Microbiology and Parasitology - Lab

Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

LESSON TITLE: INFLUENZA, AVIAN INFLUENZA, LEPROSY Materials:

AND LEPTOSPIROSIS
Pen, paper, index card, book, and class List
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can: Reference:
1. Describe what is influenza, avian influenza, leprosy and
leptospirosis; Navales D., (2010). Handbook of Common
rd
2. Explain the mode of transmission influenza, avian influenza, Communicable and Infectious Diseases 3
leprosy and leptospirosis; Edition, Philippines: C&E Publishing Inc.
3. Identify the etiologic agent influenza, avian influenza, leprosy
and leptospirosis;
4. Enumerate the signs and symptoms of influenza, avian
influenza, leprosy and leptospirosis; and,
5. Outline the different nursing management of influenza, avian
influenza, leprosy and leptospirosis.

A. LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Enumerate the 12 Cranial Nerves.

Number Name

B.MAIN LESSON (50 minutes)

Content and Skill-Building

Influenza

Influenza/ La Grippe is an acute viral infectious disease affecting the respiratory system.

Causative Agent: RNA-containing Myxovirus, types A, A-prime, B, and C

This document is the property of PHINMA EDUCATION Page 1

 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Incubation Period:
⎯ 24 to 48 hours

Period of Communicability:
⎯ Communicable until 5th day of illness (up to 7th day in children)

Mode of Transmission:
⎯ Airborne spread
⎯ Droplet spread
⎯ Direct contact
Clinical Manifestations:
⎯ Chilly sensation, hyperpyrexia, malaise, sore throat, coryza (colds and pharyngitis), rhinorrhea, myalgia and
headache.
⎯ Severe back pain, with severe sweating.
⎯ GI symptoms and vomiting

Complications:
Directly related to primary viral infection
⎯ Hemorrhagic pneumonia
⎯ Encephalitis and other neurologic syndrome
⎯ Reye’s syndrome, a swelling in the liver and brain associated with epidemic influenza B infection.
⎯ Myocarditis, which can lead to cardiac failure
⎯ SIDS
⎯ Myoglobinuria
⎯ Bacterial infections due to Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, and
Staphylococcus aureus.
⎯ Otitis media
⎯ Sinusitis
⎯ Pneumonia

Diagnostic procedures:
⎯ Leukopenia
⎯ Oropharyngeal swab
⎯ Viral serology
✔ Complement- fixation test
✔ Hemo-agglutination test
✔ Neutralization test

Management:
No specific treatment for influenza
⎯ Stay at home
⎯ Drink plenty of fluids
⎯ Paracetamol, aspirin, or ibuprofen
⎯ Aspirin should not be given to children below 16 year
⎯ TSB
⎯ Respiratory isolation
⎯ Limit strenuous activity
⎯ Watch out for complications

This document is the property of PHINMA EDUCATION Page 2

 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Preventive measure:
⎯ Immunization
✔ The elderly
✔ People who have poor immunity
✔ Those with diabetes and lungs, kidney, heart, or liver disease
⎯ Avoidance of crowded places
⎯ Educate the public regarding basic personal hygiene

Avian Influenza

Avian Influenza/Bird’s Flu is a type of “influenza” that was first identified in Italy in the early 1900s and is now known to
exist worldwide.

Causative Agent: Avian influenza (A1) virus. All A1 viruses belong to Influenza virus A, a genus of the Orthomyxoviridae
family

Mode of transmission:
⎯ It spreads in the air and in manure.
⎯ Cats are possible vectors for H5N1 strains of avian flu.
⎯ H5, H7, and H1 are known to be capable of crossing the species barrier.

Incubation period:
⎯ 3 to 5 days after exposure to manure or infected birds.

Signs and symptoms:

⎯ Similar with human influenza (fever, sore throat, cough, and pneumonia)

Prevention:
⎯ Rapid destruction (culling or stamping out of all infected or exposed birds) proper disposal of carcasses and
quarantining and rigorous disinfection of farms.
⎯ Restriction of movement of live poultry.
⎯ Antiviral drugs [Oseltamivir (Tamiflu) or Zanamivir].
Leprosy

Leprosy (Hansen’s Disease/Hansenosis) is chronic systemic infection characterized by progressive cutaneous lesions.
Contrary to popular belief, leprosy is not highly contagious and actually has a low infectivity.

Causative Agent: Mycobacterium Leprae

⎯ An acid-fast bacillus that attacks cutaneous tissues and peripheral nerves, producing skin lesions, anesthesia,
infections, and deformities.

Incubation Period: 5 ½ months to 8 year

Mode of transmission:
⎯ Respiratory droplets.
⎯ Break in the skin and mucous membranes

This document is the property of PHINMA EDUCATION Page 3

 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Three forms:
1. Lepromatous Leprosy (Multibacillary)
⎯ Most serious and most infectious.
⎯ Causes damage of the respiratory tract, eyes, and testes as well as the nerves and skin.
⎯ Gradual thickening of skin with granulomatous condition.
⎯ Lesions appear as macules and become nodular in character (leproma).
⎯ Loss of sensation (anesthesia).
⎯ Atrophy of the skin and muscles, melting of small bones, usually of the hands and feet
⎯ Lepromin test is negative.

2. Tuberculoid leprosy
⎯ Affects the peripheral nerves and sometimes the surrounding skin, especially on the face, eyes, and testes.
⎯ Lepromin test is positive
⎯ Macules are elevated, with clearing at the center, and are more clearly defined than in the lepromatous form.
⎯ Anesthesia is present.

3. Borderline (Dimorphous) Leprosy

⎯ Has the characteristics of both lepromatous and tuberculoid leprosy?

WHO classification of leprosy:

1. Paucibacillary (Tuberculoid and Indeterminate)
⎯ Non-infectious types
⎯ Duration of treatment: 6-9 months

2. Multibacillary (Lepromatous and Borderline)

⎯ Most infectious type
⎯ Duration of treatment: 24 to 30 months

Clinical Manifestations:
1. Neural Involvement
⎯ Atrophy of the muscles of the hands
⎯ Paralysis and peripheral anesthesia can occur independently or concurrently
⎯ Malperforant (neuropathic ulcerations), claw hand, and ocular complications, paralysis of the eyelids
2. Skin
⎯ In lepromatous disease, early lesions are multiple, symmetrical and erythematous, appearing as macules or
papules
⎯ Lesions are enlarged and form plagues on nodules on the earlobes, nose, eyebrows, and forehead= leonine
appearance
⎯ Loss of eyebrows or eyelashes
⎯ Anhidosis or the loss of function of sweat and sebaceous glands
3. Eye
⎯ Photophobia, conjunctivitis, iridocyclitis (depigmentation of the iris of the affected eye)
4. Upper Respiratory Tract
⎯ In lepromatous leprosy it involves the nose, mouth, pharynx, larynx, trachea, and esophagus.
⎯ Epistaxis, ulceration of the uvula and tonsils, septal perforation and nasal collapse.
5. Visceral Leprosy
⎯ Involves the reticuloendothelial system, lymph system, and the liver.

This document is the property of PHINMA EDUCATION Page 4

 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Late manifestations:
⎯ Madarosis
⎯ Lagophthalmos
⎯ Contractures/permanent shortening causing deformity
⎯ Sinking of the nose bridge
⎯ Chronic ulcers
⎯ Gynecomastia
⎯ Clawing of fingers and toes

Diagnostic test:
⎯ Physical exam – indicating the signs and symptoms
⎯ Tissue biopsy
⎯ Tissue smear
⎯ Blood test
⎯ Lepromin skin test

⎯ Diagnosis of leprosy is currently based on presenting signs and symptoms especially if there is history of contact with
person with leprosy. Only in rare instances is there really a need to use laboratory and other investigations to confirm
a diagnosis.
⎯ Lepromin skin test is used to determine what type of leprosy a person has. It involves the injection of a standardized
extract of the inactivated "leprosy bacillus",(Mycobacterium leprae or "Hansen's Bacillus") under the skin. It is not
recommended as a primary mode of diagnosis
⎯ Slit skin smears are used for the determination of the number of bacilli and the state of those bacilli, in the lesions of
patients undergoing treatment for leprosy.
✔ The lesion is first cleaned with alcohol.
✔ The skin is pinched to make it bloodless.
✔ An incision is made into the crest of the pinched skin with a scalpel blade (#15), 5 mm long to a depth of 3 mm.
✔ The blade is then turned 90 degrees and the tissue is scraped repeatedly in one direction.
✔ The scrapings are gently spread onto a glass slide, the slide is fixed, and is stained for acid-fast bacilli.
⎯ Acid-fast bacilli are common in lepromatous leprosy; they are absent or rare in tuberculoid. With adequate
treatment, lepromatous smears become negative in a few years (up to 10).

Multidrug Therapy
⎯ MDT is used for the treatment of leprosy to prevent drug resistance.
⎯ Rifampicin is the most important anti-leprosy drug.
⎯ Clofazimine causes brownish black discoloration and dryness of the skin, but it disappears once medication stopped.
⎯ In Multibacillary, after taking 12 months doses of multidrug therapy, the person is considered cured
⎯ In Paucibacillary, after taking 6 months doses of MDT, the person is cured.

Multidrug Therapy Paucibacillary Multibacillary

Rifampicin 600 mg once a month 600 mg once a month
Dapsone 100 mg daily 100 mg daily
Clofazimine 50 mg daily for 12 months
Duration of treatment 6 – 9 months 24 to 30 months
Management:
⎯ Respiratory isolation and medical asepsis
⎯ Full nutritious diet
⎯ Personal hygiene
⎯ Terminal disinfection
This document is the property of PHINMA EDUCATION Page 5
 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Prevention:
⎯ BCG
⎯ Separation of NB infants from leprous mothers
⎯ Health education

Leptospirosis

Leptospirosis (Weil’s Disease, Canicola Fever, Hemorrhagic Jaundice, Mud Fever, Swine Herd Disease, Japanese Seven
Days Fever) is a zoonotic infectious bacterial disease carried by both domestic or wild animals whose urine contaminates
water or food which is ingested or inoculated through the skin.

Causative Agent: Leptospira Interrogans

Incubation period: 6 to 15 days

Period of Communicability: 10 to 20 days

Source of Infection:
⎯ Rats (L. Icterohaemorrhagiae) are the source of Weil’s disease.
⎯ Dogs (L. Canicola)
⎯ Mice (L. Drippotyphosa)
⎯ Rats (L. Bataviae)
Mode of transmission:
⎯ Ingestion or contact with the skin and mucous membrane of the infected urine or carcasses of wild and domestic
animals
⎯ Leptospira enters the blood to cause damage in the kidneys, liver, meninges, and conjunctivae.
⎯ Contact with the semen of infected animals.
⎯ Common among veterinarians, slaughter house workers, farmers, and sewer workers.

Three Septic Stages:

1. Septic Stage
⎯ Abrupt onset of remittent fever, chills, headache, anorexia, abdominal pain, and severe prostration or tiredness.
2. Immune Phase or Toxic Stage
⎯ With or without jaundice
⎯ Meningeal manifestations like disorientation, and convulsions
⎯ Oliguria and anuria with progressive renal failure
⎯ Shock, coma, and congestive heart failure.
th th
⎯ Death occurs between on 9 and 16 day of infection.
3. Convalescence
⎯ Relapse may occur during the 4th and 5th week.

Laboratory Diagnosis:
⎯ LAAT (Leptospira Antigen-Antibody Test)
⎯ LAT (Leptospira Antibody Test)
⎯ ELISA (Enzyme-linked Immunosorbent Assay)
⎯ BUN and creatinine
⎯ Liver function are slight or moderately elevated

This document is the property of PHINMA EDUCATION Page 6

 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Organs Invaded by Leptospira:

⎯ Liver leads jaundice
⎯ Kidney leads renal failure
⎯ Muscles leads pain and edema
⎯ Eyes leads conjunctivitis

Complications:
⎯ Meningitis and respiratory distress
⎯ Weil’s disease (renal interstitial tubular necrosis that results in renal failure)
⎯ Cardiovascular problems

Medical Treatment:
⎯ Aetiotropic Drugs:
✔ Penicillin, Doxycycline, Ampicillin, Amoxicillin
⎯ Prophylaxis:
✔ Doxycycline 100 mg PO q 12 hours for 1 week
⎯ Peritoneal dialysis
⎯ F&E and blood products as indicated.

Management:
⎯ Isolation, pay particular attention to urine of an infected person.
⎯ Darken the patient’s room.
⎯ Regularly replace water in pools, vases, aquaria to prevent stagnation.
⎯ Eradicate rats and rodents.
⎯ Encouraging OFI.

Prevention and Control:

⎯ Sanitation
⎯ Proper drainage system and control of rodents
⎯ Vaccination among domestic animals.
⎯ Information dissemination

CHECK FOR UNDERSTANDING (30 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 30 minutes for this activity:

Multiple Choice

1.Complications of Influenza includes swelling in the liver and brain associated with epidemic influenza B infection.
This is known as?
a. Encephalitis
b. Reye’s syndrome
c. Ramsay-Hunt Syndrome
d. Epstein Barr virus
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

This document is the property of PHINMA EDUCATION Page 7

 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

2. What do you call a condition in which the number of WBC circulating in the blood is abnormally low?
a. Thrombocytopenia
b. Anemia
c. Leukemia
d. Leukopenia
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

3. Which is a causative agent of an avian influenza?

a. Myxovirus
b. Orthomyxoviridae
c. Varicella
d. Necator americanus
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

4. How long is duration of treatment for lepromatous and borderline leprosy?

a. 6-9 months
b. B.10- 13 months
c. 14 to 16 months
d. 24 to 30 months
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

5. The period of communicability of leptospirosis is?

A. 5 to 10 days
B. 12 to 15 days
C. 20 to 25 days
D. 10 to 20 days
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

This document is the property of PHINMA EDUCATION Page 8

 Microbiology and Parasitology - Lab
Module #14 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

C. LESSON WRAP-UP (5 minutes)

AL Activity: Minute Paper

Instruction:
1. Reserve a few minutes at the end of class session. Leave enough time to ask the questions, to allow students to
respond, and to collect their responses.
2. Pass out slips of paper on index cards for students to write on. You may also ask students to bring out and write on a
half sheet of paper instead.
3. Collect the responses as or before students leave. One way is to station yourself at the door and collecting “minute
papers” as student file out.
4. Respond to students’ feedback during the next class meeting or as soon as possible.

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

This document is the property of PHINMA EDUCATION Page 9