Viral Meningitis

Causative Agent

Non-polio enteroviruses are the most common cause of viral meningitis in the

United States, especially from late spring to fall. That is when these viruses spread most
often. However, only a small number of people infected with enteroviruses will actually
develop meningitis.

Incubation Period

The incubation period is usually between 3 and 7 days from the time you are
infected until you develop symptoms. You can usually spread the virus to someone else
beginning about 3 days after you are infected until about 10 days after you develop
symptoms.

Signs and Symptom

Symptoms include fever, headache, stiffed neck, photosensitivity, sleepiness,

nausea, vomiting, irritability, lack of appetite and lethargy.

Reservoir

Humans are the only known reservoir for N. meningitis.

Method of Transmission

You can get viral meningitis by breathing in viral particles that have been
sneezed or coughed into the air by another infected person. You can also become
infected by touching surfaces contaminated with the virus, or through contact with feces.

Portal of Exit

Viral meningitis is spread through direct contact with saliva, nasal mucus and feces
making the mouth and nose as portal of exit.

Portal of Entry
 Portals of entry are often ear–nose–throat-related in cases of both acute and
chronic pathology.

Susceptible Host

People of any age can get viral meningitis. However, some people have a higher risk of
getting the disease, including children younger than 5 years old; people with weakened
immune systems caused by diseases, medications (such as chemotherapy), and recent
organ or bone marrow transplantations and babies younger than 1 month old and
people with weakened immune systems are also more likely to have severe illness.

Prevention

There are no vaccines to protect against non-polio enteroviruses, which are the
most common cause of viral meningitis.  The best way to help protect yourself and
others from non-polio enterovirus infections is to wash your hands often with soap and
water for at least 20 seconds, especially after changing diapers or using the toilet; avoid
close contact, such as touching and shaking hands, with people who are sick; clean and
disinfect frequently touched surfaces; stay home when you are sick and keep sick
children out of school.

Vaccines can protect against some diseases, such as measles, mumps,

chickenpox, and influenza, which can lead to viral meningitis. Make sure you and your
child are vaccinated on schedule.

Nursing Responsibilities

Vital signs and neurological observations including blood pressure must be done

at 15 minute intervals for the first two hours, then at intervals determined by the child’s
conscious state, or at a minimum of 4hrly when the child is stable. 

 Order observation frequency in Epic. 

 Low threshold for medical review.
 In infants, fontanel assessment to be documented at least once per shift. 
 Strict fluid balance monitoring to be maintained. 
  Skin assessment to be done at least once per shift, with any new or increasing
rash identified.
 Monitor LP site for signs of infection or swelling at least once per shift

Pharmacological treatment

In most cases, there is no specific treatment for viral meningitis. Most people who
get mild viral meningitis usually recover completely in 7 to 10 days without treatment.
Antiviral medicine may help people with meningitis caused by viruses such as
herpesvirus and influenza.

Antibiotics do not help viral infections, so they are not useful in the treatment of viral
meningitis. However, antibiotics do fight bacteria, so they are very important when
treating bacterial meningitis. People who develop severe illness, or are at risk for
developing severe illness may need care in a hospital.
 Tetanus

Causative Agent

Tetanus is an infection caused by bacteria called Clostridium tetani.

Incubation Period

The average incubation period is seven to 10 days.

Signs and Symptom

Tetanus symptoms include jaw cramping, muscle spasms, painful muscle

stiffness all over the body, trouble swallowing, seizures, headache and fever, changes
in blood pressure and increase in heart rate.

Reservoir

C. tetani is widely distributed in cultivated soil, and in the gut of humans and
animals. Spores can usually be found wherever there is contamination with soil.

Method of Transmission

The spores can get into the body through broken skin, usually through injuries
from contaminated objects. Tetanus bacteria are more likely to infect certain breaks in
the skin.  These include:

 Wounds contaminated with dirt, poop (feces), or spit (saliva)

 Wounds caused by an object puncturing the skin (puncture wounds), like a nail or
needle
 Burns
 Crush injuries
 Injuries with dead tissue

Portal of Exit

Tetanus leaves the body through feces.

Portal of Entry

The spores can get into the body through broken skin, usually through injuries
from contaminated objects. Tetanus bacteria are more likely to infect certain breaks in
the skin.

Susceptible Host

Most tetanus deaths occur among infants and the elderly. Everyone who has not
had a tetanus shot is at risk to this disease.

Prevention

Vaccination and good wound care are important to help prevent tetanus infection.
Doctors can also use a medicine to help prevent tetanus in cases where someone is
seriously hurt and doesn’t have protection from tetanus vaccines.

Nursing Responsibilities

 Assess the type of wound and provide appropriate wound care.

Wounds may be clean or contaminated and dirty, superficial or deep and
penetrating. Dirty wounds pose an increased risk for tetanus.
 Evaluate the immunization status of the patient. Unvaccinated
persons should start and complete a primary series with an age-appropriate tetanus
toxoid-containing vaccine as currently recommended by CDC. Consider persons
with unknown or uncertain history of receiving previous prior doses tetanus toxoid-
containing vaccines to have had no previous tetanus toxoid-containing vaccine.
 Assess need for administering TIG for prophylaxis.
 Do not use antibiotics for prophylaxis against tetanus.

Pharmacological treatment

Several vaccines protect against tetanus, all of which also protect against other
diseases:
 DTaP protects against diphtheria, tetanus, and pertussis (whooping cough)
 DT protects against diphtheria and tetanus
 Tdap protects against tetanus, diphtheria, and pertussis
 Td protects against tetanus and diphtheria
 Giardiasis

Causative Agent

Giardiasis is a diarrheal disease caused by the microscopic parasite Giardia.

Incubation Period

Symptoms of giardiasis normally begin 1 to 3 weeks after becoming infected. In

otherwise healthy people, symptoms of giardiasis may last 2 to 6 weeks. Occasionally,
symptoms last longer. Medications can help decrease the amount of time symptoms
last.

Signs and Symptom

Giardia infection can cause a variety of intestinal symptoms, which include:

 Diarrhea
 Gas or flatulence
 Greasy stool that can float
 Stomach or abdominal cramps
 Upset stomach or nausea
 Dehydration

These symptoms may also lead to weight loss. Some people

with Giardia infection have no symptoms at all.

Reservoir

People are considered to be the most important reservoir hosts for

human giardiasis.

Method of Transmission

Anything that comes into contact with feces (poop) from infected humans or
animals can become contaminated with the Giardia parasite. People become infected
when they swallow the parasite. It is not possible to become infected through contact
with blood.

Portal of Exit

Cysts of Giardia are present in the feces of infected persons. Thus, the infection
is spread from person to person by contamination of food with feces, or by direct fecal-
oral contamination. Cysts also survive in water, for example in fresh water lakes and
streams.

Portal of Entry

Drinking contaminated water and the fecal-oral route are the most common
pathways of entry.

Susceptible Host

High-risk groups for giardiasis include travelers to highly endemic areas,

immunocompromised individuals, and certain sexually active homosexual men.

Prevention

 Practice good hygiene.

 Avoid drinking contaminated water.
 Avoid eating food that may be contaminated.
 Prevent contact with feces during during intercourse.
 Clean up after ill pets and people.

Nursing Responsibilities

 Fluid therapy. Appropriate fluid and electrolyte management is critical,

particularly in patients with large-volume diarrheal losses.
 Diet. No special diet is required; a significant portion of patients have symptoms
of lactose intolerance (cramping, bloating, diarrhea), and maintenance on a
lactose-free diet for several months may be helpful.
  Activity. Activity restrictions are not indicated; however, infected subjects who
are at risk of spreading the infection should be isolated and treated

Pharmacological treatment

Metronidazole (Flagyl). Metronidazole is the most commonly used antibiotic

for giardia infection.
 Westnile Fever

Causative Agent

West Nile fever is an infection by the West Nile virus, which is typically spread by
mosquitoes.

Incubation Period

The period between when you're bitten by an infected mosquito and the
appearance of signs and symptoms of the illness ranges from 2 – 14 days.

Signs and Symptom

Symptoms of severe illness include high fever, headache, neck stiffness, stupor,
disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness
and paralysis.

Reservoir

Birds are the natural reservoir host, and the virus is maintained in nature in a

mosquito-bird-mosquito transmission cycle. The virus has also been isolated from dogs.

Method of Transmission

It is most commonly spread to people by the bite of an infected mosquito.

Portal of Exit

Humans cannot pass the virus on to others. An infected mosquito must bite you
for you to be at risk of infection.

Portal of Entry

 If the mosquito is infected with the West Nile virus, it can pass on the infection
through its bite.
Susceptible Host

The elderly and people with suppressed immune systems are most

susceptible to its effects, which include fever, headache, muscle pains, and various
neurological diseases such as meningitis.

Prevention

In the absence of a vaccine, the only way to reduce infection in people is by

raising awareness of the risk factors and educating people about the measures they can
take to reduce exposure to the virus.

Nursing Responsibilities

No specific medicine is needed for this disease, and there's no cure; usually the
disease goes away without treatment and most people recover fully. The health care
provider will tell patient how to manage symptoms such as headache, fever, and
nausea. If the patient has a severe case of West Nile virus, they may need to be
hospitalized and be given I.V. fluids and medications and breathing support to prevent
complications.

Pharmacological treatment

Treatment is supportive for patients with neuro-invasive West Nile virus, often
involving hospitalization, intravenous fluids, respiratory support, and prevention of
secondary infections. No vaccine is available for humans.
 Shigollosis

Causative Agent

Shigellosis is an infectious disease caused by a group of bacteria called Shigella.

Incubation Period

The incubation period is 12-96 hours, meaning that illness usually starts between
12 and 96 hours after shigella bacteria enter the body.

Signs and Symptom

People who are sick from Shigella infection usually start experiencing symptoms

1 to 2 days after contact with the germ. Symptoms of shigellosis include:

 Diarrhea (sometimes bloody)

 Fever
 Stomach pain
 Feeling the need to pass stool [poop] even when the bowels are empty

Some people with shigellosis will not have any symptoms.

Reservoir

Humans are the primary reservoir of the Shigella species.

Method of Transmission

Shigella is very contagious; just a small amount of germs can make someone
sick. People could get sick by:

 Getting Shigella germs on their hands and then touching their food or

mouth. This may happen after:

 Touching surfaces contaminated with germs from stool from a sick person,
such as toys, bathroom fixtures, changing tables or diaper pails.

 Changing the diaper of a sick child or caring for a sick person.

  Eating food that was prepared by someone who is sick with shigellosis.

 Foods that are consumed raw are more likely to be contaminated

with Shigella germs.

 Shigella germs can contaminate fruits and vegetables if the fields where they
grow contain human waste.

 Swallowing recreational water (for example, lake or river water) while

swimming or drinking water that is contaminated with stool (poop) containing
the germ.

 Having exposure to stool during sexual contact with someone who is sick or
recently (several weeks) recovered from shigellosis.

Portal of Exit

Anus through fecal matter.

Portal of Entry

Transmission of Shigella occurs when people put something in their mouths or

swallow something that has come into contact with stool of a person infected with
Shigella.

Susceptible Host

 Young children are the most likely to get shigellosis, but people of all ages
can get this disease 1. Many outbreaks are related to childcare settings
and schools. Illness commonly spreads from young children to their family
members and others in their communities because it is so contagious.

 Travelers to developing countries may be more likely to get shigellosis,

and to become infected with strains of Shigella bacteria that can’t be
treated effectively by important antibiotics 2,3. Travelers may get sick from
food, drinking water, recreational water, and surfaces containing Shigella
 germs. Travelers can protect themselves by sticking to safe eating and
drinking habits, and washing hands often with soap and water. For more
information, see Travelers’ Health – Food and Water Safety.

 Gay or bisexual men and other men who have sex with men† are more
likely to get shigellosis than other adults 4. Shigella germs pass from
stools (poop) or soiled fingers of one person to the mouth of another
person, which can happen during sexual activity. Many shigellosis
outbreaks among gay and bisexual men have been reported in the United
States, Canada, Tokyo, and Europe since 1999 5-11. For more
information, see Shigella Infections among Gay & Bisexual Men.

 People whose immune systems are weakened due to illness (such as

HIV) or medical treatment (such as chemotherapy for cancer) can get a
more serious illness. A severe shigellosis illness may involve the infection
spreading into the blood, which can be life-threatening 12.

 Large outbreaks of shigellosis often start in childcare settings and spread

among small social groups such as in traditionally observant Jewish
communities 13-15. Similar outbreaks could occur among any race,
ethnicity or community social circle because Shigella germs can spread
easily from one person to another.

Prevention

 Carefully washing your hands with soap and water during key times:

 Before eating or preparing food for others

 After changing a diaper or helping to clean another person who went to

the bathroom

 If you care for a child in diapers who has shigellosis, promptly throw away
soiled diapers in a covered, lined garbage can. Wash your hands and the
 child’s hands carefully with soap and water immediately after changing the
diapers. Clean up any leaks or spills of diaper contents immediately.

 Safe & Healthy Diapering in the Home

 Diaper-Changing Steps for Childcare Settings

 Avoid swallowing water from ponds, lakes, or untreated swimming pools.

 When traveling internationally, follow safe food and water guidelines and
wash hands often with soap and water. For more information, see
Travelers’ Health – Food and Water Safety.

 Avoid sexual activity with those who have diarrhea or who recently
(several weeks) recovered from shigellosis.

Nursing Responsibilities

Healthcare providers may prescribe antibiotics for some people who have severe
cases of shigellosis. Antibiotics such as ciprofloxacin (common treatment for adults),
and azithromycin (common treatment for children) are useful for severe cases of
shigellosis because they can help people get better faster 4. However, some antibiotics
are not effective against certain types of Shigella bacteria. Healthcare providers can
order laboratory tests to determine which antibiotics are likely to work.

Pharmacological treatment

In some people, bismuth subsalicylate (for example, Pepto-Bismol) can help to

relieve symptoms.

People with shigellosis should not use anti-diarrheal medication, such as

loperamide (for example, Imodium) or diphenoxylate with atropine (for example,
Lomotil). These medications may make symptoms worse.
 Leptospirosis

Causative Agent

It is caused by bacteria of the genus Leptospira.

Incubation Period

The time between a person’s exposure to a contaminated source and becoming

sick is 2 days to 4 weeks.

Signs and Symptom

In humans, Leptospirosis can cause a wide range of symptoms, including:

 High fever
 Headache
 Chills
 Muscle aches
 Vomiting
 Jaundice (yellow skin and eyes)
 Red eyes
 Abdominal pain
 Diarrhea
 Rash

Reservoir

The primary reservoir hosts are wild animals such as rodents, which can

shed leptospires throughout their lifetimes.

Method of Transmission

Exposure may occur through either direct contact with an infected animal or
through indirect contact via soil or water contaminated with urine from an infected
animal.
Portal of Exit

Droplets expelled from the nose and mouth, for example when an infected
person coughs or sneezes.

Portal of Entry

Portals of entry include cuts and abrasions or mucous membranes such as the
conjunctival, oral, or genital surfaces.

Susceptible Host

Leptospirosis occurs worldwide, but is most common in temperate or tropical

climates. It is an occupational hazard for many people who work outdoors or with
animals, such as:

 Farmers
 Mine workers
 Sewer workers
 Slaughterhouse workers
 Veterinarians and animal caretakers
 Fish workers
 Dairy farmers
 Military personnel

The disease has also been associated with swimming, wading, kayaking, and rafting
in contaminated lakes and rivers. As such, it is a recreational hazard for campers or
those who participate in outdoor sports. The risk is likely greater for those who
participate in these activities in tropical or temperate climates.

Prevention

The risk of acquiring leptospirosis can be greatly reduced by not swimming or

wading in water that might be contaminated with animal urine, or eliminating contact
with potentially infected animals.
 Protective clothing or footwear should be worn by those exposed to
contaminated water or soil because of their job or recreational activities.

Nursing Responsibilities

Health teaching

 Provide education to clients telling them to avoid swimming or wading in

potentially contaminated water or flood water.
 Use of proper protection like boots and gloves when work requires exposure
to contaminated water.
 Drain potentially contaminated water when possible.
 Control rats in the household by using rat traps or rat poison, maintaining
cleanliness in the house.
Management

 Isolate the patient and concurrent disinfection of soiled articles.

 Stringent community-wide rat eradication program.Remove rubbish from work
and domestic environment to reduce rodent population.
 Report all cases of leptospirosis.
 Investigation of contacts and source of infection
 Chemoprophylaxis can be done in a group of high risk infected hosts.
Pharmacological treatment

Leptospirosis is treated with antibiotics, such as doxycycline or penicillin, which

should be given early in the course of the disease.

Intravenous antibiotics may be required for persons with more severe symptoms.
Persons with symptoms suggestive of leptospirosis should contact a health care
provider.
 Zika Virus

Causative Agent

 Zika virus disease is caused by a virus transmitted primarily by Aedes

mosquitoes, which bite during the day

Incubation Period

The incubation period (the time from exposure to symptoms) of Zika virus
disease is estimated to be 3–14 days. 

Signs and Symptom

Symptoms are generally mild and include fever, rash, conjunctivitis, muscle and
joint pain, malaise or headache. Symptoms typically last for 2–7 days. Most people with
Zika virus infection do not develop symptoms.

Reservoir

Nonhuman and human primates are likely the main reservoirs of the virus

Method of Transmission

Zika virus is primarily transmitted by the bite of an infected mosquito from

the Aedes genus, mainly Aedes aegypti, in tropical and subtropical
regions. Aedes mosquitoes usually bite during the day, peaking during early morning
and late afternoon/evening. This is the same mosquito that transmits dengue,
chikungunya and yellow fever.

Zika virus is also transmitted from mother to fetus during pregnancy, through
sexual contact, transfusion of blood and blood products, and organ transplantation.

Portal of Exit

When a mosquito bites a person that’s already infected it draws in the virus
contained in the blood.
Portal of Entry

Through mosquito bites. Zika virus is transmitted to people primarily through the

bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus).

Susceptible Host

Pregnant women are mosre susceptible to Zika.

Prevention

Protection against mosquito bites during the day and early evening is a key
measure to prevent Zika virus infection. Special attention should be given to prevention
of mosquito bites among pregnant women, women of reproductive age, and young
children.

Personal protection measures include wearing clothing (preferably light-coloured)

that covers as much of the body as possible; using physical barriers such as window
screens and closed doors and windows; and applying insect repellent to skin or clothing
that contains DEET, IR3535 or icaridin according to the product label instructions.

Young children and pregnant women should sleep under mosquito nets if
sleeping during the day or early evening.  Travellers and those living in affected areas
should take the same basic precautions described above to protect themselves from
mosquito bites.

Nursing Responsibilities

Since there are no antiviral treatments for the virus, supportive care should be
given for any symptoms such as rest, antipyretics, pain management, and fluids

Pharmacological treatment

There is no treatment available for Zika virus infection or its associated diseases.