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Chapter 40 Infectious Disorders Stages of infectious disease • Incubation period – Time between the invasion of an organism & the onset of S/S – 7-10 days (maybe longer depending upon pathogen) • Prodromal period – Time between the beginning of nonspecific symptoms & specific symptoms – Hours to a few days • Illness – Specific symptoms are evident • Convalescent period – Time between when the S/S begin to fade and a return to full wellness Chain of infection • Reservoir – Place in which organisms grow & reproduce • Portal of exit – Method by which organisms leave an infected person’s body to be spread to another individual – Table 43-1 (blood, respiratory secretions, feces, & exudate from lesions) • Means of transmission – Direct contact, indirect contact, fomites (inanimate objects, ex. food, bedding, towels, combs, drinking glasses, etc), insects, or vermin • Portal of entry – Means by which a pathogen can enter an individual’s body – Inhalation, ingestions, breaks in the skin (ex. bites, abrasions, burns) • Susceptible host VIRAL INFECTIONS • Viral exanthems (rashes) – Exanthem subitum (Roseola Infantum) • Rash following a high fever – Rubella (German measles) • Rarely seen because of MMR • Important because it can cause serious birth defects – Measles (Rubeola) • Rarely seen because of MMR • Occurs with Coryza (rhinitis and sore throat), cough, and conjunctiva • Koplik’s spots-whitish spots on the buccal membranes • Viral exanthems (rashes) – Chickenpox (Varicella zoster) • Will become rare because of mandatory immunization • Fluid filled vesicles that crust over, occur in different stages • Highly contagious, spread by respiratory droplets as well as contact – Herpes zoster • Same virus as chicken pox but usually occurs in older children/adults • Causes painful vesicles along a dermatome • May be treated with acyclovir – Erythema infectiosum (Fifth disease) • “slapped cheeks” appearance and a lacy rash • Important because it can cause birth defects – Smallpox (Variola) • Important because of bioterrorism • People with this are really sick with fever, chills, vomiting, then rash • Rash progresses from macule to papule to vesicle to pustule. VIRAL INFECTIONS • Enteroviruses – Coxsackievirus infections • Herpangina – Poliovirus infections: Poliomyelitis • Occurs in other parts of the world • IPV used now instead of OPV because of immunocompromised people contracting disease shed in stool Cytomegalovirus • Common cause of congenital infection in infants • Some children are asymptomatic for years and then manifest with – Mental retardation/learning disabilities – Hearing loss/blindness • Symptoms evident at birth can include – – – – Jaundice Seizures Respiratory distress microcephaly • Therapy is experimental • Viruses causing central nervous system diseases – Rabies • Other viral infections – Mumps • Rarely seen because of MMR • Mumps in a teenage or adult man can lead to sterility – Infectious mononucleosis • S/S similar to tonsillitis with sore throat, lymphadenopathy, and fever • Spleen is enlarged and fatigue can last ~6 weeks • Treat symptoms only OTHER INFECTIONS • Scarlet fever – – – – Group A beta-hemolytic strept Often seen with Strept throat Usually not seen with “cold” symptoms Treated for 10-14 days with antibiotics • Eye infections/inflammations – Conjunctivitis (viral or bacterial) • • • • Starts in one eye and moves to the other Bacterial…purulent discharge Viral…watery discharge Schools or day care will only believe it is bacterial so treat with antibiotic ointment • Highly contagious, can be spread by gnats • Anthrax OTHER BACTERIAL INFECTIONS – Important because of bioterrorism – Three types, inhalation, cutaneous, & gastro – Inhalation • Most serious, >90% mortality • Begins with flu like symptoms – Cutaneous • Begins as a papule and progresses to a painless depressed black eschar • Mortality 1% with antibiotic therapy – Gastrointestinal • Acquired by eating undercooked meat infected with anthrax • Develops abd. pain, diarrhea; mortality is 25% – Management • Cipro for >18 years, Doxycycline for <18. • Diphtheria – S/S • Foul nasal discharge, low-grade fever • Gray membranes on tonsils and pharynx • Neck edema – Therapeutic management • DTaP…rarely seen due to immunization • Pertussis – S/S • See Box 40-1 pg. 1034 – Therapeutic management • DTaP…rarely seen due to immunization OTHER BACTERIAL INFECTIONS • Lyme disease – Transmitted by the deer tick – S/S • Papule at the site of the tick progressing to a large swollen ring • Systemic involvement – Therapeutic Management • Amoxicillin or PCN V or doxycycline • Prevention is the most important tool OTHER INFECTIOUS PATHOGENS • Rickettsial diseases – Rocky mountain spotted fever • Transmitted by the wood, dog, or rabbit tick • S/S – A reddened area develops at the site of the tick bite – Afterwards, rash, headache, fever, and mental confusion – CNS involvement • Management – Tetracycline for 7-10 days – Prevention OTHER INFECTIOUS PATHOGENS • Helminthic infections – Roundworms (Ascariasis) – Hookworms – Pinworms