Febrile Conditions, Infections, and Communicable Diseases

I. Definition
1. Fever an elevation in body temperature above normal (98.6F or 37C) which may occur in response to
infection, inflammation, or unknown causes

2. Infection a condition wherein the body is invaded by a disease-causing microorganisms or virus which
grows and causes illness

3. Communicable or infectious disease an illness caused by transmission of a specific infectious agent or its
toxic products from an infected person or animal to a susceptible host, either

II. Etiology
*exogenous agents such as bacteria or fungi or endogenous factors such as antigen-antibody reaction,
malignancy, or graft rejection

III. Classification of Fever
1. Acute fevers are short in duration (less than 10 days); include influenza, pneumonia, tonsillitis, measles,
and other bacterial or viral infections
2. Chronic fevers last for weeks or months; the fever may be long-standing as in tuberculosis
3. Intermittent (ex. Malaria)

IV. Metabolic Changes
1. Increased metabolic rate
*7% for every 1F or 13% for every 1C rise in body temperature
2. Increased protein catabolism
*this increases nitrogen wastes and renal load
3. Decreased glycogen store and adipose tissue
*this results in weight loss
4. Accelerated loss of body water and electrolytes (Na and K) through perspiration and polyuria
5. Modified motility of GI tract which affects appetite, digestion, and absorption of nutrients

V. Diet

Diet Rationale
1. High in calories (1.5 x basal energy
expenditure)
Increased metabolism; restlessness also increases energy
requirements
2. Protein increased (1.3 1.5 g/kg/day) To replace nitrogen losses from tissue destruction characteristic
of febrile conditions
3. CHO: liberal intake, simples sugars as glucose
may be used; lactose may result to diarrhea
To replenish glycogen stores
To spare protein and provide easily absorbed energy sources
4. Fat: use judiciously Source of energy
To spare protein
Too much may retard digestion
5. Vitamins A, C, B-complex To increase energy and protein intake. Antibiotics and drugs
interfere with B-complex synthesis
6. Fluids: liberal (as much as 2.5 -4 liters/day may
be lost from excretion (urination, perspiration,
insensible losses))
To replace losses from the skin, especially if accompanied by
diarrhea and vomiting
To permit adequate volume of urine for excretion of wastes
To replace electrolyte losses
7. Consistency: full liquid during high fever For easy digestion and rapid digestion
Diet Rationale
progressing to soft diet
8. Feeding interval: give as small quantity; more
frequent intervals (2-3 hours); at least 8
feedings in acute fevers
To allow adequate nutrient intake without overtaxing the GIT


Acute Fevers

Typhoid Fever
*infectious and caused by Salmonella typhosa
*transmitted through ingestion of contaminated food, water, or milk

Characteristics:
a. If not treated with antibiotics, the illness lasts about 4 weeks; the body temperature gradually increases for 5 to
7 days and then plateaus as 39-40C (102-104F) for 2-3 weeks then gradually decreases in the fourth week
b. Enlargement of lymphoid tissues in the intestines (Peyers patches) particularly the terminal ileum
c. Erosion of blood vessels and haemorrhage due to necrosis in hyperplastic Peyers patches
d. Perforations of the bowel
e. Anorexia and weakness
f. Loss of tissue protein, depletion of body glycogen, diarrhea

Treatment: with appropriate antibiotic treatment, improvement begins within 48 hours and the temperature returns to normal
in 2 to 5 days

Diet Rationale
1. High kcal, high PRO To prevent excessive catabolism of tissue protein
2. High CHO To replenish glycogen stores
3. Liberal fluids To maintain water balance
4. Low fiber, low residue, bland Avoid further irritation of the GIT
5. Small frequent feedings Avoid further irritation of the GIT

Rheumatic Fever (RF) - acute or chronic inflammatory process that comes as a sequel to haemolytic streptococcal
infection, usually after 3-4 weeks
*it occurs frequently in children and tends to recur
*the inflammatory process initially affects connective tissues, but can spread to many organs; when pronounced,
myocarditis and arthritis occur
*Acute rheumatic fever: characterized by a sudden onset with high fever and swelling and pain in the joints
*Recurring episodes of rheumatic fever can lead to damage of the heart muscle and heart valves, a disorder called
rheumatic heart disease

Diet Rationale
1. During acute phase: full liquid to soft diet -easy digestion and rapid absorption
2. Mild Na restriction -due to edema especially if steroids are prescribed
3. Kilocalories: normal to high levels -to maintain DBW
4. Vitamin C supplements -to replace losses due to infection

Poliomyelitis (commonly called polio or infantile paralysis) an infectious disease caused by one of three polioviruses.
The nonparalytic form lasts for periods ranging from a few days to a week and is characterized by fever, malaise, and
nausea and vomiting, and back stiffness. The paralytic form has all the clinical signs and symptoms of the nonparalytic type
plus paralysis. The large proximal muscles of the limbs are often affected, and in the bulbar type of polio-myelitis, the brain
stem and spinal cord are affected

Characteristics:
a. Fever, sore throat, headache, vomiting, and often stiffness of the neck and back in the early stage
b. Later the central nervous system is involved with paralysis and atrophy of the muscles, ending in contraction
and permanent deformity

Types:
1. Spinal paralysis of the skeletal muscles
2. Bulbar affects brain nerve cells resulting in the dysfunction of the swallowing mechanism

Diet: During the acute stage, the dietary management is the same as in other acute fevers. Bulbar poliomyelitis needs
special dietary management because of the difficulty of swallowing. Seiferts recommended program for bulbar poliomyelitis:

Diet Rationale
Stage I - Tube feedings of 30 to 50 ml gradually increasing
to 200ml alternately with water every 2 hours
Due to dysphagia and to avoid choking
Stage II Tube feedings and 1 tsp diluted fruit juice,
gradually adding other clear liquids
To test swallowing ability
Stage III Tube feedings and addition of soft, bland, low
fiber foods
To initiate normal eating process
Stage IV Tube feedings gradually reduces while more
solid foods of soft consistency are added
To resume normal eating process

*Nutrition intervention is very important due to the high fever, nausea, vomiting. Foods that tend to produce mucus, usually
milk and cream, are generally not tolerated and should be avoided

Cholera an infection of the intestines producing sudden and massive diarrhea causing water and electrolyte losses
Symptoms: diarrhea, sometimes vomiting, causing dehydration, shock and ultimately death

Diet Rationale
1. IV fluids recommended To replace fluids lost
2. Oral administration of electrolytes & glucose Glucose aids in the reabsorption of Na and water from the
intestinal tract and stool
3. Clear liquids initially, progressing to soft, bland diet To rest the GIT and provide easily digested and absorbed
foods
4. Fat: restricted, milk is also reduced Poorly digested
5. CHO and PRO: high CHO needed to replenish depleted glycogen stores and to
spare protein. Protein will be used to compensate for the
increased tissue catabolism
6. Fluids: liberal amounts; 2500-5000ml/day given in
small but frequent feeding
For fluid replacement

Chronic Fevers

Pulmonary Tuberculosis (PTB) an infectious disease caused by the tubercle bacillus, Mycobacterium tuberculosis,
which invades the lungs. It is usually transmitted by airborne droplets produced by a person with untreated tuberculosis. It
affects the lungs most often but may also be localized in other organs such as the lymph nodes or kidneys, or it may be
generalize. Tuberculosis is common among persons with HIV infection.

Characteristics:
a. PTB is associated with wasting of tissues, exhaustion, cough, anorexia, expectoration, fever usually in the
afternoons or evenings, and night sweats (cold clammy perspiration even during cold weather)
b. The acute phase resembles pneumonia, with high fever and increased circulation and respiration
c. The chronic phase is accompanied by low-grade fever and the metabolic rate is lower than in acute illness
d. Because of the protracted illness, wasting may be considerable

Management:
1. Drugs
a. Primary drugs
1. Isoniazid (INH) isonicotinic acid hydrazide, an antagonist of vitamin B6
2. Ethambutol
3. Streptomycin
4. Para-aminosalycylic acid: can cause malabsorption of vitamin B12
b. Secondary drugs
1. Ethionamide
2. Pyrazinamide
3. Cycloserine

2. Diet

Diet Rationale
1. Energy: High kilocalorie (2500-3000 kcal) To achieve desirable weight
2. PRO: High To help generate the serum albumin levels which are often
low
To promote healing of the tuberculosis lesions
3. Minerals: Ca
Fe supplementation
To promote healing of the tuberculosis lesions
Needed if there has been haemorrhage
4. Vitamins
Preformed Vit. A increased
Vit. C

Vit. B6 supplementation

B complex vitamins

Vit. D
Vit. K

Carotene is poorly converted to Vit. A
To replace losses, to promote resistance to infections, for
wound healing
To protect against peripheral neuritis due to INH antagonism
of vit. B6
To stimulate appetite and to improve utilization of CHO and
PRO
For better absorption and metabolism of Ca
Anti-hemorrhagic factor
5. Fluid to Soft to Regular diet In acute stage, due to poor appetite
6. Meal frequency: 5 to 6 meals a day Due to poor appetite, to increase food intake

Emphysema it is a lung disorder characterized by enlargement of the air spaced beyond the terminal bronchioles and
pathologic changes in the walls of the alveoli

Characteristics:
a. Occurs primarily in men over 40 years of age with long history of cigarette smoking and bronchitis. Other
possible causes are air pollution, asthma, and respiratory infections
b. Exertional dyspnea is often the first symptom and may be accompanied by chronic cough, wheezing and
fatigue
c. The course of the disease may be slow over many years or it may progress to the terminal stage in a few years
d. In early stages, some patients may be obese, and the distress in breathing is further accentuated. Some
improvement is noted if weight is brought within desirable levels
e. Shortness of breath places severe limitation upon the ability to ingest an adequate diet, chewing and
swallowing require further effort and the patient often stops short of satisfactory intake

Diet Rationale
1. Provide adequate kilocalories (BEE x 1.5) To counteract weight loss and tissue wasting
2. PRO: 1.2-1.5 g/kg Body weight To correct tissue wasting
3. Consistency: soft, low fiber, bland Require minimum chewing effort; provide non-distending,
non-stimulating, non-irritating food
4. Small frequent meals, eating slowly is emphasized To increase caloric intake; to avoid swallowing too much air

*Avoid gas-forming vegetables and encourage intake of plenty of fluids (2-3 liters/day). Restrict Na if there is pulmonary
edema and monitor for effects of nutrient-drug interactions. Supplementation with vitamins and minerals may be necessary
if intake is inadequate. Provide high-protein supplements for snacks to correct any tissue wasting.

Malaria a recurrent infection caused by protozoa of the genus plasmodium and transmitted by Anopheles mosquitoes
*It may be spread by blood transfusion or by the use of an infected hypodermic needle

Symptoms: intermittent attacks of chills, fever, and sweating, debility, hypochromic anemia, and swelling of the liver
and spleen

Diet Rationale
1. Kilocalorie: High Level depends on body temperature and rate of tissue
catabolism
2. PRO: high To replace losses due to infection
3. CHO: Liberal To replenish glycogen stores
4. Fats: moderate Due to enlargement of the spleen
5. Salts & Fluids: liberal to high To replace losses

Human Immunodeficiency Virus (HIV)
*a type of retrovirus that principally attacks CD4
+
T-cells, a vital part of the human immune system and causes
acquired immunodeficiency syndrome (AIDS). Consequently, the bodys ability to resist opportunistic viral other
infection is greatly weakened
*AIDS is viral infection caused by the human immunodeficiency virus (HIV)
*levels of CD4
+
(helper) and CD8
+
(non-helper) subsets of T cells are used in evaluating immunological competency
in HIV/AIDS; after identifying the levels, stages of HIV infection range from stages 1 to 3 according to severity of
depletion

I. Etiology
*a retrovirus HIV, invades the genetic core of the CD4
+
or T-helper lymphocyte cells which are the principal
agents involved in protecting the body from infections

II. Mode of Transmission
*HIV can be transmitted via blood, semen, pre-semenal fluid, vaginal fluid, breast milk other body fluids that
contain blood
*Persons at risk include homosexual or bisexual males, haemophiliacs, intravenenous drug addicts,
heterosexuals with multiple partners, and infants of HIV-positive mothers (especially those who are breastfed)
A. Sexual transmission sexual intercourse between men, between men and women
B. Introduction of contaminated blood or blood products
Possible Causes:
1. People who received transfusions or blood products contaminated with HIV
2. Use of contaminated needles for injection and skin-piercing instruments
C. Infected mother to child
1. Through the placenta during childbirth: exposure to infected blood and vaginal secretions
2. Through breastfeeding shortly after birth

III. Symptoms
A. May be asymptomatic no visible clinical signs but laboratory tests show reduced number of T-helper cells
or T-4 lymphocytes, or is HIV-positive
B. Symptoms and signs include fever, chills, sore throat, headache, tachypnea, anxiety, fatigue, night sweat,
hypoxemia, dyspnea on exertion, rales or rhonchi, cyanosis, pneumonia, diarrhea, cryptococcosis, severe
viral infections, ulcerating herpes simplex lesions, meningitis, anorexia, inflamed mouth or esophagus,
malabsorption, weight loss, and poor nutritional status

IV. Treatment
There is no cure for AIDS and HIV-infection. Some drugs acyclovir, AZT, amphotericin B can slow down the
degenerative process wrought by HIV on the immune system but once one is infected with HIV, he/she is HIV-
positive for life

V. Nutritional Care
Nutrition has both direct effects (immune-cell trigerring) and indirect effects (on DNA and protein synthesis)
on the progression of HIV stages. High intakes of niacin, vitamin C, and thiamine have been found to slow
the progression from HIV infection to full-blown AIDS; increased zinc intake has been correlated
significantly with rapid progression. Use of antioxidants (vitamins A, C, and E, selenium, and beta carotene)
might have beneficial effects.

1. Educate the HIV-infected and persons with AIDS on the importance of consuming a well-balanced diet.
2. Provide adequate nutrition for maintenance or improvement of nutritional status.
3. Prevent protein-energy malnutrition and vitamin and mineral deficiencies.
4. Educate patient about food safety because of vulnerability to food-borne pathogens.

Diet
1. Energy depends on health status
a. BEE x 1.3 for maintenance; BEE x 1.5 for weight gain
2. Protein: 1.0-1.4g/kg body weight for maintenance 1.5-2.0g/kg for up-building
3. Low-fat, low-lactose, low-fiber modifications if there is malabsorption or diarrhea
4. MCT oil more readily absorbed than long-chain triglycerides
5. Electrolytes Na, K, Cl replacement with vomiting and diarrhea
6. Supplementation with beta-carotene, vitamin E, ascorbic acid, vitamin B12, vitamin B6, and folic acid
7. Low-bacteria diet
8. Total Parenteral Nutrition (TPN) if enteral feeding is not adequate