Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Other Name(s):
Undulant Fever
Malta Fever
Gibraltar Fever
Mediterranean Fever
Clinical Features:
Dry Cough
Headache
Fever
Lymphadenopathy
Night Sweats
Hepatosplenomegaly
Weight Loss
Malaise and Myalgia
Arthralgia
Complications:
Orchitis
Meningoencephalitis
Endocarditis
Osteomyelitis
Arthritis
Vector:
Cattle
Sheep
Goats
Pigs
Mode of Transmission:
1. Contact Infection
- Direct inoculation into skin by contact with infected
Tissues
Blood
Urine
Vaginal discharges & placenta
Direct conjunctival inoculation
2. Food-borne
- Ingestion of contaminated raw milk
Cheese (unpasteurized milk)
Raw meat
Raw vegetables
3. Air-borne
- Inhalation of infectious aerosols
Medical Management:
ANTIBIOTIC THERAPY
Prevention in Humans:
: Protective measure
Personal hygiene
Pasteurization of milk
Vaccination: B. abortus strain 19-BA
Early diagnosis and treatment
Prevention in Animals:
: Environmental hygiene
Nursing Management:
If the patient has draining lesions, perform wound care as ordered; keep suppurative
granulomas and abscesses dry.
Adhere to standard precautions and appropriate infection control precautions as
indicated.
Provide meticulous skin care as appropriate.
Administer prescribed medications, such as oral rifampin and doxycycline. Give rifampin
on an empty stomach with a full glass of water 1 hour before or 2 hours after eating.
Administer I.M. streptomycin deeply into a large muscle mass.
Reassure the patient that the infection is curable.
Encourage intake of fluids to maintain fluid balance; suggest intake of high-calorie foods
to prevent weight loss.
Provide frequent rest periods to combat fatigue.
Obtain specimens for laboratory testing, such as cultures and complete blood count.
BURULI ULCER
Signs and symptoms.Buruli ulcer often starts as a painless swelling (nodule). It can also initially
present as a large painless area of induration plaqueor a diffuse painless swelling of the legs,
arms or face edema. Local immunosuppressive properties of the mycolactone toxin enable the
disease to progress with no pain and fever. Without treatment or sometimes during antibiotics
treatment, the nodule, plaque or edema will ulcerate within 4 weeks with the classical,
undermined borders. Occasionally, bone is affected causing gross deformities.
Medical Management
Antibiotics.Different combinations of antibiotics given for 8 weeks are used to treat the
Buruli ulcer irrespective of the stage. One of the following combinations may be used depending
on the patient:
a combination of rifampicin (10 mg/kg once daily) and streptomycin (15 mg/kg once daily); or
a combination of rifampicin (10 mg/kg once daily) and clarithromycin (7.5 mg/kg twice daily).
Nursing Management
Assess patient’s condition specifically wound healing process. Comfort the patient and family
members thus improve treatment compliance and outcome. Educate patient regarding diet and
personal hygiene. Register malnourished patient for supplementary nutrients. Encourage patient
to eat high calorie and protein foods. Encourage patient to increase fluid intake in not
contraindicated. Psychological support and education.
-It is caused by a large DNA virus of the Asfarviridae family, which also infects ticks of the
genus Ornithodoros.
-ASF is a disease listed in the World Organization for Animal Health (OIE) Terrestrial Animal
Health Code and must be reported to the OIE.
Clinical signs of African swine fever can be very variable. Most outbreaks are of mild to severe
disease. In severe outbreaks the incubation period is 5 to 7 days and pigs rapidly become
feverish. Many die after 7 to 10 days of illness with a variety of non-specific clinical signs
including haemorrhage. In "per acute" infections, the pigs die so rapidly that the only sign of
disease is sudden death.
Milder strains of the virus can cause less severe illness with a longer incubation period (5 to 19
days). The most serious “chronic” form is not usually seen in outbreaks - it is more likely to be
found in areas where the disease is endemic.
Signs are variable but will include some or all of the following:
Vomiting
Gummed-up eyes
Although signs of ASF and classical swine fever (CSF) may be similar, the ASF virus is
unrelated to the CSF virus.
Vector / MOT:
African swine fever results from infection by the African swine fever virus, which belongs to the
genus Asfivirus in the family Asfarviridae. More than 20 genotypes of ASFV have been
identified, most from wildlife cycles in Africa.
African swine fever can be transmitted either with or without tick vectors as intermediaries. After
direct (non-tickborne) contact with the virus, ASFV is mainly thought to enter the body via the
upper respiratory tract. This virus has been found inall secretions and excretions of sick
domesticated pigs, with particularly high concentrations in oronasal fluid. There may, however,
be species differences among the Suidae. For instance, concentrations of ASFV appear to be
much lower in adult warthogs, compared to pigs, and adult warthogs might not transmit the virus
by direct contact. In pigs, aerosolized viruses may contribute to transmission within a building or
farm, although current evidence suggests that this only occurs over relatively short distances.
Because ASFV can persist in blood and tissues after death, it is readily spread by feeding
uncooked swill that contains tissues from infected animals.
Vector-mediated transmission is through the bites of Ornithodoros spp. soft ticks. In some
regions of Africa, ASFV is thought to cycle between juvenile common warthogs (Phacochoerus
africanus) and soft ticks of the Ornithodoros moubata complex, that live in their burrows.
Transstadial, transovarial and sexual transmission have been demonstrated in these ticks. A
similar cycle is thought to exist between domesticated pigs and the Ornithodoros moubata
complex ticks that colonize their pig pens in Africa. Ornithodoros erraticus acted as a biological
vector during an outbreak on the Iberian Peninsula in Europe, and additional species of
Ornithodoros have been infected in the laboratory. Ornithodoros spp. ticks are long-lived, and
colonies have been demonstrated to maintain ASFV for several years (e.g., 5 years in O.
erraticus).
Management:
There is no treatment for African swine fever, other than supportive care.
As no vaccine for ASF is available, the control of this disease is based on rapid laboratory
diagnosis and the enforcement of strict sanitary measures. Depending on the epidemiological
status of disease in a particular region, different measures are recommended.
Epizootiological studies have shown that the most frequent source of ASF contamination in
infection-free countries is refuse from international airports or ports. All leftover food from
aeroplanes and ships should be routinely incinerated or efficiently sterilised. Import policy for
animals and animal products should consider the disease status of the exporting nation. In
infected European areas such as Sardinia (Italy) where the disease is enzootic and where mild
or non-apparent clinical signs can be observed, the most important aspects of ASF prevention
are the control of animal movement and the use of extensive serological surveys to detect
carrier pigs. In endemic areas of Africa, the most important factor is to control the natural tick
vectors and wild pig reservoirs, and/or limit their contact with domestic pigs.
AMERICAN TRYPANOSOMIASIS (Chagas Disease)
Also called:
New World Trypanosomiasis
South American Trypanosomiasis
Mal de Chagas
Chagas-Mazza Disease
History:
- Discovered by DR. CARLOS CHAGAS on 1909.
- Geographically distributed in SOUTH and CENTRAL AMERICA
People at risk:
- Impoverished people
- Veterinarians, laboratory personels
- Wildlife handlers
- Hunters
- Travellers to endemic areas
VECTOR-BORNE
Vectors:Triatomine insects
Reduviid insects, kissing beetle/bug, assassin bug
- Multiple species capabale of transmission:
Triatoma
Rhodnius
Panstrongylus
TRANSMISSION:
Congenital – from pregnant woman to her baby
Blood transfusions
Organ Transplantation
Consumption of uncooked food that is contaminated with feces from infected triatomine
bugs
Accidental laboratory exposure
TAKE NOTE:
( breastfeeding is SAFE as long as no bleeding or wound on the nipples)
NOT transmitted from person-person like cold, flu or casual contact with infected people
INCUBATION PERIOD:
- 5-14 days after exposure to the bugs infected feces
- 20-40 days after blood transfusion
- 5-40 years after infection (Chronic stage)
SIGNS/SYMPTOMS:
Acute Phase Chronic Phase
Asymptomatic or mild symptoms a few weeks Asymptomatic or mild symptoms for decades
or months or even lifetime
Fever
Fatigue 20-30 % may develop:
Body aches
Headache Cardiac complications
Rash - Cardiomegaly
Loss of appetite - Heart failure
Diarrhea - Arrhythmias
Vomiting - Cardiac arrest
Romañas Sign- the swelling of the eyelid Which may lead to death
- Swelling is due to bug feces
accidentally rubbed into the eye or the GI complications:
bite wound was on the same side of -Megaesophagus
the face as the swelling -Megacolon
Chagoma- swelling at the site of the bite
(where parasite entered the body) Which can lead to difficulties in eating and
Other signs: eliminating.
Mild enlargement of liver and spleen
Swollen glands
MEDICAL MANAGEMENT:
(NO VACCINES AVAILABLE YET)
- ANTIPARASITIC DRUGS
to kill the parasite
Benznidazole (children 2-12 y.o) FDA approved
Nifurtimox (still in CDC investigational protocol)
- SYMPTOMATIC TREATMENT
to manage the symptoms and signs of infection
NURSING MANAGEMENT:
Other Names:
BancroftianFilariasis
Filarial Elephantiasis
FilariasisMalayi
Malayi Tropical Eosinphilia
Wuchereriasis
Medical Management:
Nursing Management:
Educate Patient and relatives about the importance off the maintenance of good hygiene
of the affected part prevent the worsening of the lymphoedema and secondary bacterial
skin infections.
The affected limb should be kept elevated and regular exercises should be done to
improve the lymph flow.
LEGIONELLOSIS
Signs and symptoms:The legionnaire’s disease symptoms usually begin 2 to 14 days after
exposure and include cough, shortness of breath, high fever, muscle aches, headaches, chest
pain, coughing up blood, fever, gastrointestinal symptoms (e.g., diarrhea, nausea, vomiting,
abdominal pain), general discomfort, joint pain, lack of coordination, loss of energy, shaking
chills, and muscle aches and stiffness. Because many of these symptoms resemble those of
pneumonia, the legionnaire’s disease may be difficult to diagnose. Possible complications
include lung failure and death
Vector/mode of transmission:Legionella spp. are found in water sources and can multiply in
stagnant water at some temperatures, usually between 25°C and 45°C. People become
infected by inhaling droplets, mist, or steam containing these bacteria species. The legionnaire’s
disease cannot not be spread from one person to another.Legionella spp. responsible for the
Legionnaire’s disease do not have animal reservoirs and/or vectors. As previously
specified, Legionella spp. grow best in warm water. For instance, these bacteria species are
likely to be found in hot tubs, cooling towers, hot water tanks, large plumbing systems, and
decorative fountain.
Medical management: There are three major classes of antibiotics that are effective in treating
a Legionella infection. These include the fluoroquinolones such as levofloxacin (Levaquin),
and moxifloxacin (Avelox), the macrolides such as erythromycin, azithromyocin (Zithromax),
and clarithromycin (Biaxin), and the tetracyclines including doxycycline (Vibramycin). A new
class of antibiotics (glycylcyclines) are also effective. The choice of antibiotic is often dependent
on the patient's clinical state, tolerance to the medication, and a health care professional's
degree of certainty as to the diagnosis. Zithromax and Levaquin are particularly effective
because of decreased gastrointestinal irritation, higher potency, better penetration into tissue,
and once-daily dosing.In severe cases of Legionnaires' disease that seem more resistant to a
single antibiotic, a second drug called rifampin (Rifadin) may be added. Hospitalization is
LYMPHATIC FILARIASIS
3 CATEGORIES:
Asymptomatic
Acute
Chronic
ASYMPTOMATIC
Skininflammation
Lymph nodes
Chronic lymphoedemaor elephantiasis
Orchitis ( testes)
MEDICAL MANAGEMENT:
Albendazole (400 mg) alone twice per year for areas co-endemic with loiasis
Ivermectin (200 mcg/kg) with albendazole (400 mg) in countries with onchocerciasis
Diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg) in countries
without onchocerciasis
Chemotherapy (recommended by WHO)
Dx Test:
MYCOPLASMA INFECTIONS
Causative Agent:
Mycoplasma pneumoniae
Mycoplasma genitalium
Mycoplasma hominis
Ureaplasmaurealyticum
Ureaplasmaparvum
Mycoplasma pneumoniae
EPIDEMIOLOGY: M. pneumoniae occurs worldwide, but there are more cases in temperate
climates. There is a slight gender difference in certain age groups. Elderly individuals and
infants are less susceptible to pneumonia. Outbreaks tend to occur in late summer and early
fall, and there are cyclic epidemics every 3-5 years in civilian and military populations.
HOST RANGE: Humans are the only known host for M. pneumonia.
COMMUNICABILITY: Transmission rates are high and M. pneumoniae will be shed in upper
respiratory infections for 2 to 8 days before onset of symptoms, and as long as 14 weeks after
infection.
RESERVOIR: Humans.
ZOONOSIS: None.
VECTORS:None.
IMMUNIZATION: Different vaccine strains have been used, but none have been successful at
protecting against infection
PROPHYLAXIS: None.
HOST RANGE:Humans are the only known host for M. genitalium, although colonization in
other animals is theoretically possible.
INCUBATION PERIOD:Unknown.
ZOONOSIS: No zoonotic transmissions have been reported for this pathogen, but it is
theoretically possible.
VECTORS: None.
PREVENTION:Use a condom during sex.The partner may need to get treated, too.
Mycoplasma hominis
INCUBATION PERIOD:Unknown.
ZOONOSIS: No zoonosis have been reported for this pathogen, but it is theoretically possible.
VECTORS: None.
IMMUNIZATION:None available.
PROPHYLAXIS: Clindamycin may be given early in pregnancy for infected women in order to
avoid neonatal infection, but the efficacy of this treatment is disputable.
PREVENTION:To help keep this infection away, always use a condom during sex and limit sex
partners.
HOST RANGE:Humans.
VECTORS:None.
NIPAH VIRUS
Earliest:
fever
headache
Late:
causing long term illness in some patients that survive, including persistent convulsions
and personality changes.
Transmission has occurred in humans through direct contact with infected bats, pigs, horses,
infected tissues and infected people. Person-to-person spread is most likely to occur in
family members and caregivers of sick individuals. Modes of transmission are still being
investigated
Medical Management:
Health care providers may offer supportive therapy (i.e., rest, fluid intake) to help
manage symptoms.
Antiviral drug, ribavirin, can reduce the duration of fever and the severity of disease.
However, how well this treatment cures the disease or improves survival is still
uncertain.
Nursing Management:
People in affected countries should also avoid eating or drinking date palm sap.
RABIES
Other names:
Incubation period for rabies is typically 2–3 months but may vary from 1 week to 1 year,
dependent upon factors such as the location of virus entry and viral load.
- Tingling
- Prickling
- itching feeling around the bite area
As the virus spreads to the central nervous system, progressive and fatal inflammation of the
brain and spinal cord develops
-Hyperactivity
-excitable behavior
-hydrophobia (fear of water)
-Aerophobia (fear of drafts or of fresh air).
-Death occurs after a few days due to cardio-respiratory arrest.
This form of rabies runs a less dramatic and usually longer course than the furious form.
Muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly
develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed,
contributing to the under-reporting of the disease.
Mode of transmission
Medical management:
to prevent the virus from infecting you. Part of this injection is given near the
area where the animal bit you if possible, as soon as possible after the bite.
Nursing management
Assessment:
Mode of Transmission:
Through sexual contact
Medical Management:
Ceftriaxone
Cefixime
Spectinomycin
Partner should also get treatment for gonorrhea, even if he/she has no
signs or symptoms.
Nursing Management
1. Administer ceftriaxone IM as ordered.
2. Emphasize the need regular of Papsmear and pelvic examinations because the
family history of ovarian cancer.
3. Discuss the feelings and concern about the diagnosis of gonorrhea.
4. Teach how to talk with future sexual partner about condom use.
Syphilis ( Treponemmapallidum )
Medical Management
Nursing Management
1. Establish a sexual history, including the number of sexual partners and whether the
patient wasprotected by a condom.
2. Question the patient about intravenous (IV) drug use and previous STIs.
3. Establish a history of fever, headaches, nausea, anorexia, weight loss, sore throat,
mild fever,hair loss, or rashes, symptoms of the primary and secondary stages.
4. Carefully inspect the patient’s genitalia, anus, mouth, breasts, eyelids, tonsils, or
hands for aprimary lesion. With female patients, be sure to determine if chancres
have developed oninternal structures such as the cervix or the vaginal wall.
5. Also inspect the scalp, skin, and mucous membranes for hair loss, rashes, or mucoid
lesions,which are characteristic of the secondary stage.
6. Assure the patient that her or his privacy and confidentiality will be maintained
duringexamination, diagnosis, and treatment, although all sexual partners need to be
notified so thatthey can be examined and treated as needed.
Candidiasis ( Candida Albicans )
Sign and Symptoms:
Medical Management
1. The use of antibiotics or birth control pills can promote yeast infections.
2. Doctors treat thrush with topical, antifungal medications such as nystatin
(Mycostatin and others) and clotrimazole. For mild cases, a liquid version of
nystatin can be swished in the mouth and swallowed, or a clotrimazole
lozenge can be dissolved in the mouth. For more severe cases, fluconazole
(Diflucan) can be taken once a day by mouth.
3. Candida esophagitis is treated with an oral anti-fungal drug such as
fluconazole.
4. Can be effectively treated with a variety of antifungal powders and creams.
The affected area must be kept clean and dry and protected from chafing.
Nursing Management
1. Avoid soap and just rinse with water to clean.
2. Avoid douching.
3. Allow more air to reach the genital area. Wear clean, preferably white,
cotton underwear. Wearing loose-fitting clothes and not wearing panty
hose.
4. Not wearing underwear at night when sleeping.
Medical Management
1. Acyclovir ( Zovirax)
2. Famciclovir ( Famvir)
3. Valacyclovir ( Valtrex)
Nursing Management
1. Assess the client’s description of pain or discomfort: severity, location,
quality, duration, precipitating or relieving factors.
2. Assess for nonverbal signs of pain or discomfort.
3. Wear loose, nonrestrictive clothing made of cotton.
4. Apply cool, moist dressings to pruritic lesions with or without Burrow’s
solution several times a day. Discontinue once the lesions have dried.
5. Avoid temperature extremes, in both the air and bathwater.
6. Avoid rubbing or scratching the skin or lesion.
7. Use topical steroids (anti-inflammatory effect), anti-histamines (anti-
itching effect, particularly useful at bedtime), and analgesics
HIV/AIDS
Mode of Transmission:
Unprotected sex( anal sex)- men having sex with men.
Blood transfusion
Needle sharing
Trans placental
Breastfeeding
Needle pricks
Medical Management
Antibody Test
ELISA- diagnostic only
Western Blot- confirmatory
CD4 T cell count- CD4 T cells are white blood cells that are specifically targeted
and destroyed by HIV. Even if you have no symptoms, HIV infection progresses
to AIDS when your CD4 T cell count dips below 200.
Viral load (HIV RNA)-This test measures the amount of virus in your blood. A
higher viral load has been linked to a worse outcome.
Nursing Management
1. Reverse Isolation with blood precaution and standard precaution.
2. Monitor for viral load. <400-normal, no circulating virus, not contagious.
>400-with circulating virus. Highly communicable.
3. Health teaching on lifestyle
Exercise can increase CD4
Healthy diet
Avoid smoking/ alcoholism
Avoid stress.
3. Perform contact tracing. Trace partner so that they can undergo treatment.
4. Do not allow breastfeeding.
5. For infants infected- do not vaccinate with live vaccines.
6. Give Bactrim ( Sulfamethazole).
CHIKUNGUNYA VIRUS
Medical Management:
3. Take medicine such as acetaminophen (Tylenol®) or paracetamol to reduce fever and pain.
4. Do not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS until dengue
can be ruled out to reduce the risk of bleeding).
5. If you are taking medicine for another medical condition, talk to your healthcare provider
before taking additional medication.
Nursing Management:
1. Wear long sleeves and pants.
2. Secure screen on windows and doors to keep mosquitoes out.
3. Monitor vital sings carefully and keep record.
4. Obtain frequent temperature reading and record it.
5. Check color, features of rash and temperature of skin.
6. Observe for shivering and diaphoresis.
7. Ensure tepid sponging of whole body to reduce temperature.
8. Maximize heat loss by minimizing external covering of patient’s body and ensuring
adequate ventilation.
9. Give antipyretic as per doctor order and check persons with no preexisting liver or
kidney disease.
10. Inform patient to avoid self-medication with aspirin or other pain killers
Sign and Sypmtoms: Fever, rashes and symptoms of referable to upper respiratory tract; the
eruption is preceded by about 2 days of coryza, during which stage grayish pecks (koplik spots)
may be found on the inner surface of the cheeks. A morbilliform rash appears on 3rd or 4th day
affecting face, body and extremities ending in branny desquamation.
Medical Management:
Emphasize the need for immediate isolation when early catarrhal symptoms appear.
Observe closely the patient for complications during and after the acute stage.
Nursing Management: Protect eyes of patients from glare of strong light as they are appointed
to be inflamed. Keep the patient in an adequate ventilated room but free from drafts and
chilling to avoid complications of pneumonia. Teach, guide and supervise correct technique of
giving sponge bath for comfort of patient. Check for corrections of medication and treatment
prescribed by the physician.
YELLOW FEVER
is an acute viral haemoorhagic disease transmitted by infected mosquitoes.
Signd and symptoms of illness appears abruptly 3 to 6 days after the bite of an infected
mosquito. Characterized by the following 3 stages: Period of infection, prriod of remission, and
period of intoxication.
3rd stage:
Beginning on day 3 to 6 after the onset of infection, the period of intoxication is characterized by
returning signs and symptoms including fever, nausea and vomiting, epigastric pain, jaundice,
oliguria, hemorrhagic diathesis and possibly organ failure.
Medical Management:
Care for the patient with yellow fever is mainly supportive because no specific antiviral therapy
is currently available. Rest, fluids, analgesics and antipyretics as early interventions may
improve the patient's prognosis. However, medications that increase the risk of bleeding, such
as aspirin and nonsteroid anti-inflammatory drugs should always be avoided as they may
compound the disease's hemorrhagic effects. Additional treatment options can include
supplemental oxygen, endotracheal intubation, enteral or parenteral nutrition, vasoactive
medications, fresh frozen plasma, dialysis and treatment for secondary infections if necessary.
Nursing Management:
a blister or as multiple blisters on or around affected areas, usually the mouth, genitals, or
rectum. The blisters break, leaving tender sores.
Type 1 - contact with saliva of carriers, infection of hands of health care personnel
Type 2 - usually by sexual contact; infected secretions from symptomatic or
asymptomatic individuals
INCUBATION PERIOD: HSV-1: 7-10 days; Primary genital HSV-2: 2 -12 days
Medical Management:
Although there is no cure for herpes, treatments can relieve the symptoms. Medication can decrease
the pain related to an outbreak and can shorten healing time.
Famvir (Famciclovir)
Acyclovir (Zovira)
Valtrex (Valacyclovir)
Warm baths may relieve the pain associated with genital sores.
Nursing Management: