1. The document discusses dietary recommendations for various infectious diseases and conditions including fever, malaria, emphysema, rheumatic fever, tuberculosis, and others. 2. For fever and infections, the recommendations are to increase calories to meet increased metabolic demands and avoid starvation, increase protein intake to correct nitrogen balance, and increase carbohydrates and fluids. 3. For specific conditions like emphysema, recommendations include high calorie, low carbohydrate, high protein diets as well as vitamin supplements and regular exercise to promote strength and efficiency.

1. Diet Therapy in Fever & Infectious DiseasesAlbert ChengSaturn DagwaseDavid L. Santos

2. FEED A COLD, STARVE A FEVER?“Fede a cold and starb of feber.”

3. Normal PhysiologyBody Temperature controlled by hypothalamic thermoregulatory center, receives 2 signals:1. Warmth/cold receptors on skin2. Temperature of blood - maintenance of maximum oral temperature at 37.2 C at 6 am and 37.7 C at 4 pmTemperature which elevates hypothalamic set defines a feverPathophysiology of a FEVERInfection, microbial toxins, mediators of inflammation, immune reactions FEVERHeat conservationHeat productionElevated thermoregulatory set pointMonocytes/ macrophages and endothelial cellsMicrobial toxinsCyclic AMPPGE2circulationPyrogenic cytokines: IL-1, IL-6, TNF, IFNHypothalamic endothelium

4. TerminologiesHyperpyrexia – Fever at > 41.5 degree CHyperthermia – Uncontrolled increase in body temperature that exceeds the body’s ability to lose heatEx: Heat Stroke

5. Metabolic Effects of FeverIncrease metabolic rate: For every one degree rise in temperature above the normal (Celsius) the metabolic rate is increased by approximately 13%Increased protein catabolism, which is especially excessive in typhoid fever, malaria, typhus and others. The end products of protein catabolism excreted as urea places a heavy burden upon the kidneys.Decreased glycogen stores and adipose tissueLoss of body fluids and electrolytes especially sodium and potassiumDecreased gastrointestinal motility affecting absorption of nutrients

6. Diet in Infections and FeverCalorie is increased to meet the demand of increased metabolic rate. “Starving a fever” leads to a prolonged convalescence and acute deficiency diseases.Protein is increased by 50-100% of the recommended daily allowances to correct negative nitrogen balance that arises from the increased tissue catabolismCarbohydrate is increasedTo provide energyTo spare body proteins from being utilized for energyTo replenish depleted glycogen stores To prevent ketosis

7. Fat is given in normal or adequate amounts to help increase the caloric content of the diet without too much bulkLiberal fluids and saltsTo compensate for water and salt loss form overt perspiration and insensible lossTo permit adequate volume of urine for excreting metabolic wastesVitamins, especially the B-vitamins are increased because there are parts of the coenzymes involved in metabolism. Thiamine, riboflavin, niacin and pyridoxine in particular are increased automatically whenever the caloric content of the diet is increased

8. MalariaMalaria is a disease caused by a parasite (plasmodium) that is transmitted person-to-person by the bite of an infected Anopheles mosquito.Malaria is the major causes of morbidity and mortality in many tropical and subtropical countries.Approximately 300 million people worldwide are affected by malaria and between 1 and 1.5 million people die from it every year.Over 90% of the deaths are in Africa, 2/3 among children.

9. Malaria SymptomsFeverChillsHeadacheMuscle acheNauseaSometimes vomiting, diarrhea, and coughing

10. TREATMENT

11. DIETARY MANAGEMENTHigh Calorie due to high metabolic rate during attackHigh Protein due to protein destruction by protozoa.Hugh Carbohydrates to replenish depleted reserves.Moderate fats to reduce workload of impaired liverLiberal fluids and salts to restore salt and water balance to eliminate toxins.Vitamin supplements.

12. EmphysemaChronic lung disease characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchiole and is accompanied by destruction of their walls.This result from an imbalance between elastase predominating and leading to excessive destruction of elastin and further proteolysis.Cigarette smoking is the major cause of emphysema.In patients with emphysema, normal lung tissue is often replaced by large “bullae,” large balloon- like structures that press on normal lung tissue and reduce the person’s lung capacity even further. If the lungs are full of bullae, the lungs become too large for the chest cavity and cannot expand properly.

13. Signs and symptoms:shortness of breath-tissue wasting and weight loss-abdominal distress-coughing, usually with very thick mucus.

14. Treatment:-give patient considerable relief-correct or diminish conditions causing the disability-light exercise-nutritional rehabilitation

15. Diet Therapy“There is little that a diet, even a healthy one, can do to help prevent the onset of emphysema. But once you have the disease diet will play a big role”Malnutrition (problem) – the marked decrease in lung function = use extra calories just to take a breath + diminished appetite = more pronounced DOB.

16. Diet Therapy1. high calorie – to combat tissue wasting and weight loss.2. low carbohydrate – to prevent CO2 retentionincreasing the caloric content of the diet-serve gravy on meat and potatoes-serve mayonnaise, oil and salad dressing whenever possible with sandwiches, salad and vegetable-along with breakfast eggs, serve bacon, ham or sausage-serve cream soups instead of clear bouillon

17. 3. high Protein- to correct the negative nitrogen balance. *There is no doubt that diet is closely associated with the functioning of the immune system. Eat food that have a high protein content to help maintain muscle strength and tone in all your muscles, including the muscles that help you breathe. The American Lung Association suggests that you eat two high-protein servings per day. Foods that are high in proteins are red meat, fish, eggs and poultry. Meat and dairy products are high in protein and help keep your muscles strong. Good sources include peanut butter, tofu, nuts, and sees are also high in protein. Many of these foods are also higher in fat and can help you prevent weight loss.

18. Regular exerciseIt is a very important part of helping your feel better.Muscles that are out of shape require more “fuel” (oxygen) and make you become more easily run out of breath. Exercise helps tone muscles so tha they are more efficient and use less oxygen.You should build up your strength slowly especially with activities that you enjoy.

19. 4. high vitamin supplements - Vitamin B complex – thiamine, riboflavin, niacin pyridoxine part of coenzymes involved in metabolism. - Vitamin C- improve the immune system.5. Eat several small meals of high nutritional valuelarge meals leaving you feeling full will restrict full inflation of the lungs, making it more difficult to breathe.Eat six small meals a day instead of three large ones. A stomach that is too full can cause shortness of breath.Eat your main meal early in the day so that you will have more energy throughout the day.

20. 6. Eat soft foods that are easy to masticate because of the difficulty in chewing7. Maintain a Healthy WeightBeing underweight can decrease your energy and make you more prone to infection and further weight loss/ tissue wasting.Excess weight can increase shortness of breath.Weigh yourself twice a week.8. Drink lots of fluidsDrinking lots of fluids helps keep mucus thin and easier to bring up. Water, juices and nectar, and mineral waters are best.

21. Your dietitian may also recommend a low-salt diet to avoid a build-up of fluids.Limit your salt intake. Sodium causes fluid retention, which may interfere with breathing.Some people with emphysema, who need diuretics, may develop low levels of potassium in their bodies. Muscles need potassium for proper contraction. Low potassium levels add to overall weakness and impaired strength of the muscles needed for breathing. Foods high in potassium include lima beans, split peas, fresh mushrooms, sweet potatoes, raw nuts, fresh spinach, dates, raisins, dried fruits, oranges and orange juice, bananas, halibut, dry skim milk and beef.

22. Rheumatic FeverLeading cause of chronic illness in children, especially the underprivilegedCharacterizedHigh feverPainful swelling of joints similar to those of early RA and inflammation of the heart muscle and valves.Preceded usually by pharyngitisTreatmentPenicillinSteroidsShortens the period of acute illnessLessens it severityDecreases the likelihood of cardiac involvement

23. Dietary treatmentFull liquid diet for acute infections is satisfactory during the acute phase of rheumatic fever.Progression from liquid to soft then regular diet depends on the rate of patients rehabilitationCaloric increased because increase in metabolic and protein rates to correct the negative nitrogen balance.Increase in ascorbic acid as a antistress factor.Iron supplement is recommended due to the presence of anemiaSodium should be restricted to 1000 mg a day when steroids are used because of the sodium-retaining property of the drug to avoid edema

24. TuberculosisTuberculosis is a chronic infectious, contagious disease and one of the major causes of illness and death in undeveloped countries. Common among malnourished, immunocompromised and elderlyAffects the lungs especially the apex and the hilar lymph nodesEtiologyM. tuberculosisM. bovisM. africanum

25. Mode of TransmissionM. Tuberculosis is transmitted via air droplets from patients with PTB.M. bovis can be acquired from unpasteurized contaminated milk

26. Clinical manifestations of TBFeverNight sweatsGeneralized malaise and weaknessAnorexiaCoughProductive/non-productive with purulent sputum or blood streakedMassive hemoptysisShortness of breathSign of presence fo air or fluid in the pleural spacePleuritic chest pain

27. Lab Dx TBChest x-rayIrregular white areas against a normal dark backgroundTuberculin skin testSputum analysis

28. Management of TBDrugsINH, streptomycin, PAS, ethionamide, rifampicinDietaryHigh calorie to meet the demands of high metabolic rateHigh protein (75-100g)Restore nitrogen balancePromote wound healingHelp regenerate serum albumin levelsHigh CarbohydrateProvide caloriesTo spare proteinsMineralsCalcium to promote healing by calcification of TB lesion and iron supplement if there is hemorrhageVitaminsIncreased vitamin A, ascorbic acid, pyridoxine, vitamin K and B-complex vitamins

29. Typhoid FeverEtiologic agent: Salmonella typhiiGm(-) bacilliFlagellatedMotile, non-spore formingPathogenic only to humanHandy organism and easily survives in natural habitat like water or inorganic material

30. Public health immunization programs have greatly reduced the incidence, while the use of antibiotics has shortened the course of the disease from what used to be a chronic fever to one of short duration.Length of convalescence is to a large extent still dependent upon nutritional therapyPeyer’s patches and diarrhea are early involvements and may interfere with absorptionDuring the height of the fever the metabolic rate may increase 50% above the normal.Protein destruction is great, approximating three times that which occurs during normal health.

31. Treatment of Typhoid FeverDrugsCeftriaxone – drug of choice; 30 mg/kg/dayCefoperazone – 60 mg/kg/dayChloramphenicol – resistance is increasingQuinolones – follow up oral therapy; must not be given to prepubertal B patientsAmpicillin – alternative therapy; 100 mg/kg/day IV or IM in 4 divided doses for 14 days

32. Dietary treatmentAcute infections – proteins 100 gm or moreLow amount of fiber in diet – not to traumatized the inflamed bowels to precipitate hemorrhage or perforationFrequent small feedings to prevent burden to the stomachThree to six eggs daily, soft custard are well toleratedMilk and provide calories, proteins, minerals and vitamins

33. CholeraCholera is an infection of the intestines by Cholera vibrio organisms transmitted through contaminated foods and drinks.CharacterizedSudden and massive diarrhea usually with vomiting leading to a rapid loss of water and electrolytes with consequent dehydration, hypovolemia and shock.Death may occur within hoursIntravenous rehydration with salts and glucose plus antibiotics to combat the infection have saved lives of infected individuals.

34. Choleramost feared epidemic diarrheal disease because of its severity 7 documented pandemics have occurred since 1817 – all originating from Asia.Agent: Vibrio cholerae

35. CholeraThe infectious dose with water: 103-106 organisms. with food: 102-104 organisms enterotoxin promotes the secretion of fluid and electrolytes into the lumen of the small intestine.Colon relatively insensitive to toxin, but overwhelmed by volume of fluid:rice water stools

36. CholeraThe drugs used for adults include: tetracycline, doxycycline, cotrimoxazole & ciprofloxacin.For children: erythromycin, cotrimoxazole and furazolidoneare the drugs of choice.

37. CholeraDisease of fluid management. Two steps: rehydration and maintenanceRehydration: 50-100 mL/kg/hLactated Ringer solution is preferred over isotonic sodium chloride solution because saline does not correct metabolic acidosis Maintenance – maintain normal hydration status by replacing ongoing losses. The oral route is preferredOral rehydration solution (ORS) at a rate of 500-1000 mL/h is recommended