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Nrsg 407 Infectious Disease Chp 4 Viral Infections • Acute or Chronic • Respiratory Tract Viruses: • • • • Rhinoviruses-numerous types. Causes most cases of the common cold Adenovirus-Upper respiratory track infections, causing tonsillitis Respiratory syncytial viruslower respiratory tract. Most common causes of pneumonia and bronchiolitis in children Influenza: Type A & B. Type B less common, more mild. Type A causes severe respiratory infection • GI: • Rotavirus- most common causes of diarrhea in infants and young children. Transmission fecal-oral • Norovirus-usually affects older children and adults. Transmission due to fecally contaminated food or water, person-to-person, and by aerosolization. Supportive treatment, virus is selflimiting Latent Virus Infections • Virus persists in noninfectious form • Can periodically reactivate, resulting in new infections • Herpes simplex virus • Herpes zoster virus/varicella-zoster virus • Cytomegalovirus • HIV (refer to chapter 3) Productive & Transformative Virus Infections Productive: • Virus persists in infectious form • Chronic infection • Hepatitis B & C • Transformative: stimulates transformation of normal tissue into a neoplasm • Epstein-Barr virus: infectious mononucleosis, Linked with some non-Hodgkin lymphomas • Human papilloma virus: skin & squamous mucosa, may cause warts, cervical cancer • Kaposi sarcoma associated herpes: malignant skin tumor, most common AIDS defining neoplasm Bacterial Infections Gram Positive Bacilli Gram Positive Coccci • Staphylococci: acute pyogenic infections • Diphtheria: acute pharyngeal/skin infection • Listeria Monocytogenes: causes food borne infections through refrigerated food. Listeriosis features bacteremia, meningitis, encephalitis, and dermatitis Streptococci: grouped according to antigenic properties • Bacillus Anthracis: agent of anthrax • • Nocardia: found in soil. Nocardiosisacute/chronic occurs in immunodeficient patients • Clostridia: includes: • • • • • • • • • S. aureus causes skin abscesses, pharyngitis, bone infection, pneumonia, & heart valve infections Spread direct contact with kin or clothing, nostrils Antibiotic resistant strains-MRSA Coagulase negative staph: common cause of endocarditis in IV drug users Can invade bloodstream & cause secondary infections (septicemia, endocarditis, meningitis) May also stimulate autoimmune responses in kidney Spread by direct contact Alpha hemolytic: S. pneumoniae Beta hemolytic: • Group A: infection of pharynx or skin (cellulitis) • Group B: neonatal pneumonia, meningitis, and sepsis. Adults-UTI • Group D: anaerobic, common in intestines • • • C. diff-commensal anaerobe usually resides in colon. When oral antibiotics kill off competition, it overgrows, releases toxins & causes pseudomembranous colitis C. perfringens-agent of gas gangrene C. tetani-agent of tetanus (acute poisoning from a neurotoxin Gram Negative Cocci • N. meningitidis (meningococcus) • Cause of meningitis in young children • Spread by respiratory droplets • Epidemics occur in underdeveloped nations • Meningococcal meningitis • Life threatening emergency • Diagnosis confirmed with spinal fluid & blood culture • When individuals encounter subtypes not immune to • Day care, college, military Lyme Disease • Spirochete Borrelia burgdorferi • Spread from rodents to humans by bite of deer tick • Three stages of disease development • Stage 1: red skin lesion with pale center, mild fever and lymphadenopathy • Stage 2: lymphadenopathy, recurrent fever, skin rash, joint & muscle pains, cardiac arrhythmias, and meningitis • Stage 3: chronic disease, 2-3 years after bite Mycobacteria • Mycobacterium tuberculosis-TB • Mycobacterium leprae-leprosy • Mycobacterium avium-infects birds & humans • Mycobacterium bovinum-infects cattle & humans TB Diagnosis & Treatment • Primary infection asymptomatic • Except when initial infection overwhelms defenses (pts. With AIDS) • Subtle onset S/S: low fever, night sweats, weight loss, poor appetite • Pulmonary s/s begin later • Mantoux test: (PPD) skin test for infection Fungus Infections • Fungi-nucleated cells with a cell wall • Grow in two forms: multicellular filaments (molds) or sing cells (yeast) • Fungus is a mycosis • • • • Superficial mycoses-skin, hair, nails (most common) Subcutaneous: skin, subcutaneous tissues & lymphatics Endemic: serious systemic disease in health people Opportunistic: fatal systemic disease in immunosuppressed, or where indwelling catheters/medical hardware is present Candida • Skin, mouth, GI, & vagina • C. albicans most common • Infection occurs when normal flora breach skin or mucosal barriers • May spread systemically especially in patients with low neutrophil count • Most common: diaper rash & vaginitis Parasite Infections • Parasite is an organism living in another organism & benefits by deriving nutrients for itself at the expense of the host • Three types: Protozoa, Worms, & Ectoparasites Protozoa • Larger & more complex than bacteria and fungi • Causes: • Malaria-small plasmodium amoebae • Amebiasis-food contaminated with human feces that contains amebic cysts • Leishmaniasis: chronic inflammation of skin, mucous membranes, & viscera caused by Leishmania. Transmitted from infected animals by sandflies • Trypanosomiasis: microscopic protozoa that infect blood. Transmitted from human to human by insects. Includes sleeping sickness • Giardiasis: acute/chronic diarrhea. Transmitted by ingesting fecally contaminated water or unwashed vegetables/fruits Worms • Helminths-worms vary in length and migrate from point of entry through various organs. Diagnosis is by detection of worm/eggs by biopsy or stool examination • Roundworms: infect intestines or subcutaneous tissues • Intestinal roundowroms: live in intestine, spread by oral-fecal contamination • Hookworms: intestinal roundworms enter through skin & infect blood • Pinworm: common pediatric infection. Transmitted oral-fecal route • Trichinosis: transmitted by eating inadequately cooked infected pork Flatworms • Infect blood vessels, GI, lungs, and liver • Schistosomiasis: most important of ALL worm infections • Eggs passed in urine and stool into water where larvae infect snails and mature before reentering water to invade skin of humans and spread through the blood Ectoparasites • Live on Skin or Hair • Lice: wingless, blood-sucking insects that infest the hair of the head, body, or pubis • Scabies: infestation of the skin mite Sarcoptes scabiei. Lives only in skin of humans. Transmitted through direct contact. Sexually Transmitted Infections (STI) • Infection transmitted by sexual contact • Any organism can cause STIs • Viral, bacterial, and parasitic • Important facts: • • • • • • • Immunity not often achieved, reinfection is possible Diagnostic testing not easily obtainable Cases treated syndromically, lacking a definitive diagnosis Infection often asymptomatic (especially in women) More than one STI may be present Patient follow-up or contagion tracing often unavailable No cure for viral STIs (HPV, HIV/AIDS, genital herpes) Laboratory Tools • Microbial culture • Gold standard