Communicable Dses Flashcards
NTP Vision
TB Free Philippines
NTP Mission
Reduce TB burden - mortality and incidence
Zero catastrophic cost
Responsive delivery of TB services
What type of TB cannot be treated with the first regimen? (2HRZE/4HR)?
TB of the CNS, bones, joints
What is the regiment for TB CNS, bones and joints
(2HRZE/10HR)
Follow up schedule for TB patients
1st: After intensive phase (2nd month)
2nd and 3rd only if still positive after intensive phase
2nd: After 5th month
3rd: After 6th month
TB Patient Classification Definition
NEW
Has never had treatment for TB or has taken anti TB drugs for less than 1 month
TB Patient Classification
RELAPSE
Previously treated and DECLARED CURED or TREATMENT COMPLETED. Now with active TB
TB Patient Classification
RETREATMENT (UMBRELLA)
Has been treated before with Anti-TB FOR AT LEAST 1 MONTH
TB Patient Classification
TREATMENT AFTER FAILURE
Previously treated for TB but failed most recent course based on positive SM follow up at 5 months or clinically diagnosed TB patient with no clinical improvement anytime in the course
TB Patient Classification
TREATMENT AFTER LOST TO FOLLOW UP
Did not complete treatment
Lost to ff up for at least 2 months
TB Patient Classification
PREVIOUS TB TREATMENT OUTCOME UNKNOWN
Previously treated but outcome of most recent course is unknown
TB Patient Classification
PATIENTS WITH UNKNOWN PREVIOUS TB TREATMENT HISTORY
Do not fit any category
Considered as previously treated
Pillars of NTP
1: Integrated patient-centered TB care and prevention
2: Bold policies and supportive systems
3: Intensified research and innovation
Nomenclature Code for Xpert results
T: MTB detected, Rifampin resistance not detected
RR: MTB detected, Rifampicin resistance detected
TI: Indeterminate rifampicin resistance
N: Not detected
I: Invalid/error
Test for Ff up in TB
Direct Sputum Smear Microscopy (DSSM)
Adverse Anti-TB Drug Reactions
Gastrointestinal Manifestations
Rifampicin, Isoniazid, Pyrazinamide
(Give at bedtime or with small meals)
Adverse Anti-TB Drug Reactions
Mild or localized skin reactions
Any drug
(Anti histamine)
Adverse Anti-TB Drug Reactions
Orange/red color urine
Rifampicin
(Reassure pt)
Adverse Anti-TB Drug Reactions
Pain at injection site
Streptomycin
(Warm compress)
Adverse Anti-TB Drug Reactions
Burning sensation in feet (Peripheral neuropathy
Isoniazid
(Vitamin B6/Pyridoxine at 50-100 mg/day for tx or 10mg/day for prevention)
Adverse Anti-TB Drug Reactions
Hyperuricemia —> Arthralgia
Pyrazinamide
(Aspirin or NSAID; Uric acid determination for gout of persists)
Adverse Anti-TB Drug Reactions
Flu like symptoms
Rifampicin
(Antipyretics)
Adverse Anti-TB Drug Reactions
Severe skin rash (hypersensitivity)
All especially Streptomycin
Adverse Anti-TB Drug Reactions
Jaundice due to hepatitis
Isoniazid, Rifampicin, Pyrazinamide
Adverse Anti-TB Drug Reactions
Optic neuritis (color vision and visual acuity impairment)
Ethambutol
Adverse Anti-TB Drug Reactions
Ototoxicity (dizziness, hearing impairment, tinnitus)
Streptomycin
Adverse Anti-TB Drug Reactions
Oliguria and albuminuria
Streptomycin, rifampicin
Adverse Anti-TB Drug Reactions
Pyschosis and convulsion
Isoniazid
Adverse Anti-TB Drug Reactions
Thrombocytopenia, anemia, shock
Rifampicin
Pregnant patients with TB, what are the 2 Anti-TB drugs we cannot give?
Rifapentine
Streptomycin
For a pregnant TB patient, what is the dose of pyridoxine/vitamin b6 we give?
Pyridoxine 25mg/day
When do breastfeeding mothers with TB breastfeed their babies? Before or after taking Anti-TB meds?
Before taking Anti-TB meds
This anti TB drug stimulates the hepatic metabolism of OCPs, lowering their efficact and may result to unwanted pregnancies
Rifampicin
In order to adjust with Anti-TB regimen, OCPs should have higher doses of ____________ or advised to use other contraception
Estrogen
What is the Anti-TB drug known to cause the most hepatotoxicity?
Pyrazinamide
TB treatment is interrupted in these following conditions:
ALT >3x ULN with S & Sx of hepatitis or jaundice
OR
ALT >5x ULN even with no S & Sx of hepatitis
Anti-TB drugs are gradually reintroduced as LFTs and clinical symptoms normalize. If monitoring of LFTs cannot be done, when should Anti-TB drugs be introduced? And in what order?
Reintroduced 2 weeks after resolution of jaundice and RUQ abdominal pain/tenderness
In the respective order (from least to most hepatotoxic)
Rifampicin + Isoniazid + Pyrazinamide
Pyrazinamide is not given to TB patients with chronic liver disease. What are their 3 alternative regimens?
2SHRE/6HR
9RE
2SHE/10HE
For those TB patients with renal failure, when should they take their medications? Before or after dialysis?
After hemodialysis
Alternative options for HIV patients with concomitant TB (cannot observe TB > HIV treatment) who have no life threatening condition
- Defer ART until TB treatment completion (6 months)
- Defer ART until intensive phase of TB treatment is completed (2 months) —> continuation phase: Ethambutol and Isoniazid
- Treat TB with rifampicin containing regimen, Efavirenz + 2 NRTIs for HAART
Best measure/strategy to combat dengue
Source reduction - elimination of mosquitoes egg laying sites
Classifications of Dengue w/o warning signs
Suspect, Probable, Confirmed
SUSPECT DENGUE
A previously well individual with acute febrile illness of _______ days duration plus 2 of the following:
_____________________________
•1-7 days duration of fever
• Two of the ff 11 symptoms
* headache
* myalgia
* nausea
* flushed skin
* body malaise
* arthralgia
* vomiting
* rash (petechial Hermann’s rash)
* retro-orbital pain
* anorexia
*diarrhea
Probable dengue is suspect dengue plus __________________
- Dengue NS1 Antigen test
- CBC (leukopenia w/ or w/o thrombocytopenia)
- Dengue IgM antibody test (optional)
Confirmed dengue is a suspect or probable dengue case with positive test result of any
- Viral culture
- Polymerase chain reaction (PCR)
- Nucleic Acid Amplification Test-Loop Mediated Amplification Assay (NAAT-LAMP)
*Plaque reduction neutralization test (PRNT)
Dengue with Warning Signs is that wherein a previously well person with acute febrile illness of _________ days plus any of the following:
Letter A to Lethargy
A - Abdominal Pain or tenderness
B - Bleeding (mucosal bleeding)
C - Continuous vomiting (persistent vomiting, >2x/day)
D - Decrease in platelet (rapid) and increased Hct
E - Enlargement of Liver (>2 cm)
F - Fluid accumulation (ascites, pleural effusion)
G - LetharGy
Severe dengue
Severe plasma leakage
* shock (DSS)
* Fluid accumulation w/ respiratory distress
Severe bleeding - evaluated by clinician
Severe organ impairment
* Liver: AST or ALT >= 1000
* CNS: seizures, impaired consciousness
*Heart and other organs (myocarditis, renal failure)
When does defervescence occur?
Day 3-7 of illness
Between 24-48 hours
Phases of Dengue Infection
*Febrile phase (2-7 days) - mild hemorrhagic manifestations
*Critical phase (3-7 days) - defervescence; improve or deteriorate; progression to either dengue with or without warning signs, even severe dengue
*Recovery phase (next 48-72 hours) - Hermann’s rash, body fluids go back to normal. WBC > Plt rate of going back to normal
ASEAN Dengue Day
June 15
National Dengue Prevention and Control Program Objectives
• Reduce dengue morbidity by 25%
• Reduce dengue mortality by 50%
• Case fatality rate <1%
National Dengue Prevention and Control Program Components
- Surveillance
- Case management and diagnosis
- Integrated vector management
- Outbreak response
- Health promotion and advocacy
- Research
Deng-Get Out 5s Strategy
- Search and destroy
- Secure self protection
- Seek early consultation
- Support fogging and spraying only in hotspot areas or outbreaks
- Sustain hydration
Principal vector of malaria in the Philippines
Anopheles flavirostris
Gold standard for malaria diagnosis
Microscopy
First line medicine for uncomplicated and severe Plasmodium falciparum malaria
Artemether-Lumefantrine
Second line medicine for uncomplicated and severe Plasmodium falciparum malaria (if first line not available or treatment failure)
Quinine + Tetracycline/Doxycycline/Clindamycin x 7 days
May be administered to unconscious patients with severe malaria that is currently in a incapacitated facility, while pending transfer
Artesunate suppository
Immediate referral of malaria cases should be done when patients are:
• With severe malaria
• Pregnant
• Children below 5 years old
A drug that can be used for all plasmodium species and mixed infections
Artemisinin
Major insecticides used for bed net treatment
Pyrethroids
Anti-malarial drugs that can be utilized for prophylaxis
Atovaquone-proguanil
* Atovaquone - 250 mg/proguanil - 100 mg 1 tab OD
* Start 1-2 days before entering malarious place, continue daily during stay and until after 7 days of leaving
Doxycycline
*100 mg 1 tab OD
* start 1 day before entering malarious place, continue daily during stay and up until 4 weeks after leaving
Mefloquine
*250 mg tab once a week
* start 1-2 weeks before entering malarious place, continue weekly during stay until after 4 weeks after leaving
What is the anti-malarial drug of choice for pregnant women who are going to an endemic place with chloroquine-sensitive malaria?
Chloroquine
What is the anti-malarial drug of choice for pregnant women who are going to an endemic place with chloroquine-resistant malaria?
Mefloquine
What are the 5 infectious Food and Waterborne diseases under surveillance in the Philippines?
TARCH
T - Typhoid
A - Acute bloody diarrhea
R - Rotavirus
C - Cholera
H - Hepatitis A
Most common symptom of food and waterborne diseases
Diarrhea
Most threatening consequence of diarrhea
Dehydration
Fluid deficit percentages in infant
No signs of dehydration - <5%
Mild to moderate dehydration - 5-10%
Severe dehydration - >10%
Fluid deficit percentages in child
No signs of dehydration - 3%
Mild to moderate dehydration - 6%
Severe dehydration - 9%
Urine output categories to determine dehydration
Normal: 0.5 ml/kg/hr in 8 hrs
Decreased: <0.5 ml/kg/hr in 8 hrs
Minimal: <0.3 ml/kg/hr in 16 hrs
None: No urine output in 12 hrs
Antimicrobials are only indicated in FWBD management in the event of diarrhea characterized by
• Acute bloody diarrhea
• Suspected case of cholera
• Diarrhea associated with other acute infections (e.g. pneumonia, meningitis)
These supplements are adjunctive therapy for acute infectious diarrhea
Zinc supplementation - 20 mg/day x 10-14 days (in children older than 6 months)
Probiotics - throughout the duration of diarrhea and may be extended up to 7 more days after antibiotic completion
Recommended treatment for adult mild dehydration
ORS at 1.5-2x the estimated amount of volume deficit + concurrent GI losses
Recommended treatment for adult moderate dehydration
- 500 - 1000 ml PLRS in first 2 hrs
- If hemodynamically stable
*<50 kg - 2-3 ml/kg/hr PLRS
*>50 kg - 1.5-2 ml/kg/hr PLRS
Recommended treatment for adult severe dehydration
- 500 - 1000 ml PLRS in first hour
- If hemodynamically stable
*<50 kg - 2-3 ml/kg/hr PLRS
*>50 kg - 1.5-2 ml/kg/hr PLRS
The components of homemade ORS
1L of clean drinking water
4-5 tsp of sugar
1 tsp of salt
Food-borne infection VS. Food poisoning/intoxication
Produced by toxins or poisonous agents present in the food before consumption
Food-borne infection VS. Food poisoning/intoxication
Produced by living organisms entering the body with the food
Disease and etiologic agent of infectious diarrhea from eating poultry, salad, and warmed over foods
Salmonellosis - Salmonella species
Disease and etiologic agent of infectious diarrhea from eating moist food, dairy products, water, salad
Dysentery - Shigella species
Disease and etiologic agent of infectious diarrhea from eating poultry, salad, and warmed over foods (another agent)
Typhoid fever - S. Typhi
Disease and etiologic agent of infectious diarrhea from eating insufficiently cooked beef, pork, or freshwater fish
Tapeworm:
T. saginata (beef)
T. solium (pork)
Diphollobotrium latum (fish)
Disease and etiologic agent of infectious diarrhea from eating insufficiently canned goods with pH over 3.5
Botulism - Clostridium botulinum
Disease and etiologic agent of infectious diarrhea from eating cooked ham and salads made from processed/canned foods
Staph food poisoning - Enterotoxin producing S. aureus
What are the different etiologic agents of acute infectious bloody diarrhea?
SEECSY
S - Shigella
E - Escherichia coli (EHEC)
E - Entamoeba histolytica
C - Campylobacter jejuni
S - Salmonella
Y - Yersinia enterocolitica
Incubation period of tetanus
Average of 8 days (3-21 days)
Tetanus prophylaxis in routine wound management
<3 OR UNKNOWN DOSES
CLEAN WOUND
* Td
DIRTY WOUND
* Td
* TIG
> =3 DOSES
CLEAN WOUND
* Td if >10 years since last dose, otherwise no need
DIRTY WOUND
* Td if >5 years since last dose, otherwise no need
ANIMAL BITES AUTOMATICALLY DIRTY WOUND
Possible routes of transmission of Rabies infection
• Bite (from saliva)
• Contact of open skin or mucous membrane with saliva of infected animal
• Aerosol (e.g. entering caves)
• Transplantation
Anti-Rabies Act of 2007 is aka
RA 9482
Organization that serves as the chair of National Rabies prevention and control program
Department of Agriculture (Bureau of Animal Industry)
What month is Rabies Awareness Month?
March
What date is World Rabies Day?
September 28
4Rs in Animal Rabies Risk Assessment
Recognizing
Recording
Reporting
Referral
When death is caused by a communicable disease, within how many hours should the body of the person be buried?
Within 12 hours
Active immune response is initiated within how many days
7-10 days
WHO Prequalified Vaccines
RABIVAX-N
VeroRab
VaxiRab N
RIG should be given within _______ days after active immunization
Within 7 days
Dose of HRIG
20 IU/Kg
Dose of ERIG
40 IU/Kg
Management of anaphylaxis in RIG administration
0.1% adrenaline or epinephrine (1:1000 or 1 mg/ml) underneath skin or into muscle
*Adults - 0.5 ml
*Children - 0.01 ml/kg, max=0.5 ml
Epi every 10-20 mins x 3 doses
Steroids after epi
Management of hypersensitivity rx in RIG administration
Antihistamines (single or combo)
Observe for 48 hrs —> no improvement —> short course oral antihistamines (5-7 days) + steroids —> no improvement —> IV steroids + antihistamine
Preferrable # of mins of washing bite wound with soap/detergent and water
10 minutes
When bite wound is gaping and really needs to be sutured, what to do?
Delay for 2 hrs after administration of ERIG to allow diffusion of antibody to tissues
Most common pathogen from dig and cat bites
Pasteurella multocida
Antimicrobials for animal bite are recommended for what conditions?
• All frankly infected wounds
• Category III cat bites
• All Category III bites that are deep, penetrating, multiple or extensive or located in the hand, face, genital area
HIV testing of a minor. When can the minor have the test without the need of parental consent?
*Age 15 to less than 18
*Below age 15 but pregnant or engaged in high risk behavior
When should consent be acquired from parents of a minor before HIV testing
*below 15
*mentally incapacitated
HAART-Antiretroviral drugs
Nucleotide/Nucleoside Reverse Transcriptase Inhibitors (NRTI)
Tenofovir
Lamivudine
Abacavir
Zidovudine
HAART-Antiretroviral drugs
Non-Nucleotide/Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
Efavirenz
Rilpivirine
Nevirapine
HAART-Antiretroviral drugs
Protease inhibitors (PI)
Lopinavir/Ritonavir
Darunavir
Ritonavir
Recommended treatment for schistosomiasis
Praziquantel 40 mg/kg once
*nonpregnant adults
*pregnant women
*children >4 y.o.
COVID VACCINES:
RNA
Pfizer
Moderna
COVID VACCINES:
Viral vector
AstraZeneca
Sputnik V
Johnson & Johnson
COVID VACCINES:
Inactivated virus
Sinovac
Sinopharm
Covaxin
COVID VACCINES:
Protein-based
Novavax
