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Discuss the causative agent, mode of transmission, clinical symptoms, and 2 priority nursing interventions for pseudomonas dermatitis, acne, and otitis externa.Your paper has to be 1 page long and in APA format. You may use the powerpoints attached as some reference as well.Module 10a
List examples of normal microbiota for each part of the
gastrointestinal tract
Describe the events that lead to dental caries and
periodontal disease
List the causative agents, suspect foods, signs and
symptoms, and treatments for staphylococcal food
poisoning, shigellosis, salmonellosis, typhoid fever,
cholera, gastroenteritis, and peptic ulcer disease
Differentiate between hepatitis A, hepatitis B, hepatitis C
List the causative agents, mode of transmission, and
symptoms of viral gastroenteritis
List the causative agent, modes of transmission,
symptoms, and treatment for giardiasis
List the causative agents, modes of transmission,
symptoms, and treatments for tapeworms, pinworm,
and ascariasis
Intro and Normal Microbiota







Diseases of the digestive system are the 2nd most
common illnesses in the US.
Diseases of the digestive system usually result from
the ingestion of microorganisms or their toxins in food
and water
Fecal–oral transmission can be interrupted by
◦ proper disposal of sewage
◦ disinfection of drinking water
◦ proper food preparation and storage
>700 bacterial species in mouth
Stomach and small intestine have few resident
microbes
Up to 40% of fecal mass is microbial cells
Bacteria in large intestine assist in degrading food and
synthesizing vitamins. They also competitively inhibit
pathogens, chemically alter medications, and produce
carcinogens

S. mutans(streptococcal mutans)
is #1 causative agent(gram positive)


Adheres to biofilm on the tooth and forms
plaque = binds to
receptors on tooth pellicle(skin of the teeth)
Sucrose → glucose + fructose
◦ Fructose fermentation → lactic acid → cavity
formation

Dental Calculus or Tartar → old calcified plaque

Control: fluoride and restricting dietary sucrose



Ginigivitis: Inflammation of gums. Due to
inflammatory response to a variety of bacteria
growing on gums
Gingivitis can progress to
periodontitis(inflammatory lesions affecting
the tissue that house the roots of the teeth)
Chronic periodontitis can cause bone
destruction and tooth loss in older people
Fig 25.4
The Stages of Periodontal Disease
Fig 25.5




Infection is caused by the growth of a
pathogen in the intestines.
◦ Incubation times range from 12 hours to 2
weeks. Symptoms of infection generally
include a fever.
Intoxication due to ingestion of preformed
bacterial toxins.
◦ Symptoms appear 1–48 hours after
ingestion of the toxin. Fever is not usually a
symptom of intoxication.
Infections and intoxications cause diarrhea
and dysentery (some gastroenteritis with
diarrhea containing mucus and blood)
Usually treated with fluid and electrolyte



Staphylococcus aureus: on skin and in nose
Food becomes contaminated by food workers
who touch the food
Is tolerant to salt, so will grow in salty
environment: ham; also foods that require no
cooking(sliced meat, puddings)

2nd most reported food borne disease

Exotoxin: toxin produced by microorganism

Enterotoxin: toxin produced by bacteria that is
specific to intestinal cells causing vomiting






The bacteria is killed by heating, but not their
toxins= toxins make you sick
Incubation period= 1-6 hours
Usually fully recovered in 1-3 days
Antibiotics not helpful against the toxin
Need rest, fluids, and bland diet
Patients are not contagious
Wash hands(including fingernails) vigorously
with soap and water prior to handling food
 Do not prepare food if nose or eye infection
 Do not prepare or serve food with wounds on
hands
 Keep kitchens and utensils clean and
sanitized
 If storing foods longer than 2 hrs:
=keep hot foods 140 F or over
=keep cold foods 40 F or under
Store cooked food in wide shallow container
and refrigeerate as soon as possible

Fig 25.6



Longer incubation periods than
intoxication (2 days to 2 weeks)
Shigellosis (Bacillary Dysentery)
◦ Common in children, institutions, and developing
countries= highly contagious(spread person to
person
◦ Severe diarrhea or dysentery
◦ Diagnosis: stool culture
◦ Treatment: rehydration, antibiotics for severe cases
Salmonellosis (Salmonella enterica) – Gastroenteritis
◦ Most reported of foodborne diseases in US
◦ Diagnosis: stool culture
◦ Treatment: self limiting: rehydration
◦ Control: food hygiene. Can excrete organisms for
several weeks after infection= food handlers should
not work until fecal cultures are negative





Cholera (vibrio cholerae)
Causes profuse watery diarrhea, fever,
tachycardia, hypotension, hypokalemia, renal
failure, and death in few hours if not treated
Spread by drinking contaminated water
Treatment: prompt rehydration is critical;
sometimes tetracyclines
No person to person spread; only transmitted
through water
Oral Rehydration
Salts (ORS) or i.v.
rehydration reduces
mortality rate from
~70% to < 1% (additional: tetracycline)  Traveler’s diarrhea may be caused by ◦ Enterotoxigenic strains (ETEC) → present like mild form of cholera ◦ Enteroinvasive strains (EIEC) → Shigella like dysentery ◦ Generally self-limiting, ORS but no chemotherapy.  Enterohemorrhagic strains produce Shiga toxins (STEC) that cause inflammation and bleeding of the colon, including hemorrhagic colitis and hemolytic uremic syndrome (HUS): hemolytic anemia, thrombocytopenia, and acute renal failure ◦ C. difficile growth following antibiotic therapy(kills good bacteria allowing c.diff to grow); exotoxin causes inflammation in colon(colitis) ◦ From mild diarrhea to life threatening colitis ◦ Most common in older populations taking antibiotics in the hospital: contagious ◦ Treatment: stop current antibiotic, then Vancomycin or Metronidazole   Inflammatory response to bacteria  Gastritis When penetrate stomach’s mucosal lining making it susceptible to damage from gastric acids: Peptic ulcer disease (gastric and duodenal ulcers)  30 - 50 % of people in US infected – only ~ 15% develop ulcers.  Antibiotic treatment is effective  Also, proton pump inhibitors and H2blockers to reduce amt of stomach acid Transmission Causative agent Chronic liver disease? Vaccine? Hepatitis A Fecal-oral Picornaviridae No Inactivated virus Hepatitis B Parenteral, STD Hepadnaviridae Yes Recombinant Hepatitis C Parenteral Filoviridae Yes No Hepatitis D Pareteral, HBV coinfection Deltaviridae Yes HBV vaccine Hepatitis E Fecal-oral Caliciviridae No No  Rotavirus: ◦ 3 million cases annually ◦ Main diarrheal illness of infants and children ◦ 1-2 day incubation; 1 week illness ◦ Treatment: rehydration  Norovirus: ◦ Shellfish and salads most often infected ◦ 1-2 day incubation; 1-3 day illness  Treated with rehydration      Giardiasis – caused by Giardia lamblia Drinking feces contaminated water (camping, swimming) Type of traveler’s diarrhea Symptoms: malaise, nausea, flatulence, weakness, and abdominal cramps that persist for weeks. Diagnosis is based on identification of the protozoa in the small intestine.      contracted by consumption of undercooked beef, pork, or fish containing encysted larvae Scolex attaches to the intestinal mucosa of humans (definitive host) → matures into adult tapeworm Eggs shed in feces and must be ingested by an intermediate host Adult tapeworms may be undiagnosed in a human Diagnosis based on observation of proglottids and eggs in feces. Fig 12.27 T a p e w o r m s e g m e n Tapeworm segments and flea dirt are found together in Rover’s dog bed. t b r e a k s , r e l e a s i n g e g g s Tapeworm segments break releasing eggs Eggs eaten by grazing flea larvae Flea larvae pupate Rover licks himself and swallows fleas      Enterobius vermicularis, up to 10 mm long Most common worm infection in US (30% of children, 16% of adults infected) Live in human rectum. While infected person sleeps, female pinworms leave intestines through anus and deposit eggs on surrounding skin= peri-anal itch common Diagnosis with cellophane tape (scotch-tape test) first thing in the morning. Treatment of all family members recommended: mebendazole or pyrantel Diagnosing Pinworm Disease Fig 17.9 pinworm paddle Do test immediately after waking up. Several samples might need to be examined. Since scratching of the anal area is common, samples taken from under the fingernails may also contain eggs. ova Pinworm (Enterobius vermicularis) in sigmoid colon  Ascaris lumbricoides  Lives in human intestines   up to 20 cm long After pinworm, 2nd most common worm infection in US. (Most prevalent in tropics and subtropics) ~85% infections are asymptomatic, however “general failure to thrive” as in many intestinal parasites.  Transmitted by ingesting Ascaris eggs  Treatment: mebendazole or pyrantel Figure 25.25 MODULE 9 List the signs and symptoms of septicemia Differentiate gram-negative sepsis, gram-positive sepsis, and puerperal sepsis. Describe bacterial endocarditis and rheumatic fever. Discuss the epidemiology of tularemia, brucellosis ,gas gangrene. Describe pathogens that are transmitted by animal bites and scratches. Compare and contrast the causative agents, vectors, reservoirs, symptoms, treatments, and preventive measures for plague, Lyme disease, and Rocky Mountain Spotted Fever. Describe infectious mononucleosis. Compare and contrast the causative agents, vectors, reservoirs, and symptoms for yellow fever, Compare and contrast the causative agents, modes of transmission, reservoirs, and symptoms for Ebola hemorrhagic fever and Hantavirus pulmonary syndrome. Compare and contrast the causative agents, modes of transmission, reservoirs, symptoms, and treatments for Chagas’ disease, toxoplasmosis, malaria, and babesiosis. Describe Swimmer’s Itch Sepsis: the presence of SIRS(systemic inflammatory response syndrome)in the setting of infection; severe systemic infection Septicemia: Sepsis involving proliferation of pathogens in the blood. Septic shock: septicemia with persistent hypotension and decreased organ perfusion; multiple organ failure Puerperal sepsis (S. pyogenes/ streptococcal pyogenes): due to uterus infection following childbirth or abortion; can progress to peritonitis or septicemia. Rheumatic fever  Endocarditis      Tularemia Brucellosis Gas Gangrene Bite Wounds Autoimmune complication of S. pyogenes infections. Can result in permanent heart damage. Antibodies against group A -hemolytic streptococci react with streptococcal antigens affecting heart valves Rheumatic fever can follow strep throat. Throat culture should always be done when patient has s/sx of strep throat Prompt treatment of streptococcal infections can reduce the incidence of rheumatic fever. Usually caused by alpha-hemolytic streptococci, but occasionally from fungi Preexisting heart abnormalities are predisposing factors. Signs include fever, anemia, and heart murmur. Causes damage to heart valves by producing “vegetations” Fig 23.4 “Rabbit fever” caused by Francisella tularensis Transmitted by bites and scratches of infected animals, carcass handling, tick bites Ulcer at the site of entry and enlargement of the regional lymph nodes → Ulcero-glandular form Aerosol infection → pneumonic form (bio weapon!) Can also infect the eyes and mouth: depends on how pathogen enters the body Treated successfully with antibiotics;Prevention through insect repellent, gloves when handling sick or dead animals, avoid mowing over dead animals Ulceroglandular Tularemia Girl with ulcerating lymphadenitis colli due to tularemia, Kosovo, April 2000. MV in MA  B. abortus (cattle, elk, bison), B. suis (swine), B. melitensis (goats,sheep, camels)  Symptoms are similar to the flu    The bacteria enter through minute breaks in the mucosa or skin, reproduce in macrophages, and spread via lymphatics to liver, spleen, bone marrow, or lining of the heart(endocardium). Contact with infected animals (slaughterhouse workers, veterinarians, farmers, dairy workers) – also via ingestion of milk or milk products. 100-200 cases/y; worldwide incidence ~ 500,000. Mortality rate ~ 2 % (endocarditis) Well-formed hepatic granuloma from a patient with brucellosis Methylene blue stain: Cultured human macrophage infected with Brucella melitensis. coccobacillary bacteria replicate in phagolysosomes (original magnification x 1,000). Photograph: Courtesy of Robert Crawford, Ph.D., Senior Scientist, American Registry of Pathology, Washington, DC. Gangrene: Soft tissue death from ischemia Usually develops at site of trauma or surgical wound As clostridium grows, it makes gas and toxins that damage tissue Develops suddenly; most at risk have an underlying blood vessel disease (atherosclerosis or arteriosclerosis) C. perfringens can invade the wall of the uterus during improperly performed abortions Develop shock(hypotension), kidney failure, coma, death Air(gas) under skin: can feel crackly sensation as you press on area  Blisters filled with brown-red fluid  Tachycardia  Severe pain  Fever  Jaundice  Foul-smelling odor *Edges of infected wound grow so quickly, changes are seen in minutes  Treatment: debridement, amputation, IV penicillin and clindamycin  generally occurs at wound or surgical site → painful swelling and tissue destruction. Rapidly progressive, often fatal. Anaerobic bacteria infect deep animal bites Pasteurella multocida – normal flora of oral and nasopharyngeal cavity of dogs and cats; may cause septicemia Bartonella henselae – (rickettsia) Cat scratch disease. Relatively common (~20,000 cases in US) – mostly in young – occasionally serious Human bites – normal mouth flora (incl. S. aureus,  hemolytic S. viridans, H. influenza and various anaerobes)        Plague Relapsing Fever Lyme Disease Ehrlichiosis Typhus Epidemic Typhus Spotted Fevers “Black death”: Yersinia pestis: gram negative Reservoir: Rats, ground squirrels, and prairie dogs Vector: infected fleas  Plague suit   Bubonic plague: Bacterial growth in blood and lymph Septicemia plague: Septic shock Pneumonic plague: Bacteria in the lungs     Swollen lymph nodes(“buboes”); develop a week after bite; size of chicken egg Fever and chills Headache Muscle aches       Bacteria multiply in bloodstream Fever Abdominal pain Bleeding from mouth, nose, rectum, or under skin Shock Gangrene       Spread person to person by droplet Cough with bloody sputum Dyspnea High fever Nausea and vomiting Fatal if antibiotics are started in first day Fig 23.11 Femoral bubo: Most common site of, tender, swollen, lymph node in patients with plague Bipolar staining: Dark stained bipolar ends in Wright's stain (blood from plague victim) Zoonosis(transmitted from animals to humans) caused by Borrelia burgdorferi Reservoir: mice, deer; Vector: blacklegged ticks 3 stages with various symptoms 1. Early localized stage: Bull’s eye rash = erythema migrans ; flu-like symptoms and swollen lymph nodes 2. Early disseminated stage: Heart and Nervous system symptoms; also skin and joints affected Diagnosis ◦ Symptoms alone(rash): often misdiagnosis ◦ In most cases not possible to isolate and culture B. burgdorferi → indirect serological tests (ELISA and Western blot) Prevention: insect repellent Treatment in through several weeks of Ixodes pacificus Life Cycle of the Tick Compare to Fig 23.13a First described in 1986 Caused by Ehrlichia species and transmitted by ticks 2 types:  Monocytic Ehrlichiosis (HME)  granulocytic Ehrlichiosis (HGE) Treated with doxycycline HME and HGE Lyme Disease and Ehrlichiosis  Rickettsia rickettsii  Vector: ticks    Characteristic hemorrhagic rash – maculopapular – starts on palms and soles Can damage vital organs; potentially fatal Doxycycline should be started before 5th day of symptoms Rocky Mountain Wood Tick (Dermacentor andersoni) Red structures indicate immunohistological staining of Rickettsia rickettsii in endothelial cells of a blood vessel from a patient with fatal RMSF Figure 23.16  Infectious Mononucleosis  Viral Hemorrhagic Fevers      “Kissing disease” – caused by Epstein-Barr virus (EBV) of Herpesviridae, also known as Well-established relationship between Mono and oncogenesis (Burkitt’s Lymphoma etc.) Virus multiplies in parotid glands and is present in saliva. – Transmission via saliva Most people (~95%) infected. Childhood infection usually asymptomatic. Adolescent infection → Mononucleosis. Characteristic triad: fever, pharyngitis, and lymphadenopathy (+spleno- and hepatomegaly) lasting for 1 to 4 weeks. Triad Swollen lymph nodes, sore throat, fatigue and headache are some of the symptoms of mononucleosis. It is generally self-limiting and most patients can recover in 4 to 6 weeks without medications. Young adults present with fever, pharyngitis, lymphadenopathy, and tonsillitis. Pathogenesis of infectious mononucleosis Enveloped RNA viruses: Arenaviruses, filoviruses, bunyaviruses, and flaviviruses  Viruses geographically restricted to where their host species live  Unsure exactly how spread; does not have to be through a bite  Human cases or outbreaks sporadic and irregular. Not easily predictable ➢ Marburg VHF: 1967 outbreak in Marburg – imported from Africa;seen in bats; Mortality rate 25% ➢ Ebola HF: 1995 major outbreaks in Zaire and Sudan; Mortality rate 50 – 90%  Caused by arbovirus (flaviviridae) transmitted by mosquitoes Direct damage to liver and heart → jaundice, hemorrhaging, weak heart → circulatory and kidney failure African and American tropical jungles Diagnosis: test for presence of virus-neutralizing antibodies No treatment Highly effective attenuated vaccine Korean hemorrhagic fever caused by Hantaan virus of Bunyaviridae HPS first reported in US in spring of 1993. Transmission through urine, droppings, or saliva of infected rodents → humans breathe in aerosolized virus. No person to person transmission in US Sudden respiratory failure Mortality rate > 35%
American Trypanosomiasis (Chagas’
Disease)
 Toxoplasmosis
 Malaria
 Babesiosis

Trypanosoma cruzi (parasite)
Reservoir: Rodents, opossums,
armadillos
Vector: night feeding reduviid bugs (kissing
bugs)
Symptoms in 1% of infected. Acute phase (fever
etc.) to chronic phase (heart damage);
parasites found in the blood
Course of trypanosome infection: emergence of variant surface
glycoproteins (VSG) – Host antibodies indicated with Y’s.
Millions in Latin America affected. No cure
and little effective treatment
Romaña’s sign: early sign of Chagas
disease.
→ Unilateral severe conjunctivitis, swelling of
eyelid, inflammation of tear
gland, swelling of regional
lymph nodes.
May produced a dilated heart
that doesn’t pump well
Toxoplasma gondii
> 60 million people infected in US (mostly
asymptomatic)
Zoonosis – Transmission via undercooked meat,
cat feces, drinking water. Flu-like symptoms
Can cross placenta  Congenital risk (TORCH) →
brain damage or vision problems
Risk of new infection or reactivation in the
immunosuppressed
T. gondii undergoes sexual reproduction in the
intestinal tract of domestic cats, and oocysts are
eliminated in cat feces.
Toxoplasmosis can be identified by serological
tests, but interpretation of the results is
uncertain.




Leading cause of death from food borne
illnesses in US
Millions carry parasite, but asymptomatic due
to immune system keeping parasite from
causing …
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