Disturbances in Inflammatory and Immunology

Prepared by: Michael John R. Victoria, RN

Infectious Disorder in Children

Measles (Rubeola)
‡ An acute, highly contagious, vaccine preventable viral infection w/ a prodromal stage charac by catarrhal symptons and koplik spots on buccal mucous membrane ‡ Dusky red blotchy rash appear on the skin on the 4th day on the face and body ‡ ´RUBEOLAµ- red spots on the body ´RUBEOLAµ-

‡ ‡ ‡ ‡

Agent: RNA Paramyxovirus MOT: droplet Incubation: 10 days CommunicabilityCommunicability- 4 days before and 5 days after rash appears

S&S
‡ Upper RTI ‡ Koplik Spots- pathognomonic sx Spots‡ Irritable, skin rash for 6 days the fades

TX
Symptomatic tx AntibioticAntibiotic- if w/ pneumonia Isolation for 7 days from onset of rash ImmunizationImmunization- 9-12 mos., SQ, single dose, w/ MMR; S.E.-fever S.E.‡ X pregnancy ‡ ‡ ‡ ‡

German Measles/ Rubella
‡ ‡ ‡ ‡ ´Rednessµ Agent: RNA Togavirus IncubationIncubation- 2-3 wks CommunicabilityCommunicability- 1 wk before to 1 wk after rash appears ‡ MOT- droplet, person to person contact MOT-

S&S
‡ ‡ ‡ ‡ Enlarged lymph nodes MaculoMaculo-papular rash on the face and trunk Petechial lesions on the soft palate FeverFever- subsides on the 2nd day

TX
‡ Isolation, hygiene ‡ Immunization- live attenuated vaccine; SQ, Immunizationgiven w/MMR ‡ X pregnancy

Diff lesions of the skin
‡ Macule-flat, circumscribed area, no elevation, up 2 cm Macule‡ Papule- circumscribed solid and elevated lesion, up to 1 Papulecm ‡ Wheal- slightly irregular, transient, superficial elevation Whealof the skin w/palpable magin (ex. Hive) ‡ Vesicle- circumscribed elevation filled w/ serous fluid Vesicleless than 1cm ‡ Bulla- a vesicle larger than 1 cm Bulla‡ Pustule- vesicle or bulla filled w/ pus Pustule‡ Nodule- solid, elevated lesion extending deeper into Noduledermis, 1-2 cm 1-

Chickenpox
Primary disease of children Occurs in epidemics AgentAgent- Human alpha herpes Varicella 3 IncubationIncubation- 2wks CommunicabilityCommunicability- 2 days before and 5 days after rash ‡ MOT- droplet, person contact MOT‡ ‡ ‡ ‡ ‡

S&S
‡ Fever ‡ Rapid Pleomorphic rash at a given point of time, centripetal (more in center) ‡ Mortality- none, (except for complications) Mortality-

TX
‡ ‡ ‡ ‡ ‡ Symptomatic Isolation Hygiene Chickenpox Vaccine V.Z.I.G.(Varicella Zoster Immunoglobulin)Immunoglobulin)before 72 hours of exposure

Herpes Zoster (Shingles)
‡ Acute viral infexn of the nervous sys ‡ Causes an inflammatory rxn in isolated spinal and cranial sensory ganglia and post gray matter of the SC ‡ Contagious esp to those who has not had varicella or those who are immunocompromised ‡ Agent: varicella-zoster virus varicella-

S&S
‡ Neuralgic pain, malaise, itching or burning ‡ Vesicles along peripheral sensory nerves, unilateral, primarily on trunk, thorax or face

TX
‡ Acetic acid or white petrolatum on lesions ‡ Meds
² Analgesics ² Corticosteroids ² Acyclovir (zovivax)- reduces severity when given (zovivax)early

Herpes Simplex Virus, Type 1
‡ Causes cold sores, fever blisters, canker sores ‡ Common in women ‡ S&S
² Cluster of vesicles (may ulcerate or crust), burning, itching and tingling w/c usually appears on lip or cheek

‡ TX
² Keep lesions dry ² Antibiotics on lesions

Poliomyelitis
‡ AKA infantile paralysis ‡ Patho: Infection of polio virus maybe asymptomatic or w/ fever meningitis/ encephalitis anterior horn cell infection lower motor neurons paralysis either death or recovery if recovers, either w/ complete recovery or incomplete recovery lame ‡ MOT- fecal-oral route MOT- fecal‡ Communicability- 1 wk before and 3 wks after Communicabilitysymtoms appear ‡ Incubation- 1-2 wks Incubation-

S&S
‡ Mild fever, H/A ‡ Weakness in one muscle group and can progress to other muscle group ‡ Respiratory failure if muscle for breathing is affected

TX
‡ Vaccine
² Oral (Sabin)-3 drops per dose (Sabin)‡ ‡ ‡ ‡ Use dropper Tilt the infants head back If child vomits, repeat 3 or 5 dose

² Injectable- IM Injectable-

‡ Symptomatic

Rabies
‡ Infects CNS and salivary gland of mammals ‡ Attacks all warm-blooded animals (dog, cat, warmbats) ‡ Agent: Rabdovirus ‡ Transmitted through saliva by bite or lick on aberrations ‡ Incubation period= 4-8 wks but may vary from 49 days to months; severe bites on head or neck is associated w/ shorter IP

S&S
Paresthesias on site of bite Fever 1- 8 days + signs of anxiousness 1Hydrophobia Delusion, hallucination, spitting, biting, mania, hyperpyrexia ‡ Mortality is 100%!!! ‡ ‡ ‡ ‡

TX
‡ Clean wound w/ soap and running water ‡ Isolate dog, for observation ‡ Anti-Rabies Vaccine ASAP or not more than 5 days Antiafter the bite!!! ‡ Once symptoms appeared, death is imminent, tx would only be palliative
² ² ² ² Muscle relaxants (Valium) NTN through IV or gastrostomy Dark and quiet room Care givers should use protective devices like goggles, gloves mask to protect from client·s secretions

Meningitis
‡ Inflammation of the meninges of the brain & SC ‡ Caused by bacteria, virus or other microorg; commoncommon- meningococcus, pnemococcus, H. Influenzae, streptococcus ‡ May reach CNS via blood, CSF, lymph; direct extension (skull fracture); oral or nasopharyngeal route

S&S
‡ headache, fever, changes in LOC, behavioral changes ‡ nuchal rigidity (stiff neck), (+)Kernig's sign, (+)Brudzinski·s sign, opisthotonos (head and heels bent backward and body arched forward) ‡ Photophobia, vomiting, seizures

DX
‡ LP- inc pressure, elevated WBC and CHON, LPdec glucose,
² (+) bacteria on culture

TX
‡ Prevention by vaccination against H. influenzae and S. pnuemoniae for all children and at-risk adults at‡ Early administration of high doses of appropriate IV antibiotics for bacterial meningitis ‡ Dexamethasone ‡ Treatment dehydration, shock, and seizures
‡ Bedrest- keep room quiet and dark if client had photophobia Bedrest-

Mumps
‡ Accdg to hippocrates it is the ´swelling behind ear accompanied by swelling of testes. ‡ Common in 5-14 y/o, B>G 5‡ Mortality is not common except if complications like enceph, meningitis or orchitis occurs ‡ Agent: RNA myxovirus ‡ MOT: droplet/ direct salivary spread ‡ IP: 16-18 days 16‡ Communicability- 1wk before and 1 wk after symptom Communicabilityappears

S&S
‡ ‡ ‡ ‡ Fever and malaise Parotid swelling (uni or bilateral) In some cases, salivary gland is also infected Oophoritis and orchitis are complication manifested by abdominal pain or testicular pain

TX
‡ ‡ ‡ ‡ ‡ Symptomatic tx If w/ ochitis or oophoritis- steroids oophoritisIsolation Proper disinfection if used articles by the client VaccineVaccine- MMR

DHF
‡ Bleedind d/o w/c can be spread by the aedes mosquito. ‡ The disease causes damage to blood and blood vessels that causes bleeeding ‡ Common in rainy season

S&S
‡ Fever that may last for 1 wk ‡ Bleeding
² Epistaxis, petechiae on skin, hemoptysis, melena, and other sx of bleeding

‡ Cold and clammy skin ‡ Abdominal pain ‡ Shock if not treated early death

DX
‡ Torniquet test ‡ PA ‡ Capillary refill test

TX
‡ Fluids
² Force fluids, IVF

‡ ‡ ‡ ‡

X ASA for fever Assess hypoglycemia Seek medical attention (if w/ severe bleeding) BT

Bacterial Infections

1. Streptococcal Infection

Impetigo
‡ Superficial bacterial infection of the outer layers of the skin (staph or streptococcus) ‡ Common in toddlers or preshoolers, R/T poor sanitation ‡ Very contagious

S&S
‡ Lesions, macule, papule, vesicles that rupture causing superficial moist erosion ‡ Once dried, it will leave a honey colored crust ‡ Spreads peripherally ‡ Most common in face, axilla and extrm ‡ pruritus

TX
Topical and systemic antibiotics Skin isolation Burrow·s sol·n- softens skin and crusts sol·nRemove crust gently Cover draining lesions to prevent spread of infexn ‡ Proper hygiene techniques ‡ ‡ ‡ ‡ ‡

2. Staphylococcal Infection

Diptheria
‡ Acute bacterial infection of Tonsil, pharynx larynx and nasal mucous membrane ‡ Local infection destroys tissue and distal infection by toxin affects vital organs ‡ Death by airway obstruction, myocarditis or polyneuritis ‡ C.A: C. diptheriae ‡ MOT: droplet, contact ‡ Communicability: 12-18 days after onset 12‡ I.P.: 2- 6 days 2‡ Milk contamination can cause epidemic

S&S
‡ ‡ ‡ ‡ ‡ ‡ ‡ Fever, tachycardia Elevated greyish-green membrane on the tonsils greyishBull neck and enlarged lymph node Blood stained nasal discharge Husky voice and high pitched cough Circulatory failure in 10 days if untreated Complications: laryngeal obstruction, myocarditis, peripheral neuropathy

TX
‡ Antitoxin (anti²diptheria serum) IM (anti²
² Watch out for allergic rxn

‡ Antibiotic- Penicillin, amox, erythro Antibiotic‡ Isolation ‡ Vaccine- DPT IM Vaccine² 6 wks after birth X 3 doses, 1 mo. Interval ² Fever=normal

Whooping cough/Pertussis
‡ C.A.: Bordetella pertussis ‡ Patho: short febrile tracheobronchitis severe episodic paroxysmal coughing bouts laryngospasm intercostal muscle tear fractured rib ‡ I.P.: 1 wk ‡ MOT: droplet, naso-pharyngeal secretions naso‡ Complications: PNM, malNTN, conjunctival bleeding, rectal prolapse, encephalopathy

S&S
‡ Cough (whoop) ‡ Vomiting ‡ After coughing, apnea may occur w/c leads to unconsciousness

TX
‡ Isolation ‡ Antibiotics- erythromycin, ampi, cotri, tetra Antibiotics‡ Vaccines- DPT Vaccines-

Anthrax
‡ ‡ ‡ ‡ Known as disease of livestock C.A.: Bacillus anthracis I.P.: 1-7 days 1MOT:
² through cut or abrasion of skin ² Through contaminated meat ² Inhalation of spores

S&S
‡ Papule and vesicle at the site of inoculation w/c will develop in black eschar followed by hard edematous swelling of deeper adjacent tissues ‡ Pain on site ‡ If GI anthrax= N,V, anorexia, fever abdo pain ‡ If inhalation= dyspnea, cough, HA, pleural eff ‡ Death can occur rapidly

TX
Early dx and tx is impt! Antibiotics Fluids Care givers needs to take prophylaxis w/ Ciprofloxacin 500mg BID ‡ Avoid dairy products of infected animals ‡ Burning and bury deeply infected animals ‡ ‡ ‡ ‡

Tetanus/ Lockjaw
‡ Produces generalized or localized hypertonia of skeletal muscles accompanied by muscle spasm ‡ C.A.: Clostridium Tetani (usualy found in soils) ‡ Neonatal tetanus- mortality for newborns tetanus‡ I.P.: 6-10 days 6-

TX
‡ Antitoxin
² Human tetnus antitoxin 3000 I.U. IV

‡ Debridement of wound ‡ antibiotic ‡ Control spasm
² Quiet room, avoid noise, light ² valium

‡ Vaccine
² DPT

Lyme Disease
‡ C.A.: Borrelia burgdorferi ‡ Transmitted by a deer tick, requires 24 hour attachment ‡ Most common in summer and early fall ‡ Involves the skin, Nervous System, joints ‡ I.P.: 3days -1 month

S&S
‡ Stage 1
² Skin rash (erythema) starting 3 days to 1 mo. Past tick bite lasting about 3 wks ² Common on thighs, axilla ² Malaise, fatigue, HA, stiff neck, fever

‡ Stage 2
² May occur months to years after initial disease ² Neuro: facial palsies, sensory losses, arthritis, focal weakness

TX
‡ Antibiotic for 2-3 wks 2‡ X high risk areas ‡ Wear long pants, long sleeved shirt, high socks if walking in grassy areas ‡ Use insect repellant for skin ‡ After exposure, check for ticks ‡ REMOVE TICK BY PULLING STRAIGHT OUT W/ TWEEZERS!!!

3. Parasitic Infection

Head Lice/ Pediculosis
‡ Parasitic infestation ‡ MOT: close physical contact ‡ Common in school-age children, those w/ long schoolhairs

S&S
‡ White eggs (nits) firmly attached to base of hair shafts ‡ Itching of scalp

TX
‡ Skin isolation prec (head coverings, gloves) ‡ Special shampoo followed by use of fine-tooth finecomb ‡ X sharing of brushes/combs

Scabies
‡ One of the oldest diseases of poor sanitation ‡ AKA itchmite ‡ Female mite(Sarcoptes scabiei) is visible to naked eye. He fertilized female makes a burrow in the layers of the skin ‡ Multiplies w/ in 4 mos. ‡ MOT: person to person contact

S&S
‡ Itchy papule at the site of infestation ‡ By scratching, it becomes pustule ‡ Common in axilla, waist, back of legs, inner thigh

TX
‡ Benzyl benzoate- applied from neck down after benzoatebath and dry, followed on the next day and on the 6th day. ‡ Secondary infection is treated w/ penicillin ‡ Crotamiton for 5 days- suitable for infants bec it dayshas anti-pruritic action anti‡ Tetmasol 5% soln

Roundworm/ Ascariasis
‡ Most common nad most widespread human intestinal infection. ‡ C.A.: Ascaris lumbricoides ‡ MOT: Fecal-oral route Fecal‡ I.P: about 50 days

S&S
‡ ‡ ‡ ‡ Abdominal pain malNTN Fever, cough, dyspnea If circulating larva is present, d/o of the brain, heart and kidney

‡ DX:
² Direct exam ² Stool exam/ Scotch test tape ² xray

TX
‡ Anti-helminthics Anti² Metronidazole ² Mebendazole 100 mg BID

‡ hygiene

Pinworms
‡ S&S
² Anal irritation, itching, disturbed sleep

‡ DX
² same

‡ TX
² same

Hookworm
‡ C.A.: Ancylostoma duodenale, Necator Americanus ‡ MOT: infective stage of larva enter through skin, breastfeeding (hypobiosis) ‡ I.P.: few weeks to months ‡ Eggs pass out of the feces

S&S
Ground itch, dermatitis If in lungs, cough w/ hemoptysis GI= NV, epig pain, AnemiaAnemia- if w/ heavy infection, may cause pulmonary eosinophilia ‡ HypoCHONemia, altered G and D ‡ ‡ ‡ ‡

TX
‡ Same ‡ FeSO4 if w/anemia ‡ BT

Protozoan Infection

Amoebiasis
‡ Clinical condition w/c harbour Entamoeba hystolitica irrespective wheter the case is symptomatic (10%) or asymptomatic (90%) ‡ At risk: immunosuppressed, malNTN, pregnancy, children ‡ MOT: fecal-oral fecal‡ I.P.: 15 days to few years

S&S
‡ Abdo pain ‡ alternating diarrhea (6-8/day) and constip (6-

‡ DX
² Stool exam

TX
‡ Metronidazole 800mg q8 x 5 days ‡ For cystic forms, Diloxanide furoate 500 mg q8 x 10 days ‡ Hygiene ‡ sanitation

Fungal Infection

Ringworm
‡ Dermatomycosis due to various species of fungus ‡ Infected sites:
² Scalp (tinea capitis) ² Body (tinea corporis) ² Feet (tinea pedis)/ athlete·s foot

‡ MOT: person to person, may be acquired from animals or soil

S&S
‡ Scaly circumscribed patches on the scalp ‡ Base of hair shafts are invaded by spores of the fungus causes hair to break off alopecia ‡ Spreads in a circular pattern ‡ Skin: red-ringed patches of vesicle, pain, scaling, reditching

TX
‡ Prevention, isolate ‡ Antifungal ointment

Infectious d/o on Adults

Integumentary

Acne Vulgaris
‡ Skin condition assoc w/ inc production of sebum from sebaceous glands at puberty ‡ Frequently on the face, neck, shoulders or back ‡ InterrelatedFactors include: inc activity of sebaceous gland, stress, meds, menstrual cycle ‡ There is no evidence to support the value of eliminating any foods from the diet; if cause and effect can be established, a particular food may be eliminated.

S&S
‡ Papule, pustule ‡ Psychologic problems
² Low self-esteem self² Social w/drawal ² Feeling of being ´uglyµ

TX
‡ OTC products ‡ Proper hygiene
² Handwashing ² Care of face ² Not to prick lesions

‡ Ointments, antibiotics if indicated

Psoriasis
‡ Chronic type of dermatitis that involve accelerated turnover rate of the epidermal cells ‡ Pred fx: stress, trauma, infection, change in climate, genetics

S&S
‡ Mild pruritus ‡ Sharply circumscribed scaling plaques most common on the scalp, elbows and knees ‡ Yellow discoloration of the nails

TX
‡ Topical corticosteroids ‡ Coal tar preparation
² Protect from direct sunlight for 24 hours

‡ UV light ‡ Antimetabolites (methotrexate)

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