DIFFERENT KINDS OF DISEASES VIRAL DISEASE FUNGAL DISEASEBACTERIAL DISEASE
CHICKENPOX (also called as VARICELLA) • also spelled as Chicken pox •is a highly contagious illness caused by primary infection with varicella zoster virus (VZV).•it is an airborne disease spread easily through coughing or sneezingof ill individuals or through direct contact with secretions from the rash.• usually starts with vesicular skin rash mainly on the body and headrather than at the periphery and becomes itchy, raw pockmarks,which mostly heal without scarring.
Continuation... • It is often stated to be a modification of chickpeas (based on resemblance of the vesicles to chickpeas) or due to the rash resembling chicken pecks. •Other theories include the designation chicken for a child (i.e., literally child pox) or a corruption of itching-pox.•Samuel Johnson explained the designation as "from its being of no very great danger."
CAUSATIVE AGENT of CHICKENPOX•Varicella zoster virus (VZV) is one of eight herpes viruses known to infect humans and other vertebrates.•It commonly causes chicken-pox in children and adults and Herpes zoster (shingles) in adults and rarely in children.• Primary VZV infection results in chickenpox (varicella), which may rarely result in complications including encephalitis or pneumonia.
Morphology •VZV is closely related to the herpes simplex viruses (HSV), sharing much genome homology. •VZV also fails to produce the LAT (latency-associated transcripts) that play an important role in establishing HSV latency (herpes simplex virus). •VZV virons are spherical and 150–200 nm in diameter.• Their lipid envelope encloses the nucleocapsid of 162 capsomeres arranged in an icosahedral form.•Its DNA is a single, linear, double-stranded molecule, 125,000 nt long.
MODE OF TRANSMISSION • Chicken Pox is transmitted from person to person by droplet infection, and by droplet nuclei.• Most patients are infected by “Face to face”, (personal) contact. The portal of entry of the virus is through the respiratory tract.Since the virus is extremely labile, it is unlikely that fomites play a significant role in its transmission.• Contact infection undoubtedly plays a role when an individual with Herpes Zoster is an index case.• The virus can cross the placental barrier and infect the fetus, a condition known as Congenital Varicella.
INCUBATION PERIOD • Usually, the incubation period is about 14 to 16 days, although extremes as wide as 21 days have been reported. • It takes between 10 and 21 days after contact with an infected person for someone to develop chickenpox (this is known as the chickenpox incubation period).• The usual chickenpox incubation period averages between 14 and 16 days.
LABORATORY EXAMINATIONS REQUIREDLABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal Negative for varicella-zoster IgG or IgM antibodies by ELISA: nonimmune. to detect the Enzyme-linked Abnormal presence of aimmunosorbent Positive for varicella-zoster IgG substance, usually an assay (ELISA) antibody: indicates a current or antigen, in a liquid Immunoassay previous infection, in the absence sample or wet sample. of current clinical symptoms, may indicate immunity. Positive for varicella-zoster IgM antibody, indicates a current or recent infection.
Continuation... LABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal A normal value means that no virus or other microorganisms grew in the laboratory dish. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the to check for immunity meaning of your specific test results. to the herpes zoster virus, the AbnormalChickenpox Blood virus responsible An abnormal (positive) result usually Test means that you have Virus or other for chickenpox. microorganisms in your blood. This is a sign of infection. . However, contamination of the blood sample can lead to a false-positive result, which means you do not have a true infection. Your health care provider can help determine the difference.
SIGNS AND SYMPTOMS •in adolescents and adults are nausea, loss of appetite, aching muscles, and headache followed by the characteristic rash, malaise and a low-grade fever that signal the presence of the disease.•In children the illness is not usually preceded by prodromal symptoms and the first sign is the rash.•Rashes begins as small red dots on the face, scalp, torso and upper arms and legs; progressing over 10-12 hours to small bumps, blisters and pustules; followed by umbilication and the formation of scabs.
Continuation... • Blisters may also occur on the palms, soles and mucous membranes, and painful, shallow ulcers may appear in the mouth, the top of the throat and the genital area. • symptoms appear from 10 to 21 days after infection, and the infected person is typically infectious from one to two days prior to the appearance of the rash and remains infectious until four or five days after its appearance• Adults may have a more widespread rash, and longer fever; and are more likely to experience complications, such as varicella pneumonia.
Continuation... •Chickenpox is rarely fatal.•It is generally more severe in adult males than in adult females or children.•Chickenpox is believed to be the cause of one third of stroke cases in children. •The most common late complication of chickenpox is shingles(herpes zoster), caused by reactivation of the varicella zoster virus decades after the initial episode of chickenpox
INTERVENTION Nursing Management Management Rationale Body substance isolation should be used for all infectious patientsProvide isolation. with diseases transmitted through air may also need airborne and droplet precautions.Encourage patient to cover mouth Prevents spread of infection viaand nose during coughs or sneezes. airborne droplet.Monitor patient’s temperature, Fever pattern aids in the diseasedegree and pattern. process and diagnosis. Chills often precede temperatureObserve for chills and profuse spikes in presence of generalizeddiaphoresis. infection.
INTERVENTION Nursing Management Management Rationale Room temperature should be alteredMonitor environmental temperature. to maintain near-normal body temperature.Provide tepid sponge baths, avoid the May help reduce the fever.use of alcohol.Encourage to use calamine lotion. To help reduce the itchiness. Used to reduce the fever by itsAdminister antipyretics as indicated. central action on the hypothalamus.
INTERVENTION Medical ManagementChildren Acyclovir decreases symptoms by one day but has no effect oncomplication rates. Use of acyclovir therefore is not currentlyrecommended for immunocompetent individuals (i.e., otherwise healthypersons without known immunodeficiency or on immunosuppressivemedication). Children younger than 12 years old and older than one monthare not meant to receive antiviral medication if they are not sufferingfrom another medical condition which would put them at risk ofdeveloping complications. Aspirin is highly contraindicated in children younger than 16years as it has been related with a potentially fatal condition known asReyes syndrome.
INTERVENTION Medical ManagementADULTS Treatment with antiviral drugs (e.g. acyclovir or valacyclovir) isgenerally advised, as long as it is started within 24–48 hours from rashonset. Adults are more often prescribed antiviral medication as it iseffective in reducing the severity of the condition and the likelihoodof developing complications. Adults are also advised to increase water intake to reducedehydration and to relieve headaches. Painkillers such as paracetamol(acetaminophen) are also recommended as they are effective inrelieving itching and other symptoms such as fever or pains.Antihistamines relieve itch and may be used in cases where the itchprevents sleep, because they are also sedative.
INTERVENTION Medical ManagementADULTS As with children, antiviral medication is considered more usefulfor those adults who are more prone to develop complications. Theseinclude pregnant women or people who have a weakened immune system. Sorivudine, a nucleoside analogue has been reported to beeffective in the treatment of primary varicella in healthy adults (casereports only), but large-scale clinical trials are still needed todemonstrate its efficacy. BACK
TINEA PEDIS (Athlete’s Foot)• Athletes foot, also called tinea pedis, is a fungal infection of the foot. It causes peeling, redness, itching, burning, and sometimes blisters and sores. • Athletes foot is a very common infection. •The fungus grows best in a warm, moist environment such as shoes,socks, swimming pools, locker rooms, and the floors of public showers. It is most common in the summer and in warm, humid climates. • It occurs more often in people who wear tight shoes and who use community baths and pools.
CAUSATIVE AGENT of Athlete’s Foot •Athletes foot is caused by a microscopic fungus that lives on dead tissue of the hair, toenails, and outer skin layers.•There are at least four kinds of fungus that can cause athletes foot. The most common of these fungi is trichophyton rubrum. •Trichophyton rubrum is a fungus that is the most common cause of athletes foot, jock itch and ringworm. •This fungus was first described by Malmsten in 1845.
Morphology Colonial Morphology• Growth rate: slow to moderately rapid• Texture: downy to cottony• Thallus color: white to pale pink• Reverse: blood red (PDA) to reddish brown (SDA, Mycosel)• Variants: – yellow, may produce red pigment on PDA – coffee brown soluble pigment – unpigmented – deeply red, heaped up, folded – yellow orange reverse
Morphology Microscopic Morphology Phase Contrast•few pyriform, lateral microconidia•pencil shaped macroconidia uncommon•microconidia form on macroconidia•arthroconidia produced from hyphae andmacroconidia
MODE OF TRANSMISSIONFrom person to person •Athletes foot is a communicable disease caused by a parasitic fungus in the genus Trichophyton, either Trichophyton rubrum or Trichophyton mentagrophytes. •It is typically transmitted in moist environments where people walk barefoot, such as showers, bath houses, and locker rooms. •It can also be transmitted by sharing footwear with an infected person, or less commonly, by sharing towels with an infected person.
Continuation...To other parts of the body • The various parasitic fungi that cause athletes foot can also cause skin infections on other areas of the body, most often under toenails (onychomycosis) or on the groin (tinea cruris).
INCUBATION PERIODThe incubation period differs:1. tinea corporis has an incubation period of four to ten days2. tinea capitis has an incubation period of 10–14 days3. the incubation period of tinea pedis and tinea unguium is probablyweeks but exact limits are unknown.
LABORATORY EXAMINATIONS REQUIREDLABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal No fungi are present in the nail, skin or hair samples. to find out whether a Other tests may be done to findKOH (Potassium fungal infection is out the cause of the skin Hydroxide) present on the infection. Preparation nails, skin, scalp, or beard. Abnormal Fungi are present in the nail, skin or hair samples.
LABORATORY EXAMINATIONS REQUIRED CONFIRMATIONLABORATOR RESULTS RATIONALE Y EXAM NORMAL VS ABNORMAL used to find out Normal whether fungi are present No fungi are present in the and, if so, what type of skin or nail scrapings. Other fungus it is. skin tests may be done to done to find out the cause of find out the cause of the skin cracking, scaling, peeling, or or nail problems.Fungal Culture blistered skin, or to find out why there is an area of Abnormal persistent irritation (and Fungi are present, and the sometimes redness) on the type of fungus is identified. feet. The presence of fungi Treatment may vary suggests that the condition depending on the type of is athletes foot (tineapedis). fungus present.
LABORATORY EXAMINATIONS REQUIREDLABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal No fungi are present in the skin performed to exclude or nail scrapings. Other skin tests a chronic skin may be done to find out the cause infection, non- of the skin or nail problems. cancerous tumors, Skin Biopsy skin cancers and Abnormal other skin diseases Fungi are present, and the type of that may mimic fungus is identified. athlete’s foot. Treatment may vary depending on the type of fungus present.
SIGNS AND SYMPTOMS As the infection progresses, the skin grows soft and thecenter of the infection becomes inflamed and sensitive to thetouch. Gradually, the edges of the infected area become milky whiteand the skin begins to peel. A slight watery discharge also may bepresent.1. Itching, stinging and burning between your toes2. Itching, stinging and burning on the soles of your feet3. Itchy blisters4. Cracking and peeling skin, especially between your toes and on thesoles of your feet5. Excessive dryness of the skin on the bottoms or sides of the feet6. Toenails that are thick, crumbly, ragged, discolored or pulling awayfrom the nail bed
INTERVENTION Nursing Management1. Keep your feet clean, dry, and cool.2. Whenever possible, take off your shoes to "air out" your feet.3. Clean your feet daily with soap and water.4. Always dry well between your toes.
Continuation...5. Use an absorbent powder such as talcum powder or aluminum chloride powder.6. Wear absorbent socks (e.g., made out of cotton or wool).7. Avoid tight-fitting footwear, since sweaty feet provide ideal conditions for fungal growth.8. Change your socks after exercising or after any excess sweating.
INTERVENTION Medical Management •By examining the feet for scaling, itchiness, and strong foot odor, doctors can easily diagnose athletes foot. •Doctor can confirm the diagnosis and exclude other possible skinconditions such as eczema, ringworm, and psoriasis by taking a scraping of lesions from the feet and sending it to the lab for testing.•Athletes foot thats soggy, inflamed, and foul-smelling requires quick medical attention.•If the foot is inflamed and your doctor has confirmed that theres a bacterial infection, the infection and inflammation must first be treated before anti-fungals are used.
INTERVENTION Medical Management •Topical anti-fungals (creams, solutions, gel, and lotions), either over-the-counter or prescription, are usually effective foruncomplicated cases of athletes foot. When these topical agents dont work, antifungal pills are often prescribed. •Some medications used to treat athletes foot contain both anantifungal and antibacterial ingredient to help speed up healing. In addition, special aluminum acetate wet dressings may be helpful when applied to vesiculated or macerated lesions. Shoes may also be treated with antifungal powders. •A foot condition that doesnt clear up after appropriate treatment may not be due to a fungal or bacterial infection. The symptoms may be caused by some other type of skin disease. Thats why its important to see your doctor to confirm the presence of athletes foot.
ONYCHOMYCOSIS (TINEA UNGUIUM) •Onychomycosis (also known as "dermatophytic onychomycosis,“"ringworm of the nail,“ and "tinea unguium”) means fungal infection of the nail. •It is the most common disease of the nails and constitutes about a half of all nail abnormalities. •This condition may affect toenails or fingernails, but toenail infections are particularly common. •The prevalence of onychomycosis is about 6-8% in the adult population.
CAUSATIVE AGENT •The causative pathogens of onychomycosis include: dermatophytes, Candida, and nondermatophytic molds.•Dermatophytes are the fungi most commonly responsible for onychomycosis in the temperate western countries;•Candida and nondermatophytic molds are more frequently involved in the tropics and subtropics with a hot and humid climate.•Another type of onychomycosis is caused by yeast (Candida albicans or Candida parapsilosis). These infections are less common and produce similar symptoms.
MODE OF TRANSMISSION•Dermatophytes are transmitted by direct contact with infected host (human or animal) or by direct or indirect contact withinfected exfoliated skin or hair in clothing, combs, hair brushes, theatre seats, caps, furniture, bed linens, shoes, socks, towels, hotel rugs, sauna, bathhouse, and locker room floors. •may be viable in the environment for up to 15 months.•There is an increased susceptibility to infection when there is a preexisting injury to the skin such as scars, burns, excessive temperature and humidity. Adaptation to growth on humans bymost geophilic species resulted in diminished loss of sporulation, sexuality, and other soil-associated characteristics.
INCUBATION PERIOD•the incubation period of tinea pedis and tinea unguium is probably weeks but exact limits are unknown.
LAB EXAMS REQUIREDLABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal No fungi are present in the nail, skin or hair samples. to find out whether a Other tests may be done to findKOH (Potassium fungal infection is out the cause of the skin Hydroxide) present on the infection. Preparation nails, skin, scalp, or beard. Abnormal Fungi are present in the nail, skin or hair samples.
LAB EXAM REQUIRED CONFIRMATIONLABORATORY RESULTS RATIONALE EXAM NORMAL VS ABNORMAL used to find out Normal whether fungi are present No fungi are present in the and, if so, what type of skin or nail scrapings. Other fungus it is. skin tests may be done to done to find out the cause find out the cause of the skin of cracking, scaling, peeling, or nail problems. or blistered skin, or to findFungal Culture out why there is an area of Abnormal persistent irritation (and Fungi are present, and the sometimes redness) on the type of fungus is identified. feet. The presence of fungi Treatment may vary suggests that the condition depending on the type of is athletes foot (tinea fungus present. pedis).
LAB EXAMS REQUIREDLABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal No fungi are present in the performed to skin or nail scrapings. Other exclude a chronic skin tests may be done to find skin infection, non- out the cause of the skin or cancerous tumors, nail problems. Skin Biopsy skin cancers and other skin diseases Abnormal that may mimic Fungi are present, and the athlete’s foot. type of fungus is identified. Treatment may vary depending on the type of fungus present.
SIGNS AND SYMPTOMS•the nail thickened and discoloured: white, black, yellow or green.•the nail can become brittle, with pieces breaking off or coming away from the toe or finger completely.•the skin can become inflamed and painful underneath and around the nail If left untreated.
Continuation...•There may also be white or yellow patches on the nailbed or scaly skin next to the nail.•There is usually no pain or other bodily symptoms, unless the disease is severe. •People with onychomycosis may experience significant psychosocial problems due to the appearance of the nail,particularly when fingers – which are always visible – rather than toenails are affected
INTERVENTION Nursing Management•Keep your nails clipped. Cut the nails straight and make sure theydo not extend beyond the tips of your toes (or your fingers). (If youhave one or more infected nails, use a separate pair of clippers forinfected nails and another for healthy nails. If you have diabetes,consult your physician before cutting your toenails.)•Disinfect. After each use, disinfect any manicure and pedicure toolsby wiping them with cotton balls saturated with alcohol. Let them airdry for 60 to 90 minutes before using them again.•Be careful at the nail salon. Make sure the salon has an autoclave(a special heating device for disinfecting instruments) and that it isused after each treatment.
INTERVENTION Nursing Management•Keep clean and dry. Wash your hands and feet daily with soap andwater and dry them well. Be sure to dry between your toes.•Use an antifungal foot powder. Avoid cornstarch because itencourages fungal growth.•Make sure your footwear breathes. Choose leather shoes withplenty of toe room. Have more than one pair and alternate your shoesto make sure they air out at least 24 hours before they are wornagain. Also, avoid socks made from nylon or polyester because theydon’t absorb perspiration as well as cotton or wool. In warm weather,wearing sandals may help prevent infections
INTERVENTION Medical Management • Your doctor will take scrapings from under the nail todiscover what type of infection is present. Once the condition is diagnosed, your doctor may prescribe one of the newer oral antifungal medication agents, itraconazole (Sporanox) or terbinafine (Lamisil). • Another option is an FDA-approved topical medication,ciclopirox, sold under the name Penlac Nail Lacquer. You apply itdaily to the affected nail and adjacent skin for up to 48 weeks and trim the nail weekly. It may cause skin irritation, but is otherwise safe; it costs less than the oral drugs.
INTERVENTION Medical Management• In rare cases, if the infection is extremely painful, your physician may recommend removing the nail (though this alone will not resolve the infection). BACK
IMPETIGO •Impetigo is a highly contagious bacterial skininfection most common among pre-school children. People who play close contact sports are also susceptible, regardless of age. •Impetigo is not as common in adults. The namederives from the Latin impetere ("assail"). It is also known as school sores.
CAUSATIVE AGENT• It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes. •According to the American Academy of Family Physicians, both bullous and nonbullous are primarily caused by Staphylococcus aureus, withStreptococcus also commonly being involved in the nonbullous form.
MODE OF TRANSMISSION•Bacteria can enter the skin through a cut, scrape, insect bite, orother breaks in the skin. A person can also get impetigo without a break in the skin. This usually happens because of dried Streptococcus bacteria in the air.•People can transmit bacteria from one person to another or within the same infected person. Impetigo sores have a large amount of bacteria in them. •Skin-to-skin contact is the most common method of impetigo transmission.
MODE OF TRANSMISSION •If you scratch or touch an active sore contaminated with bacteriaand then touch another part of the body, you can spread infection tothat area. The infection can also spread from one person to another in the same manner. •The bacteria that cause impetigo may also spread by touchingshared items or surfaces that have come into contact with someone elses infection. This includes things such as towels, bedding, uniforms, razors, washcloths, and sporting equipment. •Finally, bacteria can be transmitted through discharge from the nose of a person colonized with bacteria.
INCUBATION PERIOD The incubation period is the time between being exposed tothe bacteria and the development of signs and symptoms. Theincubation period is usually one to three days for Streptococcal andfour to 10 days for Staphylococcal infections.
LAB EXAMS REQUIREDLABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal A normal value means that no bacteria or other microorganisms grew in the laboratory dish. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific is a test to find an test results. infection in the blood.BLOOD CULTURE A blood culture can Abnormal An abnormal (positive) result usually means show what bacteria or that you have bacteria or other fungi are in the blood. microorganisms in your blood. This is a sign of infection. However, contamination of the blood sample can lead to a false-positive result, which means you do not have a true infection. Your health care provider can help determine the difference..
LAB EXAMS REQUIREDLABORATORY CONFIRMATION RESULTS RATIONALE EXAM NORMAL VS ABNORMAL Normal No fungi are present in the skin or nail scrapings. Other skin tests may be done to find out the cause performed to exclude a of the skin or nail problems. chronic skin infection,SKIN LESION non-cancerous tumors, BIOPSY skin cancers and other Abnormal skin diseases that may Fungi are present, and the type of mimic athlete’s foot fungus is identified. Treatment may vary depending on the type of fungus present. .
SIGNS AND SYMPTOMSThe following are signs and symptoms of impetigo:1. Red sores that quickly rupture, ooze for a few days andthen form a yellowish-brown crust2. Itching3. Painless, fluid-filled blisters4. In the more serious form, painful fluid- or pus-filledsores that turn into deep ulcers
INTERVENTION Nursing Management1. Penicillin or Erythromycin orally administered.2. Application of mupirocin (Bactroban) ointment for 7 to 10days.3. Wash the crusts daily with soap and water for the lesions toheal quickly.4. Contact precautions should be implemented.5. Instruct the patient to stay indoors for a few days to stopany bacteria from getting into the blisters and making theinfections worse.6. The infected person’s bed linens, towels, and clothing shouldbe separated from those of other family members.7. The infected person should use separate towels for bathingand hand washing.
INTERVENTION Medical Management• Agents for nonbullous impetigo: benzathine penicillin or oralpenicillin or erythromycin.• Agents for bullous impetigo: penicillinase-resistant penicillin orerythromycin• Topical antibacterial therapy Is the usual treatment for diseasethat is limited to a small area. The topical preparation is applied tolesions several times daily for 1 week. Lesions are soaked or washedwith soap solution to remove central site of bacterial growth and togive the topical antibiotic an opportunity to reach the infected site. BACK
DIFFERENT KINDS OF DISEASES VIRAL DISEASE FUNGAL DISEASEBACTERIAL DISEASE