INFECTIOUS DISEASES

dr. Karina R. Ekawidyani, M.Gizi

Outline
 Introduction
 Food-borne diseases
 Typhoid fever
 Helminth infection
 Dengue Hemorrhagic Fever
 Measles
 Varicella
INTRODUCTION
Colonization vs Infection
 Colonization occurs when bacteria live within or
on your body without causing infection (also
known as normal flora).
 All healthy individuals have normal flora and/or
colonization
 Altered immune system  pathogenic  infection
 Infection is invasion and multiplication of
microorganisms in or on body tissue that cause
signs, symptoms, and an immune response.
Etiology
 Bacteria
 Virus
 Parasites
 Fungi
Infection Transmission
 Microorganism → Portal of exit → Mode of transmission →
Portal of entry → Susceptible host
 Portal of exit : how the microorganism leaves the reservoir.
 Mode of transmission :
 Person-to-person.
 Direct contact with microorganism, such as touching a contaminated
surface or medical instrument.
 Droplets (large particles enter the air and “drop” due to weight).
 Airborne (travels long distances, e.g., Mycobacterium tuberculosis).
 Vector-borne infections
 Food-borne infections
Infection Transmission
 Portal of entry : how the microorganism enters the
susceptible host.
 Susceptible host : a person who is susceptible to
an infection for various reasons.
 Infants
 Elderly
 Immunocompromised
Sign and Symptoms
Stages of infection
 Stage 1 Incubation
 Duration can range from instantaneous to several years.
 Pathogen is replicating, and the infected person becomes contagious, thus capable of
transmitting the disease.
 Stage II Prodromal stage
 Host makes vague complaints of feeling unwell.
 Host is still contagious.
 Stage III Acute illness
 Microbes actively destroy host cells and affect specific host systems.
 Patient recognizes which area of the body is affected.
 Complaints are more specific.
 Stage IV Convalescence
 Begins when the body's defense mechanisms have contained the microbes.
 Damaged tissue is healing.
FOOD BORNE DISEASES
Food-borne diseases
 Any diseases resulting from contaminated food
 Food-borne illness, food poisoning
 Etiology:
 Pathogenic bacteria
 Virus
 Parasite
 Toxin
 Poisonous mushroom
Pathogenic Bacteria
 Campylobacter jejuni
 Clostridium perfringens
 Salmonella
 Escherichia coli EHEC, EIEC, ETEC, EPEC,
EAEC
 Bacillus cereus
 Shigella
 Vibrio cholerae
 Etc.
Exotoxin
 Clostridium botulinum
 Clostridium perfringens
 Staphylococcus aureus
 Bacillus cereus
Virus
 Enterovirus
 Hepatitis A & E
 Noravirus
 Rotavirus
Parasite
 Helminth : tapeworm, Ascaris lumbricoides,
Trichuris trichiura
 Protozoa: Giardia lamblia, Entamoeba histolytica,
Toxoplasma gondii

Other pathogen
 Prions
Clostridium botulinum (botulism)

 A gram-positive,
spore-forming rod
capable of producing
deadly neurotoxins
causing rapid death
Sign and symptoms
 A blood test can identify the toxin. It can also be
identified in stool or food.
 Treatment may include:
 Botulinus antitoxin.
 Intubation with mechanical ventilation, if necessary.
 IV fluids and nutrition.
 Complications
 Respiratory failure and death.
Prevention
 Clostridium botulinum is a soil bacterium. The spores
can survive in most environments and are very hard
to kill. They can survive the temperature of boiling
water at sea level, thus many foods are canned with a
pressurized boil that achieves an even higher
temperature, sufficient to kill the spores.
 Growth of the bacterium can be prevented by high
acidity, high ratio of dissolved sugar, high levels of
oxygen, very low levels of moisture or storage at
temperatures below 3°C
Hepatitis A
 A virus that causes liver disease.
 Incubation is about 30 days, and the virus is
excreted in the stool for about 2 weeks before the
illness and about a week after it.
 The mortality rate is low.
 Children are typically asymptomatic. Adults
generally have a more severe illness.
 The disease is not chronic and is not “carried”
 Transmission through fecal-oral
Sign and symptoms
 A blood test detects the presence of the antibody IgM.
 No specific treatment is effective after clinical signs
appear.
 Prevention includes:
 Hand hygiene after using the bathroom and before
preparing food.
 Properly cleaning eating utensils.
 Exclusion of food handlers from work.
 Providing vaccination.
What can harm my client?
 Dehydration from nausea/vomiting.
 Since the bleeding/clotting factors can be altered with
HAV, the client can experience a GI bleed or even a
cranial bleed, causing a massive hemorrhage but this
would be very rare with type A.
Typhoid Fever
Etiology
 Salmonella typhi  typhoid fever
 Salmonella paratyphi  paratyphoid fever
 Food-borne disease
Pathophysiology
 Salmonella contaminated food enter the stomach  some
are destroyed by gastric acid, some enter the intestine and
multiplied
 If humoral immunity response of intestinal mucose (IgA)is
compromised  Salmonella penetrate epithelial cells to
lamina propria  multiplied and are fagocyted by
macrophag  Salmonella can live and multiply in the
macrophag  spread to Peyeri plaque of distal ileum and
enter mesenteric lymph nodes  thoracic duct  blood
stream  1ST BACTEREMIA (asymptomatic)  spread
to RES organ especially liver and spleen.
Pathophysiology
 In these organs, Salmonella leave the macrophag
and multiply outside cells/ sinusoid  enter blood
stream  2ND BACTEREMIA (symptomatic)
 In the liver, Salmonella enter the gallbladder,
multiply and excreted with bile to the intestinal
lumen intermittenly  feses or penetrate epithelial
cells (repeat process above)
Pathophysiology
 In the Peyeri plaque, hiperactive macrophag induce
tissue hyperplasia reaction (delayed
hypersensitivity) and organ necrosis  blood
vessel erosion  bleeding  perforasion
 Endotoxin can attach to the receptor of capillary
endothelial cells  complications such as
neuropsychiatric, cardiovascular, respiratory and
other organ disorder
Sign and symptoms
 Fever  Cough
 Headache  Epistaxis
 Myalgia  Relative bradycardia
 Anorexia  Coated tongue
 Nausea  Hepatomegaly
 Vomit  Splenomegaly
 Obstipation or diarrhea  Mental disorder
 Abdominal dyscomfort
Laboratory test
 Leucopenia  Widal test
 Mild anemia  Blood culture
 Thrombocytopenia
 Aneosinophilia
 Lymphopenia
 ESR >>
 AST & ALT >>
Treatment
 Bedrest
 Diet and supportive therapy
 Porridge
 Rice with low selulose side dish (avoid vegetables with
high fiber)
 Antibiotic
Complications
 Intestinal bleeding
 Intestinal perforasion
 Hematologic disorder
 Hepatitis
 Pancreatitis
 Myocarditis
 Toxic typhoid/encephalopathy typhoid
Carrier
 A patient whose stool or urin containing S. typhi
one year after the illness, without any clinical
symptoms
 Salmonella hide in the gallbladder
 Typhoid Mary
Helminth Infection
Hookworm
 An intestinal roundworm with a complex life cycle.
 These worms need warm, moist, shaded soil to
hatch larvae.
 The larvae penetrate the skin often through bare
feet and are carried to the lungs through the
respiratory tract, then to the mouth, and are
eventually swallowed and end up in the small
intestine.
 When they reach the small
intestine, they grow into
worms, attach themselves
to the intestinal wall, and
suck blood.
 Adult worms produce
thousands of eggs that are
released into the stool.
They cannot be spread
from person-to-person
Etiology
Signs and symptoms
Laboratory tests & treatments
 Stool samples are evaluated to detect hookworm.
 Treatment includes:
 Mebendazole or albendazole.
 Iron supplements and improved nutrition to correct
anemia.
What can harm my client?
 Anemia related to blood loss.
 Enlarged heart and irregular heartbeat, in severe
cases.
 Heavy and/or chronic infections in children can
cause stunted growth and mental retardation that’s
usually irreversible.
 Hookworms can be fatal, especially in infants.
Prevention
 Wear shoes/sandals
 Hand washing
 Consume helminth drug every 6 months, especially
children
Tapeworm
 Several species of tapeworm cause intestinal disease:
 Pork tapeworm: Taenia solium.
 Beef Tapeworm: Taenia saginata.
 Dwarf tapeworm: Hymenolepis nana.
 Fish tapeworm: Diphyllobothrium latum.
 They can measure up to 50 feet long and survive 20
years or longer.
 Some attach to the intestinal wall, causing
inflammation, and some pass through the stool and
exit the body
Signs and Symptoms
Treatment
 Albendazole or praziquantel to kill adult worms
only.
 Hand-washing by the client before eating and after
toileting to prevent reinfection with eggs.

 Serious tapeworm infections can develop when the

worm migrates out of the digestive system, causing
organ and tissue damage that may result in vitamin
deficiencies, seizures, or fever.
Dengue Hemorrhagic Fever
Dengue hemorrhagic fever
 Dengue fever, is caused by Dengue virus and
transmitted by a mosquito bite.
 Incubation is usually 3 to 6 days after the bite.
 Signs and symptoms include fever, severe joint and
muscle pain, and rash.
 Dengue hemorrhagic fever (DHF) is a more severe
presentation of dengue fever caused by the same
virus.
Pathophysiology
Signs and Symptoms
Laboratory test
 Leucocyte normal or low
 Thrombocytopenia
 Hematocrit  plasma leakage characterized by
increase of Ht >20%
 Protein/albumin low
 AST & ALT may increase
 Ureum creatinin high if there is renal disorder
 X-ray: pleural effusion
Stages of DHF
 DF  fever, headache, retro-orbital pain, myalgia,
athralgia, leukopenia, thrombocytopenia, no plasma
leakage
 DHF stage I  rumple leed (+), thrombocytopenia
(<100000/mL), plasma leakage
 DHF stage II  spontaneous bleeding
 DHF stage III  circulatory failure (cold skin, damp,
restless)
 DHF stage IV  shock (low BP & pulse)  DSS
(Dengue shock syndrome)
Treatment
 Bedrest
 Crystaloid fluid 1500 + [20 x (BB-20)]
 Monitoring Hb, Ht, thrombocyte
 Symptomatic medication
Measles
Measles
 Also known as rubeola, morbilli
 A respiratory disease in which the virus can be
found in the back of the throat or in the cells that
line the lungs.
 Clients are contagious 1 to 2 days before the onset
of symptoms and until 4 days after the rash
appears.
 Transmission occurs by the airborne route through
coughing or sneezing.
Signs and Symptoms
Risk factors
 Children with immunodeficiency due to HIV or AIDS, leukemia,
alkylating agents, or corticosteroid therapy, regardless of immunization
status
 Travel to areas where measles is endemic or contact with travelers to
endemic areas
 Infants who lose passive antibody before the age of routine
immunization
 Risk factors for severe measles and its complications include the
following:
 Malnutrition
 Underlying immunodeficiency
 Pregnancy
 Vitamin A deficiency
Treatment Prevention

 Symptomatic medication  Measles vaccine at 9

 Vitamin A supplementation month age
 50000 IU (<6 months)
 100000 IU (6-11 months)
 200000 IU (12 months – 5
years)
 Malnutrition  3 times
Varicella
Varicella
 Etiology: Varicella zoster virus
 Varicella (chicken pox) in children
 Highly contagious and is transmitted by the airborne

route (initial infection occurs in the respiratory tract).

 Later, when the rash develops, chickenpox can be

transmitted by contact with the rash

 Herpes zoster (shingles) in adult  Virus lies dormant
in the nervous system after chickenpox infection, is
reactivated when the immune system is compromised,
and lesions develop
Sign and symptoms
 Skin rash that resembles an ant bite because it
forms blisters, usually on the face, head, and trunk
 Rash itches
 Fever

Treatment
 Symptomatic medication
 Antiviral
Click icon to add picture

TERIMA KASIH