Infectious Disease Flashcards
What is bacteria?
single-celled microorganisms, examples are Streptococcus, Staphylococcus, Enterococcus
What is a virus?
Need a host cell to live and grow, examples are the common cold, AIDS, hepatitis, mononucleosis
What is mycoplasma?
neither a bacteria or a virus, does not require a host cell, does not have a cell wall which makes it resistant to antibiotics, usually infects the respiratory tract, examples pneumonia, pharyngitis, urethritis
What is Rickettsiae?
a form of bacteria that need a host cell to live and grow like a virus, transmitted through the bite of an arthropods, examples are Rocky Mountain Spotted Fever, typhus
What is fungi?
classified as either molds or yeasts, can live in a wide variety of environments and do not necessarily need a host, examples are candidiasis, tinea pedis, histoplasmosis
What is a parasite?
organism that lives on or in another organism and obtains nourishment, examples are hookworms, Giardia, Malaria
What is a resevoir?
Place where the causative agent can survive and may or may not multiply
Examples: human body, soil, water, equipment
Reservoirs can be carriers meaning they do not have symptoms but carry an active pathogenic microorganism
What is a portal of exit from the reservoir?
Path that allows the causative agent to escape from the reservoir
Common human portals include the respiratory, gastrointestinal, genitourinary systems, and the skin and mucous membranes
Blood, sputum, emesis, stool, urine, wound drainage, genital secretions
Methods of transmission
A mode of transmission by which the causative agent travels from the reservoir to the susceptible host
- Contact: Occurs with direct, indirect, or droplet contact
- Airborne: expelled from an infected person and suspended in the air in droplets no larger than 5 microns
- Vehicle: maintained on a nonliving object such as food, water, blood
- Vector-borne: carried by a living intermediate host such as a mosquito or tick
What is the portal of entry?
The path by which the infective organism enters the new susceptible host
Usually the same as the portal of exit
What makes a host susceptible?
Weakened defenses put the host at increased risk of infection
Stages of the infective process
- Incubation period
- Prodromal stage
- Acute illness
- Convalescent stage
What happens in the incubation period?
organism is establishing itself, no symptoms, the infected person is contagious
What happens in the prodromal stage?
symptoms begin to appear and are usually nonspecific
What happens during the acute illness?
the infective organism is growing and spreading rapidly, inflammatory and immune response, development of more specific symptoms
What happens in the convalescent stage?
damaged tissue begins to heal and symptoms resolve
Defense mechanisms
Human beings have many defenses against infectious disease including physical, chemical, and immune mechanisms
Examples include: skin, mucous membranes, respiratory cilia, secretion of oil and moisture, normal flora, chemical secretions
The immune response
Humoral response involves the antigen-antibody reactions
Cellular response involves the reaction of the WBCs
Infection prevention and control
The single most important factor in the control and prevention of infection is good hand hygiene
-Compliance with hand hygiene by healthcare workers is less than 50%
-Alcohol based agents are more effective for hand antisepsis than soap and water
Private rooms
Use of PPE
Proper disposal of soiled equipment including linens
Use of isolation precautions including neutropenic precautions
Immunization programs
Patients with increased susceptibility to infections
Very old and very young
impaired skin, aspiration, poor nutrition
Immunodeficient
cancer, HIV
any client with recurrent infections such as otitis media, pneumonia, candidiasis should be evaluated for immune dysfunction
HIV, secondary immune deficiency
Occurs when the immune system is damaged and unable to mount an appropriate immune response
Causes include chemotherapy, age, malnutrition, burns, malignancy, HIV/AIDS
Cellular level of HIV
HIV devastates the hosts immune system by invading CD4+ T cells (T-helper cells)
T cells start and stop the immune process
If unable to initiate an immune response due to loss of T cells then even benign infections can be deadly
HIV is an RNA or retrovirus. To reproduce it must take over a cells DNA where it then directs proteins and enzymes to replicate the HIV portion and create more HIV particles
HIV epidemiology
There are 36.9 million people living with HIV/AIDS
The majority are women and under the age of 15
Sub-Saharan Africa is home to 71% of the world’s HIV/AIDS population
-This is due to heterosexual transmission, lack of condom use, migration patterns, mother-to-infant transmission
-Poverty, lack of health care resources, lack of prevention education
In the US there are about 1.2 million people with HIV
-One in eight are unaware they are infected
-Groups at greatest risk in the US are gay and bisexual males, heterosexuals especially women, IV drug users
HIV transmission routes
Transmission is by contact with infected body fluids such as blood, semen, vaginal secretions, breast milk
Transmission does not occur through sweat, tears, saliva, urine, emesis, sputum, respiratory droplets, or feces
When can HIV be transmitted?
For transmission to occur there must be a sufficient viral load and a susceptible host
Viral loads are high in the first few months after initial infection and during an AIDS-related illness
Prolonged or repeated exposure to infected fluids greatly increases the risk of transmission
Clinical manifestations of HIV
Vary and may affect almost any organ in the body
Specific clinical manifestations are related to opportunistic infections
As CD4+ counts drop to <200 cells/uL the incidence of opportunistic infections accelerates rapidly
Malignancies are common
Diagnosis of HIV
Rapid HIV test
Western Blot tests
CDC recommends HIV screening as a routine part of medical care
Rapid HIV test
Rapid HIV tests screen for HIV antibodies and provide results in 15 to 60 minutes
- Enables easy post-test counseling
- Negative result require no further testing, positive result confirmed by Western Blot
Western Blot test
Western Blot tests screen for HIV antibodies and provide results in 1 to 3 days
- 99% accurate
- Greater sensitivity and specificity
Progression of AIDS diagnosis
Progression to AIDS is confirmed with a CD4+ T cell count of <200 cells/uL and/or documentation of an AIDS defining condition
-Mycobacterium avium complex, Pneumocystis jiroveci, Histoplasmosis that has spread, etc.
HIV treatment
The virus mutates frequently which makes vaccine development and even treatment difficult
Antiretroviral drugs (HAART)
Treatment of opportunistic infections
Antiretroviral drugs to treat HIV
Antiretroviral drugs are the cornerstone of treatment, HAART
-Treatment begins when HIV RNA levels >55,000 copies/mL or <350 CD4+ T cells/uL
-Prevents viral replication
Adherence to the treatment plan is essential to avoid drug resistance. Noncompliance can be caused by:
-Complexity of dosing
-Side effects include fatigue, anorexia, diarrhea, N&V
-Socioeconomic issues
Nursing management for HIV
Education about -Prevention -Transmission -Medication regime -Prevention of opportunistic infections -When to see the doctor -Laboratory testing Emotional care Referrals for social services Counseling should be open, honest and nonjudgmental
Oral candidiasis (thrush)
Fungal opportunist infection that affects virtually all clients with AIDS
Small amounts of the candidal fungus are present in the mouth in healthy people
Oral candidiasis creates white patches in the mouth that can extend into the esophagus and stomach
Oral lesions provide a portal for candidiasis into the bloodstream causing a life-threatening fungal infection
Cause pain and difficulty swallowing which further impairs nutrition
Treatment is Mycostatin oral rinse
Monitor oral intake ability
Pneumocystis Jiroveci Pneumonia
Fungal infection that proliferates in the alveoli causing bronchial consolidation
S&S include: mild, dry cough, tachypnea, fever, SOB, decreased O2 sats
Chest x-ray shows bilateral patchy infiltrates
Sputum culture
Treatment is Bactrim and corticosteriods
It does not respond to antifungals
If untreated can lead to respiratory arrest and death
Monitor ABGs, pulse oximeter, respiratory rate and quality, lung sounds, may need supplemental oxygen or ventilator support
Histoplasmosis
Histoplasma fungus grows as mold in the soil enriched with bird or bat droppings. Spores are inhaled when the soil is disturbed or when around areas with a large amount of birds
Those with AIDS often have disseminated histoplasmosis
The most common S&S include fever, hepatomegaly, splenomegaly, and generalized lymphadenopathy
may also have skin, GI, or neuro involvement
Diagnosis through urine and serum culture
Amphotericin B therapy is the treatment of choice for patients with AIDS
Cytomegalovirus
Very common virus that has no or mild symptoms in healthy adults
50-80% of adults have the CMV virus
Those that are immunocompromised can have reactivation of the CMV virus
Inflamed oral mucosa, GI pain and cramping, bloody diarrhea, weight loss
Major contributor to wasting syndrome
Diagnosis through stool specimen, endoscopic exam and tissue biopsy
Treatment with antivirals such as foscarnet, ganciclovir, and cidofovir
Monitor I&Os, BM, electrolytes
Mycobacterium Avium Complex
Usually found in food, water, and soil
Most often infect the GI tract causing chronic diarrhea, anorexia, N&V, weight loss and abdominal pain
Major contributor to wasting syndrome
Diagnosis made through stool specimen or small bowel biopsy
Treatment with antibiotics such as Biaxin, Zithromax, and Cipro
Monitor I&Os, BM, electrolytes
Toxoplasmosis
Caused by a single-celled parasite called Toxoplasma gondii
Eating undercooked, contaminated meat, drinking contaminated water, contact with cat feces
Toxoplasmic encephalitis in AIDS patients in the United States is almost always caused by reactivation of a chronic infection
S&S include headache, altered mental status, fever, motor weakness, speech disturbances, and seizures
Diagnosed through serologic tests, direct observation of the parasite in stained tissue sections or CSF
Treatment consists of Pyrimethamine (antiparasitic) plus Sulfadiazine
Cryptoccocal Meningitis
Fungal infection of the meninges
Comes on slowly, over a few days to a few weeks
S&S include: fever, headache, mental status change, N&V, photophobia, stiff neck, seizures
If untreated it can lead to brain damage, hearing loss, coma, and death
Diagnosed by CSF, CT scan, serum antigen test
Treated with antifungals such as Amphotericin B
Monitor the LOC and symptoms of infection
Latex Allergy Type I
Type I reactions are IgE-mediated hypersensitivity reactions that involves production of antigen-specific IgE antibodies after exposure to an allergen
Type I reactions occur immediately, histamine release
S& S of Type I include: redness, hives, asthma, itching, conjunctivits
Latex Allergy Type IV
Type IV, cell mediated reactions are mediated by the T cells of the immune system instead of by antibodies
Type IV have a delayed onset, 4-48 hours after exposure
S&S include: dryness, itching, cracking of the skin, swelling
Risk factors for latex allergy
Allergies to bananas, avocado, kiwi, and strawberry can trigger an allergic reaction
Those at risk include health care workers, neural tube defects, chronic bladder catheterization, multiple surgeries
Anaphylaxis
Localized or systemic hypersensitivity response to an antigen that can quickly progress to a medical emergency if not treated
S&S include itching, redness, vomiting, laryngeal edema, respiratory distress, vascular collapse, shock, and death
Symptoms are usually immediate, within 30 minutes of exposure
Anaphylaxis treatment
Treatment immediate administration of epinephrine, supplemental oxygen, IV access, fluids, corticosteroids
May also need antihistamines, inotropic and antiarrhythmic agents
Anaphylaxis complications
The result of systemic anaphylaxis is distributive shock that results in massive vasodilation, hypotension, and inadequate perfusion
Concurrently bronchoconstriction and laryngeal edema that can progress to complete airway obstruction
Autoimmune Hypersensitivity Response
When the immune system fails to recognize self antigens an autoimmune response occurs
The exact mechanism that simulates and autoimmune response is unknown but is probably multifactorial
Clinical manifestations vary depending on the system that is the target
Initiation of an autoimmune disorder is commonly associated with the onset of another illness or stressor
Diagnosis is through an autoantibody tests specifically the antinuclear antibody (ANA). An elevated ANA means the body is making antibodies to self proteins
Examples of autoimmune disorders include Rheumatoid arthritis, Graves’ disease, Autoimmune hemolytic anemia
Meningitis
Inflammation of the meninges by a bacteria or virus
Bacterial meningitis is less common, 4 cases per 100,000 but is associated with a higher morbidity and mortality rate
Viral meningitis is more common but less likely to be fatal unless the client has a weakened immune system
Bacteria enter the brain through various routes such as bloodstream, dural tear, skull fractures, unsterile lumbar puncture
Virus penetration into the CNS in not well understood but probably through the bloodstream or nerve root
Meningitis signs and symptoms
Clinical triad is fever, stiff neck, altered mental status
Also have photophobia, Kernig’s sign and Brudzinski sign
Kernig’s sign: flex the client’s hip 90 degrees, straighten the leg at the knee, pain in the hamstring prevents straightening the leg, if present bilaterally it is a positive Kernig’s sign
Brudzinski sign: positive when flexion of the client’s neck elicits flexion of the hips and knees
Headache, seizures
Meningitis diagnosis
CT scan to look for lesions
Lumbar puncture
-Bacterial meningitis will have cloudy CSF with high protein and low glucose
-Viral meningitis will have clear CSF with high protein and normal glucose
C-reactive protein
CBC
Blood cultures
Meningitis treatment
Bacterial meningitis is treated with IV or intrathecal antibiotics. Type and route depends on the causative organism
Antibiotics need to be started within 30 minutes of clinical presentation because of rapid progression of the disease
Mortality is between 5-40% depending on causative agent, client age, degree of neurological impairment, severity of infection, client’s general health, timeliness of treatment
Viral meningitis is treated with supportive measures
Encephalitis
Acute infection and inflammation of the brain tissue
Caused by bacteria, viruses, fungi, or a parasite with virus being most common (Herpes Simplex & Rabies)
Viruses enter the CNS through the bloodstream or nerve pathways
Symptoms include severe headache, fever, N&V, confusion, lethargy, seizures
If there is cerebral edema there may be agitation, personality changes, loss of sensation, problems with speech or hearing, loss of consciousness
Diagnosis through CSF, MRI, CBC, blood cultures
Treatment consists of antivirals such as acyclovir and famciclovir, dexamethasone to reduce cerebral edema, phenytoin (Dilantin) for seizures
Brain abscess
Localized infection carried from other sites of the body into the cerebral tissue
Most often occur in the cerebellum
Caused by bacteria, viruses, fungi, and parasites
Organisms enter the brain through direct extension or through the bloodstream. Direct extension occurs from the sinuses, infections of the teeth, trauma, surgery. Can also be idiopathic
S&S include headache, malaise, fever, N&V, chills. Neurological deficits depend on the location of the abscess. Symptoms may develop slowly over a period of several weeks or suddenly
Diagnosis is through CT or MRI
Treatment consists of surgical drainage if possible, antibiotics and steroids
Nursing management for CNS infections
Pain management
Darkened room, quiet calm environment, limit visitors
Anxiety reduction strategies
Monitor temp and vital signs
Assess respiratory status
Administer oxygen and prepare for intubation if needed
Skin care and turning
Monitor for seizure activity and implement precautions if necessary
Sinusitis
Inflammation of the nasal cavity and paranasal sinuses
Can be acute (less than 4 weeks), subacute (4-12 weeks), or chronic (more than 12 weeks)
Caused by virus, bacteria, or fungus
S&S: nasal congestion, purulent drainage, fever, maxillary tooth pain, headache
Diagnosed through S&S
Treatment is antibiotics, nasal endoscopy, supportive
50% of bacterial infections will clear on their own
Pharyngitis
Inflammation of the pharynx which results in a sore throat
Upper respiratory infections can lead to pharyngitis
Treatment is supportive, increase fluid intake, NSAIDS, gargle with warm saltwater
If bacterial, antibiotics
Pneumonia
Inflammatory process that results in edema of the alveoli and bronchioles
Bacteria are the most common cause. Can also be caused by viruses, fungi, and parasites
Community-acquired: microaspiration of secretions usually during sleep, inhalation of aerosolized agents, spread of bloodstream infection
Hospital-acquired: mechanical ventilation
Normally we have a good defense system: nasal hair, saliva, cough, epiglottic reflexes, alveolar macrophages
Pneumonia signs and symptoms
Fever, Chills, Increased respiratory rate, Increased heart rate, Bloody sputum, Crackles, Dyspnea, Cough, X-ray abnormalities, Headache, Abdominal pain, N&V, Diarrhea, Muscle aches
Pneumonia diagnosis
Signs & Symptoms with physical exam
Chest x-ray showing infiltrates
Positive sputum or blood cultures
Management of pneumonia
Antibiotics Respiratory assessment Monitor pulse ox Apply supplemental oxygen ABGs Rest with gradual increase in activity Cough & deep breathing or spirometry exercises Good nutrition and fluid intake
Pulmonary Tuberculosis
Chronic and contagious bacterial infection caused by Mycobacterium tuberculosis
Develops after inhaling droplets sprayed into the air from a cough or sneeze by someone who is infected. Requires repeated close contact
Most prominent risk factor is HIV infection
95% of infections are asymptomatic and move to a dormant (latent) phase. Those in the latent phase cannot spread TB. A latent infection can turn active.
Inhaled bacteria are ingested by macrophages which stimulates an inflammatory response. Develops into a granuloma with a necrotic center.
Pulmonary Tuberculosis signs and symptoms
Often vague and do not develop until the disease is advanced
Cough - starts nonproductive progresses to purulent, blood streaked
Fever, Night sweats, Dyspnea, Chest pain, Weight loss, Sleep disturbances, Lethargy, Low-grade fever for weeks or months
Pulmonary Tuberculosis diagnosis
Mantoux skin test (PPD)
-Falsely negative in 20-25% of adults
-5 mm or greater is positive for immunocompromised clients
-10 mm or greater is positive for healthy individuals
TB blood test that can be used instead of a PPD skin test
-Both PPD and blood test detect antibodies
Chest x-ray
-cavitation
Sputum for acid-fast bacilli
-3 positive samples confirms TB
Pulmonary Tuberculosis management
Most will be treated on an outpatient basis
Drug therapy takes 6 to 9 months
Multiple drugs used in treatment
-isoniazid, rifampin, pyrazinamide, ethambutol
Continued until 2-3 sputum cultures are negative
Monitor LFT
Hospital needs for active infection
-negative pressure room
-airborne isolation
-N-95 or higher mask
Otitis Media
Infection or inflammation of the middle ear
It can be acute with a rapid onset and short duration or chronic with persistent inflammation for longer duration
Caused by food and airborne allergies, bacteria and viruses, blockage of the Eustachian tube
S&S of acute infection include earache, headache, fever, discharge from the ear, hearing problems, difficulty sleeping, loss of appetite
Chronic otitis media includes tinnitus, hearing loss, pain, feeling of fullness in the ear
Treated with symptom relief, antibiotics, or myringotomy tubes
Mastoiditis
Acute or chronic infection of the mastoid process that can lead to changes in hearing and balance
Usually caused by a middle ear bacterial infection
Mastoid bone is located just behind the outer ear. It has a honeycomb structure that fills with infected material
S&S include ear pain, fever, headache, hearing loss, redness and swelling behind the ear
Difficult to treat because antibiotics may not reach the mastoid bone
Repeated or long-term antibiotics
Mastoidectomy
Labyrinthitis
Inflammation of the inner ear that affects the cochlear and/or vestibular portion of the labyrinth
Viral labyrinthitis is the most common and often times follows a viral illness such as a cold or the flu
Labyrinth is a maze of interconnected fluid-filled channels and canals. The cochlea comprises half of the labyrinth and sends information about sound to the brain. The vestibule sends information about position and movement.
S&S include vertigo, N&V, loss of balance, mild headache, tinnitus, and hearing loss
Symptoms can last from days to weeks
CT, MRI, and EEG help to rule out other causes
Treatment includes supportive measures such as antihistamines and antiemetics, scopolamine patch, sedatives
Labyrinthectomy, will cause deafness in the affected ear, or vestibular nerve dissection, involves a crani and risk for increased hearing loss
Meniere’s Disease
Metabolic alteration in the labyrinthine fluid of the inner ear that causes spontaneous episodes of vertigo and fluctuating hearing loss
Factors that alter the properties of inner ear fluid may contribute to Meniere’s disease
-Improper fluid drainage, abnormal immune response, allergies, viral infection, genetic predispositio, trauma
Episodes last 2-3 hours and then resolve
Often occur in clusters with periods of remission between
CT or MRI to rule out other causes, hearing and balance testing
Treatment involves medications to relieve nausea and motion sickness, diuretics will relieve fluid retention
Meniett device: a pulse generator that applies positive pressure to the middle ear through a tympanoplasty tube
Endolympatic sac procedure removes bone that encases the endolymph reservoir
Labyrinthectomy
Conjunctivitis
Inflammation of the clear mucous membrane that covers the sclera of the eye, the inner lining of the eyelid and the space between the lid and the globe
Can be caused by a virus, bacteria, or allergic reaction. Viral is most common
Viral Conjunctivitis
Starts unilaterally but quickly spreads bilaterally
S&S include clear, sticky discharge, excessive tearing, foreign body sensation, conjunctival inflammation, preauricular lymph node enlargement
Treatment include artifical tears, steroid eyedrop, cold compress
-Should clear on its own
It is extremely contagious
-hand washing, no sharing of towels, washcloths, pillows
Bacterial Conjunctivitis
Usually unilateral in the early stages but then becomes bilateral
S&S include purulent discharge, eyelid edema, crusting, conjunctival inflammation, redness, there is no preauricular node enlargement
Treatment includes antibiotic eyedrops or ointment for 7 to 10 days, warm/cold compress
Remember good hand hygiene
Allergic Conjunctivitis
Often called hayfever
Type I hypersensitivity reaction
Causative agents include animal dander, dust, smoke, feathers, pollen
Usually bilateral
S&S include a whitish discharge, swelling, burning, pruritus
Treatment includes decongestant eyedrops for 7 to 10 days, cold compress, oral antihistamines, avoiding the allergen if possible
Allergic Contact Dermatitis
Type IV cell-mediated immune reaction that occurs after contact with an allergen
Type IV immune reactions have a delayed onset, 4-48 hours after exposure
Mediated by the T cells of the immune system instead of by antibodies
There are 3000 chemicals that can cause allergic contact dermatitis
One of the most common is poison ivy or oak
Extent of the reaction depends on the sensitivity, concentration and quantity of the exposure
Dermatitis presents as red, swollen, itchy lesions that may spread beyond the area of contact
Treatment is topical corticosteroid, oral steroids may be needed, and antihistamines
Pediculosis (lice)
Female lice produce hundreds of eggs or nits that they attach to a hair shaft.
They secrete toxic saliva that leads to itching and dermatitis.
They are spread though close personal contact. Treatment includes application of a pediculocide shampoo.
Scabies
Female mite tunnels into the skin, creating a burrow and depositing eggs.
Causes intense itching that is worse at night.
Signs are lesions that are papular, vesicular, or linear on the wrists, web spaces of the hands, sides of hand or feet, genital area, abdomen.
Highly contagious and transmitted through close personal contact.
Treatment is application of a scabicidal cream for six hours
Bed bugs
Reddish brown, oval, flat insects that feed on human blood during the night hours.
Bites cause itching, pain, and swelling.
Transmission is through infested furniture and clothes. They are hard to eradicate because common insect repellents are not effective.
Candidiasis (skin)
Caused by Candida fungus
Most common cause of fungal infection in immunocompromised clients
Normally found in the GI tract, mouth, and vagina and causes no harm
Intact immune system, intact skin, and other microoganisms keep it controlled
Predisposing factors: wet clothing, obesity, hyperglycemia
Treatment: antifungal cream such as miconazole, cool compress, dry skin, loose clothing, topical agents such as mycostatin
Systemic infections are treated with oral or IV antifungal agents
Tinea
Also known as ringworm, jock itch, athlete’s foot
Predisposing factors: depressed immune system, crowded conditions, poor hygiene, tight clothing
Signs & symptoms: abnormal pigmentation, itchy rash shaped in a ring, thick, dry, scaly skin. Between fingers and toes may be moist with open sores
Treatment is usually topical or oral antifungal agent, ex: Lotrimin, Lamisil
Potassium hydroxide wet mount- to identify if fungus is cause of skin disorder
Viral skin infections
Herpes Simplex Type 1 and Type 2 cause oral and genital lesions- Spread by direct contact with infected lesions or genital secretions
Herpes Zoster also known as shingles- Reactivation of a latent varicella-zoster virus
Warts are caused by the human papillomavirus- Spread by contact when there are small breaks in the skin
Genital warts are sexually transmitted- These cannot be cured so treatment is aimed at symptom management
Nursing management includes education: Avoid contact with immunocompromised people when a lesion is present, Wash your hands, Avoid sharing glasses, utensils, toothbrushes, Avoid kissing and sexual contact while the disease is active, Condoms
Cellulitis
Non-necrotizing inflammation of the skin and subcutaneous tissues, usually caused by staphylococcus or streptococcus infections that does not involves the fascia or muscles
Organisms gain entrance through a fissure, cut, laceration, bite, etc.
Common on the legs, face, ears, and buttocks
Those with compromised immune systems, are obese, have venous insufficiency are susceptible
S&S: red, swollen, tender, with indefinite border, blisters, regional lymphadenopathy, fever, chills, headache, vomiting
Diagnosed through exam, increased WBC, wound culture
Treatment: antibiotics, rest, elevation, moist wound care
Necrotizing Fasciitis
Infection of the superficial fascia or connective tissue surrounding muscle
Bacteria release enzymes and toxins
Infection causes: tissue ischemia, superficial nerve damage, vascular thrombosis and occlusion, tissue liquification, septicemia
Risk factors: diabetes, chronic renal failure, obesity, malnutrition, drug use, PVD
Necrotizing Fasciitis signs and symptoms
Early
-begin in the first 24 to 48 hours
-flu like symptoms, localized pain, redness, swelling
-pain beyond what is expected
Advanced
-2 to 4 days
-skin is swollen, tight, and dusky, fluid filled blister, lack of sensation
Critical
-4 to 5 days
-gangrene, skin sloughing, septic shock
Mortality is high 40% with treatment, 100% without
Necrotizing Fasciitis treatment
Three pronged Broad spectrum antibiotics -PCN, clindamycin Surgical debridement -daily until margins are clear -may have to amputate Supportive therapies -high calorie diet -negative pressure wound therapy -hyperbaric oxygen therapy
Lyme Disease
Bacterial infection that affects the organs and joints
Transmitted by deer ticks
The bacteria is transferred slowly over a couple of days of feeding
Most prevalent in the northeast, southwest, and west coast
Hiking, camping, gardening
Lyme disease signs and symptoms
Three stages of Lyme Disease
- Early Localization: days to 1 month
- bull’s eye reddened area, 70-80% of cases
- fatigue, malaise, lethargy, joint and muscle pain, stiff neck - Early Disseminated: days to 10 months
- 5% carditis
- 15% CNS involvement - encephalitis, peripheral neuropathy, meningitis
- 60% arthritis
- rash, lymphadenopathy, inflammation of the eye, liver, kidneys - Late or Chronic Disease: months to years
- arthritis and CNS involvement
Lyme disease diagnosis and treatment
Diagnosed by blood test for antibodies
Early phase involves treatment with oral antibiotics (doxycycline) for 14 to 21 days
If the disease has progressed to the early disseminated phase IV antibiotics for 14 to 28 days is recommended
Other signs and symptoms are treated through supportive measures
Rest, antipyretics, NSAIDS, etc.
Education and prevention
Rocky Mountain Spotted Fever
Affects the vasculature causing it to leak
Tickborne disease caused by Rickettsiae
Carried by the American dog tick, Rocky Mountain wood tick, brown dog tick
Most prevalent in the southeast
Rocky Mountain Spotted Fever Signs and Symptoms
Most people become ill within the first week of infection
Some may not exhibit signs for up to 14 days
Signs include: high fever, chills, headache, muscle aches, nausea & vomiting, fatigue
Red non-itchy rash that appears a few days after initial symptoms
-Starts on the wrists and ankles and spreads outward
Severe, untreated cases can lead to heart, lung, or kidney failure, seizures, gangrene of the fingers and toes
Rocky Mountain Spotted Fever Diagnosis and treatment
Appearance of rash and skin biopsy
Can be diagnosed by blood test but Rickettsiae do not circulate in large volumes. May take 7-10 days after initial symptoms for a positive result. This may be to late to avoid long term damage or death
Start antibiotics (doxycycline) within five days of development of signs and symptoms to avoid complications
Can be treated with oral or IV antibiotics
Without prompt treatment it can be fatal within the first 8 days
