Bacteria

BOTULISM

CAUSES:
Botulism is a serious illness caused by the botulinum toxin. The toxin causes paralysis. Paralysis starts in
the face and spreads to the limbs. If it reaches the breathing muscles, respiratory failure can result.
The toxin is produced by Clostridium botulinum (C. botulinum), a type of bacterium.
All types of botulism eventually lead to paralysis, so any case of botulism is treated as a medical
emergency.

SYMPTOMS AND SIGNS:

constipation
poor feeding
bad temper
excessive drooling when feeding
sagging eyelids
flat facial expression
lethargy and listlessness
respiratory difficulties
slow or improper reflexes
weak crying weakly
floppiness and poor muscle tone
no gag reflex
unfocused eyes
weak sucking
difficulty swallowing or speaking
facial weakness on both sides of the face
blurred vision
drooping eyelids
trouble breathing
nausea, vomiting, and abdominal cramps (only in foodborne botulism)
paralysis

DIAGNOSTIC METHOD:
If you suspect that you or someone you know has botulism, get medical help immediately. Early
diagnosis and treatment is crucial for survival.

To diagnose botulism, a doctor will complete a physical exam, noting any signs or symptoms of botulism
poisoning. They’ll ask about foods eaten within the past several days as possible sources of the toxin,
and if anyone else ate the same food. They’ll also ask about any wounds.

In infants, a doctor will also check for physical symptoms, and will ask about any foods that the infant
ate, such as honey or corn syrup.
Your doctor may also take blood or stool samples to analyze for the presence of toxins. However, results
for these tests may take days, so most doctors rely on a clinical observation of symptoms to make a
diagnosis.

Some symptoms of botulism can mimic those of other diseases and conditions. Your doctor may order
additional tests to rule out other causes. These tests may include:

electromyography (EMG) to evaluate muscle response

 imaging scans to detect any internal damage to the head or brain

 spinal fluid test to determine if infection or injury to the brain or spinal cord is causing
symptoms
NURSING INTERVENTION:
Botulism isn't contagious, so don't isolate the patient. Using standard precautions, collect
specimens for diagnostic testing. Prepare the patient for a skin test to check his sensitivity to
equine antitoxin; about 10% of patients are allergic to it.
If indicated and if the patient isn't allergic, administer botulinum antitoxin to an adult as
ordered and provide supportive care. Infants should receive supportive care, but antitoxin isn't
indicated. For wound botulism, the health care provider will also explore and debride the
wound and order an antibiotic. If symptoms worsen, prepare to transfer the patient to the ICU
for intubation and mechanical ventilation.
To prevent botulism contamination, instruct patients to heat home-canned foods to 241° F to
250° F (116° C to 121° C) for at least 5 minutes and teach them good hand hygiene.
PREVENTION:

 Preserved food should be heated to a temperature above 100°C (212°F) for at least 10
minutes during the canning process.

 Cook food at 79.9°C (176°F) for at least 30 minutes. This usually destroys toxins.

 Do not eat or store cooked foods that have been at room temperature for 4 hours or
more.

 Do not eat foil-wrapped baked potatoes that have been left at room temperature, and
do not store chopped garlic or onions in oil at room temperature.

 If eating home-canned food, boil it first with frequent stirring for 10 minutes.

 Do not feed honey to infants less than 6 months old.

TREATMENT/MANAGEMENT:
 The symptoms of botulism make hospitalization necessary. If diagnosed early, botulism
can be treated with an antitoxin, which blocks the action of the toxin circulating in the
blood. This can prevent patients from worsening, but recovery still takes many weeks. If
left untreated, a patient may need to be on a breathing machine (ventilator) for weeks
and would require intensive medical and nursing care. Infant botulism is treated with
immune globulin, which is similar to the antitoxin. Most cases of botulism recover with
appropriate medical care.

CHOLERA
CAUSES:
Cholera is an infectious disease that causes severe watery diarrhea, which can lead
to dehydration and even death if untreated. It is caused by eating food or drinking water
contaminated with a bacterium called Vibrio cholerae.
SYMPTOMS AND SIGNS:
Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often,
symptoms are mild. But sometimes they are very serious. About one in 20 people infected have
severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although
many infected people may have minimal or no symptoms, they can still contribute to spread of the
infection.
Signs and symptoms of dehydration include:

 Rapid heart rate
 Loss of skin elasticity (the ability to return to original position quickly if pinched)
 Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
 Low blood pressure
 Thirst
 Muscle cramps

DIAGNOSTIC METHOD:

Although signs and symptoms of severe cholera may be unmistakable in endemic areas, the
only way to confirm a diagnosis is to identify the bacteria in a stool sample.

Rapid cholera dipstick tests are now available, enabling health care providers in remote areas to
confirm diagnosis of cholera earlier. Quicker confirmation helps to decrease death rates at the
start of cholera outbreaks and leads to earlier public health interventions for outbreak control.

NURSING INTERVENTION: (ara sa phone)

 PREVENTION:

 Good sanitation, since cholera is most commonly transmitted through drinking water
that is contaminated with infected faeces. In addition to having access to good
sanitation systems and clean drinking water, people should also wash their hands after
using the toilet and before preparing and eating a meal.
 Surveillance and reporting of all cases of cholera. The identification, treatment and
isolation of cholera prevents further spreading of the disease.
 Education of mass populations regarding good hygiene and safety practices. Such
education can help contain the bacteria and prevent it from spreading.

Cholera vaccines

There are two oral cholera vaccines, Dukarol and Shanchol that have been licensed for use in
areas where cholera is endemic. Both vaccines contain whole-cell killed bacteria and reduce the
chance of picking up cholera by more than 50% for two years in endemic regions. Dukoral can
be used in all age groups to provide short-term protection of up to 85-90% against Vibrio
cholerae 01 at 4-6 months following immunization. Shanchol provides longer-term protection
against both Vibrio cholerae O1 and O139 in children aged less than five years.

TREATMENT/MANAGEMENT:

Replace lost body fluid by giving Oral Rehydration Solution (ORESOL) or a homemade solution
composed of 1 teaspoon of salt, 4 teaspoons of sugar mix to 1liter of water. If diarrhea persists,
consult your health workers or bring the patient to the nearest hospital.

DIPHTERIA

CAUSES:

Diphtheria is an infectious disease caused by the bacterial microorganism known

as Corynebacterium diphtheriae. Other Corynebacterium species can be responsible, but this
is rare.
 Some strains of this bacterium produce a toxin, and it is this toxin that causes the most serious
complications of diphtheria. The bacteria produce a toxin because they themselves are infected
by a certain type of virus called a phage.

The toxin that is released:

 inhibits the production of proteins by cells

 destroys the tissue at the site of the infection

 leads to membrane formation

 gets taken up into the bloodstream and distributed around the body's tissues

 causes inflammation of the heart and nerve damage

 can cause low platelet counts, or thrombocytopenia, and produce protein in the urine in
a condition called proteinuria

SYMPTOMS AND SIGNS:

Diphtheria signs and symptoms usually begin two to five days after a person becomes infected
and may include:

 A thick, gray membrane covering your throat and tonsils

 A sore throat and hoarseness

 Swollen glands (enlarged lymph nodes) in your neck

 Difficulty breathing or rapid breathing

 Nasal discharge

 Fever and chills

 Malaise

DIAGNOSTIC METHOD:
 They can use a swab from the back of the throat and test it for the bacteria that cause
diphtheria. A doctor can also take a sample from a skin lesion (like a sore) and try and
grow the bacteria. If the bacteria grow, the doctor can be sure a patient has diphtheria.

NURSING INTERVENTIONS: (ara sa phone)

PREVENTION:

Patients with the pharyngeal form should be isolated to prevent further spread of the disease.
Both Erythromycin and Penicillin are usually effective in eradicating the disease but they do
not affect the acute phase of the disease. Treatment should be continued for 10 days. Patients
shown to have a carrier state should also be treated.

Immunization of infants with 3 doses of DPT (at ages 6 weeks old, 10 weeks old and 14 weeks
old).

TREATMENT:
Diphtheria is a serious illness. Doctors treat it immediately and aggressively with these
medications:

 An antitoxin. If doctors suspect diphtheria, the infected child or adult receives an

antitoxin. The antitoxin, injected into a vein or muscle, neutralizes the diphtheria toxin
already circulating in the body.

Before giving an antitoxin, doctors may perform skin allergy tests to make sure that the
infected person doesn't have an allergy to the antitoxin. People who are allergic must first
be desensitized to the antitoxin. Doctors accomplish this by initially giving small doses of
the antitoxin and then gradually increasing the dosage.

 Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or

erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics
reduce to just a few days the length of time that a person with diphtheria is contagious.

GONORRHEA

CAUSES:

 Gonorrhea is caused by the bacterium Neisseria gonorrhoeae.

 SIGNS AND SYMPTOMS:

Symptoms may be absent despite an active gonorrheal infection. Symptoms can appear
anywhere from 1-14 days following exposure to the infection.

Men and women experience slightly different symptoms; these can include:

Men:

 white, yellow, or green urethral discharge, resembling pus

 inflammation or swelling of the foreskin

 pain in the testicles or scrotum

 painful or frequent urination

 anal discharge, itching, pain, bleeding, or pain when passing stools

 itching, difficulty swallowing, or swollen neck lymph nodes

 eye pain, light sensitivity, or eye discharge resembling pus

 red, swollen, warm, painful joints

Women:

 painful sexual intercourse

 fever

 yellow or green vaginal discharge

 vulvar swelling

 bleeding in-between periods

 heavier periods
 bleeding after intercourse

 vomiting and abdominal or pelvic pain

 painful or frequent urination

 sore throat, itching, difficulty swallowing, or swollen neck lymph nodes

 eye pain, light sensitivity, and eye discharge resembling pus

 red, swollen, warm, painful joints

Anal gonorrhea signs include:

 itching, bleeding, or pain with passing bowel movements

 anal discharge
An itching or burning sensation in the eyes may be a symptom of conjunctivitis. If infected
semen or fluid comes into contact with the eyes, a person can develop conjunctivitis.

DIAGNOSTIC METHOD:

Most of the time, urine can be used to test for gonorrhea. However, if you have had oral
and/or anal sex, swabs may be used to collect samples from your throat and/or rectum. In
some cases, a swab may be used to collect a sample from a man’s urethra (urine canal) or a
woman’s cervix (opening to the womb).

NURSING INTERVENTION:

Administer ceftriaxone IM as ordered.

• Emphasize the need for regular Pap smears and pelvic examinations because of the family history of
ovarian cancer.
• Discuss feelings and concerns about the diagnosis of gonorrhea. Stress that such a diagnosis does not
reflect on one’s self-worth as a person.
• Teach how to talk with a future sexual partner about condom use

PREVENTION:
Treating Genital Gonorrhea

The following medications are usually given to non-pregnant women with gonorrhea infections
affecting the cervix, urethra, or rectum:

 cefixime (Suprax), 400 milligram (mg) taken orally

 ceftriaxone (Rocephin), 125 mg injected into a muscle as a single dose

 ciprofloxacin (Cipro), 500 mg taken orally

 ofloxacin (Floxin), 400 mg taken orally as a single dose

 spectinomycin (Trobicin), 2 grams injected into a muscle in a single dose

Treating Oral Gonorrhea

Gonorrhea infections that affect the throat are more difficult to treat than those that affect the
genital area. Although the same medications are recommended for treating oral gonorrhea
infections, they tend to be less effective. A doctor may perform a throat culture five to seven
days after treatment begins. This can help them determine whether the infection is gone.
Prolonged treatment will be needed if the infection doesn’t go away within a few days.

Treating Disseminated Gonorrhea

Disseminated gonorrhea occurs when the Neisseria gonorrhoeae bacterium infects the
bloodstream. People need to be hospitalized during the first phase of treatment for this type of
gonorrhea. Initial treatment often consists of a medication called ceftriaxone. Every day,
approximately1 gram of ceftriaxone will be given intravenously ( through an IV).

If you have disseminated gonorrhea but are allergic to ceftriaxone, your treatment will likely
begin with:

 intravenous ciprofloxacin, 500 mg

 intravenous ofloxacin, 400 mg

  intramuscular spectinomycin, 2 grams every 12 hours

The first phase continues until the condition has shown signs of improvement for at least 24 to
48 hours. During the second phase, one of the following medications will need to be taken for
at least one week:

 cefixime, 400 mg taken twice per day

 ciprofloxacin, 500 mg taken twice per day

 ofloxacin, 400 mg taken twice per day

Treating Conjunctivitis

In rare cases, gonorrhea may lead to the development of conjunctivitis. Conjunctivitis,

commonly known as pink eye, is an infection that causes swelling around the eyes. Blood
vessels within the outer lining of the eye become inflamed, giving the eye a red or pink color.
When conjunctivitis occurs as a result of a gonorrhea infection, the recommended treatment is
ceftriaxone. One gram will be injected into a muscle. The affected eye will also need to be
washed thoroughly with a saline solution.

TREATMENT:
 Gonorrhea is treated with antibiotics. Commonly used medications include Rocephin
(injection) and Cefixime (pills or liquid).  
 Since the symptoms of gonorrhea and chlamydia are similar and both diseases can occur
at the same time, most people who are treated for gonorrhea are also treated for chlamydia.
 It is recommended that individuals be re-screened three months after receiving
treatment.

LEPROSY

CAUSES:

Leprosy is a chronic, progressive bacterial infection caused by the bacterium Mycobacterium

leprae. It primarily affects the nerves of the extremities, the skin, the lining of the nose, and
the upper respiratory tract. Leprosy is also known as Hansen’s disease.
 SIGNS AND SYMPTOMS:
The symptoms of leprosy can present differently in different people with the condition.

The main symptoms include:

 the appearance of skin lesions that are lighter than normal skin and remain for weeks or
months

 patches of skin with decreased sensation, such as touch, pain, and heat

 muscle weakness

 numbness in the hands, feet, legs, and arms, known as "glove and stocking anesthesia"

 eye problems

 enlarged nerves, especially in the elbows or knees

 stuffy nose and nosebleeds

 curling of the fingers and thumb, caused by paralysis of small muscles in the hand

 ulcers on the soles of the feet.

Injuries, breaks, and burns can go unnoticed, due to the numbing of sensation caused by nerve
damage, potentially becoming infected or more seriously injured. Over time, the extremities
can be lost to repeated damage.

The wounds are also more likely to become infected, as immune defenses are weakened by
leprosy. The reabsorption of cartilage by the body means that these secondary infections can
result in tissue loss. This leads to the characteristic shortening of the toes and fingers seen in
leprosy.

Damage to the mucous membrane that coats the inside of the nose can sometimes lead to
internal damage and scarring. The nose might eventually collapse.
Leprosy can destroy the nerves responsible for blinking. This can lead to the eyes becoming
dried out and prone to infection, potentially resulting in ulceration and blindness.

DIAGNOSTIC METHOD:

A lepromin skin test is performed by injecting a small sample of inactivated M. leprae under

your skin. The term “inactivated” means that the bacterium isn’t able to cause infection. The
bacterium is usually injected into the forearm. A small lump will form at the injection site,
indicating that the correct amount of bacterium has been injected at the correct depth in the
skin for the test to be effective.

You’ll need to be examined three days after the injection to see if you’ve had a reaction to the
bacterium. If no reaction occurs, you’ll need to be examined again in 28 days. Specific reactions
at the injection site indicate certain types of leprosy.

NURSING INTERVENTION: (ARA SA PHONE)

PREVENTION:

treat all leprosy cases to prevent spread of infection

* young children should avoid direct contact with untreated patients
* practice personal hygiene
* maintain body resistance by healthful living
   o good nutrition
   o enough rest and exercises
   o clean environment

TREATMENT:

Multi-Drug Therapy (MDT)

* Go to the nearest health center for immediate treatment