CDN Review

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COMMUNICABLE DISEASE An illness due to an infectious agent or toxic products which is transmitted directly or indirectly to all person or animal or through an agency of an intermediate animal host, vector of the inanimate environment. ESSENTIAL ELEMENTS OF DISEASE AGENT microorganism that is living and capable of invading and multiplying in the body of the host. Viruses – are the smallest known microbes. They are incapable of replication independently in the host’s cells to participate in the formation of additional viruses.

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b. Bacteria – are simple, one-celled microbes with double cell membranes that protect them from harm. They reproduce rapidly and they are considered as the most common cause of fatal infectious diseases. c. Fungi – are found almost everywhere on earth. They live in organic matter, soil, water, animals and plants. Fungi can also be beneficial in cheese, yogurt, beer, wine, and certain drugs like penicillin. Parasites – any organism that derives benefits from others. They don’t usually kill their host but take only the nutrients they need. HOST is a person, animal or plant on which a parasite depends for its survival.

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Once the microorganism is already present on the body and begins to proliferate we can say that the body is now infected. The degree of severity of an infectious disease can range from mild to life threatening depending on many variables the health of the host and the virulence of the microorganism Types: 1. infected body – which the infectious agent has entered and multiply 2. susceptible host – the one that don’t possess resistance against infectious agents ENVIRONMENT – encompasses the ways and means of transmission of the infectious agent to the susceptible host.

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TERMS Contagious – applied to a disease that are easily spread directly or indirectly transmitted from one person to another. Usually respiratory disease. Ex. SARS, PTB Infectious – are those disease not transmitted by ordinary contact but require a direct inoculation through a break in the previously intact skin and mucus membrane. On the other hand all contagious disease are infectious. Ex. Hepatitis B Infection - An invasion of the body by pathogenic organisms that multiply and produce injurious effects. Types: 1. local – limited to the site. 2. focal – a local infection from which the organism themselves spread to other parts of the body.

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3. Systemic – infection is spread throughout the body. Ex. Septicemia a. recurrent – an infection that returns periodically. b. reinfection – a secondary infection of the same microorganism either after recovery or during the original infection. c. superinfection – an infection occurring during antimicrobial treatment for another infection d. autoinfection – an infection already present in the body but developing to the other parts of the body. e. acute infection – infection that develops rapidly, usually resulting in a high fever or severe sickness

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f. chronic – slowly, mildly but longer lasting g. bacteremia - presence of non multiplying bacteria in the blood h. septicemia – presence of bacteria cells actively multiplying in the blood i. toxemia – presence of microbial toxins in the blood j. viremia – presence of virus in the blood Carrier – a person who harbors and disseminates the specific microorganisms of a communicable disease, but does not manifest the signs and symptoms of the disease. Contact – a person or an animal known or believed to have been exposed to a disease.

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Contamination – the process by which something is rendered unclean or unsterile. Infection of the person or of matter by contact. (contaminated) Isolation – The separation of persons with CD from other persons so that either direct or indirect transmission to susceptible persons is prevented. Ex. Measles, chickenpox etc. Reverse isolation – The separation of persons with immunodeficiency. ex. Leukemia and AIDS patient Quarantine – the limitation of freedom and movement of persons, or animals which have been exposed to communicable disease, for a period of time equal to the longest incubation period of the disease to which they have been exposed. Ex. SARS

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1. Complete – the limitation of freedom and movement, in such manner as to prevent effective contact with those not so exposed. 2. Modified – selective partial limitation of freedom and movement that is determined commonly on the basis of known or presumed difference in susceptibility or sometimes because of the danger of disease transmission. Ex. Exclusion of children from schools) 3. Surveillance – the practice of close supervision of contacts without restrictions of movements. This may apply to domestic animals also. 4. Segregation – the separation for special consideration, control or observation of some part of a group of persons from the other to facilitate the control of some CD.

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Pathogenecity – the ability to produce a disease Virulence – The vigor with which the organism can grow and multiply. COURSE OF INFECTIOUS PROCESS The course of any infectious disease can be divided into several stages after the potential pathogen has entered. The duration of each phase and the pattern varies. 1. Incubation – extends from the entry of microorganism into the body to the onset of signs and symptoms. -is the phase wherein the pathogen begins active replication without producing recognizable symptoms in the host.

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-the incubation period may be short as in Salmonella that is from 6 – 24 hours or prolonged as in Hepatitis B that is from 50 to 180 days or two to five months, HIV that is from months to years. 2. Prodromal – it is premonitory or early sign indicating an impending attack of a disease. 3. Illness / invasion/ Acute stage – is the period wherein the host experiences the maximum impact of the infectious process. 4. Convalescent – is characterized by the containment of infection, progressive elimination of the pathogen, repair of damaged tissue and resolution of associated symptoms. The RESOLUTION is the total elimination of a pathogen from the body without residual signs and symptoms.

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THE CHAIN OF INFECTION ETIOLOGIC/INFECTIOUS AGENT: Bacteria. Fungi, virus, parasites RESERVOIR (SOURCE) Human beings, animals, inanimate object, plants, general environment such as air, water and soil. PORTAL OF EXIT Sputum, emesis, stool, blood MODES OF TRANSMISION Contact, vehicle, airborne, vector-borne

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PORTAL OF ENTRY Mucous membrane, non intact skin, GI tract, GU tract, Respiratory tract. SUSCEPTIBLE HOST Immunosuppressed children, elderly, chronically ill, those with trauma or surgery.

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ETIOLOGIC AGENT Invading microorganisms which is capable of producing disease These may be bacteria, virus, fungi, parasites. The ability of the infectious agent to cause a disease depends on its pathogenecity, virulence, invasiveness and specificity. 1. Bacteria – are simple, one-celled microbes with double cell membranes that protect them from harm. They reproduce rapidly and they are considered as the most common cause of fatal infectious diseases. 2. Virus – microorganism that resides within other living cells, they invade and stimulate the host’s cells to participate in the formation of additional viruses.

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3. Fungus – plant like organism that grows as single cells and can be found almost everywhere on earth. 4. Protozoans – are much larger than bacteria. They are the simplest single-celled organism of the animal kingdom. 5. Rickettsias – are small, gram negative(-) bacteria-like microbes that can induce life threatening infections. These are usually transmitted through a bite of arthropod carriers like lice, fleas, ticks, as well as through waste products. RESERVOIR Environment in which the invading organism lives and multiplies

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inanimate objects, humans and other animals can all serve as reservoir. PORTAL OF EXIT Mode of escape from reservoir or the path by which an infectious agent leaves it’s reservoir. usually this portal is the site where the organism grows. a. respiratory system b. genitourinary tract c. gastrointestinal tract d. skin and mucous membrane MODE OF TRANSMISSION Method by which the infectious agent passes through from the portal of exit of the reservoir to the susceptible host. This is the easiest link to break the chain of infection

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Infections can be transmitted into four modes. 1. Contact Transmission -is the most common mode of transmission. *Droplet -is a transmission through contact with respiratory secretions when the infected person coughs, sneezes or talks. Microbes carried in droplets can travel up to three feet or one meter. The organism is not suspended in the air but settles on surface. *Direct contact - refers to a person to person transfer of organism.

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*Indirect contact -occurs when the susceptible person comes in contact with a contaminated object. 2. Vehicle -This involves the transfer of microorganism through articles or substances that harbor the organism until it is ingested or inoculated into the host. Ex. milk, food, water, blood, utensils, pillows and mattress. 3. Airborne -this occurs when fine microbial particles are suspended in the air for a long time or when dust particles contain pathogens. Air currents disperses microorganism, which can be inhaled or deposited on the skin of a susceptible host.

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4. Vector-borne -occurs when intermediate carriers, such as fleas, flies, mosquitos, rats, snails transfer the microbes to another living organism. -mechanical like inanimate objects that are infected with infected body fluids like contaminated needles and syringes. PORTAL OF ENTRY this permits the organism to gain entrance into the susceptible host. pathogens can enter susceptible host through body orifices such as the mouth, nose, ears, vagina, rectum or urethra. Breaks in the skin increases the chance for organism to enter the host.

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Usually this path is the same as the portal of exit. SUSCEPTIBLE HOST a person who is at risk for infection; whose own body defense mechanism, when exposed are unable to withstand the invasion of pathogens. Susceptibility determined by factors such as number of invading organisms, duration of exposure, age, state of health, nutritious status. A susceptible host is also required for the transmission of infection. The human body has many defenses against the entry and multiplication of organism. When these defenses functions normally, no infection will take place. However, in a weakened host, an infectious agent is more likely to invade the body and launch an infectious disease.

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Defense mechanism – the bodies defense mechanism falls into two categories: 1. First line defenses These are the external and mechanical barriers such as: a. Skin -intact skin, mucus membrane, certain chemical substances, specialized structures such as cilia and normal micro flora can stop pathogens from establishing themselves in the body. b. The gag, cough reflex and GI peristalsis -work to remove pathogens. c. Chemical substances that help prevent infection or inhibit microbial growth -saliva, perspiration, interferon ( a naturally occurring glycoprotein with antiviral properties.), GI and vaginal secretions

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c. Normal flora -control the growth of potential pathogens through a mechanism called microbial antagonism. -they use nutrients that pathogens need for growth, compete pathogens for their sites on tissue receptor and secretes naturally occurring antibiotics to kill the pathogens. Ex. Candida. 2. Second Line defenses -WBC and the inflammatory response -respond to any type of injury, their response is termed non specific. 3. Immune System

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a. Cell mediated immunity -involves T cells (a type of WBC). -some T cells synthesize and secrete lymphokines, others become killer (cytotoxic cell), setting out to track down infected body cells. b. Humoral immunity -mediated by antibodies, involves the action of B lymphocytes in conjunction with helper T cells. >Conditions that may weaken a person’s defense includes: *poor hygiene *Malnutrition *Extremes of age *Climate

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*Inadequate physical barriers *Inherited and acquire immune deficiencies *Emotional and physical stressor *Chronic disease *Medical and surgical treatments *Inadequate immunizations HERD IMMUNITY Is when a group of people is immune to a specific disease. Ex. Measles vaccine

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TERMS 1. Incidence -the number of cases of disease, or infection or other events during a prescribed time period in relation to the unit population in which they occur. 2. Prevalence -the number of cases of disease of infected persons. 3. Sporadic -occurring occasionally and irregularly with no specific pattern. example: tetanus -occasional cases occur. (dengue during rainy season, leptospirosis during floods.)

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4. Endemic -a disease is found to be continuously present in a community. -usually involve few people during specific periods. (e.g. Malaria in Palawan and Mindanao, Goiter in mountain province) 5. Epidemic -a condition in which a disease attacks a large number of people in the community over a specific time, or during the same season, and in which the disease tends to spread rapidly to others. 6. Pandemic -a widespread epidemic that affects several countries or continents. Ex. SARS, AIDS, Meningococcemia

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7. Morbidity rate -the sick rate 8. Mortality rate -relates to the number of deaths to the total number of population. 9. Morbidity -condition of being diseased. 10. Mortality -condition of being subject to death. SIGNS AND SYMPTOMS OF INFECTION 1. FEVER a. Intermittent

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b. Remittent -the temperature fluctuates within a wide range over the 24 hour period but remains above normal range. c. Hectic -a fever that occurs each day with profound sweating chills and facial flushing. d. Relapsing -the temperature is elevated for few days, alternated with 1 or 2 days of normal temperature. e. Factitious -self induced fever. f. Drug-fever -induced by drugs or medicine - the onset of fever occurs between 7 – 10 days after the medication is begun and return to normal 2- 3 days after the medication is stopped.

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g. Hyperpyrexia -very high fever. h. Constant -body temperature is consistently high. 2. RESPIRATORY 3. BLOOD PICTURE 4. GASTROINTESTINAL 5. CNS 6. CARDIOVASCULAR Immunity Refers to the body’s specific protective response to an invading organism or particular disease.

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Types of Immunity 1. Natural -is non specific immunity present at birth. -they provide non specific response to any foreign invader, regardless of the invader’s composition. -such natural mechanism include physical and mechanical barriers, the WBC, and inflammatory response.

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Common Colds (Coryza) an acute, usually afebrile viral infection may cause inflammation of the upper respiratory tract benign and self limiting may lead to secondary bacterial infection Etiology: -Over a hundred virus can cause common colds -Rhinoviruses, adenoviruses, coxsackieviruses and echoviruses -Parainfluenza virus, RSV, coronaviruses Source of Infection: -Contact with contaminated objects and hand to hand transmission.

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MOT: -direct or indirect -airborne respiratory droplets. Period of Communicability: -2 to 3 days after the onset of symptoms Incubation Period: -1 to 4 days Clinical Manifestation: -pharyngitis -fever -nasal congestion -chills -rhinitis -myalgia & arthralgia -headache -malaise & lethargy -burning, watery eyes -hacking nocturnal cough.

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Complications: -otitis media -pharyngitis -lower respiratory tract infections -sinusitis (for adults) Diagnosis: -no explicit test to isolate the specific organism Management: 1. aspirin – eases myalgia and headache 2. acetaminophen – drug of choice for children (prevention of Reye’s syndrome) 3. Fluids and rest – loosen secretions 4. Increase fluid intake 5. Adequate nutritious diet 6. Symptomatic

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a. decongestant – decongestion b. throat lozenges – soreness c. steam – encourages expectoration d. saline nose drops and mucus aspiration with bulb syringe -for nasal congestion Prevention: *No known measure can prevent common colds. *Zinc and Vitamin C remain controversial.

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MUMPS (Infectious or Epidemic Parotitis) -is an acute viral infection of the salivary glands particularly the parotids, with constitutional manifestation of varying degrees. -characteristic of which is that there is swelling of one or both the parotid gland usually occurring in an epidemic form. -common among ages 5 – 9 Etiology: -filterable virus of mumps -paramyxovirus Source of Infection: -secretions of the mouth and nose

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Mode of Transmission -direct contact -droplet *virus is present in the saliva 6 days before and 9 days after the swelling (48 hours prior to the onset– highest communicability) Pathophysiology: Inhalation of Respiratory Droplet 14-25 days (inc period) Prodromal Period (lasts for 24 hours) -myalgia -low grade fever -anorexia -headache -malaise

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Acute Stage -earache (aggravated by chewing) -parotid gland inflammation -fever (38.3 to 40 C) -pain aggravated by chewing (especially when taking sour or acidic liquids) Complications -epididymo-orchitis -mumps meningitis

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Diagnosis: 1. Serologic Antibody Test *Diseases that may mimic mumps: a. other viral infections -influenza A infection -parainfluenza infection -coxsackie infection b. sarcoidosis c. Sjogren’s syndrome 2. Viral Culture 3. Blood Examinations

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Treatment: 1. supportive a. adequate fluids (oral and/or IV) b. nutrition c. bed rest 2. Symptomatic a. analgesics b. antipyretics c. TSB 3. Respiratory Isolation 4. Prevention -vaccination with MMR (95% protective- lasts 5 years) -within 24 hours exposure

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MENINGITIS (Epidemic Cerebrospinal Meningitis Cerebrospinal Fever) -is an acute contagious disease as a result of inflammation of meninges of the spinal cord. Etiology : -Haemophilus influenzae, EB virus, Coxsackie virus MOT -droplet contact or indirect Source of Infection: -secretions Incubation Period: -2 – 10 days

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Clinical Manifestation: -headache -photophobia cause is unclear -malaise -irritability -chills and fever -vomiting -seizures – cortical irritability -Increase ICP – widening pulse pressure, irregular RR, headache, vomiting and decreased LOC -Childish pitch cry, bulging fontanels

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*Sign’s of meningeal irritation 1. nuchal rigidity – stiff neck, an early sign 2. Kernig’s sign – pain in the hamstring muscle when attempting to extend the leg when the hip is flexed. - The client is placed in supine position. Flex the knee, attempt to extend the leg. Pain is experienced. 3. Brudzinski’s sign – flexion at the hip and knee in response to forward flexion of the neck. - passively flexed the neck, spontaneous flexion of the hips occur. Diagnosis: 1. Lumbar puncture – increased ICP, elevated WBC, CHON and decreased glucose. Increase lymphocytes. 2. Blood culture – positive for specific microorganism

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Management: 1. Drugs and antibiotics 2. Provide nursing care for patient with increase ICP, seizures and hyperthermia – to decrease workload of the brain 3. Bed rest, keep room quiet and dark 4. Monitor fluid and electrolytes balance 5. Neurologic test 6. High protein, calorie, with small frequent feeding. 7. Respiratory isolation Prevention: -Proper disposal of secretions. Complications: 1. Pneumonia 2. Otitis media 3. Hydrocephalus

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ENCEPHALITIS (Brain Fever) -is an acute inflammatory condition of the brain as a complication of various infectious diseases causing manifestations of cerebral dysfunction. Classification: 1. Primary – virus attacks the brain directly *MOT: mosquito bites (Culex tarsalis, aedes sollicitas), infected goat’s milk 2. Secondary – occurs as a complication of communicable disease of viral origin such as measles, mumps, chicken pox, 3. Toxic – as a result of the action of metal poisoning such as lead and mercury.

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Clinical Manifestation: -Lethargy and alteration on the LOC -Fever, nuchal rigidity -Headache, convulsions -Fever chills and vomiting -Decorticate rigidity -Decerebrate rigidity -Signs of meningeal irritation Diagnosis: 1. Lumbar puncture – CSF studies 2. EEG 3. Blood culture – positive for specific microorganism Management: -Similar with Meningitis

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Poliomyelitis Also called as Polio or Infantile Paralysis Is an acute communicable disease caused by polio virus Ranges in severity from an inapparent infection to fatal paralytic illness May also develop in adults Adults and girls -greater risk of infection Boys -greater risk of paralysis once infected With mortality rate of 5-10% (strongly correlated with CNS involvement)

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Has distinct serotypes: Type I – Brunhilde Type II – Lansing Type III – Leon Mode of Transmission: -feco-oral route Incubation Period: -5 to 35 days (average of 7 to 14 days) Pathophysiology: Ingestion of the Virus Multiplication in the -oropharynx -lower GIT

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Spread (thru: lymph nodes and blood) Inapparent Abortive Major Infection Poliomyelitis Poliomyelitis (95% of cases) (4-8% of cases) a. non paralytic -slight fever b. paralytic -malaise -headache -sorethroat -inflamed pharynx -vomiting

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*Forms of Major Poliomyelitis 1. Non Paralytic Poliomyelitis >lasts about a week, meningeal irritation lasting about 2 weeks -moderate fever -irritability -headache -pain in the neck, back, arms, legs -vomiting abdomen -lethargy -muscle tenderness and spasms in the neck, back and hamstring (during ROM ex) 2. Paralytic Poliomyelitis >usually develops within 5-7 days of the onset of fever >with s/sx of non paralytic type

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>specific s/sx -asymmetrical weakness of various muscles -loss of superficial and deep reflexes -paresthesia -hypersensitivity to touch -urine retention -constipation -abdominal distention -tripod posture -Hoyne’s sign -inability to flex the hip joint to 90 degrees from a supine position -(+)Brudzinski’s sign, (+)Kernig’s sign

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Bulbar Paralytic Poliomyelitis -involvement of the medulla oblongata -is the most perilous type -fatal pulmonary edema and shock are possible Landry’s paralysis – rapid progressive flaccid paralysis starting in the legs, abdominal and back muscles, arms and neck and the respiratory. Complications: >due to immobility and respiratory muscle failure a. hypertension e. pneumonia b. UTI f. myocarditis c. urolithiasis g. cor pulmonale d. atelectasis h. paralytic ileus

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Diagnosis: 1. Culture from throat washings -early in the disease 2. Culture from the stools -throughout the disease 3. Culture from the CSF -in CNS involvement 4. Serum Antibody Titers -fourfold increase during convalescence 5. CSF Analysis -increased pressure and protein -increased WBC (primarily PMN- 80-90% of total)

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Treatment: 1. Symptomatic management: a. analgesics (except Morphine) b. moist heat -prevention of muscle spasms and pain 2. Supportive management: a. bed rest b. nutrition and hydration c. rehabilitation -physical therapy -braces -corrective shoes -surgery

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3. Prevention a. Salk and Sabin Vaccine Rabies Is an acute CNS infection caused by a ribonucleic acid (RNA) virus Usually transmitted by an animal bite 2 types: 1. Major Bite -animal bite from the umbilicus upward -bites on the head (60%) -bites on the upper extremities (15-40%)

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2. Minor Bite -animal bites from the umbilicus downward -bites on the lower extremity (10%) Animal reservoirs of rabies virus: a. dogs c. foxes b. skunks d. bats Almost always fatal Pathophysiology: Animal bite Inoculation of the rabies virus Viral replication @ the striated muscle (bitten area)

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spreads up the nerve CNS nerves salivary glands and other tissues *other modes of transmission: 1. droplet 2. transplantation of infected organs Incubation period: -3 to 8 weeks for rabid animals -10 days to 10 years for man

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Clinical Manifestation: a. for rabid animals >dumb form -complete change in disposition -animal becomes withdrawn -very affectionate and walking to and from. -paralysis and copious flow of saliva >furious form -vicious, agitated, then become paralyzed, emits excessive saliva and dies. b. for man >invasive stage -numbness on site of bite -restlessness -malaise -fever and photosensitivity

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-headache -apprehension >excitement stage -hydrophobia -spasm of laryngeal and pharyngeal muscle (sight, sound or thought of water will cause spasm of muscle.) -maniacal – climbing the wall and excessive salivation >paralytic stage -laryngospasm stopped -last for how many seconds or hours. -gradual flaccid paralysis that leads to peripheral vascular collapse, coma and death.

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Diagnosis: 1. Fluorescent rabies antibody -examination of blood -specimen: blood of individual 2. Brain biopsy of animal -viral inclusion “negri bodies” 3. 10 days observation of the animal Management: 1. provide a dim and quiet non stimulating room for the patient 2. wear gown, mask and goggles 3. always noises should be avoided no matter how minor 4. restraint the patient when needed

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5. stimulation of any senses by fluid must be avoided 6. anti rabies vaccine Prevention: -immunization of animals -keep away from stray animals First aid -immediately wash with soap and water at least for 10 minutes to remove saliva -don’t suture the wound allow blood flow -apply sterile dressing

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Dengue Hemorrhagic Fever (Breakbone or Dandy Fever) -an acute infectious disease characterized by severe pain behind the eyes, joints and bones, accompanied by initial erythema and terminal rash of varying morphology. Etiology : 1. Dengue virus type 1,2,3,4 2. Chikungunya 3. Onyong yong virus 4. West Nile 5. Flavivirus MOT : >Mosquito bites of the following: 1. Aedes Aegypti 2. Aedes albopticus 3. Culex fatigans

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Clinical Manifestation: 1. Stage I (last for 3 to 5 days) -anorexia -abdominal pain -bone and joint pain -petechiae -Herman’s Sign -pain behind the eyes (generalized flushing of -nausea and vomiting the skin) -headache 2. Stage 2 (grade I plus spontaneous bleeding) -melena -hematochezia -epistaxis -hematemesis 3. Stage 3 (grade II plus circulatory failure) -hypotension -cold clammy perspiration -restlessness -rapid, weak pulse

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4. Grade IV (grade III plus hypovolemic shock) Diagnosis: 1. Tourniquet test (Rumple Leede test) -crude test of vascular resistance and platelet number and function -done by placing blood pressure cuff on arm for 5 minutes and then counting the petechiae. 2. Hematocrit level -increased 3. Platelet count determination -decreased Management: 1. Provide a comfortable and quiet room

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2. Provide adequate rest 3. Ice pack to relieve constant headache 4. Protect the eyes from bright light 5. Boric acid or saline compresses to the eyes relieves soreness of the eyeball. 6. Good oral hygiene 7. Monitor intake and output 8. Prevent and control bleeding Preventive measures: -Screening -Good environmental sanitation -Eradicate source of infection

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HERPES ZOSTER ( Shingles, Zoster Acute Posterior Ganglionitis) Is an acute unilateral and segmental inflammation of the dorsal root of the ganglia. Found primarily in adults especially those older than age 50.

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With an acute localized vesicular eruption distributed over a dermatomal segment of the skin. Inhalation of Varicella Virus Viremia Eruption of vesicular lesions (Chicken pox) Varicella evades immune response Dormant Reactivation Vesicular lesions with dermatomal pattern of distribution (Herpes Zoster)

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Signs and symptoms: -fever -dermatomal manifestations -malaise (onset within 3-4 days) *severe deep pain- before the rash appears and scabs form *pruritus *paresthesia *hyperesthesia (up to 2 weeks after the first s/sx) *nodular, red lesions appear on the painful areas > later become vesicular with clear fluid or pus

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-involvement of the geniculate ganglion *vesicles in the external auditory canal *ipsilateral facial nerve palsy *hearing loss *dizziness *loss of taste -involvement of the trigeminal ganglion *eye pain *corneal and scleral damage *impaired vision -involvement of the oculomotor nerve *conjunctivitis *ptosis *extraocular weakness *paralytic mydriasis

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Complications: 1. Postherpetic neuralgia -most common in the elderly patients -intractable neuralgic pain -may persist for years 2. CNS infection 3. Muscle atrophy and motor paralysis Diagnosis: 1. Examination of the vesicular fluid and infected tissue -esinophilic intranuclear inclusions and varicella virus 2. Lumbar puncture -increased pressure -pleocytosis -increased protein levels

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3. Staining antibodies from vesicular fluid Management: 1. No specific treatment 2. The primary goal of symptomatic treatment is to relieve itching and neuralgic pain. *analgesics *Calamine lotion and aspirin possibly with codeine. *Tincture of benzoin to unerupted lesion *Antibiotics *Idoxuridine ointment – cornea *Steroid – for 50 y/o and above to decrease the incidence of POSTHERPETIC NEURALGIA (Triamcinolone subcutaneous) Acyclovir(zovirax), – prevents the spread of rashes and prevents visceral

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Herpes Simplex Recurrent viral infection affecting the skin and the mucous membranes caused by Herpes Virus Hominis Commonly produces cold sores and fever blisters 2 types: 1. HSV 1 -more commonly affects the oral mucous membranes -transmitted by oral and respiratory secretions 2. HSV 2 -more commonly affects the genital area -transmitted through sexual contact equally common in males and females

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*Primary Herpes Simplex Hominis Infection -is the leading cause of gingivo-stomatitis in children 1-3 years old -is the most common cause of non-epidemic encephalitis -second to the most common viral infection in women Adult Infection (subclinical) Carrier State Recurrent Infection (no constitutional s/sx)

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Neonatal Infection (1-2 weeks after birth) Localized Skin Lesions Disseminated Infection (liver, lungs and brain) Complications: *seizures *mental retardation *blindness *chorioretinitis *deafness *microcephaly *diabetes insipidus *spasticity

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Disseminated Infection: Infection (2-12 days) Onset of Generalized Infection (fever, pharyngitis, erythema and edema) Prodromal Tingling and Itching Eruption of the Primary Lesion (vesicles on an erythematous base) Rupture Painful Ulcer Formation of yellowish crust Healing (7-10 days—partial; 3 weeks---complete)

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Localized Infection contact with secretions infection genital herpes herpetic herpetic keratoconjunctivitis whitlow painful genital (unilateral) tingling sensation fluid filled -conjunctivitis -redness vesicles -reg adenopathy -swelling (fever, reg LAP, -blepharitis -pain dysuria) -vesicles on the lid -satellite vesicles ulceration -excessive lacrimation -fever healing -edema, pus -chills (1-3 weeks) -chemosis, photophobia -malaise -red streaks (arm)

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Diagnosis: 1. Viral Culture 2. Biopsy 3. Increased antibody titer and leukocytosis Treatment: 1. Symptomatic a. analgesic/anesthetic b. antipyretic 2. Antiviral agents a. Acyclovir b. Idoxuridine/Trifluridine c. Vidarabine

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MEASLES (Rubeola, Hard Measles, Little Red Disease., Morbilliform Rash, 7 Day Measles, Red Measles) Etiology: -Morbilli virus -filterable virus of measles -paramyxovirus Source of Infection: -respiratory secretion (nose and throat), blood and urine of infected persons Description : -it is one of the most common and most serious of all communicable childhood diseases. -use of vaccine has reduced the occurrence of measles during childhood, as a result measles is becoming more prevalent in adolescents and adults.

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MOT : -droplet or direct contact -indirectly through soiled articles -airborne Period of Communicability: -during the period of coryza or catarrhal symptoms – 9 days (from 4 days before and 5 days after rash appears) Prodromal stage Incubation Period: -10 days from exposure to appearance of fever about 14 days until rash appears. (8 – 20 days)

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Susceptibility, resistance and Occurrence : -All persons are susceptible. -Babies born of mothers who had disease before the baby is born are immune for the 1st month of life. -Permanent acquired immunity is usually after attack of measles. -Common in childhood. Pathophysiology: Inhalation of respiratory droplet

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-at the end of the prodromal stage >>KOPLIK’s Spots appear which is the hallmark sign of the disease. -Koplik’s spots > are like tiny, bluish gray specks surrounded by a red halo. They appear on the oral mucosa opposite the molar and occasionally bleed.

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Tetanus An acute exotoxin mediated infection caused by anaerobic, spore-forming, gram positive bacillus Clostridium tetani. Usually systemic; less often localized Fatal in 60% of unimmunized cases (within 10 days of onset) *the prognosis is poor if developed within 3 days from exposure Pathophysiology: punctured wound (deep hacking) local infection and tissue necrosis production of toxins

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bloodstream and lymphatics CNS Risk factors: 1. Agricultural regions 2. Developing countries that lack mass immunizations 3. Infants of unimmunized mothers delivered in an unsterile conditions Incubation Period: -3 to 4 days (mild tetanus) -less than 2 days (severe tetanus) > death is more likely

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Clinical Manifestations: 1. Localized s/sx -inflammation of the wound -muscle spasm and increased muscle tone near the wound 2. Generalized s/sx -marked muscle hypertonicity -hyperactive deep tendon reflexes -tachycardia -profuse sweating -low grade fever -painful involuntary muscle contractions -specific manifestations: >trismus and risus sardonicus

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>ophistotonus and board-like muscle rigidity >intermittent tonic convulsions (several minute duration) > cyanosis > asphyxiation > death *cerebral and sensory functions remain normal Complications: 1. Atelectasis 2. Pneumonia 3. Pulmonary Emboli 4. Acute Gastric Ulcers 5. Flexion Contractures 6. Cardiac Arrhythmias *Neonatal Tetanus -always generalized -difficulty in sucking 3-10 days after birth

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Diagnosis: 1. History 2. Wound culture -usually negative 3. Serologic Test -usually negative 4. CSF pressure -elevated Conditions that mimic Tetanus: 1. Meningitis 2. Rabies 3. Phenothiazine toxicity

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Treatment: 1. Tetanus Immune Globulin or Tetanus Antitoxin -should be administered within 72 hours 2. Tetanus Toxoid -every 5 to 10 years 3. Airway Maintenance and Muscle Relaxant Txt -Diazepam >to decrease muscle rigidity and spasm -if unresponsive, neuromuscular blocker should be given 4. Antibiotic Treatment -IV penicillin 5. Wound Debridement -use H2O2

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6. Monitor ECG for arrhythmias 7. Monitor I&O and V/S 8. Maintain less environmental stimuli 9. Prevent the development of pressure sores 10. Watch out for urinary retention -urinary catheterization 11. Adequate nutrition 12. Watch out for allergic reactions due to pharmacologic treatment -have Epinephrine on hand -prepare resuscitative equipments 13. Educate as to the importance of booster doses -every 10 years

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Meningococcal Infections 2 types: -caused by Neisseria meningitidis 1. meningitis 2. meningioma -other infections caused by N. meningitidis: 1. primary pneumonia 2. purulent conjunctivitis 3. endocarditis 4. sinusitis 5. genital infections Meningococcemia -occurs as simple bacteremia, fulminant meningococcemia and rarely, chronic meningococcemia

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-may occur sporadically or in epidemics -may be fatal in a matter of hours -risk factors: 1. age (6months to 1 year) 2. living in an overcrowded place (military recruits) -has at least 7 serotypes: A, B, C, D, X, Y, Z *serotype A as the most common cause of epidemics -mode of transmission: >respiratory droplet -incubation period: 3 – 4 days

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Inhalation of infected droplet Localization in the nasopharynx Spread to the joints, skin, lungs, central nervous system through the bloodstream Meningococcal bacteremia/Fulminant meningococcemia Hemorrhage, thrombosis and necrosis

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-signs and symptoms: >signs and symptoms of meningococcal bacteremia *sudden spiking fever *cough *headache *chills *tachycardia and tachypnea *myalgia *sorethroat *arthralgia *mild hypotension *petechial, nodular or maculopapular rash >signs and symptoms of fulminant meningococcemia *extreme prostration *enlargement of the skin lesions *DIC and shock

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-diagnosis: >positive blood and CSF culture >lesion scraping >counterimmunoelectrophoresis of the CSF or blood >dec WBC count with skin or adrenal hemorrhages, dec platelet and clotting levels -management: >prevention is the best *quadrivalent vaccine A/C/Y/W-135 (not a part of routine immunization – only for travelers to an endemic area) >prompt treatment of acute cases (results to death from respiratory or heart failure if not treated in 6 to 24 hours)

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>treatment of acute cases: 1. antibiotics *Pen G *Ampicillin *Cephalosporin (Cefoxitin) *Moxalactam *Chloramphenicol 2. osmotic diuretic (mannitol) 3. heparin 4. dopamine 5. digoxin 6. IVF

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7. proper ventilation 8. CVP 9. chemoprophylaxis

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Malaria An infectious disease caused by a protozoa of genus Plasmodium 1. Plasmodium falcifarum- causes the most severe form of malaria 2. Plasmodium malariae 3. Plasmodium ovale 4. Plasmodium vivax Rarely fatal when treated With period of relapses With universal susceptibility to the disease Transmitted by the bite of female anopheles mosquito

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bite of an infected female anopheles mosquito injection of Plasmodium sporozoites blood circulation invasion liver parenchymal cell invasion formation of merozoites release of merozoites erythrocyte invasion (feeds on hemoglobin) RBC ruptures release of more merozoites infection of a mosquito through a bite spread

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Signs and symptoms: -non specific signs and symptoms: *fever *headache *chills *myalgia -specific signs and symptoms in acute attacks: 1. cold stage -lasting 1-2 hours, ranging from chills to extreme shaking 2. hot stage -lasting 3-4 hours characterized by a high fever (u to 41.7 C 3. wet stage -lasting 2-4 hours, characterized by profuse sweating

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-paroxysms of acute attacks: *P. malariae - every 48 to 72 hours *P. vivax and ovale - every 42 to 50 hours *P. falcifarum 1. Persistently high fever 2. Orthostatic hypotension 3. RBC hemolysis >RBC sludging > capillary obstruction > ---> cerebral- hemiplegia, seizures, delirium ---> pulmonary- coughing, hemoptysis ---> splanchnic- vomiting, abdominal pain, diarrhea, melena ---> renal- oliguria, anuria, uremia

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BLACKWATER FEVER -a complication of P. falcifarum infection massive intravascular hemolysis -jaundice -hemoglobinuria -splenomegaly -acute renal failure -uremia Diagnosis of Malaria 1. peripheral blood smear -identification of the parasite in the RBC 2. Indirect Serum Antibody Test -to detect contaminated blood -unreliable (no antibody yet within the first 2 weeks)

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3. CBC -decreased hemoglobin levels -normal to decreased WBC count -decreased number of platelets 4. U/A -(+) protein -(+) WBC 5. Coagulation studies (suggests DIC) -prolonged pro time (18-20 seconds) -prolonged partial thromboplastin time (60-100 seconds) -decreased plasma firinogen

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Treatment: 1. Chloroquine -drug of choice except in P. falcifarum resistant strains -s/sx will decrease during the first 24 hours -recovery within the first 3-4 days -may be given IM (comatose and profusely vomiting) -A/R: *GI upset *headache *pruritus *visual disturbances 2. Quinine -to be used for 10 days -given with pyrimethamine and a sulfonamide (sulfadiazine) -to be followed with Tetracycline for relapses

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3. Primaquine -the only drug effective against the hepatic stage -given daily for 14 days -drawback: a. hemolytic anemia (especially if with G6PD def) Prevention: 1. Chloroquine (oral) -should be taken 2 weeks before and 6 weeks after traveling to an endemic area -for travelers planning to spend 3 weeks where malaria exists 2. Chloroquine + Sulfadoxine-Pyrimethamine -for susceptible individuals staying more than 3 weeks

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Gastrointestinal Infectious Diseases 1. Cholera Is an acute enterotoxin-mediated GI infection caused by gram negative, aerobic bacillus Vibrio cholerae Causes transient immunity Risks: 1. lower socio-economic group 2. poor hygiene 3. children 1-5 years of age 4. achlorhydria/hypochlorhydria Mode of transmission: Feco-oral route

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Incubation Period: Few hours to 5 days Pathophysiology: ingestion of contaminated food bacteria produce toxins toxin-mediated mucosal injury secretory diarrhea massive F&E losses -intense thirst -sunken eyes -loss of skin turgor -pinched facial expression -wrinkled skin -muscle cramps -cyanosis -tachycardia and tachypnea -oliguria & dec BP -thready or absent peripheral pulses

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Diagnosis: (should rule out E. coli infection, Shigellosis and Salmonellosis) 1. Bacterial Culture of feces and vomitus 2. Serologic Test- definitive diagnosis 3. Dark-Field Microscopy -visualization of rapidly moving bacilli (shooting stars) -for a quick tentative diagnosis Management: 1. Prevention a. environmental sanitation b. administration of cholera vaccine -confers only 60-80% immunity -effective only for the first 3-6 months

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2. Intravenous Fluid Therapy -50 to 100ml/min -isotonic saline solution alternating with isotonic sodium lactate or bicarbonate 3. Potassium replacement 4. Antibiotic therapy a. Tetracycline (Doxycycline) -for severe cases -not documented to shorten the course of infection 5. Oral glucose-electrolyte solution 6. Enteric precaution 7. Monitor I & O, s/sx of fluid overload 8. Prophylaxis -oral tetracycline

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-avoid eating raw vegetables and unpeeled fruits -boil all drinking water for 30 minutes -cholera vaccine (booster dose after 3-6 months) Amebiasis Also known as amebic dysentery Is an acute or chronic protozoal infection caused by Entamoeba histolytica May have no symptoms at all or mild diarrhea to fulminant dysentery Risk factors: 1. Gays and lesbians 2. Poor sanitation and health practices 3. Malnutrition

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2 forms of E. histolytica: 1. Cyst form -exists in the environment 2. Trophozoite form -exists in the body Pathophysiology: ingestion of cysts from a fecally contaminated food and/or water stomach gastric secretions break the cysts release of trophozoites

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mutiplication of trophozoites invasion/ulceration of the large intestinal mucosa some will be transported towards the rectum E. Histolytica encysted again passage through feces spread Manifestations: 1. Acute Amebic Dysentery -sudden high temperature (40-40.6C) -chills -abdominal cramping

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-profuse, bloody, mucoid diarrhea -tenesmus -diffuse abdominal tenderness (due to the presence of ulcers- rectosigmoid) 2. Chronic Amebic Dysentery -intermittent diarrhea that lasts 1-4 weeks -recurs several times a year -with 4-8 foul-smelling mucus and blood tinged stools/day -with mild fever -vague abdominal cramps -possible weight loss, tenderness (cecum and ascending colon) -hepatomegaly

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Complications: 1. Ameboma 2. Intestinal Stricture 3. Hemorrhage or perforation 4. Intussusception 5.Abscess 6. Subacute Appendicitis 7. Liver > Diaphram > Lungs > Pleural Cavity > Brain Diagnosis: 1. Isolation of E. histolytica -from the feces, aspirates from abscesses, ulcers 2. X-Ray, Sigmoidoscopy, Stool Exam, Cecum Palpation -differentiation of cancer from ameboma

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3. Serologic tests a. Indirect Hemagglutinaton test -positive with current of previous infection b. complement fixation -positive only in current infection 4. Barium Studies -rule out polyps or cancer 5. Biopsy -definitive test *no preparatory enemas -will interfere with the accuracy of the results

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Conditions that mimic amebiasis: 1. Shigellosis 2. Campylobacter infection 3. Pseudomembranous colitis 4. Salmonellosis 5. Yersinia infection 6. Ulcerative colitis 7. Crohn’s disease 8. Ischemic colitis 9. Pyrogenic Liver Abscess Treatment: 1. Metronidazole -for intestinal and extraintestinal sites

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2. Iodoquinol 3. Diloxanide 4. Paromomycin

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