HIV.

– 18% of children are died because of HIV infection.

– 4% children are in ARV therapy.

– India, thailand, myanmar, indonesia are HIV affected regions.

HIV IN INDIA:

One third of children will die by their 1st birthday.

More than half of the children will die by the age of 2 years.

AP, karnataka, maharastra, manipur , nagaland, TN bear this burden.

MODE OF TRANSMISSION:

– Sexual, mucosal, blood, semen, and vaginal fluids.

– In India, spread in adults through heterosexual intercourse.

– Sexually abused children are also at high risk of HIV infection.

– Drug use, infected needles.

– Commonly from perinatally from an infected mother to her infant.

PATHOPHYSIOLOGY:

• HIV virus infects T lymphocytes, CD4 T cells

• The virus takes over CD4 cells and reduce the cell function.

• The CD4 count decreases leads to immunodeficiency.

• The count reaches the low level and cause illness followed by death.

CLINICAL MANIFESTATION:

Stage1:

– Asymptamatic, lymphadenopathy.

Stage 2:

– Hepatospleenomagaly, parotid enlargemenet, skin lesions, pruritic

papular eruptions.

– Oral ulcerations oral mucosal lesions.

Stage 3:

– Fever, Diarrhea, TB, Pneumonia, Malnutrition, Oral thrush, Anemia.

Stage 4:

– Rectal fistula, cardiomyopathy, nephropathy, lymphoma.

DIAGNOSTIC EVALUATION:

• Serological tests

and

• Virology tests.

GENERAL CARE:

– Immunization,

– Anti retro viral therapy,

– Prevention of pediatric HIV,

– Prevention of mother to child transmission(ante, intra, post natal),

– Immediate new born care.

DENGUE

• Consists of anthropod borne viral fever.

3 types of dengue infection are seen in children;

–Dengue fever,

–Dengue hemorrhagic fever,

–Dengue shock syndrome.

ETIOLOGY:

• Caused by dengue fever.

PATHOPHYSIOLOGY:

• Primary and secondary.

PRIMARY:

• Bite of an infected dengue mosquito leads to entry of the virus

into the child’s blood.

• Leads to viremia.

SECONDARY:

• Bites which leads to DHF / DSS.

CLINICAL MANIFESTATIONS:

Grade 1:

• Fever,

• Hemorrhage.

Grade 2:

• Hemorrhages.

Grade 3:

• Circulatory failure, Rapid and weak pulse,

• Hypotension with cold and clammy skin.

Grade 4:

• Shock and undetectable hypotension.

INVESTIGATIONS:

• COMPLETE BLOOD COUNT,

• CHEST X-RAYS,

• ELISA,

• SODIUM AND ALBUMIN LEVEL,

• BUN.

TREATMENT:

• Antipyretic, Tepid sponging, NS, RL, dextrose5%,

• Blood transfusion, hemodialysis.

TETANUS

• Caused by anaerobic bacteria, clostridium tetani.

• Affect all ages, Incidence is 60/100000.

TRANSMISSION:

• Through spores of clostridium tetani.

• Enters through dust, soil, wound.

• Spores transform to produce powerful exotoxins, named

tetanospasmin and tetanolysin.

• Not transmitted through man to man.

CLINICAL FEATURES:

• Incubation period- 3-21 days.

• muscle rigidity and spasms,

• Pain, stiffness in the jaw, dysphagia,

• Sustained contraction of facial muscle.

• Dyspnea, pneumonia leads to death.

TREATMENT:

• Isolation, visual acoustic or physical stimuli are avoided.

• Inj.TT, diazepam, chlorpromazine, pencilline,

• Avoid asepsis.

PREVENTION:

• Aseptic delivery,

• Clean hands, clean surface, clean blade, clean cord tie,

• Inj. TT,

• Care of wound,

• Foreign bodies and debris in the wound should be removed,

• Soil, dirt necrotic tissue should not be allowed to remain at the

injury site.

TYPHOID FEVER

• It is a food or water borne disease caused by bacteria salmonella

typhi.

• Paratyphoid fever caused by S.Paratyphi, S.Schottmuelleri and

S.Hirscheilla.

EPIDEMIOLOGY:

• Man is the only reservoir of s.typhi.

• Often seen in females.

• Spreads through urine, feces and vomitus.

PATHOLOGY:

• Bacilli enters blood stream through intestinal lymphoid tissue and

affects spleen and liver.

CLINICAL MANIFESTATION:

• Incubation period is 8 -21 days.

• Headache, malaise, low grade fever,

• Irregular fever, gets high within a week at 40 degree celsius.

• Coated tongue, rose red spots over the abdomen,

• Hepatomegaly and splenomegaly. Abdominal pain, slightly distended

abdomen.

• Lethargy.

LABORATORY INVESTIGATIONS:

• Blood culture,

• widal tests,

• Stools and urine culture.

MANAGEMENT:

• Chloramphenicol 50-75 mg/kg/day.

• Ampicilline 150 mg/kg/day.

• Cephalosporin, ceftriaxone 50-100 mg/kg/day.

• Ciprofloxacine 20 mg/kg/day.

• Good nursing care by oral hygeine, antipyretics.

• Maintenance of bowel and bladder functions,

• Prevention of urinary stasis, management for constipation,

• Prevention of bed sores, preventing soiling of skin.

• Nutritious doet such as high calories, proteins, iron and vitamins.

• More oral fluids to be encouraged.

PREVENTION:

Immunization and maintain sanitation.

CHOLERA

• Caused by vibrio cholerae characterized by acute diarrhea and

dehydration.

EPIDEMIOLOGY:

• Environmental factors.

MODE OF SPREAD:

• Feces,

• Inadequate facilities of sewage disposal,

• Contaminated hands and fomites.

CLINICAL FEATURES:

• Incubation period between 1-3 days.

• Painless diarrhea, vomiting,

• Hypovolemic shock, coma, convulsions hypoglycemia and death.

MANAGEMENT:

• Reporting to health department.

• Oral rehydration therapy.

• Iv fluids.

PREVENTION:

• Safe water supply.

• Sanitation, food safety.

RABIES

• Caused by acute infection of nervous system by a virus.

• Transmitted through humans by saliva of an infected mammals

and is introduced through a bite or skin abrasion.

CLINICAL FEATURES:

• Malaise, fever, sore throat

• Increased reaction to external stimuli,

• Convulsions, choking, severe spasms,

• Hydrophobia.

MANAGEMENT:

• Rabies vaccine.

• Antibiotics.

• Intramuscular regimens: Both a five-dose and a four-dose i.m. regimen are recommended for post-exposure vaccination; the fivedose regimen is the more commonly used:

• The five-dose regimen is administered on days 0, 3, 7, 14 and 28 into the deltoid muscle.• The four-dose regimen is administered as two doses on day 0 (one dose in the right and one

in the left arm (deltoid muscles), and then one dose on each of days 7 and 21 into the deltoid muscle.

• An alternative post-exposure regimen for healthy, fully immunocompetent exposed people who receive wound care plus high-quality rabies immunoglobulin plus WHO-prequalified rabies vaccines consists of four doses administered i.m. on days 0, 3, 7 and 14.

• Intradermal regimens: Intradermal administration of cell-culture- and embryonated-egg-based rabies vaccines has been successfully used in many developing countries that cannot afford the five- or four-dose i.m. schedules.

• The two-site i.d. method: one i.d. injection at two sites on days 0, 3, 7 and 28.• The volume per intradermal injection should be 0.1 ml with both purified Vero cell rabies

vaccine, and purified chick embryo rabies vaccine.

NURSING CARE MANAGEMENT:

• Immunization.

SEVERE ACUTE RESPIRATORY SYNDROME(SARS)

• Caused by corono virus.

EPIDEMIOLOGY:

Through spreaders, direct contact with the infected persons.

CLINICAL FEATURES:

• 1 week recurrence of fever,

• Respiratory distress.

TREATMENT:

• Antiviral drugs- ribavarin, lipinavir, interferon therapy.

PLAGUE:

Caused by bite of a rat flea.

Causative organism is yersinia (pasteruella pestis).

CLINICAL FEATURES:

Incubation perios is 2-5 days,

Pneumonia, tremors, high fever,

Flushed face, hemorrhages from the mucous membrane, petichiae

Chest pain, frothy, bloody sputum, circulatory failure,

Death.

DIAGNOSIS:

• CBC.

TREATMENT:

• Streptomycin,30mg/kg/day every 12 hours IM.

• Chloramphenicol or doxycycline for septicemia and meningitis.

PREVENTION AND PROGNOSIS:

• Isolation, destruction of rats, fleas.

• If treated, mortality rate is reduced less than 10%

• If untreated, the mortality rate is 50% for bubonic and 100% for

primary pneumonic plague.

MALARIA

• Caused by female anopheles mosquito.

4 species of malarial parasites;

• P.vivax, P.falciparum, P.ovale, P.malariae.

CLINICAL FEATURES:

• Incubation period is 9-30 days.

• Irritability,restlessness, rigors, cold and clamy skin.

• Tenderness over spleen and liver.

• Convulsions and coma.

• GI disorders, growth failure in endemic areas.

DIAGNOSIS:

• CBC, serological tests, smear tests

• Urine analysis,

• Chest X-ray.

TREATMENT:

• Chloroquinine 10mg, followed by 5mg at 6, 24 ,48 hrs.

• Repeat the dose if vomits.

• Maintain IV fluids, oxygen theraphy, ventilator.

PREVENTION:

• Antimalarial prophylaxis,

• National anti malarial programme.