N-Trivia

Herpes Viruses: Herpes Simplex
Paramyxoviruses: Measles
Escherichia Coli
Herpes Viruses: Herpes Zoster
Herpes Viruses: Chickenpox

Posted: 05 Jan 2011 07:04 PM PST

Herpes Viruses: Herpes Simplex

Herpes Simplex viruses establish latent infections in nerve cells and recurrences of the disease are common. These viruses have been linked with malignant diseases in humans and even in animals. There are two distinct types of herpes simplex virus: Herpes simplex type 1 and Herpes simplex type 2.

Herpes Simplex Type 1

Herpes simplex type 1 or HSV-1 is transmitted through contact, the transmission of infected saliva. The virus must come in contact with mucosal surfaces or broken skin so that development of an infection is possible. This virus is usually limited to respiratory system specifically the oropharynx through droplet infection. Herpes simplex type 1 has the following clinical forms:

Fever Blisters

It is characterized by the presence of small blisters in the corners of the mouth and at times around the eyes. These blisters can cause itching, burning feeling and general discomfort. The virus is said to be present in the skin but lies undeveloped until it is activated by infection.

Keratoconjunctivitis

It appears as recurrent lesions in the eye which shows as dendritic keratitis or corneal ulcers or vesicles in the eyelids. There may be progressive involvement of the corneal stroma, with permanent opacification and blindness with the recurrent keratitis.

Acute Herpetic Gingivostomatitis

It is a common form of infection with HSV-1. It is characterized by extensive vesiculoulcerative lesions in the mucus membranes of the mouth, local lymphadenopathy, fever and irritability.

Encephalitis

The severe form of encephalitis is produced by herpes virus. In U.S., HSV-1 causes the most fatal type of encephalitis.

Herpes Simplex Type 2

Herpes simplex type 2 or HSV-2 is transmitted through genital routes. The virus is usually acquired through sexually transmitted disease. Herpes simplex type 2 has the following clinical forms:

Genital Herpes

It is characterized by vesiculoulcerative lesions of the penis for males or the cervix, vagina, vulva and the perineum of the females. These lesions are painful and can even lead to bouts of fever, malaise, dysuria and inguinal lymphodenopathy. In females, there are studies that link the recurrence of HSV-2 to the development of cervical cancer. Genital herpes in pregnancy can cause infection in the newborn especially when they are premature.

Herpetic vulvovaginitis

It is a common infection among female infants where the vulva is infected. The skin looks macerated and the labia seem to be stucked together by gummy exudates.

Neonatal Herpes

It is the type of virus transmitted by a mother with genital warts to her newborn through vaginal birth where the newborn passes the birth canal infected with herpetic lesions.

Treatment includes the use of several antiviral drugs which include: Acyclovir, Vidarabine and Valacylovir. These drugs suppress clinical manifestations and shorten the time of healing.

Nursing Consideration

Although antiviral drugs are available in the market, this does not cure the viral infection per se, rather it just suppress further manifestations of the infection and will hasten the body's natural recovery from the infection. The treatment focuses of the relief of the symptoms experienced. The nurse may give analgesics as ordered by the physician to relieve bouts of pain. The nurse should also encourage the patient for proper nutrition and adequate fluid intake. To those with HSV-2, the nurse should educate the patient that this infection is spread through sexual transmission. Since patients with herpes simplex infection are given antiviral drugs, it is a must that the nurse stresses the importance of compliance to drug therapy. The nurse should also emphasize the importance of avoiding contact with individuals having an active infection.

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Paramyxoviruses: Measles

Posted: 05 Jan 2011 06:28 PM PST

Measles is also known as Rubeola; Red measles or 7-day Measles. Measles is an acute, highly infectious disease characterized by fever, respiratory symptoms and maculopapular rash. Humans are the only natural hosts for measles virus, although this virus can be acquired by monkeys and dogs through experimental means. The incubation period is 10-13 days and is transmitted through droplet infection by inhalation of the virus which is expelled by the infected patient through sneezing and coughing.

The prodrome starts with high fever and the 3 C's: cough; coryza (inflammation of the mucus membranes lining the nasal cavity which usually leads to nasal congestion) and conjunctivitis. . The cough and coryza signifies an intense inflammatory reaction involving the mucosa of the respiratory tract. The conjunctivitis is usually associated with photophobia. During this period the patient is highly contagious. Koplik spots, which is the pathognomonic sign of the infection is also present. Koplik spots are tiny bluish- white spots or ulcerations occurring on the inside of the cheek or the buccal mucosaThe fever and cough will persist until the rashes will start to appear. Rashes usually start in the head and spreads to the trunk and then the lower extremities. These rashes appear as light pink,, discrete maculopapules that coalesce to form blotches, which become brownish in 5-10 days. The fading rash results to desquamation.

The most common complication brought about by measles infection is the Otitis media. Pneumonia, on the other hand, is the most common life threatening complication that is brought about by secondary bacterial infections. Mortality to pneumonia increases with malnutrition and is inversely proportional to age.

Measles is endemic throughout the world. It is highly contagious and the infection confers lifelong immunity. It is primarily a disease of cold weather because of the great susceptibility of the mucus membranes to the virus due to the frequent congestion of the nose and pharynx.

There is no specific treatment for the infection but rather the alleviation of the experienced signs and symptoms. The use of antibiotic is done to treat complications due to secondary bacterial infection such pneumonia.

Nursing Consideration

The nurse has the major role in preventing the occurrence and spread of measles infection. To prevent its occurrence the nurse should be active in promoting the compliance of mothers to the immunizations while the child is still young. Once the child has an active infection, the nurse should educate the child caregivers to initiate respiratory isolation for 4 days after onset of rash and to burn the tissue papers which contains the secretion of the child to prevent the spread to other people at home. The nurse should also make sure that child receives Vitamin A if he is suspected to be deficient of this vitamin. Alleviation of symptoms should be thought to child's caregivers. These method s include: daily skin care for rashes, sponge bathing and increased fluids for fever, warm gargles for sore throat and clean noses for coryza.

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Escherichia Coli

Posted: 05 Jan 2011 06:28 PM PST

Escherichia Coli

Features

Gram (-), short, plump rods
Common inhabitants of human intestinal tract
Considered as a laboratory "pet" by microbiologists because it is so common and easily cultivated
Its presence in water or food is an indication of fecal contamination
It's not usually pathogenic but pathogenic strains can cause urinary tract infection, traveler's diarrhea and sometimes very serious foodborne disease because they produce toxins responsible for gastrointestinal disturbances.
All pathogenic strains have specialized fimbrae that allow them to bind to certain intestinal epithelial cells
Aerobic but facultatively anaerobic
Pathogenic strains are capsulated but are nonsporeforming
Comprise about 75% of all bacteria in the feces
Enters the intestinal tract shortly after birth and persist throughout life.
Present in greatest quantity in the region of the ileocecal valve and diminish in numbers upward towards the duodenum and downward as far as the rectum.
Non-pathogenic strains serve a useful function in the body by suppressing the growth of certain proteolytic organism normally present in the intestines and by synthesizing appreciable amounts of vitamins; B-complex vitamin deficiencies cannot be produced by dietary restriction in animals unless the colon bacilli first are eliminated or suppressed by feeding of large amounts of sulfonamides.

Pathology and Symptomatology

Urinary tract infections
Meningitis
Gastroenteritis
Traveler's diarrhea (severe blood diarrhea, abdominal cramps, nausea and vomiting)
Infantile diarrhea
Epidemic diarrhea
Summer's diarrhea (hemorrhagic colitis, severe abdominal pain, bloody diarrhea with little or no fever, watery stools, nausea and vomiting)
Appendicitis
Peritonitis
Puerperal sepsis
Infections of the gallbladder, bile ducts and liver
Septicaemia
Endocarditis
Infections of the sinuses, bronchi and lungs

Treatment

There is no single specific therapy available. Drugs like sulfonamides, ampicillin, cephalosporins, chloramphenicol, tetracyclines, polymyxins and aminoglycosides are known to be effective as antibacterial agents against coliform organisms, but variation in strain susceptibility is great and laboratory tests for antibiotic sensitivity are essential.
Replacement of the depleted water in the body
Avoid use of antidiarrheal drugs
Kidney dialysis and blood transfusions in human uremic syndrome (HUS)

Prevention and Control

Always clean any surface that has come in contact with raw meat before any other item is placed on that surface.
Always thoroughly wash your hands after handling raw meat, and before you handle any other utensils or other food item.
Never use the same plate, tray or utensils for the cooked meat that you use for the raw meat – unless you thoroughly wash the plate, tray or utensils in between.
Always cook meat especially ground meat, until the juices run absolutely clear – pink in not good enough. In fact, it is necessary for the internal temperature of a hamburger pattie to reach 160^oF to kill all any contaminating E. Coli.
In a day care centers, schools, etc. , any small children with diarrhea should be carefully handled, and kept separate from all well children. The day care workers, teachers, and health care personnels should practice strict hygiene at all times, regardless of the health of the children.

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Herpes Viruses: Herpes Zoster

Posted: 05 Jan 2011 06:12 PM PST

The virus responsible for Herpes Zoster is the one responsible for the spread and development of Chicken pox. Herpes Zoster is also known as Shingles or Acute posterior ganglionitis. It is a sporadic incapacitating disease of adults and those immuncompromised patients. This is linked to the inflammation of the sensory posterior nerve roots and ganglia accompanied by crops of vesicles in the skin supplied by affected sensory nerves. The lesions brought about by the virus are the same with that of chickenpox. The lesions are distributed in the skin corresponding closely to the areas of innervations from patient's dorsal root ganglion.

The initial infection of this virus leads to chickenpox. Recurrence of varicella-zoster virus leads to herpes zoster or shingles infection. Its incubation period is unknown. One attack of herpes zoster confers immunity.

Chills, fever and malaise are the initial symptoms experienced on third to fourth day before the distinctive features of the infection shows up. The infection usually starts with severe pain in the area of skin supplied by one or more groups of sensory nerves and ganglia. Days after the onset of pain in the skin, vesicles start to develop over the skin supplied by the affected nerves. The appearance of these vesicles is unilateral with intensified pain (burning and stabbing).

Herpes Zoster varies in the area where it affects a specific nerve and this includes the following:

Geniculate Herpes

It is caused by the involvement of geniculate ganglion. There is a lesion found in the 7th cranial nerve where there is the development of vesicles in the pinna that can lead to facial paralysis and loss of taste over the anterior of the tongue.

Herpes Zoster of C2 and C3 with facial paralysis

The vesicles are present in the right side of the neck complicated by the presence of facial paralysis and deafness.

Herpes Zoster of C4 and C5 with paralysis

When the infection affects the 4th and 5th cervical roots, the patient experiences rheumatism or pain in the right shoulder.

Like any other viral infections, antiviral compounds are used as a drug of choice. Since it is a viral infection, treatment of symptoms experienced is usually done. Analgesics are given to relieve pain and warm bath with baking soda is usually soothing for the vesicles.

Nursing Consideration

The main goal of nurses in taking care of patients having this infection is the alleviation or relief from the symptoms experienced. Analgesics are usually ordered by the physicians to alleviate pain felt. Cortecosteroids are also ordered by the physicians in early stage to shorten the course and relieve the symptoms. The nurse's role in regards with these medications is the observation of the 10 rights to drug administration and to ensure patients compliance to drug therapy. Proper assessment should be done to patients in order to identify whether the infection is recovering or still progressing. Strict respiration isolation should be observed in patients having the infection. Health teaching regarding the transmission and prevention of infection should be given to patient's folks. Strict hand washing is the single most effective way to prevent transmission of disease.

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Herpes Viruses: Chickenpox

Posted: 05 Jan 2011 06:09 PM PST

Herpes viruses have the ability to establish lifelong persistent infections in their hosts and to undergo periodic reactivation. Their frequent reactivation in immunosupressed patients causes serious health complications.

Chickenpox is more commonly known as Varicella. It is a highly infectious disease that is characterized by fever and a maculopapular rash that develops into vesicular eruptions of the skin and the mucus membrane then after 3-4 days, granular crusts develops. This is usually present in children but can be severe in adults and those immunocompromised. The incubation of this infection usually lasts for two to three weeks or 14-21 days. This infection is transmitted through direct contact, through droplet infection and by contact with formites or contaminated with the vesicular secretions. The course of infection starts in the mucosa of the upper respiratory tract or the conjnuctiva. The replication follows in the lymphnodes, primary viremia starts in the liver and then spreads into the spleen. Secondary viremia then follows in the skin, where the rash starts to develop.

Malaise, fever, headache and loss of appetite are the earliest symptoms, soon followed by rashes which initially appear on the trunk, then on the face, limbs and the buccal and pharyngeal mucosa of the mouth. Mucus membrane lesions in the mouth, rectum and vagina in women, rupture easily because of their location and eventually develop into ulcerations. Fever persists as long as new lesions appear and is proportionate to the severity of the rash.

Chickenpox is highly contagious during its recovery period when the vesicles begin to rupture shedding millions of virus. The infection is also contagious when the rash appears as long as 6 days after the appearance of the new skin and the vesicles have crusted all over.

Chickenpox is a mild viral disease which needs no treatment. However, there are available antiviral compounds in the market that provide effective therapy to the infection and help prevent the development of systemic infection in immunosuppressed patients.

Nursing Consideration

Nursing role in taking care of patients with chickenpox includes health teaching in regards with the course of the disease and how it is transmitted. The nurse should stress the importance of isolation of the patient during periods when he is highly contagious. Since there is no specific cure to this infection, supportive care for the symptoms experienced is observed. These care are as follow: the use of calamine lotion and oatmeal bath to relieve itching, cutting of fingernails to minimize the effects of scratching and stress the importance of not using Aspirin for fever ( to prevent Reye's Syndrome).

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