ª

ª




  ª

 
ª  
 

LEPROSY͙
4 an ancient disease and is a leading cause of
permanent physical disability among the
communicable diseases.

4 a chronic mildly communicable disease that

mainly affects the skin, the peripheral nerves, the
eyes, and mucosa of the upper respiratory tract

4 a public health problem in the Philippines for

several decades
   


Early signs and symptoms:
• Loss of sensation on the skin
lesion
• Decrease/loss of sweating and
hair growth over the lesion
• Thickened and / or painful
nerves
• Muscle weakness or paralysis
of extremities
• Pain and redness of the eyes
• Nasal obstruction or bleeding
• Change in skin color- either
reddish or whitish
• Ulcers that do not heal
Late signs and symptoms
• Loss of eyebrow ʹ madarosis
• Inability to close eyelids -
lagophthalmos
• Clawing of fingers and toes
• Contractures
• Sinking of the nosebridge
• Enlargement of the breast in
males or gynecomastia
• Chronic ulcers
›
›   

Mycobacterium Leprae, an acid fast, rod-shaped bacillus

which can be detected by Slit Skin Smear (SSS)

   ››

4 ²irborne ʹ inhalation of droplet/spray form coughing

and sneezing of untreated leprosy patient
4 Prolonged skin ʹ to ʹ skin contact

›››

Children especially twelve years old and below are more

susceptible
! 
4 ²voidance of prolonged skin-to-skin contact
especially with a lepromatous case.
4Children should avoid close contact with active,
untreated leprosy case.
4 BCG vaccination
4 Good personal hygiene
4 ²dequate nutrition
4 Health education
    

4 ²mbulatory chemotherapy through use

of Multi-drug therapy.
4 Domiciliary treatment as embodied in
R.². 4073 which advocates home
treatment
î ›
›› 

î› ›  › 
 
     › 

4 Paucibacillary ( tuberculoid and indeterminate)
Non-infectious type
Duration of treatment: 6 ʹ 9 months

4 Multibacillary ( Lepromatous and borderline)

Infectious types
Duration of treatment: 24 ʹ 30 months

"
 #$
4 use of 2 or more drugs for the treatment of
leprosy

4 proven effective cure for leprosy and renders

patients non-infectious a week after starting
treatment

4 makes home treatment of leprosy patients

possible



 

 
½
  
½

 

Monthly treatment: Day 1 Monthly treatment: Day 1
Rifamficin 600 mg Rifampicin 450 mg
Dapsone 100 mg Dapsone 50 mg

Daily treatment: days 2 ʹ 28 Daily treatment: Days 2 ʹ 28

Dapsone 100 mg Dapsone 50 mg

Duration of treatment: Duration of treatment:

6 blister pack to be taken 6 blister pack to be taken
monthly within a maximum monthly within a maximum
period of 9 months period of 9 months
 
   ª
½
  
½

 

Monthly treatment: day 1 Monthly treatment: day 1
Rifampicin 600 mg Rifampicin 450 mg
Clofazimine 300 mg Clofazimine 150 mg
Dapsone 100 mg Dapsone 50 mg

Daily treatment: Days 2-28 Daily treatment: Days 2-28

Clofazimine 50 mg
Clofazimine 50 mg every
other day
Dapsone 100 mg
Dapsone 50 mg

Duration of treatment: Duration of treatment:

12 blister packs to be taken 12 blister packs to be taken
monthly within a maximum monthly within a maximum
period of 18 months period of 18 months
 ª
  



²ll patients who have complied with the
above mentioned treatment protocol are
considered 
 and no longer regarded as a
case of leprosy, even if some sequelac of
leprosy remain.
 
 #

 ! 
4 Health education of patients, families and the
community on the nature of the disease,
symptomatology and its transmission. Children
who are more susceptible to the disease should
not be exposed to untreated leptromatous case.
4 ²dvocates healthful living through proper
nutrition, adequate rest, sleep, and good personal
hygiene.
4 BCG vaccination especially of infants and
children.
 ª

4 Recognize early signs and symptoms of leprosy and refers
suspects to the RHU physicians or skin clinic for diagnosis
and treatment.
4 Takes patient and family history and fills up patients
records.
4 Conducts epidemiological investigation and report
findings to MHO.
4 ²ssists physicians in physical examination of patients in
the clinic/home.
4²ssesses health of family members and other household
contacts. Performs/assists in examination of contacts
4 Integrates casefinding of leprosy cases in other activities
such as MCH, EPI, inspection/examination of school
children and other programs


  

4 Promotes healthful living by teaching the value of
good personal hygiene, proper
nutrition,adequate rest and sleep.
4 Helps patient/family understand and accept the
problems brought about by the illness and assess
their capacities to deal with them.
4 Provides and arranges for provision of nursing
care of patients at home
4 Guides and supports patients/family throughout
the treatment phase by giving them information on
the importance of sustained therapy, correct
dosage, effects of drugs and the need for medical
check-up from time to time.
4 Gives mental and emotional support by
encouraging self-confidence and self-reliance on
the part of the patient/family and by maintaining
an understanding and objective attitude
4 Refers patient to other health and allied workers as
the physician, dentist, social worker,
physiotherapist, mental hygienist, occupational
therapist as needed.
 €

OBJECTIVE: keep the patient, in so far, he/she is
capable, to be an active, self-respecting member of
society.
4 Helps create a congenial atmosphere essential to
progressive recovery.
4Must be kind and maintain attitude of professional
concern and interest.
4 Encourage patient͛s participation in occcupational
activities suited to his interest, experience and
capacity.
4 Refers patient to other person/agencies who can help
in his/her physical, mental, and social rehabilitation.

›
Promotes family health by:
4 Providing information education to patient
and his/her family on family planning and
nutrition.
4 Encouraging utilization of available family
planning and nutrition service.
4 Providing counseling and guidance aimed at
improving health of every member of the
family
 ª

 ##
4 Participates in community assemblies and
shares information on leprosy and its
environment.
4 Participates in seminars/workshops/consultative
meetings of other GOs and NGOs on leprosy
control.
4 Participates in tri-media dissemination of
leprosy facts and NLCP-MDT program.
=
 
  

 

4 Conducts orientation of student nurses,
midwives and other students on leprosy and
the control program.
4 Participates in orientation of new RHU/BHS
staff on leprosy and its control.
4 Participates in studies on leprosy and its
management.


#
#ª
!
% # & !'
1953 - Philippine hemorrhagic fever was reported
1958 ʹ H-fever became a notifiable disease in the
country and was later reclassified as Dengue
Hemorrhagic Fever
1959 ʹ lowest rate was recorded with 0.1/100,000
and 0.04/100,000 morbidity and mortality
rate respectively
1966 ʹ biggest epidemic occurred with 28/100,000
morbidity rate and 0.7/100,000 mortality rate
  
 
Dengue Virus Types 1, 2, 3, and 4 and ª
  



S €


4 Immediate source is a vector mosquito, the ²edes
²egypti or the common household mosquito.
4 the infected person

ª 
²n acute febrile infection of sudden onset with clinical
manifestation of 3 stages:
4 
 Febrile or invasive stage starts abruptly as
high fever, abdominal pain, and headache; later flushing
which may be accompanied by vomiting, conjuctival
infection and epistaxis
4 

 Toxic or hemorrhagic stage ʹ lowering of
temperature, severe abdominal pain, vomiting, and
frequent bleeding from gastrointestinal tract in the form
of hematemesis or melena. Unstable BP, narrow pulse
pressure and shock. Death may occur. Tourniquet test
which may be positive on 3rd day may become negative
due to low or vasomotor collapse.
4 
 
 convalescent or recovery stage
generalized flushing with interventing areas of
blanching appetite regained and blood
pressure already stable.
 ªª 
4Seve
e,
e with flushing,sudden high
fever, severe hemorrhage, followed by sudden
drop of temperature, shock, and terminating in
recovery or death.
4 ž e
e with high fever, but less hemorrhage,
no shock
4ž  with slight fever, with or without petichial
hemorrhage but epidemiollogically related to
typical cases usually discovered in the course of
investigation of typical cases


  
 
Mosquito bite (²edes ²egypti)

ª  

Uncertain. Probably 6 days to one week.

ª( ª( 

ªªª
²ll persons are susceptible. Both sexes are equally
affected.
²ge groupf predominantly affected are the preschool age
and school age. ²dults and infants are not exempted.
Peak age affected 5-9 years

 ª

ª
Unknown. Presumed to be on the 1st week of
illness when virus is still predent in the blood.

ªªª
Sporadic throughout the year. Epidemic usually
occur during the rainy seasons June-November .
Peak months are September and October.
Occurs wherever vector mosquito exists.
Susceptibility is universal. ²cquired immunity
may be temporary but usually permanent

 ª 
=

 
ee
e e=e
4 Inflate the blood pressure cuff on the upper arm to a
point midway between the systolic and diastolic
pressure for 5 minutes.
4 Release cuff and make an imaginary 2.5 cm square or
1 inch square just below the cuff, at the antecubital
fossa.
4 Count the umber of petechiae inside the box.

² test is (+) when 20 or more petechiae per 2.5 cm

square or 1 inch square are observed.
    
4 Supportive
4 Symptomatic
For fever, give paracetamol for muscle pains. For
headache, give analgesic. Don͛t give ²SPIRIN.
Rapid replacement of body fluids is the most
important treatment
Includes intensive monitoring/follow-up
Give ORESOL to replace fluid as in moderate
dehydration.
 ª  

4Eliminate vector by:
changing water and scrubbing sides of lower vases
once a week
destroy breeding places of mosquito by cleaning
surroundings, proper disposal of rubber tires, empty
bottles and cans.
keep water containers contaminated
4 ²void too many hanging clothes inside the house.
4 Residual spraying with insecticides
› ››
›
ª! 
Protozoan ʹ =

 




 Usually
passed by direct sexual contact. Can be
transmitted through contact with wet objects,
such as towels, washclothes and douching
equipment

ª 
4 to 20 days, with average being 7 days.
 



Many women and most men have no
symptoms. 
  white or greenish-
yellow odorous discharge; vaginal itching
and soreness, painful urination. 
 
Slight itching of penis, painful urination,
clear discharge from penis.

 
Microscopic slide of discharge; culture tests;
examination.


Curable with an oral medication.

ª
ª 
Long-term effects in adults not known.
There is some evidence that infected
individuals are more likely to develop
cervical cancer.
  

½½

 
ª! 
=
 

  Passed by direct
contact with infectious sore

ª 
Ten days to 3 months, with average of 21
days.
   


0


 
Painless chancre (sore) at the site of entry of
germs, swollen glands


  (usually appear 1 week to six

months)
Rash, patchy hair loss, sore throat, and swollen
glands
Primary and secondary sores will go away even
without treatment, but the germs continue
to spread throughout the body. Latent
syphillis may continue 5 ʹ 20+ years with no
symptoms, but the person is no longer
infectious to other people. ² pregnant
woman can transmit the disease to her
unborn child (congenital syphilis). 



 varies from no symptoms to
indication of damage to body organs such as
the brain and heart and liver.

 
4 Dark field illumination test
4 Kalm test



²ntibiotics as prescribed

ª
ª 
Severe damage to nervous system and other body
organs possible after many years: heart disease,
brain damage and severe illness or ddeath of
newborns.

#
4 an acute febrile infection of the tonsil,
throat, nose, larynx, or a wound marked by
a patch or patches of grayish membrane
from which the diphteria bacillus is readily
cultured.
4 Nasal diphteria is commonly marked by
one sided nasal discharge and excoriated
nostrils.

  ª 

ª


 
 

 (Klebs-Loeffler
bacilus)
 ª  ª 
Discharges and secretions from mucus surface
of nose and nasopharynx and from skin and
other lesions.

  
 
Contact with a patient or carrier or with articles
soiled with discharges of infected persons.
Milk has served as a vehicle.
ª  

Usually 2 to 5 days, occasionally longer.


 ª

ª
Variable until virulent bacilli have disappeared
from secretions and lesions usually 2 weeks
and seldom more than 4 weeks.
 

!"
!"
4 Infants born of mothers who had diphteria
infection are relatively immuned but the
immunity disappears before the 6th month.
4 Recovery from an attack of diphteria is usually but
not necessarily followed by persistent immunity.
4 Immunity is often acquired through unrecognized
infection.
4 Two- thirds or more of the urban cases are in
children under 10 years of age.

#
  !  

ª  
4 ²ctive immunization of all infants (6 weeks) and
children with 3 doses of Diphteria. Pertussis
and Tetanus (DPT) toxoid administered at 4 ʹ 6
weeks intervals and then booster doses
following year after the last dose of primary
series and another dose on the 4th or 5th year of
age.
4 Pasteurization of milk
4 Education for parents.
4 Reporting of the case to the Health officer for
proper medical care.
 ª ## 
 
4 Carry on continuous preventive education in the
community to maintain a high level of immunity
with emphasis on the infant and pre-school age
groups.
4 Observe correct technique for taking nose and
throat cultures for diphteria.
4 Encourage early prophylactic immunization of
infants and children.
4 Teach procedures of disposal by burning of nose
and throat discharges and uneaten food as
concurrent disinfection.
  ª
4 Follow prescribed dosage and correct technique
in administering antitoxin infections.
4 Comfort of the paient shoild always be in mind.
4 ²s in any other nursing care of communicable
disease patient, the visiting bag set up should
be outside the room of the patient or should be
far from the bedside of the patient and a
separate set upon a paper towel as in
temperature taking may be brought and placed
on the bedside table or chair.
 "
""!"½
""#
½!##!
4 acute disease induced by toxin of tetanus
bacillus growing anaerobically in wounds and at
site of umbilicus among infants.
4 characterized by muscular contractions.

# #"
= 

 




 


! $ "$"
Immediate source of infection is soil, street
dust, animal and human feces.


  
 
Usually occurs through contamination of the
unhealed stump of the umbilical cord.

ª  

Vary from 3 days to 1 month or more, falling
between 7 and 14 days in high proportion of
cases


 ª

ª
Not directly transmitted from man to man.
››››  
 

Susceptibility is general. ²n important

cause of death in many countries in ²sia,
²frica, and South ²merica especially in
rural tropical areas.

› 

²ctive immunity is induced by tetanus

toxoid anti-toxin.
 ½$!%"""½
"!
4 Pregnant women should be actively
immunized in regions where tetanus
neonatorum is prevalent.
4 Licensing of midwives into professional
supervision and education as to methods,
equipment and techniques of sepsis in
childbirth.
4 Health Education of mothers, relatives and
attendants in the practice of strict aseptic
methods of umbilical care in the newborn.
ª ## 
 
Report immediately to physician, including case
history to determine circumstances of injury,
especially competence of attendance at birth.

 ª

Employ measures which decrease frequency and
severity of convulsions. Keep patient away
from noise, bright lights or anything else that
will irritate him/her. ²dminister prescribed
medication by physician and observe and
report untoward effects to physician.
  



#
#
4 the third most prevalent infection
worldwide, second only to the diarrheal
disease and tuberculosis
4 ranked 10th among the World͛s Top Ten
infectious diseases killer according to WHO
report, 1996
4 The prevalence of STH among the two to
five years old is lesser but they suffer the
greatest impact of the disease when they
get infected

  ª  
ª ª   #
#
4 ² 






4 =








4 Hookworm ²
   
 



 
They are classified as STH because their
major development takes place in the
soil.
 ›  
4 ²nemia
4 Malnutrition
4 Stunted growth in height and body size
4 Decreased physical activity
4 Impaired mental development and school
performance

2-5 years old ʹ easily infectes and should be given

treatment
6-14 years old ʹ harbor the greatest local of infection
and are significant source of infection
 
  
ª 

de

 
4 Good personal hygiene ʹ thorough washing of
hands before eating and after using the toilet.
4 Keeping fingernails clean and short.
4 Use of footwear ( slipper, shoes, etc. )
4 Washing fruits and vegetables very well
4 ²dvocate use of sanitary toilets
4 Sanitary disposal of refuse and garbage
4 Once signs and symptoms appear, consult RHU
staff
½&

& '&
4 Consult RHU or BHS staff
4 Laboratory/stool/blood exam
4 Ensure proper dosage of medication
and completion of treatment
4 Referral and re-check up/follow up
as needed.
ª# 
4 acute bacterial entric diseases of the GIT
characterized by profuse diarrhea, vomiting,
massive loss of fluid and electrolytes that could
result to hypovolemic shock, acidosis and death.

4 Sometimes known as ²   or e e  

e


4 originally endemic to the Indian subcontinent

4 now no longer considered a pressing health

threat in Europe and North ²merica due to filtering
and chlorination of water supplies, but still heavily
affects populations in developing countries.
   &
4 ’


 ª 

’


 
4 The organisms are slightly curved rods (coma
shape), gram negative (-) and motile with a single
polar flagellum.
4 The organisms survive well at ordinary
temperature and can grow well in temperature
ranging from 22-40 degrees centigrade.
4 They can survive well in ordinary temperature and
can survive longer in refrigerated foods.
4 ²n enterotoxin, choleragen, is elaborated by the
organism as they grow in the intestinal tract.
› !

4 Vomitus and feces of infected persons and feces

of convalescent or healthy carriers. Contacts may
be temporary carriers.

›"# !!$

4 The incubation period ranges from a few hours to

five days; usually one to three days.

!$%%!#"!&! '

4 The organisms are communicable during stool

positive stage, usually a few days after recovery,
however occasionally the carrier may have the
organism for several months.


4 Fecal transmission passes via oral route form
contaminated water, milk, and other foods.

4 The organisms are transmitted through

ingestion of food or water contaminated with
stool or vomitus of patient.

4 Flies, soiled hands and utensils also serve to

transmit the infection.

4 Fluid loss is attributed to the enterotoxin elaborated by the
organism as they lie in opposition with the lining cells of
the intestines.
4 The toxin stimulates adenylate cyclase, which results in the
conversion of the adenosine truphosphate (²TP) to cyclic
adesine monophasphate (C²MP).
4 The mucosal cell is stimulated to increase secretion of
chloride, associated with water and bicarbonate loss.
4 The toxin acts upon the intact epithelium on the vasculator
of the bowel, thus, resulting in outpouring of intestinal
fluids.
4 Fluid loss of 5 to 10 percent of the body weight resulting in
dehydration and metabolic acidosis.
4 If treatment is delayed or inadequate, acute renal failure
and hypokalemia become secondary problems.
 ª

 



 
There is an acute, profuse, watery diarrhea with no
tenesmus or intestinal cramping. Initially, the
stool is brown and contains fecal materials, but
soon becomes pale gray, ͞rice-water͟ in
appearance with an inoffensive, slightly fishy
odor. Vomiting often occurs after diarrhea has
been established. Diarrhea causes fluid loss
amounting to 1 to 30 liters per day owing to
subsequent dehydration and electrolyte loss.
Tissue turgur is poor and eyes are sunken into the
orbit.
The skin is cold, the fingers and toes are
wrinkled, assuming the characteristic ͞washer-
moman͛s hand͟. Radial pulse become
imperceptible and the blood pressure
unobtainable. Cyanosis is present. The voice
becomes hoarse and then, is lost, so that the
patient speaks in whisper (aphonia).
Breathing is rapid and deep. Despite
marked diminished peripheral circulation,
consciousness is present.
Patients develops oliguria and may even develop
anuria. Temperature could be normal at the
onset of the disease but becomes subnormal
in later stage especially if the patient is in
shock. When the patient is in deep shock, the
passage of diarrhea stops. Death may occur as
short as four hours after onset, but usually
occurs on the first or second day if not
properly treated.


()
!

& 
& 
4 Susceptibility and resistance general although
variable. Frank clinical attacks confer a temporary
immunity which may afford some protection, for
several years.
4 Immunity artificially induced by vaccine is of
variable and uncertain duration.
4 ²ppears occasionally in epidemic form in the
Philippines and in other parts of the world.
½&
 *'

4 Rectal Swab
4 Darkfield or phase microcopy
4 Stool Exam

 )* + ,**
4 Treatment of cholera consist in correcting the basic
abnormalities without delay ʹ restoring the circulating
blood volume and blood electrolytes to normal levels.
4 Intravenous treatment is achieved by rapid intravenous
infusion of alkaline saline solution containing sodium,
potassium, chloride and bicarbonate ions in proportions
comparable to that in water-stool.
4 Oral therapy rehydration can be completed by oral route
(Oresol, Hydrites) unless contraindicated or, if the patient is
not vomiting.
4 Maintenance of the volume of 
ee
e to
ensure rehydration. This is done by careful intake and
output measurement.
4 ²ntibiotics Tetracycline 500mg every 6 hours
might be administered to adults, and 125 mg/kg
body weight for children every 6 hours to 72
hours.
4 Furazolidone 100 mg for adults and 125mg/kg for
children, might be given every 6 hours for 72
hours.
4 Chlorampenicol may also be given 500 mg for
adults and 18 mg/kg for children every 6 hours
for 72 hours.
4 Cotrimoxazole can also be administered 8mg/kg
for 72 hours.
 „

  

4 Medical septic protective care must be provided.
4 Enteric isolation must be observed.
4 Intake and output must be be accurately
measured.
4 ² thorough and careful personal hygiene must be
provided.
4 Excreta must be properly disposed of.
4 Concurrent disinfection must be applied.
4 Food must be properly prepared.
4 Environmental sanitation must be observed.
 +& &
4 Food and water supply must be protected from
fecal contamination.

4 Water should be boiled or chlorinated.

4 Milk should be pasteurized.

4 Sanitary disposal of human excreta is a must.

4 Sanitary supervision is important.

SªS
4 a communicable disease of the skin caused by

 

characterized by the eruptive
lesions produced from the burrowing of the female
parasite into the skin.
ORG²NISM:
4 causative factor is the itch mite, Sarcroptes
scabiei
4 female parasite is easily visible with magnifying
glass and measures 0.33 to 0.45 mm in length by
0.25 to 0.33 in breath
4 male is smaller and resides on the surface
ª 
It occurs within 24 hours from the original contact,
the length of time required from itch mite to
(burrow) or infected skin and lay ova.

 
4 ²pperance of the lesion, and the intense itching
and finding of the causative mite.
4 Scraping from its burrow with a hypodermic
needle or curette, and then examined under
lower power of the microscope by hard lens.
SIGNS AND SYMPTOMS
4 itching
4 When secondarily infected the skin may
feel hot and burning but this is a minor
discomfort.
4 When large areas are involved and
secondary infection is severe there will
be fever, headache and malaise.
Secondary dermatitis is common.
 !"
4 The whole family should be examined
before undertaking treatment, as long as a
member of family remains infected, other
members will get the disease.
4 Treatment is limited entirely to the skin.
4 Benzyl benzoate emulsion ( Burroughs,
Welcome) is cleaner to use and has more
rapid effect.
4 Kwell ointment is also effective.
 !  
ª  
4 Good personal hygiene ʹ daily bath; washing the
hands before and after eating, and after using
the toilet; cutting off fingernails.
4 Regular changing of clean clothing beddings and
towels.
4 Eating the right kind of food like rich in Vitamin
² and Vitamin C such as green leafy vegetable
and plenty of fruits and fluids.
4 Keeping the house clean.
4 Improving the sanitation of the surroundings.
 

S 
4 Weil͛s Dse, Mud fever, Canicola fever, Flood
fever, Swineherd͛s Dse, Japanese Seven Days fever

4 a bacterial zoonotic disease caused by

spirochaetes of the genus Leptospira that affects
humans and a wide range of animals, including
mammals, birds, amphibians, and reptiles first
described by ²dolf Weil in 1886 when he reported
an ͞acute infectious disease with enlargement of
spleen, jaundice and nephritis
ª 

 

4 Leptospira-genus bacteria was isolated in 1907
from post mortem renal tissue slice
4 commonly found: Leptospira pyrogenes,
Leptospira manilae, & other species like L.
icterohemorrhagiae, L. canicola, L. batavia, L.
Pomona, L. javinica
4 in animals often is subclinical; an infected
animal may appear healthy even as it sheds
leptospires in its urine; humans are dead-end
hosts for the leptospire
 
(
&$  

4 age: < 15 years of age
4 sex: male
4 season: rainy months
4 geographic: prevalent in slum areas

½   
4 culture: blood (1st week)
4 CSF (5th to 12th day)
Urine (after 1st wk til pd of convalescence)
4 agglutination tests ( 2nd or 3rd week)

  ,&,  &

4 Infection comes form contaminated food and water,

and infected wild life and domestic animals
especially rodents.
4 Rats ( L. leterohemoragiae) are the source of Weil͛s
disease frequently observed among miners, sewer,
and abattoir workers.
4 Dogs (L. canicola) can also be the source of infection
among veterinarians, breeders, and owners of dogs.
4 Mice (L. grippotyphosa) may alos be a source of
infection that attacks farmers and flax workers.
4 Rats (L. bataviae) are the source of infection that
attacks ricefield workers.
&
) & 
4 6 ʹ 15 days/ 2 ʹ 8 weeks

& &,
 &


4 }

 


 
  
 
 
- onset of high remittent fever, chills, headache,
anorexia, nausea & vomiting, abdominal pain,
joint pains, muscle pains, myalgia, severe
prostration, cough, respiratory distress, bloody
sputum.
4 e 
e/=  
e 
- if severe, death may occur between the 9th &
16th day
2 types:
4 ²nicteric (without jaundice) ʹ return of fever of a
lower degree with rash, conjunctival injection,
headache, meningeal manifestations like
disorientation, convulsions & signs of meningeal
irritations (with CSF finding of aseptic meningitis)
4 Icteric (with jaundice) ʹ Weil syndrome; hepatic &
renal manifestations: hemorrhage, hepatomegaly,
hyperbilirubinemia, oliguria, anuria with
progressive renal failure; shock, coma &
congestive heart failure in severe cases
4 ˜
 

 
- Relapses may occur during 4th or 5th week
0


4 cause of death: renal & hepatic failure
4 disease usually last 1 ʹ 3 weeks but may be more prolonged;
relapse may occur

= = =
4 specific measures: beneficial if done < 4 days of dse
4 ²queous penicillin G (50,000 units/kg/day in 4-6 divided
doses intravenously for 7-10 days
4 Tetracycline (20-40 mg/kg/day in 4 doses); may not be given
to children < 8 years old
4 general measures
4 symptomatic & supportice care
4 administration of fluid, electrolytes & blood as indicated
4 peritoneal dialysis (for renal failure)
  ! 

4 Isolation of patient:
urine must be properly disposed

4 health teachings:
keep a clean environment