Whooping Cough Cont’n.

Catarrhal Stage
1-2 weeks; coryza, fever

Paroxysmal Stage
2 – 6 weeks of severe violent coughing

Convalescent Stage
Return to normal respiration
 Diagnosis
Bordet Gengaou Agar Plate
 Drug of Choice
Erythromycin; Supportive care: bedrest;
humidified oxygen, as ordered; gentle and
brief suctioning; avoid excitement, dust,
smoke and sudden temperature change; don’t
bring by seashore; abdominal support.
 Management
Prevention is by active immunization of DPT 0.5
IM three (3) doses (ages 6, 10, 14 weeks) and
two (2) boosters (15 – 16 months and 4 – 6
years); isolation with droplet precaution
 CHICKEN POX (Varicella)
Etiologic Agent

Varicella-Zoster (VZ) virus, a herpes virus

 Transmission
Highly contagious by direct contact,
communicable from 1- 2 days prior to
appearance of rashes until 5 to 6 days after
onset and all vesicles have become crusted,
with incubation period of 10 to 21 days (14
days). An attack confers long immunity.
 Clinical Manifestation
Rashes (starts as macule to papule to vesicle then
scabs then fall off to leave shallow pink
depression) that start from trunk then spread
to other parts of the body. With fever peaking
on 2 – 4 days.
Zoster (activation of latent infection by
exogenous factors as stress)

Rash with the same progress as varicella

with severe pain and tenderness along
posterior nerve roots, and regional
lymph nodes may become tender and
enlarged.
 Management
Aciclover
Supportive management (antipyretics; short
finger nails)
Isolation and airborne precaution
Prevention is by active immunization of live
attenuated varicella vaccine (subcu for 9-12
years)
 MUMPS (Epidemic Parotitis)
Etiologic Agent

Mumps virus (filterable), an RNA virus

classified as Rubivirus, family of
Paramyxoviridae
 Transmission
Direct contact by airborne droplet or fomites
contaminated by saliva, within 1 to 2 days
before onset of parotid swelling to 5 days after
onset of swelling. Incubation of 16-18 days.
Lifelong immunity after recovery from disease.
 Clinical Manifestation
Asymtomatic in 30 – 40% of cases, otherwise
presents with fever, anorexia, malaise, with
swollen, painful and tender parotid glands
(often bilateral) affecting submaxillary and
sublingual gland.
 Complications
Epididymo-orchitis (unilateral or bilateral) is
common complication after puberty leading to
some impairment of fertility. Also
meningoencephalitis, oophoritis, and
pancreatitis.
 Management
Prevention is by MMR (12 to 15 months, booster
dose at 4 to 6 years or anytime earlier with at
least 4 weeks apart)
Supportive management (comfort measures. For
post pubertal male – bedrest with properly
fitted suspender to minimize dangers to
orchitis)
Isolation and droplet precaution; and concurrent
and terminal disinfection.
 SCABIES
Etiologic Agent

Sarcoptes Scabie, var hominis and var canis, a

mite
Female, visible with a magnifying glass, burrow
beneath the epidermis to lay eggs.
Diagnosis by microscopic studies of scrapings.
 Transmission
By direct contact, person to person with
contaminated clothing or bedding,
communicable as long as the patient remains
infected and untreated, with incubation period
of 24 hours
 Clinical Manifestation
Intense pruritic (most intense at night),
erythematous papules, common in interdigital
folds, wrist, elbows, axilla, beltline, thigh,
navel, genitalia, buttocks.
Secondary dermatitis is common.
 Management
Benzylbenzoate emulsion. Also Permethrin
cream, crotamiton cream (Eurax), Gamma
benzene hexachloride (Kwell) for all members
of households!
Good personal hygiene environmental sanitation;
fingernails trimmings; ironging of clothes and
beddings.
SEXUALLY TRANSMITTED
DISEASES

4 C’s in STD

Compliance
Counselling
Contact Tracing
Condom
 GONORRHEA
Etiologic Agent

Neisseria Gonorrhea
Incubation of 2 – 10 days
Detected by gram staining urethral discharge
 Clinical Manifestation
Males: burning urination, pus discharge
Female: 80% asymptomatic, otherwise, vaginal
discharge, urethritis, endocervicitis that can
progress to PID, and sterility in both sexes
 Management
Cefriaxone Sodium

Opthalmia neonatorum (profuse conjuctival

exudates that can progress to corneal
ulceration and loss of eye/s) develops 2 to 5
days after birth by an infected mother.
Terramycin ointment (formerly silver nitrate)
as Credes prophylaxis given at birth.
 CHLAMYDIA
One of the most common STD!
Highly Contagious
Etiologic Agent:

Chlamydia Trachomatis
Incubation period of 2 – 3 weeks
Can be isolated in tissue culture
 Clinical Manifestation
Males: discharge from penis, burning and itching
of urethral opening; burning sensation on
urination

Females: slight vaginal discharge, painful

intercourse, itching vagina, abdominal pain
 Management
Antibiotics
Vaginal creams or suppositories
 Syndromic Case Management of
STDs
The 4 Cs
Compliance

 Gives information and counsels the client

resulting in client following treatment,
prevention and recommendation successfully
Counselling/Education

 instruction about treatment

 information about the disease
 guidance on how to avoid STD again
 facts about HIV and AIDS
Contact tracing

 provider facilities the process of partner

treatment

Condoms

 promoting condoms use, instructing

about their use and providing them
 SYPHILLIS
Etiologic Agent:

Treponema pallidum
Incubation of 10 days to 3 months (21 days)
Detected by Dark field illumination test
 Clinical Manifestation
Primary Stage: Painless chancre and buboes
(hard painless, enlarged lymph node) at entry
of germs;
Secondary Stage: rash, patchy hair loss, sore
throat, and disappearance of sores as germs
continue to spread;
Latent Stage: Asymptomatic for years
Late syphillis: damage to body organs
 Management
Benzathine Penicillin

Congenital syphillis is asymptomatic at birth but

presents osteochondritis, rashes, fissures
around nares and late symptoms like
Hutchinson’s teeth, keratitis, VIII nerve
deafness.
 TRICHOMONIASIS
Etiologic Agent:

Trichomonas vaginalis, a protozoan

Incubation period of 4 to 20 days (7 days)
 Clinical Manifestation
Females: white or greenish yellow frothy musty
odorous discharge; vaginal itching and
soreness, painful urination

Males: slight itching of penis, painful urination,

clear discharge
 Management
Metronidazole
(Abstain from alcohol for 2 days to avoid
disulfiram-like effect)
 CHANCROID
Etiologic Agent:

Haemophilus ducreyi, gram negative

coccobacillus
Incubation period of 3 to 10 days
 Clinical Manifestation
Ulcer (painful, tender erythematous papule,
erodes over several days, forms sharply
demarcated superficial lesion)
 Management
Azithromycin, Ceftriaxone, erythromycin or
ciprofloxacin
Human Immunodeficiency Virus
Infection/Acquired Immune
Deficiency Syndrome (HIV/AIDS)
HIV/AIDS first occurred in Africa and
spread to the Caribbean Islands. It was
reported in the USA in 1981 and cases were
soon described in other countries.
 This sexually transmitted disease spread so
rapidly that it soon occurred in epidemic
proportion in several countries of the world
including the Philippines. It is currently
pandemic.
 The first case of AIDS in the Philippines
was reported in 1984. As of May 2000, based
on Philippine National AIDs Council (PNAC)
records, there were 1,385 HIV positive and
464 AIDs cases. There had been 206 deaths.
Causative Agent: Retrovirus – Human T-cell
lymphotrophic virus 3 (HTLV-3)
Mode of Transmission:
 Sexual contact
 Blood transfusion
 Contaminated syringes, needles, nipper,
razor blades Direct contact of open
wound/mucous membrane with contaminated
blood, body fluids, semen and vaginal
discharges.
Incubation period: varies from several months
(3-6) to many years (8-10)
Signs and Symptoms:

1.Physical: maculo-papular rashes

 loss of appetite
 weight loss
 fever of unknown origin
 malaise
 persistent diarrhea
 Tuberculosis (localized and
disseminated