Nursing 202 Immune System disorders - Module D

Treatment for Rabies

Rabies: Passive & active immunizations before onset of symptoms: Immediate vigorous wound cleansing with soap and water Intensive cardiopulmonary supportive care if symptomatic No steroids: reduce the response to the vaccine - and we do want to give them the vaccine as soon as they are bitten

Incubation period

Rabies: can last from 20 - 90 days or it can be a __________ _________ of less than < 50 days of there are multiple bites or they have bitten on the head or neck -- generally asymptomatic

Prodromal period

Rabies: is when the virus enters into the central nervous system, the _________ _________ last from 2 - 10 days -- S/S: malaise, anorexia, H/A, fever, chills, N/V/D, insomnia, pain ~ 100% mortality rate if tx is not started

Acute neurologic period

Rabies: when there is development going on in the CNS, this period lasts for 2 - 7 days -- H/A and fever are PROMINENT SYMPTOMS!!

MRSA

Common bacteria found on skin, perineum and in the nose of many people - not usually infectious in these areas because the number of bacterial is controlled by general good hygiene measures. o __________ does not respond to methicillin or other penicillin based drugs

~ Scarlet fever ~ Diptheria

DROPLET precautions ....

Furious rabies

Episodes periods of agitation, hyperactivity, restlessness, thrashing, biting, confusion, or hallucinations -- 80% develop the __________ rabies, the other 20% stay relatively quiet ~ Hydrophobia ~ Aerophobia

Antihistamine (such as Benedryl)

For TYPE 1 response -- SECOND line drug therapy for anaphylaxis. 25 - 100 mg given IM or IV ~ ___________ can be given for patients with angioedema and/or urticaria (hives)

Stage 2 -- early disseminated

Lyme Disease: Stage.... o Occurs anywhere from 2 - 12 weeks after the tick bite o It can affect the CNS and if it does affect the CNS the disorders that might occur with that would be meningitis, facial paralysis - which is often misdiagnosed as Bell's palsy, or peripheral neuritis o S/S: carditis w/dysrhythmias, dyspnea, CNS disorders, dizziness, palpitations o Treatment: IV antibiotics x 30 days

Type I Rapid Immune Response

Most common type of hypersensitivity response - It deals with the production in the body of IgE -- RAPID REACTION -- "inhalation, ingestion, injection, in contact with"

Overreaction

Occur in response to the presence of an antigen or a foreign body, or an allergen to which the patient has usually been exposed to o Symptoms range from uncomfortable to life threatening o Hypersensitivity is classified into 5 basic types and the types is determined by timing, the pathology, and by the symptom

Periphery CNS

The Rabies virus travels from the _________ to the _________

~ Pulmonary disorders ~ Corticosteroids ~ DM

Top 3 conditions placing the patient at increased risk for FUNGAL infection: Aspergillosis

VRE - Vancomycin Resistant Enterococcus

Zyvox and Synercid have been effective for the most part; but we are now beginning to see some types of ___________ resistant enterococcus that has become resistant to Zyvox also o In recent years we have seen vancomycin resistance. It has appeared in about 25% of the patients that have enterococci bacterial infections o Risk factors are a prolonged hospital stay, a severely ill client, abdominal surgery, someone who had enteral nutrition or someone who has been immunosuppressed o Place on Contact precautions!!

Bacterial infections - Streptococcal: CAT SCRATCH FEVER

o A bacterial disease comes from a bite or a scratch from a cat or a kitten. A mild infection occurs at the point of injury o Lymph nodes, especially those around the head, neck and upper limbs become swollen o S/S: single lesion at the site, fever, regional lymphadenopathy, Headache, fatigue, poor appetite o Infection begins 7-14 days before the symptoms start - it may even be up to 2 months before the symptoms start o Treatment: symptomatic, antibiotics

Hypersensitivity / Allergic response

o A prolonged and excessive stage inflammation or immune response o Inappropriate response that keeps it going or keeps it prolonged and excessive

Viral Infection: Pityriasis Rosea

o A skin rash that usually begins as one large circular or oval spot on the chest, abdomen, or back - this spot is referred to as a herald patch. This initial spot can be up to 4 inches across. It is the herald patch that is typically followed by a distinctive pattern of similar but smaller lesions that sweep out from the middle of the body in the shape that resembles a drooping pine tree branch o Can affect any age group but is most commonly seen in your ages 10 to 35 o Usually goes away on its own within 6 weeks o S/S: Lesions over trunk, asymptomatic, mild pruritus - causes itching o Treatment: focused on relieving symptoms (the itching) - topical corticosteroids, PO antihistamines, antiviral drugs such as the Zovirax can reduce the duration - usually if given it can reduce the duration by 1 to 2 weeks o It is an acute inflammatory skin disorder o The progression from the herald patch to the other lesions usually takes 2 - 5 days

Rabies Virus

o Affects the CNS o Occurs not frequently - there were 3 cases reported in 2006 o There were between 16 and 39,000 cases that were treated prophylactively to prevent actual rabies o Caused by being bitten by an unvaccinated dog or an undomesticated canine such as coyotes, wolves, or foxes, or raccoons, skunks can carry it; insect eating bats have also been proven to carry it o Contact with saliva or infected CNS tissue via: ~The bite ~Contact with broken skin ~Contact with mucous membranes ~Exposure to aerosolized secretions from rabid animal ~Unpasteurized milk ~Transplants (corneal, kidney and liver tissue)

Scratch test

Allergens introduced through a scratch test cause a localized reaction (wheal) when the test is positive -- the results from these are usually in about 15 to 20 minutes from the _________ _________

Rickettsia Diseases: Rocky Mountain Spotted Fever

o Caused by an organism that multiplies inside a tick, lice, mite or flea o Transmitted primarily by the bite of one of those insects o Most common form of rickettsia diseases - difficult to diagnose early o Can be lethal if not diagnosed o About 3-5% of the patients with this die if not treated o S/S: reddened area at site, rash beginning with macule then petechial on ankles, wrists, soles, wrist and palms. Can progress to CNS, cardiac and respiratory involvement o Treatment: antibiotics (tetracycline, doxycycline)

Hospital Acquired MRSA

o Spread by direct contact as well as invasion through broken skin, catheters, IV's and endotracheal tubes. o This type of infection is called health care associated MRSA. o Treatment with Vancomycin and Zyvox. o Patients at risk are older, immunosuppressed, been on antibiotic therapy for a long period of time, invasive tubes or lines.

TYPE 1 Rapid Response Reactions

~ Hay fever ~Anaphylaxis ~Latex (can be Type 1 or 4) ~Food

Nursing interventions for anaphylaxis

- If your patient is independently breathing we want to put on a High flow non-rebreather mask at 90-100% Oxygen with a goal for the patient to SAT at higher than 90%. - Continually monitor your patient's respiratory rate and depth, assess frequently for breath sounds indicating bronchiole spasms by wheezing or crackles, monitor for stridor - Interventions are to keep the head of the bed elevated at 45 degrees unless your patient is experiencing severe hypotension - Change tubing & hang NS -- DO NOT D/C the IV, only the tubing! - Have Benadryl & epinephrine IV available - Ensure that intubation and tracheotomy are ready - Stay with the patient and reassure them

Anaphylaxis

- Other TYPE 1 reactions may involve all blood vessels and bronchiole or smooth muscles. An example of this would be in the case of ___________

Allergic rhinitis Latex allergy

- Some of your TYPE 1 reactions occur just in the area that is exposed to the antigen. Such as: ___________ and a __________

Epinephrine (Adrenalin)

For TYPE 1 response -- FIRST line drug therapy for anaphylaxis. 0.3 - 0.5 mL IM or IVP ~ ___________ constricts the blood vessels, thereby improving cardiac concentration, cardiac contraction, it also dilates the bronchioles ~ ___________ may be repeated every 5 minutes PRN until other drugs can be given

Serum sickness

Is a group of symptoms that occur after receiving serum or certain drugs. o Most common causes- Penicillin, other antibiotics, some animal based serum drugs. o Symptoms occur 7-12 days (she says she believes it is 7-10 though) after the causative agent was received o Symptoms are fever, arthralgia, rash, lymphadenopathy, malaise, arthritis, o Immune complex reactions and _________ _________ is usually self-limiting and subsides in a few days

Patch testing

Is usually reserved for type 4 (delayed) allergies

Stage 1 -- early / localized

Lyme Disease: Stage.... o Signs and symptoms begin within 3 to 30 days but most of the symptoms are present within the first 7 to 14 days o S/S: Flu-like symptoms, erythema migraines (round or oval, flat or slightly raised rash), usually only 1 lesion (bulls-eye) pain and stiffness in muscles and joints o Treatment: antibiotics (doxycycline, amoxicillin, ceftin) x14-21 days Even without antibiotics the symptoms that you see tend to disappear in 4-5 weeks but the problem still exist. So if it is not treated or is unsuccessfully treated then it will progress to a more serious complicated state

Incubation stage

Stage of infection: silent stage - as the pathogen has already entered the host and has begun replicating - and there may not be any symptoms during this stage

Prodromal stage

Stage of infection: symptoms begin: itching, runny nose, dry eyes, etc...the S/S begin but are not significant or severe at this point

Illness stage

Stage of infection: when the disease reaches its highest point of development - there are usually severe aches, chills, vomiting, etc...

Convalescence stage

Stage of infection: where the S/S have nearly completely vanished and the pathogen has been mostly eliminated

TYPE 3: Immune Complex Reactions

Systemic Lupus is an example of __________ type of hypersenstitivity...

12% 1 - 2%

TYPE 1: Conduct a thorough physical assessment, ask for any signs and symptoms, and observe for any symptoms, it is possible there will be an order to draw a CBC with differential. This is done because the eosinophils will indicate the presence of an allergic response as high as _______%. You do need to know what the normal eosinophil count is _______%

ID (intradermal) test

The ________ ________ is done for substances that are strongly suspected of causing allergy but did not test positive with scratch testing

Skin, Kidneys, and Joints

The most common sites for the circulating complexes in TYPE 3 Hypersensitivity to lodge are the _________, _________, _________

Zyvox / Synercid

Treatment for Vancomycin Resistant ENTEROCOCCUS

Minocycline / Doxycycline

Treatment of COMMUNITY acquired MRSA ....

Vancomycin / Zyvox

Treatment of HOSPITAL acquired MRSA .....

Papilloma Virus: Verrucae

WARTS!! Occurs in about 7-10% of the population o Caused by papilloma virus o May or may not be Spread by direct contact o Treatment: some OTC acne meds are useful in treatment of these general warts o This wart virus survives months without a host. It can live on any moist surface!!! o Warts are benign tumors of the outer skin layer and can occur at any time in life o Most prevalent during early to middle adolescence infecting approximately 1 in 20 teens. o A break in the skin allows this human papilloma virus to invade the body and months later several tiny firm bumps with a well-defined border start to grow nearby the site o Most common sites are the fingers, hands, forearms, and feet. o These bumps often emerge as clusters. Sometimes several small warts will encircle a larger growth o Some forms cause genital warts o Commonly these warts are passed through casual contact like shaking hands, using towels, or other types of items that get used by someone who has warts on their fingers or hand o Generally the warts do not cause itching, nor are they painful except when the warts are grown on the soles of the feet - these are called plantar warts o Two-thirds of the cases will resolve on their own within two years - rarely do the general warts remain for more than 5 years and again there are some forms of the HP virus that can cause genital warts but those are not the type we are talking about with this virus

Emerging Infections

__________ __________ is an infectious disease that is simply defined by one whose incidence has increased in the past 20 years and threatens to increase in the near future.....

Hantavirus

___________ can progress to __________ Pulmonary Syndrome (HPS) - can be fatal o People become Infected through contact with hantavirus infected rodents, saliva, fresh urine or droppings o Early symptoms: fatigue, fever, muscle aches, especially in large muscle groups, headaches, dizziness, chills, nausea, vomiting, diarrhea, and abdominal pain. The old world hantavirus was found in Asia - can cause hemorrhagic fever with renal syndrome o Late Symptoms: 4- 10 days after the early symptoms occur- late symptoms appear: coughing & SOB, as the lungs fill with fluid. o Rodent control in and around the home remains primary strategy for preventing hantavirus infection o Symptoms may begin to develop anywhere from 1 to 5 weeks after the exposure

Avian Influenza - bird flu

o A flu infection in birds - the virus can mutate and then infect humans o People at a greater risk for developing the flu are farmers and others who work closely with poultry, travelers visiting affected countries, anyone who touches an infected bird, those who eat raw or undercooked poultry, eggs or blood from the infected bird, o Health care workers in contact with infected patients that have avian influenza are also at greater risk because the avian flu can survive in the environment for long periods of time o The infection may be spread as simply as touching contaminated surfaces o Birds who are infected with this flu can continue to release the virus in their feces and their saliva as long as 10 days o S/S: Cough (dry or productive), Diarrhea, Difficulty breathing, Fever greater than 100.4, Headache, Malaise, Muscle aches, Runny nose, Sore throat o Treatment o Different types of avian flu virus may cause different symptoms therefore the treatment may vary somewhat o Antivirals: Oseltamivir (Tamiflu) or zanamivir (Relenza) may make the disease less severe if they are started within 48 hours of the first symptoms o Tamiflu may also be prescribed for people who live in the same household as those diagnosed with the Avian flu o The virus that causes human avian flu appears to be Resistant to antivirals amantadine and rimantadine. Therefore these medication should not be used when avian flu is suspected

Anaphylaxis - TYPE 1

o A life threatening occurrence o Rapid and systematic o Affects multiple organs within seconds to minutes after the patient is exposed -- ex. throat closing, tongue swelling, breathing difficulty

Protozoan Infections: Cholera

o Although cholera can be life-threatening it is easily prevented and treated In the U.S because of the advanced water and sanitation that the U.S has - cholera is not a major threat in the U.S. o It is an acute, diarrheal illness caused by infection of the intestine with the bacteria - Vibrio cholera o The infection is often mild and without symptoms at all, but it can sometimes be very severe o There is approximately 1 in 20 or 5% infected persons who will have a severe disease that is characterized by profuse watery diarrhea and leg cramps. In that 5% there is a rapid loss of body fluid that leads to the dehydration and hypovolemic shock can occur - without treatment this could lead to death within hours o Cholera lives in the environment in rivers and coastal waters, it can be seen in shell fish, if these shell fish are eaten raw and have been infected with the vibrio cholera they can infect the persons eating them - a few people have contracted cholera this way after eating raw or undercooked shell fish that came from the Gulf of Mexico. o Found in water or food sources that have been contaminated by feces from a person infected o Symptoms: after ingesting the bacteria it can take anywhere from a few hours to 5 days (typically in 2-3 d) for the symptoms to appear o Diagnosis is made through a stool sample or a rectal swab o Treatment: can be simple and successfully treated by immediately and replacement of lost fluid & electrolytes that occurs through the diarrhea o Patients are usually treated with oral rehydration solutions. Severe cases may also require IV fluid replacement, but with prompt rehydration fewer than 1% patients that are infected with cholera have a poor outcome

Severe Acute Respiratory Syndrome (SARS)

o An acute viral respiratory infection that is caused by the corona virus - however SARS is a new corona virus o The corona virus family cause many different forms of the common cold, but SARS is a more virulent and mutated form of the corona virus o S/S: ~ Usual respiratory s/s, fever > 100.4, HA, general aches, mild cold s/s. ~ Develop dry cough and difficulty breathing w/in 2-7 days they will often report a breathlessness type of feeling. o It is easily spread through airborne droplets in routes such as coughing, sneezing, talking or it does spread through contaminated surfaces as well o It infects the cells of the respiratory tract causing an inflammatory response to be triggered o The virus itself stays in the respiratory tract rather than spreading into the blood, but the RNA of the virus spreads to the blood. o The people at greater risk are those in close direct care of the infected person o The virus is able to enter the through the mucus membranes of the eyes, nose and mouth o The more severe cases or forms of SARS are indicated by hypoxia cyanosis and a decreased oxygen saturation Treatment: o No effective treatment. Supportive care, O2, respiratory treatments to dilate the bronchiole to improve the ventilation, potential need for intubation and ventilator - standard antibiotics and antivirals have proven to be ineffective against this virus They also cannot stop its replication o Chest x-ray for this patient will show a similar looking pattern to a client with pneumonia - Diagnosis is made through the symptoms that are presented as well as through a rapid SARS test o The SARS test can detect the corona virus's RNA in the blood and it does move into the blood within about 2 days when the symptoms begin. ~ Prevention: isolation (airborne and contact), meticulous hand washing, particulate respirator mask

Food allergy TYPE 1

o An allergic reaction usually occurs within minutes within eating the foods o Symptoms include asthma, hives, vomiting, diarrhea, angioedema, articaria -- any of these can come in a very mild to a very severe type. o Children HAVE THE ABILITY to sometimes outgrow their food allergies; but an adult that is allergic to a food allergy DOES NOT outgrow that o Symptoms range from irritating to life-threatening. Children with food allergies are more likely to have asthma, eczema

Viral Infections: Types of Enteroviruses: COXSACKIEVIRUS -- Acute hemorrhagic conjunctivitis (AHC)

o An enterovirus - coxsackievirus o No antibiotics given in the absence of a proven bacterial infection however acute hemorrhagic conjunctivitis is highly contagious o S/S: pain and edema of eyelids, subconjunctival hemorrhage, photophobia, serous type discharge o Treatment; symptomatic, cold compresses, antihistamine eye drops, again no antibiotics unless there is a confirmed bacterial infection as well o Seen in our children age 10 to 14. These are the ones that have the highest risk o We want to avoid spreading this o There is really no treatment available for this type of coxsackievirus o In 24 to 72 hours it has an incubation period o Management would be symptomatic treatment and just waiting for the disease to run its course - it usually has a 5 to 7 day course o It is almost always resolved without having any sequelae, having a good prognosis - it just looks kind of nasty

Parasitic Infections: TOXOPLASMOSIS

o Humans become infected by ingesting undercooked meats or vegetables or by contact with Cat feces, mammals, and birds serve as hosts o Symptoms include subtle changes in mental status, pulmonary infections, feverish illness that mimics pneumocystis pneumonia with SOB and a non-productive cough, eye infections with a loss of visual acuity as well as photophobia, o Affects any tissue; mainly brain, lungs, eyes o ____________ encephalitis the most common in immunosuppressed patients o Dull, constant headache, weakness, seizures o Wash hands, avoid undercooked raw meats, and avoid cat litter boxes!!!!!

Protozoan Infections: Shigella

o Can cause gastrointestinal illness with serious risks but some people who have _____________ infection never exhibit any symptoms. They may not even know that they are infected o Initially present as a simple GI illness o S/S: abdominal pain, diarrhea (possibly bloody, pus, mucous), vomiting and fever o Large amounts of blood in the feces should be monitored very closely o Symptoms begin 1-2 days after the initial exposure - These symptoms will normally pass without treatment in about 1 week o Symptoms usually do not require treatment & pass in about 7 days o Severe cases may take up to 2-3 months for bowel movements to return to normal, severe dehydration may occur, hospitalization may be required. o In rare cases there are severe dehydrations that occur through losing the fluid in diarrhea and vomiting - hospitalization may be required

Legionnaires

o Caused by Legionella bacilli o Can be inhaled from contaminated water supplies o Examples: humidifiers that have mold growing in them and have a medium for bacteria, old and dirty air conditioner vents or contaminated respiratory equipment o Usually does cause pneumonia in your patient o Lab test for diagnosis is done through your ABGs o Most at risk are your middle aged or older adults smokers, those with COPD, immune-compromised patients, o S/S: fever, chills, cough, fatigue, HA o Treatment: antibiotics, supportive respiratory care

Latex allergy TYPE 1

o Caused by a specific allergen that is a Protein found in processed natural latex rubber products. o Production of and interaction of IgE o Sometimes contact is limited to the skin or mucus membrane causing a contact dermatitis which is a TYPE 4 (DELAYED) hypersensitivity. TYPE 1 is RAPID ----- o Some of your patients may experience a mixed symptoms of both type 1 and type 4 responses. Type 4 deals with the T lymphocytes - meaning it may take hours up to days after the exposure for the response to occur (hence, DELAYED) and type 1 again is RAPID.

Bacterial Infections: Tetanus

o Caused by bacillus (bacteria) that is found in the soil and the excretions of animals o Usually enters the body through a wound or a burn o S/S: stiffness of neck and jaw (lockjaw), progresses to painful spasms of all muscles & larynx, when this occurs then death follows o It has a prolonged contraction of the skeletal muscle fibers o Treatment: can be avoided with the treatment of the Vaccine

Protozoan Infections: Campylobacter

o Caused by bacteria of the genus campylobacter. One of the most common factors of our diarrheal illnesses that we see in the U.S. o Most people who become infected with this get ~ S/S: bloody diarrhea, cramping, abdominal pain, fever, nausea and vomiting ~ Symptoms begin within 2-5d after - the illness typically lasts one week. o Diagnoses made through a culture of a stool specimen o Some infected persons do not have any symptoms. o Complications: patients with compromised immune systems can become septic and causes a serious life-threatening infection. (especially if spread to the blood stream) o Most of our patients will recover without any specific treatment in 2 - 5 days and almost completely resolve in 10 days. o During this time the patient should be encouraged to drink plenty of fluids as long as the diarrhea is present. If it is a very severe case antibiotics may be given to shorten the duration of symptoms - need to be given early in the illness. o Antibiotics: azithromycin or erythromycin

Bacterial Infections: Diptheria

o Causes a deterioration of the myelin sheath in peripheral and central nervous systems o Contagious through direct physical contact or through breathing the aerosol secretions. It leads to hearing and nervous system involvement if it is left untreated o S/S: thick coating in the nasopharynx may extend out into nose & bronchi. URI, sore throat, fever o Treatment: antibiotics, Diphtheria antitoxin, DROPLET PRECAUTIONS!!

TYPE 4 - Delayed Reaction

o Delayed Sensitized T cells from a previous exposure respond to an antigen by releasing chemical mediators that trigger macrophages to destroy the antigen. o Doesn't happen immediately it Occurs hours to days later. o Lymphocytes and macrophages collect locally and cause: o Edema, induration, ischemia, and tissue damage at the site. Ex. Positive PPD, Contact Dermatitis, Poison Ivy, Tissue Transplant Reactions, insect sting

Bacterial infections - Streptococcal: SCARLET FEVER

o Develops in some people who have strep throat o Also known as Scarletina o Symptoms - a bright red rash that covers most of the body, scarlet fever is almost always accompanied by a sore throat and a high fever, hence the strep o Most common type in children ages 5 - 15 years of ages - although __________ ___________ was once considered a very serious childhood illness, antibiotics treatments have now made it much less life threatening - none the less if it is left untreated _________ __________ just like any strep throat infection can result in more serious conditions that can result in infecting the heart, the kidney and other parts of the body as well o S/S: fever, sore throat, HA, fine sandpaper rash 12-48 hours later on mucous membranes and skin, tongue o Treatment: symptomatic, usually a full 10 days of antibiotics o DROPLET PRECAUTIONS!

TYPE 5 - Stimulatory Reaction

o Excessive stimulation of an otherwise normally functioning cell. o The surface receptor of the cell is stimulated by an autoantibody and this happens excessively - this causes the cell to be in a turned on kind of state. - meaning it continues to be stimulated o Involvement of 1 organ treatment focuses on removing enough of the responding tissue to return to normal function. o More widespread effect treatment focuses on reducing the production of auto antibodies through immunosuppression. ~ Example is Graves Disease

Viral Infections: Types of Enteroviruses: COXSACKIEVIRUS

o Group A: skin and mucous membranes o AHC, HFM disease o Group B: heart, pleura, pancreas and liver o Myocarditis, hepatitis o A & B: nonspecific febrile illnesses, rashes, URT disease, aseptic meningitis o It replicates in the urinary tract and distal small bowel, can be seen in the respiratory in tract up to 3 weeks after the initial infection occurs and it can be detected in the feces up to 8 weeks after the initial infection occurs. o Mortality is rare - neonate most common febrile infection is caused by coxsackievirus o Usually seen in the summer and fall months with your neonates - but it is mostly seen in young children and infants 90% of these are asymptomatic or they cause a nonspecific febrile illness o CONTACT PRECAUTIONS!!

Stage 3 -- (late, chronic, and persistent)

o If it is not diagnosed or treated properly in the early stages it can cause chronic complications o Chronic persistent stage - it occurs either months up to years after the tick bite o In some of your patients arthritis may the first and only sign and symptoms of Lyme disease o Chronic complications: arthritis, chronic fatigue, memory/thinking problems o May not respond to any antibiotics in any stage Leads to Permanent damage to joints and nervous system damage Prevention is the best strategy

Community Acquired MRSA

o Infection that Develops in the community based health care settings (nursing homes, dialysis centers, prisons, dorms, schools, day cares, military units) o S/S - skin and soft tissue infections, abscesses, boils, blisters o No risk factors or previous history MRSA colonization o Treatment of ________ is Minocycline, or Doxycycline (a broad spectrum harsh in body causes different kinds of side effects - yeast infection, goes in there and kills everything) - both of these are generally usually effective

Fungal Infections: Aspergillosis

o It LIVES IN SOIL, water and air - found in every region of the world o A pulmonary infection that can develop when the spores are inhaled o Some of the risk factors would be a dirty air conditioner unit, a compost heap or a dampened or flood damaged area or housing that could yield a very high number of the aspergilla spores o Immune suppression of an individual is the most important factor in becoming infected or sick with this o Mortality rate of someone untreated by the invasive Aspergillosis is nearly 100% o A fungus that is found in every region of the world o A wide range of disorders, including pulmonary and nasal allergy, chronic pulmonary infection, and invasive disease o Most commonly found in decaying vegetation but is also found in soil, water, food, and air o PULMONARY D/O, CORTICOSTEROID USE, and DM are the top 3 conditions placing the patient at increased risk o Unfortunately this fungal infection is emerging as a cause of opportunistic infection and is associated with fatality within 8 weeks of the onset o S/S: fever, cough, dyspnea, chest pain, and hemoptysis

Paralytic rabies

o Manifested through fever and nuchal rigidity, symmetric paralysis o Patient is usually calm, their clarity gradually progresses from a calmness to delirium or stupor and then into a coma

Enteroviruses: Echovirus

o Most common cause of an acute febrile illness in infants and young children o There is a higher infant mortality rate associated with a Echovirus o It mimics a bacterial and a viral infection o Targets children o Boys: generally seem to have more of a clinical presentation of the illness o Girls: seem to be more asymptomatic o Most common cause of acute aseptic meningitis (infants < 3 months) o Less severe than bacterial meningitis o + Brudzinski and Kernig signs in 33% patients o Biphasic o Fever and myalgia for a few days, then subside and recur suddenly o 5-10% has severe complications: seizures, lethargy, coma, chronic fatigue o S/S: Similar to Coxsackievirus findings, may see encephalitis, vesicular rashes, acute respiratory disease, paralysis o The echovirus is infectious but does tend to clear up on its own o There are no specific antiviral medications available o Immune system treatments called IVIG may help the patients with severe cases of echovirus infection who already have a very weakened immune system o Prognosis - a complete recovery without treatment - generally expected in the patients with the lesser type or the less severity of the illness o Some infections such as pericarditis and myocarditis may cause a severe type of this virus and it can be deadly if left without any supportive measures o Treatment: Supportive, CONTACT PRECAUTIONS!!

Protozoan Infections: Giardiasis

o Most common intestinal parasite in the U.S. o Common cause of gastroenteritis o Oral-fecal route of transmissions o Usually by unclean hands or a lack of hand washing o S/S: diarrhea, weight loss, abdominal cramps and nausea o Treatment: Flagyl x 7 days o Prevention: good hand washing, regular and frequent diaper changing for your infants

West Nile Virus

o Most prevalent in tropical and temperate regions o A virus that is transmitted through the bite of an infected mosquito, it can also be transmitted through infected blood products and it can be passed from mother to child through breast milk o S/S: ~ Mild- asymptomatic, or flu-like symptoms ~ Serious- fever, severe HA, decreased LOC, tremors, seizures, paralysis ~ May last for several weeks but is rarely fatal o If your patient does have the more serious west Nile virus and the CNS is involved the neurological deficits may be permanent o Incubation is 2-15 days o More severe in more compromised and older adults

Viral Infections: Types of Enteroviruses: COXSACKIEVIRUS -- Myopericarditis

o Occurs in males more than females at a rate of 2:1 o S/S: asymptomatic to heart failure and death, dyspnea, chest pain, fever, malaise, o May be preceded by an upper respiratory infection within the preceding 7 to 14 days o Treatment: supportive, manage pain, arrhythmias, and heart failure; bedrest

TYPE 3 - Immune Complex Reactions

o Occurs when excess antigens cause antigen/antibody immune complexes to form in the blood circulation - these complexes begin circulating o The circulating complexes Usually lodge in the small vessel walls causing inflammation and vessel/tissue damage. o Most common sites are the kidneys, the skin and the joints o Systemic lupus erythematosis is an example of _________ _________ _________ Symptoms were vasculitis and glomerular nephritis

TYPE 2 hypersensitivity - Cytotoxic

o Occurs when the body makes Specific autoantibody against a self-cell that has a foreign protein attached to it. o The autoantibodies begin to bind to that cell and form what we call an immune complex. This immune complex destroys the cell and the attached protein through phagocytosis or lysis. - Ex. Hemolytic Anemia/Drug induced Hemolytic Anemia, Blood transfusion (patient receives the wrong type of blood), Good pasture's Syndrome

Lyme Disease

o Occurs when your client is bitten by an infected deer tick. o It does cause a systemic infectious disease process o A vector is a the transmitter of a disease causing organism that can carry pathogens from one host to another o Lyme disease is especially seen in the summer months when people are outside more and there are more infestations of ticks in the grass and in the woods, and we see them on our pets and it is easy to transfer them inside o Early detection is done usually it is a test that is done with the disease within the first 4 to 6 weeks after the bite - this is when we want to diagnose ___________ ___________, because it will progress without treatment

Enteroviruses: Poliomyelitis

o Rapid progression to paralysis o Paralytic polio: exercise increases the severity o Loss of reflexes: lose superficial first then 8-24 hours later loss of Deep Tendon Reflex o Lower extremities more than the upper extremities o Affects the nerves and can lead to a partial or a full paralysis o Enters through the mouth and nose and multiplies in the throat and the intestinal tract. Then it gets absorbed and spread through the blood and lymph system o Incubation period ranges from 5 to 35 days with an average of about 7 to 14 days o Children in the United States are now routinely vaccinated against this disease o __________ often occurs when someone travels to a region where the disease is common o __________ now is only existent in a few countries such as Africa and Asia o Vaccines are pretty safe and very encouraged o If it occurs though boys usually get it more than girls and usually before the age of 15 in those countries that it is prevalent o There are IM injections and muscle injury will predispose this client to a localized case of polio in that extremity where the IM injection was given and it can affect the respiratory muscles and it can cause pharyngeal paralysis also o S/S: fever, HA, sore throat, loss of appetite, abdominal pain, o Paralytic: weakness of 1 or more muscle groups, there will be a notable change to reflexes 12-24 hours before paralysis. There will be some loss of deep tendon reflex o Treatment: CONTACT PRECAUTIONS, supportive, bedrest, analgesics, sedatives, hot packs provide pain relief, keeping the body aligned seems to decreased deformities, getting physical therapy in and active and early with different type of exercises - the exercises can range from passive stretching and movement to active movement, possible need for intubation if it continues and it affects the respiratory muscles, cholinergic - help with bladder control, increased fluid intake is supportive is supportive.

Viral infections: Enteroviruses

o Small virus that is made up of RNA and protein o Enters the body through the gastrointestinal tract o Responsible for about 10 million symptomatic infections a year o Cause wide range of infections o Common cold/fever o Aseptic meningitis o South > North o Young > adult o Transmitted by fecal/oral route, also respiratory/oral spread. o Average incubation 3-10 days o CONTACT PRECAUTIONS!!! o Causes are poor sanitation, a low socioeconomic status, crowded living conditions - this can facilitate the spread o The viral particles are shed in feces and the upper respiratory secretions - this happens for days prior to symptoms showing up - so the incubation period is when the virus actually spreads to the lymphoid tissues and begins to replicate

Bacterial Infections - Staphylococcal: RITTERS DISEASE (Scalded Skin)

o This is the MOST SEVERE STAPH infection o Seen mostly in our newborns o S/S: macular erythema (thin-walled easily ruptured, widespread blisters over the body) with sandpaper texture of involved skin. o The epidermis becomes very wrinkled and large bulla appear, the skin peals and leaves that scalded look - leaves very tender skin - don't handle the baby a lot o Treatment: systemic antibiotics, very meticulous skin care

Viral Infections: Types of Enteroviruses: COXSACKIEVIRUS -- Aseptic Meningitis

o This type is seen in our infants usually less than 1 year of age o Onset can be very rapid or can be gradual o S/S: fever, chills, N/V, malaise, HA, neck pain, light sensitivity, irritability and anorexia, nuchal rigidity, stiff neck o Symptoms will usually subside within 2-7 days o Treatment: supportive, hospitalization for those with changes in mental status or neuro deficits, analgesics for H/A relief

Treatment to TYPE 2 - Cytotoxic hypersensitivity

o Treatment - immediately discontinue the offending drug or blood product, plasmaphoresis may need to be done which is the filtering of the plasma to remove these autoantibodies o Otherwise the treatment for this is symptomatic o Complications are such as renal (kidney) failure and hemolytic crisis are life threatening and can be fatal.

Allergic rhinitis ("hay fever") - type 1

o Triggered by airborne allergens o Type one hypersensitivity reaction o May be seasonal - meaning it occurs at the same time of the year o Environment exposure is usually a precipitating factor o Usually last for a couple of weeks o ½ of all the patients that have __________ __________ have a parent that experiences some type or degree or form of TYPE 1allergies

Viral Infections: Types of Enteroviruses: COXSACKIEVIRUS -- Hand, Foot, and Mouth DZ

o Usually is seen in children less than 10 years of age o Very contagious from 2 days before any of the symptoms and after the rash o No need to isolate this patient - you just want to avoid spreading it o The little fluid filled rash lesions are very tender and they may ulcerate, they usually do not itch - which makes it different from chicken pox - o Lesions fun their course and resolve within 5 to 7 days o S/S: fever, sore throat, anorexia, vesicular lesions on tongue or buccal mucosa as well as hands and feet. o Treatment: symptomatic, sore throat (mouth wash, saline rinses, viscous lidocaine)

Ebola Hemorrhagic Fever & Marburg Virus

o ____________ ___________ ___________ and ____________ ____________ are related viruses. They are sometimes referred to as the green monkey disease. They both cause hemorrhagic fevers. The illness is marked by severe bleeding or hemorrhage, organ failure and in many cases it results in death. There is a 50-90% mortality rate. o Both are native to Africa where there are sporadic outbreaks that have been occurring for decades now. o Both live in animal hosts and humans can contract the viruses from the infected animals o After the initial transmission the viruses can spread from person to person through the contact with infected body fluids or through contaminated needles o There has been no drug approved to treat either virus o S/S: sudden fever, weakness, HA, muscle pain, then N/V, diarrhea, internal and external bleeding o Treatment: supportive care, standard precautions and treatment for complications as they arrive

C-diff - Clostridium Difficile

~ Associated with antibiotic use. o Spread by indirect contact with things such as equipment, from nurses using them from patient to patient, and room to room, it is also associated with a spread through the use of commodes, o The toxin cause a type of Colon dysfunction and cell death due to sepsis o Diagnosis is Confirmed through stool culture. o Significant Symptoms 3 or more large liquid stools per day are suspect of C-diff. o If this is what the patient is experiencing it is highly suspected that the patient having been on a long antibiotic regimen has C-diff o Older adults are the most at risk for this infection. o Treatment is with Flagyl and/or Vancomycin