NERVOUS SYSTEM communicable diseases

LEPROSY
In order, the ten countries
with the most leprosy cases:

India
Brazil
Myanmar (Burma)
Indonesia
Nepal
Epidemiology in the Philippines
Ilocos Norte
Ilocos Sur
Abra
La Union
Pangasinan
Leprosy
CA:  Mycobacterium Leprae or Hansens bacillus
MT: prolonged skin to skin contact, droplet infection
Susceptible: below 12 yrs. Old
Incubation: 3 – 5 years
Dx: Skin Slit test,
Prevention:
B CG vaccination
A voidance of prolonged skin B to skin contact with active untreated case,
G ood Personal Hygiene
A dequate Nutrition
H ealth Education  
Leprosy
Early Signs – reddish or white change in skin color, loss of sensation on the skin lesion,
decrease/loss of sweating and hair growth over the lesion, thickened and or painful
nerves, Muscle weakness, pain or redness of the eye, nasal obstruction/bleeding, ulcers
that do not heal
Late Signs – Loss of eyebrow (madarosis), Inability to close eyelids (lagopthalmos),
clawing of fingers and toes, contractures, Sinking of the nose bridge, enlargement of the
breast in males (gynecomastia), chronic ulcers

Leprosy
Mgt/Tx: Ambulatory Chemo by MDT (2 drugs), Domiciliary- home by RA 4073
Completion of Tx: Cured – all who complied, even is with sequelae of leprosy remain.

Patient Classification
Paucibacillary:
Negative slit skin smear, or
5 skin lesions or less
Multibacillary:
Positive slit skin smear and
More than 5 skin lesions

Single-lesion paucibacillary (SLPB):

Single dose of three drugs (ROM):
Rifampicin 600 mg
Ofloxacin 400 mg
Minocycline 100 mg
Multidrug therapy:
Paucibacillary case
Supervised dose (day 1):
Rifampicin 600 mg
Dapsone 100 mg
Daily dose (days 2-28):
Dapsone 100 mg
6 blister packs to be taken monthly in 6 to 9 months

Multidrug therapy:
Multibacillary case
Supervised dose (day 1):
Rifampicin 600 mg
Dapsone 100 mg
Clofazimine 300 mg
Daily dose (days 2-28):
Dapsone 100 mg
Clofazimine 50 mg
12 blister packs to be taken monthly in 12 to 18 months

TETANUS
Causative Agent: Clostridium Tetani
Mode of Transmission:
thru break in the skin and mucous membrane
Neonates – umbilical cord
Children – dental carries
Adults – e.g. septic abortion, puncture wound, etc
Incubation Period:  3 – 14 days
Release of tetanospasmin – spasm
Release of Tetanolysin – lysis of RBC & WBC

TETANUS
Signs and Symptoms:
Neonate –    malaise
    difficulty in sucking
    excessive crying
    stiffness of jaw
Trismus – painful spasm of the masticatory muscles
Risus sardonicus – painful spasm of the facial nerve
Opisthotonus – aching of the back, neck bowed backward
Muscular spasm
TETANUS
Diagnostic examination:
    History of wound
    Clinical manifestations
Treatment:
    ATS/TAT – Anti Tetanus Serum, Tetanus Aglutunin Toxoid
    TIG – Tetanus Gammaglobulins
    IVF
Penicillin G Sodium
Diazepam
Supportive:    O2 inhalation
Tracheostomy
Suction secretions
TETANUS
Nursing care:
Quiet room
Avoid unnecessary handling
Padded tongue-depressor
NPO, if can’t open mouth
liquid to soft diet, with partial lockjaw
observe aspiration precautions
suction secretions
Observe frequency, duration of muscular spasm
assess respiration during spasm
put bedrails
do not restrain
Prevention:
Proper wound care
Immunization