Chain of Infection

Element in

Explanation

Common examples

the cycle of
infection
1. Infectious
Agent

When germs enter the

body, they can cause
illness

Bacteria, virus, fungi, protozoa

2. Reservoir

Where germs normally

live and multiply

Humans

3. Portal of
Exit

4.
Transmission

5. Portal of
Entry

How germs leave the

body

Insects, animals, soil

Respiratory tract

Intestinal tract

Urinary/genitourinary tract

Open wounds

Blood and body fluids

How germs are spread

* Refer to next page for

a detailed explanation of
how infections spread.

How germs enter the

body

Contaminated food, water, toys,

sports equipment

Direct physical contact

Respiratory droplet
Stool (fecal-oral route)

Contact with blood/body fluids

Indirect contact

Needle stick injury

Ingestion of contaminated food

and water

Contaminated dust particles

Contaminated objects

Insects/animals

Respiratory tract

Intestinal tract

Urinary/genitourinary tract

6.
Susceptible
Host

A person who gets an

infection because he/she

is unable to successfully
fight the infection

Open wounds
Mucus membrane, e.g. eye,
mouth
Infants, elderly and debilitated.
Persons who are ill.
Children who are not fully
immunized or have underdeveloped
immune systems.

Persons taking certain drugs that

lower their defenses against germs.

Persons with underlying disease

conditions that lower their defense
against other germs.

Dengue Fever: The Silent killer.

The rainy season is coming and with it comes the dengue fever. Dengue Fever
(DF) is a viral infectious disease transmitted by mosquitoe (AEDES) bite. The
virus attack blood cell, liver, and spleen and leads to low white blood cell and
decreases platelets (Blood Clotting component). The high temperature due to the
general inflammation causes dehydration together with serum leak into body
cavities such as intra-abdominal and Chest cavity results in blood thickening
(haemoconcentration). Too many red cells and low fluid in blood circulation
(Hypovolemia) lead to low blood pressure and low blood supply to body tissue
and cause damage to vital organs such as kidney, liver, heart and eventually the
brain. In severe case, with very low platelets, patients could have spontaneous
bleeding in body cavities such as pleural cavity and the worst case is intracerebral hemorrhage.
The symptoms are high fever with headache, body ache, fatigue, loss of appetite,
abdominal pain especially right lower rib cage with nausea and vomiting
occasionally with dry cough and slightly sore throat. The nature course of the
disease is about 3-9 days and can be self limited in healthy individuals who have
been rehydrated sufficiently. There are 3 phases of the disease.
Stage I:Acute fever stage.(~Day 1-5). At this phase the patients have high fever
(39-40 degree Celsius) with aching, abdominal pain, nausea, vomiting. Anti-pyritic
such as paracetamol is important to lower body temperature in order to provide
the body minimizes fluid loss. REHYDRATION by food and electrolyte fluid, will
replace the fluid in the circulation for the patients. If the patient, especially
children do not eat/drink enough and look weak, seek medical attention urgently.
Stage II:Critical stage.(~Day 5-7), at this stage when the body temperature drops,
normally within 24 hours, the plasma (Fluid part of blood component) leaks and
the blood pressure will drop. Patients will be restless, weak, have cold clammy
skin, fast pulse, in severe case with very low platelets they could vomit up blood,
have internal hemorrhage and die with circulatory failure or respiratory failure
due to internal bleeding/ fluid retention. It is very important to provide appropriate
intravenous fluid to the patients in this stage to prevent poor blood perfusion to
the vital organ and not to overload the fluid in term of third space leakage
prevention.
Stage III: Recovery phase.It takes a couple days for the patients to get back to
normal. At this phase the patients will gain back appetite (A), have slower pulse
rate (Bradycardia=B), have convalescent rash at legs and arms (C) and pass
more water (Diuresis=D). You may recognize these steps by A-B-C-D.

DF at a glance.
Prevention: Mosquitoes elimination by getting rid of stagnant water containers
around your residence or place of work, this is where the mosquitoes breed,
smoke the mosquitoes. Use appropriate net to avoid mosquitoe bite if you stay
close to lake/pond/canal.
Symptom: Fever, headache, abdominal pain, nausea, vomiting, dry cough,
fatigue, body aching, rash, bleeding.
Diagnosis: Tourniquets test, Complete blood count, urine test, Serology test
Treatment: Anti-pyritic agent (Paracetamol), do not use aspirin or any NSAID for
the fever due to the increase risk of bleeding. Symptomatic treatments and
rehydration with fluid and electrolyte are essential in prevent hypovolemic shock
and save the patients lives.
Special Precaution:
Do not eat food containing blood, dark red color, and beetroot, to avoid
confusion of internal bleeding.
Take the patient to the hospital/Clinic if high fever persists more than a couple
of days without specific source of infection.

CHAIN OF
INFECTION
&
STAGES OF
DENGUE

SUBMITTED BY:
VERNICE NICOLI IBANEZ

SUBMITTED TO:
MS. ANA SISON