Communicable Disease

UNIT 1: COMMUNICABLE DISEASES

NURSING MANAGEMENT GOALS

  • Identify Infectious Agent: The necessity to determine the specific pathogen responsible for infection.

  • Prevent Transmission to Others: Focus on protocols such as hand hygiene to reduce the spread of infections.

  • Prevent Complications: Mitigate risks of secondary infections through proactive care and monitoring.

  • Provide Comfort: Emphasis on treatment and symptomatic care for the patient.

  • Support Patient & Family: Acknowledge the psychological and emotional needs of both patient and family during treatment.

  • Immunizations for Primary Prevention: Advocate for vaccination as a critical step in preventing disease spread.

ROUTINE IMMUNIZATIONS

  • Hepatitis B (HEP B)

  • Meningococcal (MENINGOCOCCAL)

  • Hepatitis A (HEP A)

  • Human Papillomavirus (HPV)

  • Tetanus, Diphtheria, Pertussis (TDP)

  • Rotavirus (ROTAVIRUS)

  • Measles, Mumps, Rubella (MMR)

  • Haemophilus influenzae type b (H FLU B)

  • Varicella (VARICELLA)

  • Pneumococcal (PNEUMOCOCCAL)

  • Influenza (INFLUENZA)

CHICKENPOX (VARICELLA)

  • Source: Primary secretions of respiratory tract from infected person.

  • Transmission: Airborne then contact until lesions are crusted and via contaminated surfaces.

  • Period of Communicability: From 1-2 days before eruption of lesions to 6-7 days after the first crop of vesicles has crusted.

  • Signs & Symptoms (S&S): Highly pruritic rash with centripetal distribution affecting face and proximal extremities, elevated fever, malaise, possible upper respiratory infection (URI), and lymphadenopathy in the first 24 hours, followed by rash.

  • Treatment (TX): Antiviral medications, avoid aspirin (ASA), diphenhydramine, antihistamines, and acetaminophen.

Chickenpox (Varicella) Continued

  • Acyclovir Effects: Decreases lesions, shortens fever duration, alleviates itching, lethargy, and anorexia.

  • Monitoring: Watch for secondary infections, bathe daily, change linens, and maintain a cool environment. Recommended Aveeno bath and topical calamine lotion.

ERYTHEMA INFECTIOSUM (FIFTH DISEASE) - SLAPPED CHEEK VIRUS

  • Source: Infected individuals, mainly in school-age children.

  • Transmission: Respiratory secretions and blood, including blood products.

  • Period of Communicability: Uncertain.

  • Signs & Symptoms (S&S): Rash develops in three stages: 1) erythema on the face (slapped cheek), 2) rash spreads from proximal to distal, 3) rash subsides but may reappear if skin is irritated.

  • Treatment (TX): Antipyretics, anti-inflammatory drugs, and analgesics to alleviate symptoms.

  • Complications: Can cause serious complications such as anemia, hydrops, or fetal death if a mother is infected during the second trimester of pregnancy.

MUMPS (PARAMYXOVIRUS)

  • Source: Saliva of infected person.

  • Transmission: Direct contact or droplet spread.

  • Period of Communicability: Most communicable immediately before and after the onset of swelling.

  • Signs & Symptoms (S&S): Fever, headache, malaise, anorexia followed by earache, and parotitis within three days, accompanied by pain and tenderness.

  • Treatment (TX): Analgesics and antipyretics. May require IV fluids, maintain isolation, risk of developing sensorineural deafness and rare sterility in males.

MEASLES (RUBEOLA)

  • Source: Respiratory tract secretions, blood, and urine of infected person.

  • Transmission: Usually by direct contact with droplets, high incidence in winter.

  • Period of Communicability: 4 days before to 5 days after rash appears, predominantly during prodromal stage.

  • Signs & Symptoms (S&S): Prodromal stage with fever and malaise followed by 24 hours of coryza, cough, conjunctivitis, and Koplik spots (red spots with bluish-white center), rash appears 3-4 days after prodromal symptoms.

  • Rash Characteristics: Begins as erythematous maculopapular on face and spreads downward; severe in earlier sites and less intense later.

  • Treatment (TX): Supportive measures including bed rest during febrile periods, antipyretics, antibiotics to prevent secondary bacterial infections in high-risk children. Administration of Vitamin A per physician order to reduce morbidity/mortality, enforce isolation; airborne precautions in hospitals.

Measles (Rubeola) Continued

  • Additional Symptoms: Anorexia, abdominal pain, malaise, generalized lymphadenopathy.

RUBELLA (GERMAN MEASLES)

  • Source: Primarily nasopharyngeal secretions from infected individuals, virus also in blood, stool, and urine.

  • Period of Communicability: 7 days before to about 5 days after rash appearance.

  • Signs & Symptoms (S&S): Low-grade fever, headache, malaise, and lymphadenopathy; rash begins on the face and spreads quickly downwards, with pinkish-red maculopapular exanthema present within the first day; rash disappears in reverse order.

  • Treatment (TX): Antipyretics and analgesics; teratogenic effects on fetus.

CONJUNCTIVITIS

  • Description: Inflammation of the conjunctiva; types include viral, bacterial, allergic, and foreign body related.

  • Bacterial Conjunctivitis: Commonly known as pink eye; treated with topical antibacterial agents (drops and ointment).

  • Viral Conjunctivitis: Managed by cleaning secretions, warm compresses, and meticulous handwashing; separate linens to prevent spread.

GIARDIASIS

  • Cause: Protozoan Giardia intestinalis, the most common intestinal parasitic pathogen in the US.

  • Common Locations: Child care centers, facilities for developmental disabilities, and recent travelers to endemic areas.

  • Source: Contaminated mountain streams/lakes, fecal contamination from diapered infants resistant to chlorine.

  • Transmission: Person to person, via food, and animal contact (especially puppies); cysts can survive in the environment for months.

  • Diagnosis (DX): Microscopic stool sample.

Giardiasis Continued

  • Clinical Manifestations: Abdominal cramps, vomiting and diarrhea with malodorous, watery, pale, greasy stools.

  • Prognosis: Spontaneous resolution within 4-6 weeks, symptomatic treatment recommended.

  • Treatment (TX): Metronidazole (Flagyl), tinidazole (Tindamax), or nitazoxanide (Alinia); prevention through education.

ENTEROBIASIS (PINWORMS)

  • Description: The most common worm infection in the United States.

  • Source: Air in temperate climates, contact with eggs from the environment; eggs can persist 2-3 weeks on surfaces, common in crowded conditions such as classrooms and daycares.

  • Transmission: Eggs are ingested or inhaled; hatch in the upper intestine and adults mature, with females migrating out of the anus to lay eggs.

  • Symptoms: Intense perianal itching; diagnosis made using the tape test (collecting samples in the morning right after waking up).

  • Treatment (TX): OTC Pin-Rid (pyrantel pamoate); repeat treatment after 2 weeks; wash all clothing in hot water and vacuum thoroughly; may require treatment of the entire family.

IMPETIGO

  • Description: Contagious bacterial skin infection caused primarily by Staphylococcus aureus.

  • Symptoms: Appearing as red sores on the face (particularly around nose and mouth), hands, and feet which break to form a honey-colored crust.

  • Treatment (TX): Topical bactericidal ointment, parental penicillin may be needed if severe; Bactroban and Augmentin can be effective; enforce good hygiene measures.

  • Prognosis: Tends to heal without scarring.

RINGWORM (DERMATOPHYTOSES)

  • Cause: Group of filamentous fungi that primarily invade the stratum corneum, hair, and nails; superficial infections.

  • Transmission: Person-to-person, animal-to-person, via contaminated items (helmets, seats).

  • Symptoms: Itching, varying types depend on affected areas:

    • Tinea capitus: Scalp

    • Tinea corporis: Face, trunk, and extremities

    • Tinea cruris: Jock itch

    • Tinea pedis: Athlete’s foot

  • Diagnosis (DX): Microscopic examination of scrapings and Wood's lamp examination which discloses yellowish gold fluorescence.

  • Treatment (TX): 2% ketoconazole and 1% selenium sulfide shampoos for 5-10 minutes thrice weekly, or griseofulvin (administered with high-fat foods for better absorption); practice good hygiene by not sharing personal grooming equipment and sleeping with a protective cap.

SCABIES

  • Overview: Female scabies mite burrows into the skin's stratum corneum and lays eggs.

  • Transmission: Direct, prolonged skin-to-skin contact; bedding and clothing must be washed in hot water after 3 days to eliminate mites.

  • Symptoms: Intense itching (worse at night), linear rash under skin may appear as burrows.

  • Treatment (TX): Topical scabicides; ensure treatment for all close contacts for 30-60 days.

LICE (PEDICULOSIS CAPITUS)

  • Overview: Head lice infestation common among school-age children; adult louse survives 48 hours away from human host, life span is one month, lays eggs (nits) at hair shaft junction, which hatch over 7-10 days.

  • Symptoms: Itching is typically the only symptom, with nits observed firmly attached to hair shafts.

  • Diagnosis: Direct observation of white eggs (nits) on hair shafts.

  • Treatment (TX): Application of pediculicides, manual removal of nits. Recommended permethrin 1% cream rinse (OTC), with a second application in 7-10 days. Daily nit removal with a metal comb at least every 2-3 days; avoid sharing personal belongings.

  • Epidemiological Factors: More likely to affect children with straight, clean hair, especially girls, and white children.

LYME DISEASE (SPIROCHETE BORRELIA BURGDORFERI)

  • Description: Most common tick-borne disorder in the United States, caused by spirochete bacteria entering the skin and bloodstream via tick saliva and feces, particularly by deer ticks.

  • Prevention: Recommendations include wearing light-colored clothing, covering all skin, tucking in clothes, performing frequent tick checks, and using insect repellents containing DEET or clove oil.

Lyme Disease Signs and Symptoms

  • Early Localized Disease (3-30 days post-bite): Erythema and papule at bite site may develop into a large circumferential ring (bull's eye), with symptoms such as itching, warmth, fever, malaise, headache.

  • Early Dissemination Symptoms: Anorexia, stiff neck, lymphadenopathy, sore throat, neurological symptoms.

  • Late Stage Symptoms: Systemic neurological, cardiac, and musculoskeletal symptoms.

  • Treatment (TX): For children < 8 years: amoxicillin; for those > 8 years: oral doxycycline for 14-21 days.

ROTOVIRUS

  • Overview: Major cause of severe gastroenteritis in children; leads to hospitalizations for diarrhea, particularly severe in children under 3 years.

  • Transmission: Fecal-oral; virus is stable on surfaces, heightening transmission risks through contaminated surfaces.

  • Incubation Period: Approximately 48 hours.

  • Signs & Symptoms (S&S): Mild to moderate fever, vomiting followed by foul-smelling watery stools; detect onset of symptoms lasting roughly 5-7 days.

  • Diagnosis (DX): Stool sample for culture.

  • Treatment (TX): Symptomatic management; hospitalization may be required for fluids and electrolytes; preventive vaccines available.

BACTERIAL MENINGITIS

  • Definition: Acute inflammation of the meninges and cerebrospinal fluid (CSF); considered a medical emergency; immediate action necessary to identify the causative organism for treatment.

  • Fatality Rate: 6-9% in infants, with higher risk for infants under 2 months; group B Streptococcus is the most common cause.

  • Pathophysiology: Brain becomes hyperemic and edematous with purulent exudate covering its surface; infection may extend to ventricles, obstructing the flow of CSF with thick pus and adhesions.

Bacterial Meningitis Clinical Manifestations

  • Presentation: May begin abruptly with fever and signs of meningeal irritation (nausea, vomiting, irritability, anorexia), headache, photophobia, confusion, back pain, and nuchal rigidity. Often a preceding upper respiratory infection history.

  • Progression: May develop seizures, confusion, and coma.

Diagnosis of Bacterial Meningitis

  • Procedure: Lumbar puncture is the definitive test; fluid pressure typically elevated; elevated white blood cell count (normal range is 0-5 WBCs); no red blood cells should be present.

  • CSF Glucose Levels: Usually reduced; normal in viral meningitis. Protein concentration is typically increased; culture and sensitivity tests allow for identification of the organism.

  • Blood Culture: Usually performed as well.

Treatment of Bacterial Meningitis

  • Precautions: Isolation precautions as droplet and ensure a quiet environment in the room; initiate antibiotic therapy based on organism identified.

  • Supportive Care: Dexamethasone may be used; restrict hydration; monitor intake/output, vital signs, and level of consciousness.

  • Management: Address increased intracranial pressure (ICP), systemic shock, control seizures and temperature, and treatment of complications.

Complications and Prevention of Bacterial Meningitis

  • Common Complications: Hearing loss assessments recommended after 6 months; preventable via immunization with Hib vaccines starting at 2 months and meningococcal vaccinations at ages 11-12 years with booster by age 16.

  • Common Long-Term Effects in Children: Hearing loss, intellectual disability, spasticity or paresis, and seizure disorders.

ASEPTIC MENINGITIS

  • Causes: Results from various viruses (arboviruses, herpes simplex virus, cytomegalovirus (CMV), adenoviruses, HIV), with enteroviruses being the most common.

  • Population: Most common in very young children; symptoms include headache, fever, photophobia, nuchal rigidity along with potential maculopapular rash.

  • Clinical Course: Shorter duration, generally without significant complications.

  • Treatment: Primarily symptomatic, and isolation until bacterial meningitis is ruled out; antibiotics may be administered as a precaution.

TETANUS (LOCKJAW)

  • Overview: Acute disease caused by an exotoxin from Clostridium tetani, which are anaerobic, spore-forming, gram-positive bacilli found in soil, dust, and the gastrointestinal tracts of humans and animals.

  • Symptoms: Tenderness and stiffness in neck and jaw leading to rigidity, difficulty swallowing, hypersensitivity to stimuli, muscle contractions, laryngospasm, respiratory arrest without affecting mental status.

Tetanus Prevention and Treatment

  • Primary Prevention: Key through immunization and boosters every 10 years; post-exposure treatment includes tetanus immunoglobulin (TIG) alongside vaccination, administered separately intramuscularly.

  • Antibiotic Treatment: Penicillin G or erythromycin; tetracycline can be used in older children; supportive treatments may include low-stimulation environment, airway maintenance, nutrition, muscle relaxants, sedation, and wound care.

HIV (HUMAN IMMUNODEFICIENCY VIRUS)

  • Transmission to Fetus: Can occur transplacentally, intrapartum, or postnatally through breast milk. Without treatment, the risk of perinatal transmission is approximately 25%; effective treatment can reduce this rate to about 2%.

  • Treatment Protocol: Administer antiretroviral therapy (typically AZT) within 2 hours of delivery. If a baby acquires HIV prenatally, rapid onset of illness often occurs with the development of AIDS within the first year of life.

HIV Interventions and Practices

  • Counseling and Testing: Implementation of counseling and voluntary testing has reduced the number of infants born with HIV to about 200 yearly.

  • Universal Precautions: Essential for caretakers handling body secretions; these must be disposed of in biohazard containers, particularly relevant in contact sports, during menstruation, or among sexually active adolescents.

HIV & IMMUNIZATIONS

  • Importance of Vaccination: Immunization knowledge for children with HIV is crucial; B-cell dysfunction affects vaccine efficacy. Most children with symptomatic HIV have a diminished response to vaccines.

  • Live Vaccines: Children can receive live viral vaccines (such as MMR and varicella) if their immunity is robust, subject to CD4 count evaluations.