communicable & parasitic disease

suspect communicable disease: obtaining careful history

type of exposure: known or community?

prodromal symptoms: signs before Hallmark symptoms (fever, GI upset)

immunization

history of having disease/co-morbitiy/risk factors

chicken pox (varicella)

agent: varicella-zoster virus

transmission: direct contact and resp secretions

precautions: airborne and contact

child is contagious a day before rash appears and until vesicles are crusted

prevention: secondary skin infection and complications

vaccine available

clinical manifestations of chicken pox

prodromal stage slight fever, malaise

pruritic rash begins a macule; vesicle then erupts

rash is typically centriceptal; extremities, face

treatment: supportive

pertussis (whooping cough)

agent: bordetella pertussis

transmission: direct contact from droplets; coughing

treatment: prevention. supportive during hospitalization with suction, humidity, careful oral feeding, and hydration

precautions: droplet (gown, gloves, mask)

vaccine available

clinical manifestations of pertussis

catarrhal stage: URI symptoms 1-2 weeks before cough

paroxysmal stage: short, rapid cough bought followed by high pitched crowing, “whoop” or grasp 4-6 weeks cyanosis may occur during episode

measles (rubeola)

agent: viral

transmission: direct contact from resp system; breathe in virus

treatment: bedrest, quarantine, and support

precautions: airborne if in hospital until day 5 of rash

live vaccine; can’t give to infants and immunocompromised; so herd immunity is important

clinical manifestations of measles

high fever 4-5 days

prodromal state: fever, malaise → coryza (spots on sclera), cough, conjunctivitis

rash develops behind ears and forehead then down body; appears on day 3 to 4 of illness

“koplick spots” on mucosa

measles mortality and morbidity

pneumonia, encephalitis most common

dehydration

immunosuppression

subacute sclerosing panencephalitis (SSPE): 2-4 years after infection; fatal

rubella (German measles)

agent: rubella virus

transmission: direct contact from droplets

treatment: supportive care

precautions: droplet

clinical manifestations of rubella

low grade fever, HA, malaise, sore throat, rash on trunk

pneumococcal disease

agent: streptococcal pneumococci

transmission: direct contact affecting children under 2 years most commonly

treatment: prevention, antibiotics, supportive care

precautions: droplet

multiple vaccines; bacterial preventable

clinical manifestations of pneumococcal disease

pneumonia, otitis media, sinusitis, localized infections

covid 19

etiology: severe acute resp syndrome coronavirus 2

s/s: fever/HA, tiredness, chills, muscle/joint pain

treapeutic management: vaccination, hospitalization: ventilation support

worse with people with cormobilites; so children were generally better when had virus

influenza (flu)

agent: influenza virus (varies from year to year; virus mutates)

transmission: direct contact

treatment: prevention, antiviral treatment if detected early, supportive care

precautions: droplet

clinical manifestations of flu

abrupt fever

URI like symptoms which progresses

malaise, anorexia

polio

s/s: range from mild flu like illness to severe paralysis

duration: mild cases can last days, severe weeks to months, paralysis can be temporary or lifelong

transmission: fecal-oral, or oral-oral

treatment: no cure, treatment focuses on relieving symptoms

conjunctivitis

inflammation of the conjunctiva; viral, bacterial, allergic or foreign body (can determine which by color of eye fluid)

treatment dependent on cause

nursing management: contact precautions, keep eye clean and dry, administer ophthalmic meds, comfort and supportive care, educate caregivers, prevent spread of infection

roseola

agent: human herpesvirus 6 (HHV-6)

<2 years old

high fever 3-5 days

may have lymphadenopathy

once fever subsides rash develops
- small, flat pink spots or patches
- starts on the chest, back and belly, then spreads to neck, arms, and legs
- not itchy or painful
- lasts from few hours to few days

erythema infectiosum (fifth disease)

agent: human parvovirus B19

transmission: droplet or direct contact with saliva or mucus

looks sick, but feels fine

treatment: supportive care

precaution: standard

clinical manifestations of erythema infectiosum

persistent fever for 3-7 days in child who is otherwise well appearing

“slapped cheek” appearance

mild URI symptoms, cough

scarlet fever

agent: group A beta-hemolytic streptococci

transmission: direct contact from droplets

treatment: penicillin and supportive care

precautions: droplet until 24 hrs of antibiotics

usually after strep

clinical manifestations of scarlet fever

prodromal stage: abrupt high fever, halitosis

enathema: tonsils large, edematous, covered with exudate

“strawberry tongue”

exanthema: sandpaper like dark pink/red rash

communicable diseases: stomatitis

two types: aphthous ulcers, herpetic gingivostomatitis

goal is to relieve pain: NSAIDs, topical anesthetics

prevent spread of illness: oral transmission, meticulous hand washing

canker sore (aphthous stomatitis)

benign

painful

biting cheek, allergy, stress

small whitish ulceration with a red border

heals without intervention, typically lasts 4-12 days

no systemic illness

cold sore/fever blister

herpes simplex virus, type 1

may have fever and severe pain

can include pharynx

erythema, vesicles

recurrent, lasts 5-14 days

stress, trauma, excessive sunlight exposure

can appear after illness bc immune system was low during the illness

treatment of cold sore

treat pain with acetaminophen or ibuprofen

topical OTCs: orabase, anbesol

viscous xylocaine: swish and spit

acyclovir

avoid acidic foods/drinks

hygiene, keep hands out of mouth

bacterial skin infections

bacterial agents: staphylococci & streptococci

MRSA on the rise

disorders include: impetigo, folliculitis, cellulitis, scalded skin syndrome

transmission: invasion and toxicity in susceptible skin

treatment: topical or systemic antibiotic, hand washing and hygiene, dilute bleach baths, may require hospitalization

fungal skin infections

fungal agents: typically dermatophystoses; tinea or candidia

disorders include: tinea capitis (scalp), tinea corporis (body or nails), tinea cruris (groin), tinea pedis (feet), candidiasis; thrush, vaginal

transmission: invasion in susceptible skin, corneum, hair, or nails

treatment: topical or systemic antifungal, clean and dry skin, avoid sharing personal items

skin infections: pediculosis capitis

infestation agent: pediculus humanus capitis

transmission: prolonged close contact when a female louse can obtain blood meal at scalp and deposit eggs on hair shaft at night

treatment:
- pediculide and removal of nits
- permethrin 1% cream (OTC), repeat in a week, treat affected family
- family may attempt other treatment regimens
- education and support to families
- advocacy and support for school attendence

clinical manifestations: pediculosis capitis

intense pruritus of scalp (behind ears of nape of neck)

nits attached to hair shaft

intestinal parasites

most frequent infections worldwide

young children at highest risk

most common in US: giardiasis and pinworms

nursing management:
- assist with identification, treatment and prevention
- fecal smears are diagnostic
- treat family members
- provide education and support to prevent reinfection

intestinal parasites: giardiasis

agent: protozoan giardia intestinalis

transmission: direct contact with contaminated water or food

treatment: flagyl or tindamax and prevention of reoccurrance

intestinal parasites: enterobiasis (pinworms)

agent: nematode enterobius vermicularis

transmission: inhalation or ingestion of eggs from contaminated hands

diagnosis: tape test; worm inserts in anus

treatment:
- pyrantel pamoate or albendazole x 1, then again in 2 weeks
- treat family members
- prevention of reoccurrence