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I. EPI DISEASES

|DISEASE |CAUSATIVE AGENT |MODE OF TRANSMISSION |PATHOGNOMONIC SIGN |MANAGEMENT/TREATMENT |PREVENTION |

|1. Tuberculosis |Mycobacterium tuberculosis |Airborne-droplet |Usually asymptomatic |Diagnostic test: |Respiratory precautions |

| | | |Low-grade afternoon fever |Sputum examination or the Acid-fast bacilli (AFB) / sputum microscopy |Cover the mouth and nose when sneezing |

|Other names: |TB bacillus |Direct invasion through mucous|Night sweating |Confirmatory test |to avoid mode of transmission |

|Koch’s Disease |Koch’s bacillus |membranes and breaks in the |Loss of appetite |Early morning sputum about 3-5 cc |Give BCG |

|Consumption |Mycobacterium bovis |skin (very rare) |Weight loss |Maintain NPO before collecting sputum |Improve social conditions |

|Phthisis | | |Easy fatigability – due to increased |Give oral care after the procedure | |

|Weak lungs |(rod-shaped) |Incubation period : |oxygen demand |Label and immediately send to laboratory | |

| | |4 – 6 weeks |Temporary amenorrhea |If unknown when was the sputum collected, discard | |

| | | |Productive dry cough |Chest X-ray is used to: | |

| | | |Hemoptysis |Determine the clinical activity of TB, whether it is inactive (in | |

| | | | |control) or active (ongoing) | |

| | | | |To determine the size of the lesion: | |

| | | | |Minimal – very small | |

| | | | |Moderately advance – lesion is < 4 cm | |

| | | | |Far advance – lesion is > 4 cm | |

| | | | |Tuberculin Test – purpose is to determine the history of exposure to | |

| | | | |tuberculosis | |

| | | | |Other names: | |

| | | | |Mantoux Test – used for single screening, result interpreted after 72 | |

| | | | |hours | |

| | | | |Tine test – used for mass screening read after 48 hours | |

| | | | |Interpretation: | |

| | | | |0 - 4 mm induration – not significant | |

| | | | |5 mm or more – significant in individuals who are considered at risk; | |

| | | | |positive for patients who are HIV-positive or have HIV risk factors and | |

| | | | |are of unknown HIV status, those who are close contacts with an active | |

| | | | |case, and those who have chest x-ray results consistent with | |

| | | | |tuberculosis. | |

| | | | |10 mm or greater – significant in individuals who have normal or mildly | |

| | | | |impaired immunity | |

|National TB Control Program: |s |

|Vision: A country where TB is no longer a public health problem | |

|Mission: Ensure that TB DOTS Services are available, accessible, and affordable to the | |

|communities in collaboration with LGUs and others | |

|Goal: To reduce prevalence and mortality from TB by half by the year 2015 (Millennium Development| |

|Goal) | |

|Targets: 1. Cure at least 85% of the sputum smear (+) patients discovered | |

|2. Detect at least 70% new sputum smear (+) TB cases | |

|Objectives: 1. Improve access to and quality of services | |

|2. Enhance stakeholder’s health-seeking behavior | |

|3. Increase and sustain support for TB control activities | |

|4. Strengthen management of TB control activities at all levels | |

|KEY POLICIES: | |

|*Case finding: | |

|- DSSM shall be the primary diagnostic tool in NTP case finding | |

|- No TB Dx shall be made based on CXR results alone | |

|- All TB symptomatic shall be asked to undergo DSSM before treatment | |

|- Only contraindication for sputum collection is hemoptysis | |

|- PTB symptomatic shall be asked to undergo other tests (CXR and culture), only after three | |

|sputum specimens yield negative results in DSSM | |

|- Only trained med techs / microscopists shall perform DSSM | |

|- Passive case finding shall be implemented in all health stations | |

| | |

|*Treatment: Domiciliary treatment – preferred mode of care | |

|DSSM – basis for treatment of all TB cases | |

|*Hospitalization is recommended: massive hemoptysis, pleural effusion, military TB, TB | |

|meningitis, TB pneumonia, & surgery is needed or with complications | |

|*All patients undergoing treatment shall be supervised | |

|*National & LGUs shall ensure provision of drugs to all smear (+) TB cases | |

|*Quality of fixed-dose combination (FDC) must be ensured | |

|*Treatment shall be based on recommended category of treatment regimen | |

| | |

|DOTS Strategy – internationally-recommended TB control strategy | |

|Five Elements of DOTS: (RUSAS) | |

|Recording & reporting system enabling outcome assessment of all patients | |

|Uninterrupted supply of quality-assured drugs | |

|Standardized SCC for all TB cases | |

|Access to quality-assured sputum microscopy | |

|Sustained political commitment | |

|2. Diphtheria |Corynebacterium diphtheria |Droplet especially secretions |Pseudomembrane – mycelia of the oral |Diagnostic test: |DPT immunization |

| | |from mucous membranes of the |mucosa causing formation of white | |Pasteurization of milk |

|Types: |Klebbs-loffler |nose and nasopharynx and from |membrane on the oropharynx |Nose/throat swab |Education of parents |

|> nasal | |skin and other lesions | |Moloney’s test – a test for hypersensitivity to diphtheria toxin | |

|> pharyngeal – most common | | |Bull neck |Schick’s test – determines susceptibility to bacteria | |

|> laryngeal – most fatal | |Milk has served as a vehicle |Dysphagia | | |

|due to proximity to | | |Dyspnea |Drug-of-Choice: | |

|epiglottis | |Incubation Period: | |Erythromycin 20,000 - 100,000 units IM once only | |

| | |2 – 5 days | | | |

| | | | |Complication: MYOCARDITIS (Encourage bed rest) | |

|3. Pertussis |Bordetella pertussis |Droplet especially from |Catarrhal period: 7 days paroxysmal |Diagnostic: |DPT immunization |

| |Hemophilus pertussis |laryngeal and bronchial |cough followed by continuous nonstop | |Booster: 2 years and 4-5 years |

|Whooping cough |Bordet-gengou bacillus |secretions |accompanied by vomiting |Bordet-gengou agar test |Patient should be segregated until |

|Tusperina |Pertussis bacillus | | | |after 3 weeks from the appearance of |

|No day cough | |Incubation Period: 7 – 10 days|Complication: abdominal hernia |Management: |paroxysmal cough |

| | |but not exceeding 21 days | |DOC: Erythromycin or Penicillin 20,000 - 100,000 units | |

| | | | |Complete bed rest | |

| | |(because if more than 21 days,| |Avoid pollutants | |

| | |the cough can be related to TB| |Abdominal binder to prevent abdominal hernia | |

| | |or lung cancer) | | | |

| | | | | | |

|4. Tetanus |Clostridium tetani – anaerobic |Indirect contact – inanimate |Risus sardonicus (Latin: “devil |No specific test, only a history of punctured wound |DPT immunization |

| |spore-forming heat-resistant and lives|objects, soil, street dust, |smile”) – facial spasm; sardonic grin | | |

|Other names: |in soil or intestine |animal and human feces, | |Treatment: |Tetanus toxoid immunization among |

|Lock jaw | |punctured wound |Opisthotonus – arching of back |Antitoxin |pregnant women |

| | | | |antitetanus serum (ATS) | |

| |Neonate: umbilical cord | |For newborn: |tetanus immunoglobulin (TIG) |Licensing of midwives |

| |Children: dental caries | |Difficulty of sucking |Pen G | |

| |Adult: punctured wound; after septic |Incubation Period: |Excessive crying |Diazepam – for muscle spasms |Health education of mothers |

| |abortion |Varies from 3 days to 1 month,|Stiffness of jaw | | |

| | |falling between 7 – 14 days |Body malaise |Note: The nurse can give fluid provided that the patient is able to | |

| | | | |swallow. There is risk of aspiration. Check first for the gag reflex | |

|5. Poliomyelitis |Legio debilitans |Fecal – oral route |Paralysis |Diagnostic test: |OPV vaccination |

| |Polio virus | |Muscular weakness | |Frequent hand washing |

|Other name: |Enterovirus |Incubation period: 7 – 21 days|Uncoordinated body movement |CSF analysis / lumbar tap | |

|Infantile paralysis | | |Hoyne’s sign – head lag after 4 months|Pandy’s test | |

| |Attacks the anterior horn of the | | | | |

| |neuron, motor is affected | |(!Safety) |Management: | |

| |Man is the only reservoir | | |Rehabilitation involves ROM exercises | |

|6. Measles |RNA containing paramyxovirus |Droplet secretions from nose |1. Koplik’s spots – whitish/bluish |No specific diagnostic test |Measles vaccine |

| | |and throat |pinpoint patches on the buccal cavity | |Disinfection of soiled articles |

|Other names: | | |2. cephalocaudal appearance of |Management: |Isolation of cased from diagnosis until|

|Morbilli | |Incubation period: 10 days – |maculopapular rashes |Supportive and symptomatic |about 5-7 days after onset of rash |

|Rubeola | |fever |3. Stimson’s line – bilateral red line| | |

| | |14 days – rashes appear |on the lower conjunctiva | | |

| | | | | | |

| | |Period of Communicability: | | | |

| | |4 days before and 5 days after| | | |

| | |the appearance of rash | | | |

|7. Hepatitis B |Hepatitis B virus |Blood and body fluids |Right-sided Abdominal pain |Diagnostic test: |-Hepatitis B immunization |

| | |Placenta |Jaundice | |-Wear protected clothing |

|Other names: | | |Yellow-colored sclera |Hepatitis B surface agglutination (HBSAg) test |-Hand washing |

|Serum Hepatitis | |Incubation period: |Anorexia | |-Observe safe-sex |

| | |45 – 100 days |Nausea and vomiting |Management: |-Sterilize instruments used in minor |

| | | |Joint and Muscle pain |> Hepatitis B Immunoglobulin |surgical-dental procedures |

| | | |Steatorrhea | |-Screening of blood products for |

| | | |Dark-colored urine |Diet: high in carbohydrates |transfusion |

| | | |Low grade fever | | |

Hepatitis A – infectious hepatitis; oral-fecal

Hepatitis B – serum hepatitis; blood and body fluids

Hepatitis C – non-A non-B, post-transfusion hepatitis; blood and body fluids

Hepatitis D – Delta hepatitis or dormant hepatitis; blood and body fluids; needs past history of infection to Hepatitis B

Hepatitis E – oral-fecal

II. DISEASES TRANSMITTED THROUGH FOOD AND WATER

|DISEASE |CAUSATIVE AGENT |MODE OF TRANSMISSION |PATHOGNOMONIC SIGN |MANAGEMENT/TREATMENT |PREVENTION |

|1. Cholera |Vibrio cholera |Fecal-oral route |Rice watery stool |Diagnostic Test: |Proper handwashing |

| |Vibrio coma | | |Stool culture |Proper food and water sanitation |

|Other names: |Ogawa and Inaba bacteria |5 Fs |Period of Communicability: | |Immunization of Chole-vac |

|El tor | | |7-14 days after onset, occasionally |Treatment: | |

| | |Incubation Period: |2-3 months |Oral rehydration solution (ORESOL) | |

| | |Few hours to 5 days; usually 3| |IVF | |

| | |days | |Drug-of-Choice: tetracycline (use straw; can cause staining of teeth) | |

|2. Amoebic Dysentery |Entamoeba histolytica |Fecal-oral route |Abdominal cramping |Treatment: |Proper handwashing |

| | | |Bloody mucoid stool | |Proper food and water sanitation |

| |Protozoan (slipper-shaped body) | |Tenesmus - feeling of incomplete |Metronidazole (Flagyl) | |

| | | |defecation (Wikipedia) |* Avoid alcohol because of its Antabuse effect can cause vomiting | |

|3. Shigellosis |Shigella bacillus |Fecal-oral route |Abdominal cramping |Drug-of-Choice: Co-trimoxazole |Proper handwashing |

| | | |Bloody mucoid stool | |Proper food and water sanitation |

|Other names: |Sh-dysenterae – most infectious |5 Fs: Finger, Foods, |Tenesmus - feeling of incomplete |Diet: Low fiber, plenty of fluids, easily digestible foods |Fly control |

|Bacillary dysentery |Sh-flesneri – common in the |Feces, Flies, Fomites |defecation (Wikipedia) | | |

| |Philippines | | | | |

| |Sh-connei |Incubation Period: | | | |

| |Sh-boydii |1 day, usually less than 4 | | | |

| | |days | | | |

|4. Typhoid fever |Salmonella typhosa (plural, typhi) |Fecal-oral route |Rose Spots in the abdomen – due to |Diagnostic Test: |Proper handwashing |

| | | |bleeding caused by perforation of the |Typhi dot – confirmatory test; specimen is feces |Proper food and water sanitation |

| | |5 Fs |Peyer’s patches |Widal’s test – agglutination of the patient’s serum | |

| | | | | | |

| | |Incubation Period: |Ladderlike fever |Drug-of-Choice: Chloramphenicol | |

| | |Usual range 1 to 3 weeks, | | | |

| | |average 2 weeks | | | |

|5. Hepatitis A |Hepatitis A Virus |Fecal-oral route |Fever |Prophylaxis: “IM” injection of gamma globulin |Proper handwashing |

| | | |Headache |Hepatitis A vaccine |Proper food and water sanitation |

|Other names: | |5 Fs |Jaundice |Hepatitis immunoglobulin |Proper disposal of urine and feces |

|Infectious Hepatitis / | | |Clay-colored stool | |Separate and proper cleaning of |

|Epidemic Hepatitis / | |Incubation Period: |Lymphadenopathy |Complete bed rest – to decrease metabolic needs of liver |articles used by patient |

|Catarrhal Jaundice | |15-50 days, depending on dose,|Anorexia |Low-fat diet; increase carbohydrates (high in sugar) | |

| | |average 20-30 days | | | |

|6. Paralytic Shellfish |Dinoflagellates |Ingestion of raw of |Numbness of face especially around the|Treatment: |Avoid eating shellfish such as tahong, |

|Poisoning (PSP I Red tide | |inadequately cooked seafood |mouth |No definite treatment |talaba, halaan, kabiya, abaniko during |

|poisoning) |Phytoplankton |usually bivalve mollusks |Vomiting and dizziness |Induce vomiting |red tide season |

| | |during red tide season |Headache |Drink pure coconut milk – weakens the toxic effect |Don’t mix vinegar to shellfish it will |

| | | |Tingling sensation/paresthesia and |Sodium bicarbonate solution (25 grams in ½ glass of water) |increase toxic effect 15 times greater |

| | |Incubation Period: |eventful paralysis of hands |Advised only in the early stage of illness because paralysis can lead to| |

| | |30 minutes to several hours |Floating sensation and weakness |aspiration | |

| | |after ingestion |Rapid pulse |NOTE: Persons who survived the first 12 hours after ingestion have a | |

| | | |Dysphonia |greater chance of survival. | |

| | | |Dysphagia | | |

| | | |Total muscle paralysis leading to | | |

| | | |respiratory arrest and death | | |

ROBERT C. REÑA, BSN

III. SEXUALLY TRANSMITTED DISEASES

|DISEASE |CAUSATIVE AGENT |MODE OF TRANSMISSION |PATHOGNOMONIC SIGN |MANAGEMENT/TREATMENT |PREVENTION |

|1. Syphilis |Treponema pallidum |Direct contact |Primary stage: painless chancre at |Diagnostic test: |Abstinence |

| |(a spirochete) |Transplacental |site of entry |Dark field illumination test |Be faithful |

|Other names: | | |Buboes |Fluorescent treponemal antibody absorption test – most reliable and |Condom |

|Sy | |Incubation Period: |Condylomata |sensitive diagnostic test for Syphilis | |

|Bad Blood | |10 days to 3 months (average |Gumma |VDRL slide test, CSF analysis, Kalm test, | |

|The pox | |of 21 days) | |Wasseman test | |

|Lues venereal | | | | | |

|Morbus gallicus | | | |Treatment: | |

| | | | |Drug of Choice: Penicillin (Tetracycline if resistant to Penicillin) | |

|2. Gonorrhea |Neiserria gonorrheae |Direct contact – genitals, |Thick purulent yellowish discharge |Diagnostic test: |Abstinence |

| | |anus, mouth |Burning sensation upon urination / |Culture of urethral and cervical smear |Be faithful |

|Other names: | | |dysuria |Gram staining |Condom |

|GC, Clap, Drip, | |Incubation Period: | | | |

|Stain, Gleet, | |2 – 10 days | |Treatment: | |

|Flores Blancas | | | |Drug of Choice: Penicillin | |

|3. Trichomoniasis |Trichomonas vaginalis |Direct contact |Females: |Diagnostic Test: |Abstinence |

| | | |white or greenish-yellow odorous |Culture |Be faithful |

|Other names: | |Incubation Period: |discharge | |Condom |

|Vaginitis | |4 – 20 days; average of 7 days|vaginal itching and soreness |Treatment: | |

|Trich | | |painful urination |Drug of Choice: Metronidazole (Flagyl) |Personal Hygiene |

| | | |Males: | | |

| | | |Slight itching of penis | | |

| | | |Painful urination | | |

| | | |Clear discharge from penis | | |

|4. Chlamydia |Chlamydia trachomatis |Direct contact |Females: |Diagnostic Test: |Abstinence |

| |(a rickettsia) | |Asymptomatic |Culture |Be faithful |

| | |Incubation Period: |Dyspareunia | |Condom |

| | |2 to 3 weeks for males; |Fishy vaginal discharge |Treatment: | |

| | |usually no symptoms for | |Drug of Choice: Tetracycline | |

| | |females |Males: | | |

| | | |Burning sensation during urination | | |

| | | |Burning and itching of urethral | | |

| | | |opening (urethritis) | | |

|5. Candidiasis |Candida albicans |Direct contact |White, cheese-like vaginal discharges |Diagnostic Test: |Abstinence |

| | | |Curd like secretions |Culture |Be faithful |

|Other names: | | | |Gram staining |Condom |

|Moniliasis | | | | | |

|Candidosis | | | |Treatment: | |

| | | | |Nystatin for oral thrush | |

| | | | |Cotrimazole, fluconazole for mucous membrane and vaginal infection | |

| | | | |Fluconazole or amphotericin for systemic infection | |

|6. Acquired immune |Retrovirus (Human T-cell |Direct contact |1. Window Phase |Diagnostic tests: |Abstinence |

|deficiency syndrome (AIDS) |lymphotrophic virus 3 or HTLV 3) |Blood and body fluids |a. initial infection |Enzyme-Linked Immuno-Sorbent Assay (ELISA) |Be faithful |

| | |Transplacental |b. lasts 4 weeks to 6 months |presumptive test |Condom |

| |Attacks the T4 cells: T-helper cells; | |c. not observed by present laboratory |Western Blot – confirmatory | |

| |T-lymphocytes, and CD4 lymphocytes |Incubation period: |test (test should be repeated after 6 | |Sterilize needles, syringes, and |

| | |3-6 months to 8-10 years |months) |Treatment: |instruments used for cutting operations|

| | | | |Treatment of opportunistic infection | |

| | |Variable. Although the time |2. Acute Primary HIV Infection |Nutritional rehabilitation |Proper screening of blood donors |

| | |from infection to the |a. short, symptomatic period |AZT (Zidovudine) – retards the replication of retrovirus | |

| | |development of detectable |b. flu-like symptoms |PK 1614 - mutagen |Rigid examination of blood and other |

| | |antibodies is generally 1-3 |c. ideal time to undergo screening | |blood products |

| | |months, the time from HIV |test (ELISA) | | |

| | |infection to diagnosis of AIDS| | |Avoid oral, anal contact and swallowing|

| | |has an observed range of less |3. Asymptomatic HIV Infection | |of semen |

| | |than 1 year to 15 years or |a. with antibodies against HIV but not| | |

| | |longer. |protective | |Avoid promiscuous sexual contact |

| | |(PHN Book) |b. lasts for 1-20 years depending upon| | |

| | | |factors | |HIV/AIDS Prevention and Control |

| | | | | |Program: |

| | | |4. ARC (AIDS Related Complex) | | |

| | | |a. a group of symptoms indicating the | |Goal: Contain the transmission of HIV |

| | | |disease is likely to progress to AIDS | |/AIDS and other reproductive tract |

| | | |b. fever of unknown origin | |infections and mitigate their impact |

| | | |c. night sweats | | |

| | | |d. chronic intermittent diarrhea | | |

| | | |e. lymphadenopathy | | |

| | | |f. 10% body weight loss | | |

| | | | | | |

| | | |5. AIDS | | |

| | | |a. manifestation of severe | | |

| | | |immunosuppression | | |

| | | |b. CD4 Count: 38 0C) | |(N95 mask) |

| | | |Chills |PREVENTIVE MEASURES and CONTROL | |

|Earliest case: Guangdong | |Incubation Period: |Malaise |Establishment of triage |Handwashing |

|Province, China in November | |2 – 10 days |Myalgia |Identification of patient | |

|2002 | | |Headache |Isolation of suspected probable case |Universal Precaution |

| | | |Infectivity is none to low |Tracing and monitoring of close contact |The patient wears mask |

|Global outbreak: March 12, 2003| | | |Barrier nursing technique for suspected and probable case |Isolation |

| | | |Respiratory Phase: | | |

|First case in the Philippines: | | |Within 2-7 days, dry nonproductive | | |

|April 11, 2003 | | |cough progressing to respiratory | | |

| | | |distress | | |

|3. Bird Flu |Influenza Virus H5N1 |Contact with infected birds |Fever |Control in birds: |Isolation technique |

| | | |Body weakness and body malaise |1. Rapid destruction (culling or stamping out of all infected or |Vaccination |

|Other Name: | |Incubation Period: |Cough |exposed birds) proper disposal of carcasses and quarantining and |Proper cooking of poultry |

|Avian Flu | |3 days, ranges from 2 – 4 days |Sore throat |rigorous disinfection of farms | |

| | | |Dyspnea |2. Restriction of movement of live poultry | |

| | | |Sore eyes | | |

| | | | |In humans: | |

| | | | |1. Influenza vaccination | |

| | | | |2. Avoid contact with poultry animals or migratory birds | |

|4. Influenza A (H1N1) |Influenza Virus A H1N1 |Exposure to droplets from the cough|- similar to the symptoms of regular |Diagnostic: |- Cover your nose and mouth when |

| | |and sneeze of the infected person |flu such as |Nasopharyngeal (throat) swab |coughing and sneezing |

|Other Name: |This new virus was first detected| |Fever |Immunofluorescent antibody testing – to distinguish influenza A and B |- Always wash hands with soap and |

|Swine Flu |in people in April 2009 in the |Influenza A (H1N1) is not |Headache | |water |

| |United States. |transmitted by eating thoroughly |Fatigue | |- Use alcohol- based hand sanitizers |

|May 21, 2009 – first confirmed | |cooked pork. |Lack of appetite |Treatment: |- Avoid close contact with sick people|

|case in the Philippines |Influenza A (H1N1) is fatal to | |Runny nose |Antiviral medications may reduce the severity and duration of symptoms|- Increase your body's resistance |

| |humans |The virus is killed by cooking |Sore throat |in some cases: |- Have at least 8 hours of sleep |

|June 11, 2009 - The WHO raises | |temperatures of 160 F/70 C. |Cough  |Oseltamivir (Tamiflu) |- Be physically active |

|its Pandemic Alert Level to | | |- Vomiting or nausea |or zanamivir |- Manage your stress |

|Phase 6, citing significant | |Incubation Period: |- Diarrhea  | |- Drink plenty of fluids |

|transmission of the virus. | |7 to 10 days | | |- Eat nutritious food  |

ROBERT C. REÑA, BSN

-----------------------

CATEGORY 1: 6 months SCC

Indications:

> new (+) smear

> (-) smear PTB with extensive parenchymal lesions on CXR

> Extrapulmonary TB

> severe concominant HIV disease

Intensive Phase: 2 months

R&I : 1 tab each; P&E 2 tabs each

Continuation Phase: 4 months

R&I : 1 tab each

TREATMENT: SCC/Short Course Chemotherapy, Direct –observed treatment short course/DOTS; Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), Streptomycin (S)

CATEGORY 2: 8 months SCC

Indications:

> treatment failure

> relapse

> return after default

Intensive Phase:3 mos

R&I 1 tab each; P&E 2 tabs each

Streptomycin – 1 vial/day IM for first 2 months = 56 vials (if given for > 2mos can cause nephrotoxicity

Continuation Phase: 5 months

R&I : 1 tab each

E : 2 tabs

CATEGORY 3: 6 months SCC

Indications:

> new (-) smear PTB with minimal lesions on CXR

Same meds with Category 1

Intensive Phase: 2 months

R&I 1 tab each; P&E 2 tabs each

Continuation Phase: 4 months

R&I 1 tab each

CATEGORY 4: Chronic (*Referral needed)

SIDE EFFECTS:

Rifampicin

• body fluid discoloration

• hepatotoxic

• permanent discoloration of contact lenses

Isoniazid

• Peripheral neuropathy

(Give Vit B6/Pyridoxine)

Pyrazinamide

• hyperuricemia /gouty arthritis (increase fluid intake)

SIDE EFFECTS:

Ethambutol

• Optic neuritis

• Blurring of vision

(Not to be givento children below 5 y.o. due to inability to complain blurring of vision)

• Inability to recognize green from blue

Streptomycin

• Damage to 8th CN

• Ototoxic

• Tinnitus

• nephrotoxic

MANAGEMENT OF CHILDREN WITH TUBERCULOSIS

Prevention: BCG immunization to all infants (EPI)

Casefinding:

- cases of TB in children are reported and identified in 2 instances: (a) patient was screened and was found symptomatic of TB after consultaion (b) patient was reported to have been exposed to an adult TB patient

- ALL TB symptomatic children 0-9 y.o, EXCEPT sputum positive child shall be subjected to Tuberculin testing (Note: Only a trained PHN or main health center midwife shall do tuberculin testing and reading which shall be conducted once a week either on a Monday or Tuesday. Ten children shall be gathered for testing to avoid wastage.

- Criteria to be TB symptomatic (any three of the following:)

* cough/wheezing of 2 weeks or more

* unexplained fever of 2 weeks or more

* loss of appetite/loss of weight/failure to gain weight/weight faltering

* failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract infection

* failure to regain previous state of health 2 weeks after a viral infection or exanthem (e.g. measles)

-Conditions confirming TB diagnosis (any 3 of the following:)

* (+) history of exposure to an adult/adolescent TB case

* (+) signs and symptoms suggestive of TB

* (+) tuberculin test

* abnormal CXR suggestive of TB

* Lab findings suggestive or indicative of TB

- for children with exposure to TB

* a child w/ exposure to a TB registered adult patient shall undergo physical exam and tuberculin testing

* a child with productive cough shall be referred for sputum exam, for (+) sputum smear child, start treatment immediately

* TB asymptomatic but (+) tuberculin test and TB symptomatic but (-) tuberculin test shall be referred for CXR examination

Most hazardous period for development of clinical disease is the first 6-12 months after infection

Highest risk of developing disease is children under 3years old

- for TB symptomatic children

*a TB symptomatic child with either known or unknown exposure to a TB case shall be referred for tuberculin testing

* (+) contact but (-) tuberculin test and unknown contact but (+) tuberculin test shall be referred for CXR examination

*(-) CXR, repeat tuberculin test after 3 months

* INH chemoprophylaxis for three months shall be given to children less than 5y.o. with (-) CXR; after which tuberculin test shall be repeated

Treatment (Child with TB):

Short course regimen

PULMONARY TB

Intensive: 3 anti-TB drugs (R.I.P.) for 2 months

Continuation: 2 anti-TB drugs (R&I) for 4 months

EXTRA-PULMONARY TB

Intensive: 4 anti-TB drugs (RIP&E/S) for 2 months

Continuation: 2 anti-TB drugs (R&I) for 10 months

Incidence: highest under 7 years of age

Mortality: highest among infants ( ................
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