DISEASE, CLINICAL INCUBATION DIAGNOSTIC TESTS MANAGEMENT COMPLICATIONS NURSING CONSIDERATIONS

INFECTIOUS MANIFESTATIONS PERIOD

AGENT, AND
TRANSMISSION
Lyme Disease  Erythema  3-32 days  IFA, ELISA, and  Doxycycline 100  Meningeal irritation  Not communicable
Borrelia migrans (the after tick immunoblotting mg bid or leading to meningitis, person to person.
burgdorferi first exposure techniques of amoxicillin 500 encephalitis  Preventive measures
Carried by manifestation in blood are helpful mg tid P.O. for  Chorea include: (a) avoiding
Ixodid ticks 60% of patients but not always 14 to 21 days.  Atrioventricular block tick-infested areas;
(affecting and the best reliable.  Ceftriaxone, (b) wearing
 Chronic neurologic
primarily mice clinical marker):  Biopsies of skin cefotaxime, protective clothing;
manifestations, such as
and deer) annular skin lesions yield the penicillin G I.V. (c) using insect
encephalopathy,
lesion that organism in regimens for 3 to polyneuropathy repellent; (d)
appears at the about 80% of 4 weeks for  Chronic arthritis inspecting the body
site of the tick cases. disseminated and clothing daily
bite and expands infection. while working or
over a period of playing in tick-
days to weeks infested areas.
and develops  Ticks should be
central clearing removed from the
 Flulike skin with tweezers
symptoms—ma or forceps, using
laise, fever, gentle, steady
headache, stiff traction to avoid
neck, myalgia, leaving mouth parts
migratory in the skin. Protect
arthralgias, hands with gloves,
lymphoadenopat cloth, or tissue when
hy removing ticks.
 Weeks to
months after
onset: limb
weakness, facial
 palsy, cerebellar
ataxia, and
aseptic
meningitis

Viral Infections  Acute, usually  1-3 days  Isolation of virus  Aspirin or  Secondary bacterial  Highly infectious
Influenza Types self-limited from pharyngeal acetaminophen pneumonia via aerosolization or
A, B, and C, febrile illness or nasal for control of  Primary viral droplets from the
with Many associated with secretions or fever. pneumonia respiratory tract of
Subtypes upper and lower identification of  Amantadine or  During major infected persons.
respiratory viral antigens in rimantadine as epidemics, severe  Best means of
Spread by infection nasopharyngeal prophylaxis for illness and death occur, prevention—annual
droplets or  Characterized cells by high-risk persons influenza
primarily among
direct contact by sudden onset fluorescent for influenza type vaccination,
elderly people and the
with articles antibody test or
of fever, chills A. chronically ill. particularly for high-
recently ELISA.
or rigors,  Amantadine or  Acute myositis risk groups and
contaminated
headache, rimantadine is characterized by calf HCWs (see Table
by respiratory
malaise, given as therapy tenderness may 31-2, page 1034).
secretions.
myalgia, and within 24-48 develop, particularly  Maintain bed rest for
nonproductive hours of with type B infections. at least 48 hours
cough, typically symptoms of after fever subsides.
followed by sore influenza A Encourage fluids.
throat, nasal illness and given Report symptoms of
congestion, and for 3-5 days; secondary infection
rhinorrhea. reduces (purulent nasal
Conjunctival symptoms. drainage or sputum,
injection,  Zanamivir ear pain, increase in
abdominal pain, inhalation or oral fever) to health care
and vomiting oseltamivir, provider.
can occur. started within 36  Continue antibiotics
hours of prescribed for
symptoms and bacterial
 continued for 5 complications for
days, can shorten defined time period
the duration and (usually 7-10 days).
possibly reduce
the incidence of
complications.
 Agent-specific
antibiotics for
bacterial
complications.

Mononucleosis  Fever, exudative  4-6 weeks  Lymphocytosis  Supportive  Splenic rupture  Person-to-person
Epstein-Barr pharyngitis, >50%, with more therapy to  Thrombocytopenia spread via saliva is
virus (EBV) fatigue, than 10% being include aspirin or purpura prolonged—can be
Spread by splenomegaly, atypical acetaminophen  Hemolytic anemia months to a year or
direct contact and lymphocytes, for sore throat  Pericarditis, more after infection.
(oropharyngeal) lymphadenopath abnormalities in and fever, bed  Convalescence may
myocarditis
with infected y liver function rest. be as long as several
 Aseptic meningitis,
person. tests (AST), or  Surgical removal months.
encephalitis, Guillain-
an elevated of the spleen for Barré syndrome  Patients with
heterophile splenic rupture.  Hepatitis splenomegaly
antibody titer.  Corticosteroids  Orchitis should avoid activity
Not useful for severe that may increase
diagnostic tool in neurologic the risk of injury to
children younger complications, the spleen, such as
than age 5. If thrombocytopeni contact sports and
negative, EBV, a purpura, heavy lifting.
IgM, and IgA hemolytic  Report any excess
may be anemia, or severe bruising or bleeding,
performed. oropharyngeal jaundice, or
involvement and abnormal CNS
airway
 encroachment. functioning.

Cytomegalovir  Ordinarily  3-12  Virus culture.  Supportive  Congenital infection  Patients with
us (CMV) asymptomatic, weeks  CMV antigen therapy for leads to neurologic splenomegaly
Spread by especially in following detection. control of fever defects (severe mental should avoid activity
direct contact children transfusio  CMV and sore throat. retardation, that may increase
with mucous  Clinical disease n; 1- 4 deoxyribonucleic  Immune gamma microcephaly, the risk of injury to
membranes, in adolescents months acid detection by globulin as a psychomotor the spleen, such as
secretions, and and adults after PCR. prophylactic retardation, hearing contact sports and
excretions; by resembles transplant agent for patients loss, and evidence of heavy lifting.
 Serologic studies
sexual mononucleosis. ation; in undergoing chronic liver disease).  Report any excess
for CMV-
intercourse; neonates, 
 More extensive specific IgM marrow Immunocompromised bruising or bleeding,
and by blood 3-12
organ antibody or a transplantation. host—progressive jaundice, or
transfusion and weeks
involvement in fourfold rise in  Ganciclovir pneumonitis, hemolytic abnormal CNS
organ
the following titer. (Foscarnet) for anemia, hepatitis, functioning.
transplant. A
immunosuppres delivery- retinitis in HIV- pericarditis, and GI  Pregnant personnel
fetus may be
sed host: colitis, produced infected ulceration should be counseled
infected in
pneumonitis, infection individuals. about potential risks
utero or at
delivery. and retinitis may and urged to practice
occur. good hygiene
 GI tract (especially hand
disorders hygiene) and to
 Congenital follow standard
infections are precautions.
serious and lead
to irreversible
CNS and liver
damage.
Rabies
Rabies virus  Initial  Usually 4-  Specific FA  Rabies is a  Almost invariably  Contact isolation for
Spread by symptoms 6 weeks; staining of brain disease best progresses to death, respiratory
direct contact nonspecific and if the bite tissue or by virus controlled usually due to secretions,
of virus-laden consist of a is on the isolation, or FA through respiratory paralysis. especially saliva, for
saliva of a rabid sense of head staining of frozen prevention rather duration of illness.
animal into a apprehension, rather skin sections than treatment.  Preexposure
bite or scratch; malaise, fatigue, than on an taken from back  Supportive prophylaxis should
may also be headache, and extremity, of neck. therapy to be offered to persons
transmitted via fever; possible duration is manage at high risk for
transplanted pain or shorter neurologic, exposure to rabies,
corneas and, paresthesia at due to respiratory, and such as
possibly, other
the site of bite's cardiac veterinarians,
organs,
exposure proximity symptoms. veterinary students,
removed from
 Usually lasts 2-6 to the  Use of high-dose wildlife personnel,
patients dying
days brain passive rabies park rangers, staff of
of undiagnosed
rabies.  Progresses to immunoglobulin kennels, and
paresis or or vaccine after laboratory workers
paralysis, the onset of working with rabies.
hydrophobia, illness has not  Bites from animals,
eventually to been successful. particularly dogs and
delirium and cats, should be
convulsions thoroughly flushed
 Respiratory and cleaned with
arrest usually soap and water
occurs, followed immediately.
by death. Wounds should not
be sutured unless
unavoidable.
 Domestic dogs and
cats should be
quarantined for 10
days.
  Wild animal carriers
include skunks, bats,
foxes, coyotes,
raccoons, bobcats,
wolves, jackals, and
other carnivores.
 Postexposure
prophylaxis must
include the use of
human rabies
immunoglobulin
followed by Human
Diploid Cell
Vaccine (HDCV)
unless preexposure
prophylaxis with
HDCV had been
administered.
HDCV requires 5
doses I.M. (fifth
dose 35 days after
the first).

Protozoan  Malarial  7 days to  Diagnosis of  General  Shock  Symptoms may

Infections paroxysm 10 malaria rests on management  Acute encephalopathy recur; instruct
Malaria characterized by months, the should include:  Renal failure patient to report
Plasmodium variations of depending demonstration of  I.V. fluids and  Hepatic failure recurrence
vivax, P. high fever, on the parasites in electrolytes immediately.
 Cerebral and
falciparum, P. chills, sweats, strain stained (restrict fluids in  Travelers to malaria-
pulmonary edema
malariae, and headache, rigor, peripheral blood cerebral edema). endemic countries
P. ovale  Disseminated
cough, diarrhea, smears. Repeated  Assisted intravascular should follow
Malaria is respiratory smears may be preventive
ventilation with coagulation
vector-borne distress, nausea, necessary. pulmonary  Coma measures:
through the vomiting, and  Liver function edema.  Death  Proper use of
bite of female arthralgia tests reveal  Dialysis in renal mosquito netting at
Anopheles  As infection elevated failure. night.
mosquito; may becomes transaminase  Transfusions in  Clothing that
be congenital synchronized, level and anemia. minimizes contact
or transmitted fever and increase in  Chemotherapy is with mosquitoes.
by transfusions paroxysms are indirect serum based on  Use of insect
or dirty generally cyclic. bilirubin. infecting species, repellents.
needles.  Moderate possible drug  Chemoprophylaxis
splenomegaly resistance and with suppressive
and tender severity of drugs, based on local
hepatomegaly disease. Drugs endemicity and
used include resistance.
chloroquine
phosphate,
quinidine
gluconate,
quinine
dihydrochloride/s
ulfate plus
doxycycline,
tetracycline, or
clindamycin.

Amebiasis
Entamoeba  Intestinal  Usually 2-  Microscopic  Treatment  Amebic granulomata of  Instruct patient to
histolytica disease: may be 4 weeks; examination of regimens depend intestinal wall wash hands
Transmitted by asymptomatic or however, stool, rectal on the severity of  Penile lesions in active thoroughly after
ingestion of mild symptoms may be as secretions; the illness. homosexuals defecating to prevent
fecally  Metronidazole  Abscess of lung, brain,
contaminated such as short as 3 positive for followed by or pericardium transmission to
food or water, abdominal days or as trophozoites or iodoquinol,  Hepatic abscess others.
or sexually by distention, long as cysts of paromomycin, or  Household and
oral-anal flatulence, months or protozoan. diloxanide sexual contacts
contact. constipation even years Examination furoate. should seek medical
and, should be done  Abscess may examination and
occasionally, on fresh require surgical treatment.
loose stools specimens. aspiration.  Instruct patient on
 Nondysenteric safer sex practices.
colitis: recurring  Travelers to areas
episodes of where the water
loose stools; supply is not
vague chemically treated or
abdominal pain; protected from
hemorrhoids sewage should boil
with occasional all water used for
rectal bleeding drinking and
 Dysenteric cooking.
colitis:
abdominal
cramps and
diarrhea
containing
blood and
mucus,
alternating with
periods of
constipation or
remission
Giardiasis  Acute: explosive,  Usually 7-  Examination of  Metronidazole is  Chronic diarrhea  Instruct patient to
Giardia lamblia watery diarrheal 10 days, but stool; positive for the drug of choice  Malabsorption leading to wash hands
Transmitted by stool; abdominal can be 1-4 cysts or (5- to 7-day significant weight loss, thoroughly after
ingestion of cramping and weeks trophozoites of course). failure to thrive, and defecating to
fecally flatulence; nausea the G. lamblia  Relapse is anemia prevent
contaminated  Chronic: protozoan. common in transmission to
water or food, intermittent foul-  Detection of G. immunocompromi others.
or sexually by smelling diarrheal lamblia antigen sed patients; may  Household and
anal stools; increased by EIA. need prolonged sexual contacts
intercourse. flatulence and therapy. should seek
distention; medical
anorexia examination and
treatment.
 Instruct patient
on safer sex
practices.
 Travelers to areas
where the water
supply is not
chemically
treated or
protected from
sewage should
boil all water
used for drinking
and cooking.


Hookworm  Chronic,  A few  Microscopic  Albendazole,  Immunosuppressed  Follow-up
Ancylostoma debilitating weeks to examination of mebendazole, or individuals septicemia examination of
duodenale, disease leading to many cultured stool pyrantel pamoate. and death the stool 2 weeks
Necator iron deficiency months, specimen positive  Iron therapy to  In children with heavy, after therapy is
americanus and hypochromic, depending for hookworm long-term necessary. Repeat
Transmitted by microcytic on intensity eggs; however, do correct anemia. infection—hypoproteine therapy if heavy
entry into the anemia due to of infection not appear until 8- mia, mental and physical worm burden
skin of soil intestinal blood 12 weeks after retardation persists.
contaminated loss to the infestation.  Nutrition
with feces from hookworm counseling and
humans, cats, taking iron
and dogs. supplements are
recommended
until deficiencies
are corrected.
 Family members
and close
contacts should
be examined and
treated for
parasites.
 Educate public
about dangers of
soil
contamination
and importance
of wearing shoes.

Trichinellosis,  Clinical disease is  5-45 days,  Skeletal muscle  Mebendazole and  Cardiac and  Instruct patient to
Trichinosis highly variable, depending biopsy not earlier albendazole. neurologic—third to thoroughly wash
Trichinella from inapparent on the than 10 days after  Corticosteroids sixth week hands after
spiralis infection to a number of exposure to added for severe  Myocardial failure first to defecation.
Transmitted by fulminating fatal worms infection symptoms. second or fourth to eighth  Proper cooking
ingestion of raw disease. involved; demonstrates the  Supportive therapy weeks of pork to 160°
or insufficiently  During first usually 8-15 Trichinella larvae. for respiratory, F (71° C) is
cooked meat, week: abdominal days after  Serology; necessary.
neurologic, and
chiefly pork and ingestion of
discomfort, complement cardiac sequelae.  Family members
pork products. nausea, vomiting infected fixation, and close
and, possibly, meat fluorescent contacts of
diarrhea antibody fourfold patients should
 Early signs: increase in be examined and
sudden antibody titer 3 treated for
appearance of weeks after parasites.
muscle soreness infection.
and pain  Differential WBC
accompanied by count increase in
edema of upper eosinophils to
eyelids, pain, 70%.
photophobia;  Increased
ocular signs may concentration of
progress to muscle enzymes.
subconjunctival,
subungual, and
retinal
hemorrhages
 Remittent fever is
usual, sometimes
as high as 104°
F (40° C)

Fungal  May be  Variable,  Complement  Amphotericin B,  Chronic pulmonary  Investigation for

Infections asymptomatic but usually fixation shows ketoconazole, and disease the common
Histoplasmosis with only 1-3 weeks increase in itraconazole.  Pneumonitis, meningitis, source of
Histoplasma hypersensitivity after antibodies within  Corticosteroids lymphadenopathy, infection should
capsulatum to histoplasmin. exposure 3-4 weeks; and pancytopenia be done in
Transmitted by  Four other fourfold increase diphenhydramine  Hepatosplenomegaly outbreaks.
inhalation of clinical forms of suggests disease (Benadryl) to  Educate public to
 Death
airborne disease: progression. minimize the minimize
particles from Acute benign  Visualization of adverse effects of exposure to dust
soil or dust that respiratory mild fungus in amphotericin. in chicken coops,
harbor chicken respiratory illness specially stained attics, and caves
or other bird to temporary flu- smears of ulcer use protective
droppings or like illness exudates, bone masks, gloves,
bat droppings.  Acute marrow, sputum, and disposable
disseminated or blood. clothing.
debilitating fever,  Fungal culture or
GI symptoms, enzyme
bone marrow immunoassay
suppression, positive for H.
hepatosplenomeg capsulatum or
aly, and detection of
lymphadenopathy antigen by EIA.
; usually fatal in  Chest X-ray acute
infants and findings: transient
immunocomprom parenchymal
ised unless pulmonary
treated infiltrates
 Chronic resembling lobar
disseminated pneumonia;
intermittent fever, chronic:
weight loss, progressively
weakness, enlarging areas of
hepatosplenomeg necrosis with or
aly, hematologic without
abnormalities, cavitation.
and focal disease,
such as
endocarditis,
meningitis, and
mucosal ulcers;
usually fatal
unless treated
 Chronic
pulmonary
disease resembles
pulmonary
tuberculosis with
cavitation; occurs
most commonly
with underlying
emphysema

 Usually 8-  Culture of urine or  I.V. fluids and  Endocarditis  Relapses occur in

Bacterial 14 days; stool positive for electrolytes.  Meningitis 5% to 10% of
Infections  Systemic however, S. typhi during  Bed rest.  Pneumonia untreated cases
Typhoid Fever insidious onset of may be as second week.  Avoid  Pyelonephritis and may be more
Salmonella fever, severe little as 3  Culture of blood antispasmodics,  Osteomyelitis common after
typhi headache, days or as positive for S. laxatives, and antibiotic
Transmitted by
 Intestinal perforation and
malaise, anorexia, long as 3 typhi during first salicylates. hemorrhage therapy. Report
ingestion of bradycardia, and months week. symptoms
 Ampicillin,  Septicemia
food and water splenomegaly immediately.
 Bone marrow amoxicillin,  Parotitis
contaminated 
 Ulceration of the culture. cefotaxime, Instruct patient to
by feces, urine,  Cerebral dysfunction
distal ileum; can ceftriaxone, wash hands
or sewage, or
progress to chloramphenicol, thoroughly after
by direct
hemorrhage or co-trimoxazole, or defecation and
contact with
perforation a fluoroquinolone. before preparing
excrement.
 Immunization is food.
advised for  Educate
travelers to areas public—control
of high flies, avoid raw
endemicity. shellfish,
thoroughly rinse
raw fruits and
 vegetables.
 Family and close
contacts should
be examined and
treated.
 Typhoid is
communicable as
long as the
infective
organism is in the
feces or urine,
which may
persist for
months or, in
2%-5% of cases,
permanently.