Disturbances in

Inflammatory and
Immunology
Prepared by: Michael John R. Victoria, RN
Infectious Disorder in
Children
 Measles (Rubeola)
• An acute, highly contagious, vaccine
preventable viral infection w/ a prodromal
stage charac by catarrhal symptons and koplik
spots on buccal mucous membrane
• Dusky red blotchy rash appear on the skin on
the 4th day on the face and body
• “RUBEOLA”- red spots on the body
• Agent: RNA Paramyxovirus
• MOT: droplet
• Incubation: 10 days
• Communicability- 4 days before and 5 days
after rash appears
 S&S
• Upper RTI
• Koplik Spots- pathognomonic sx
• Irritable, skin rash for 6 days the fades
 TX
• Symptomatic tx
• Antibiotic- if w/ pneumonia
• Isolation for 7 days from onset of rash
• Immunization- 9-12 mos., SQ, single dose, w/
MMR; S.E.-fever
• X pregnancy
 German Measles/ Rubella
• “Redness”
• Agent: RNA Togavirus
• Incubation- 2-3 wks
• Communicability- 1 wk before to 1 wk after
rash appears
• MOT- droplet, person to person contact
 S&S
• Enlarged lymph nodes
• Maculo-papular rash on the face and trunk
• Petechial lesions on the soft palate
• Fever- subsides on the 2nd day
 TX
• Isolation, hygiene
• Immunization- live attenuated vaccine; SQ,
given w/MMR
• X pregnancy
 Diff lesions of the skin
• Macule-flat, circumscribed area, no elevation, up 2 cm
• Papule- circumscribed solid and elevated lesion, up to 1
cm
• Wheal- slightly irregular, transient, superficial
elevation of the skin w/palpable magin (ex. Hive)
• Vesicle- circumscribed elevation filled w/ serous fluid
less than 1cm
• Bulla- a vesicle larger than 1 cm
• Pustule- vesicle or bulla filled w/ pus
• Nodule- solid, elevated lesion extending deeper into
dermis, 1-2 cm
 Chickenpox
• Primary disease of children
• Occurs in epidemics
• Agent- Human alpha herpes Varicella 3
• Incubation- 2wks
• Communicability- 2 days before and 5 days
after rash
• MOT- droplet, person contact
 S&S
• Fever
• Rapid Pleomorphic rash at a given point of
time, centripetal (more in center)
• Mortality- none, (except for complications)
 TX
• Symptomatic
• Isolation
• Hygiene
• Chickenpox Vaccine
• V.Z.I.G.(Varicella Zoster Immunoglobulin)-
before 72 hours of exposure
 Herpes Zoster (Shingles)
• Acute viral infexn of the nervous sys
• Causes an inflammatory rxn in isolated spinal
and cranial sensory ganglia and post gray
matter of the SC
• Contagious esp to those who has not had
varicella or those who are
immunocompromised
• Agent: varicella-zoster virus
 S&S
• Neuralgic pain, malaise, itching or burning
• Vesicles along peripheral sensory nerves,
unilateral, primarily on trunk, thorax or face
 TX
• Acetic acid or white petrolatum on lesions
• Meds
– Analgesics
– Corticosteroids
– Acyclovir (zovivax)- reduces severity when given
early
 Herpes Simplex Virus, Type 1
• Causes cold sores, fever blisters, canker sores
• Common in women

• S&S
– Cluster of vesicles (may ulcerate or crust), burning, itching
and tingling w/c usually appears on lip or cheek
• TX
– Keep lesions dry
– Antibiotics on lesions
 Poliomyelitis
• AKA infantile paralysis
• Patho: Infection of polio virus maybe asymptomatic
or w/ fever meningitis/ encephalitis anterior horn
cell infection lower motor neurons paralysis either
death or recovery if recovers, either w/ complete
recovery or incomplete recovery lame
• MOT- fecal-oral route
• Communicability- 1 wk before and 3 wks after
symtoms appear
• Incubation- 1-2 wks
 S&S
• Mild fever, H/A
• Weakness in one muscle group and can
progress to other muscle group
• Respiratory failure if muscle for breathing is
affected
 TX
• Vaccine
– Oral (Sabin)-3 drops per dose
• Use dropper
• Tilt the infants head back
• If child vomits, repeat
• 3 or 5 dose
– Injectable- IM
• Symptomatic
 Rabies
• Infects CNS and salivary gland of mammals
• Attacks all warm-blooded animals (dog, cat,
bats)
• Agent: Rabdovirus
• Transmitted through saliva by bite or lick on
aberrations
• Incubation period= 4-8 wks but may vary from
9 days to months; severe bites on head or neck
is associated w/ shorter IP
 S&S
• Paresthesias on site of bite
• Fever 1- 8 days + signs of anxiousness
• Hydrophobia
• Delusion, hallucination, spitting, biting, mania,
hyperpyrexia
• Mortality is 100%!!!
 TX
• Clean wound w/ soap and running water
• Isolate dog, for observation
• Anti-Rabies Vaccine ASAP or not more than 5 days
after the bite!!!
• Once symptoms appeared, death is imminent, tx
would only be palliative
– Muscle relaxants (Valium)
– NTN through IV or gastrostomy
– Dark and quiet room
– Care givers should use protective devices like goggles,
gloves mask to protect from client’s secretions
 Meningitis
• Inflammation of the meninges of the brain &
SC
• Caused by bacteria, virus or other microorg;
common- meningococcus, pnemococcus, H.
Influenzae, streptococcus
• May reach CNS via blood, CSF, lymph; direct
extension (skull fracture); oral or
nasopharyngeal route
 S&S
• headache, fever, changes in LOC, behavioral
changes
• nuchal rigidity (stiff neck), (+)Kernig's sign,
(+)Brudzinski’s sign, opisthotonos (head and
heels bent backward and body arched forward)
• Photophobia, vomiting, seizures
 DX
• LP- inc pressure, elevated WBC and CHON,
dec glucose,
– (+) bacteria on culture
 TX
• Prevention by vaccination against H. influenzae and S.
pnuemoniae for all children and at-risk adults

• Early administration of high doses of appropriate IV

antibiotics for bacterial meningitis

• Dexamethasone

• Treatment dehydration, shock, and seizures

• Bedrest- keep room quiet and dark if client had photophobia

 Mumps
• Accdg to hippocrates it is the “swelling behind ear
accompanied by swelling of testes.
• Common in 5-14 y/o, B>G
• Mortality is not common except if complications like
enceph, meningitis or orchitis occurs
• Agent: RNA myxovirus
• MOT: droplet/ direct salivary spread
• IP: 16-18 days
• Communicability- 1wk before and 1 wk after
symptom appears
 S&S
• Fever and malaise
• Parotid swelling (uni or bilateral)
• In some cases, salivary gland is also infected
• Oophoritis and orchitis are complication
manifested by abdominal pain or testicular
pain
 TX
• Symptomatic tx
• If w/ ochitis or oophoritis- steroids
• Isolation
• Proper disinfection if used articles by the
client
• Vaccine- MMR
 DHF
• Bleedind d/o w/c can be spread by the aedes
mosquito.
• The disease causes damage to blood and blood
vessels that causes bleeeding
• Common in rainy season
 S&S
• Fever that may last for 1 wk
• Bleeding
– Epistaxis, petechiae on skin, hemoptysis, melena,
and other sx of bleeding
• Cold and clammy skin
• Abdominal pain
• Shock if not treated early death
 DX
• Torniquet test
• PA
• Capillary refill test
 TX
• Fluids
– Force fluids, IVF
• X ASA for fever
• Assess hypoglycemia
• Seek medical attention (if w/ severe bleeding)
• BT
Bacterial Infections
1. Streptococcal Infection
 Impetigo
• Superficial bacterial infection of the outer
layers of the skin (staph or streptococcus)
• Common in toddlers or preshoolers, R/T poor
sanitation
• Very contagious
 S&S
• Lesions, macule, papule, vesicles that rupture
causing superficial moist erosion
• Once dried, it will leave a honey colored crust
• Spreads peripherally
• Most common in face, axilla and extrm
• pruritus
 TX
• Topical and systemic antibiotics
• Skin isolation
• Burrow’s sol’n- softens skin and crusts
• Remove crust gently
• Cover draining lesions to prevent spread of
infexn
• Proper hygiene techniques
2. Staphylococcal
Infection
 Diptheria
• Acute bacterial infection of Tonsil, pharynx larynx
and nasal mucous membrane
• Local infection destroys tissue and distal infection by
toxin affects vital organs
• Death by airway obstruction, myocarditis or
polyneuritis
• C.A: C. diptheriae
• MOT: droplet, contact
• Communicability: 12-18 days after onset
• I.P.: 2- 6 days
• Milk contamination can cause epidemic
 S&S
• Fever, tachycardia
• Elevated greyish-green membrane on the tonsils
• Bull neck and enlarged lymph node
• Blood stained nasal discharge
• Husky voice and high pitched cough
• Circulatory failure in 10 days if untreated
• Complications: laryngeal obstruction,
myocarditis, peripheral neuropathy
 TX
• Antitoxin (anti–diptheria serum) IM
– Watch out for allergic rxn
• Antibiotic- Penicillin, amox, erythro
• Isolation
• Vaccine- DPT IM
– 6 wks after birth X 3 doses, 1 mo. Interval
– Fever=normal
 Whooping cough/Pertussis
• C.A.: Bordetella pertussis
• Patho: short febrile tracheobronchitis severe
episodic paroxysmal coughing bouts
laryngospasm intercostal muscle
tearfractured rib
• I.P.: 1 wk
• MOT: droplet, naso-pharyngeal secretions
• Complications: PNM, malNTN, conjunctival
bleeding, rectal prolapse, encephalopathy
 S&S
• Cough (whoop)
• Vomiting
• After coughing, apnea may occur w/c leads to
unconsciousness
 TX
• Isolation
• Antibiotics- erythromycin, ampi, cotri, tetra
• Vaccines- DPT
 Anthrax
• Known as disease of livestock
• C.A.: Bacillus anthracis
• I.P.: 1-7 days
• MOT:
– through cut or abrasion of skin
– Through contaminated meat
– Inhalation of spores
 S&S
• Papule and vesicle at the site of inoculation
w/c will develop in black eschar followed by
hard edematous swelling of deeper adjacent
tissues
• Pain on site
• If GI anthrax= N,V, anorexia, fever abdo pain
• If inhalation= dyspnea, cough, HA, pleural eff
• Death can occur rapidly
 TX
• Early dx and tx is impt!
• Antibiotics
• Fluids
• Care givers needs to take prophylaxis w/
Ciprofloxacin 500mg BID
• Avoid dairy products of infected animals
• Burning and bury deeply infected animals
 Tetanus/ Lockjaw
• Produces generalized or localized hypertonia
of skeletal muscles accompanied by muscle
spasm
• C.A.: Clostridium Tetani (usualy found in
soils)
• Neonatal tetanus- mortality for newborns
• I.P.: 6-10 days
 TX
• Antitoxin
– Human tetnus antitoxin 3000 I.U. IV
• Debridement of wound
• antibiotic
• Control spasm
– Quiet room, avoid noise, light
– valium
• Vaccine
– DPT
 Lyme Disease
• C.A.: Borrelia burgdorferi
• Transmitted by a deer tick, requires 24 hour
attachment
• Most common in summer and early fall
• Involves the skin, Nervous System, joints
• I.P.: 3days -1 month
 S&S
• Stage 1
– Skin rash (erythema) starting 3 days to 1 mo. Past
tick bite lasting about 3 wks
– Common on thighs, axilla
– Malaise, fatigue, HA, stiff neck, fever
• Stage 2
– May occur months to years after initial disease
– Neuro: facial palsies, sensory losses, arthritis, focal
weakness
 TX
• Antibiotic for 2-3 wks
• X high risk areas
• Wear long pants, long sleeved shirt, high socks
if walking in grassy areas
• Use insect repellant for skin
• After exposure, check for ticks
• REMOVE TICK BY PULLING STRAIGHT
OUT W/ TWEEZERS!!!
3. Parasitic Infection
 Head Lice/ Pediculosis
• Parasitic infestation
• MOT: close physical contact
• Common in school-age children, those w/ long
hairs
 S&S
• White eggs (nits) firmly attached to base of
hair shafts
• Itching of scalp
 TX
• Skin isolation prec (head coverings, gloves)
• Special shampoo followed by use of fine-tooth
comb
• X sharing of brushes/combs
 Scabies
• One of the oldest diseases of poor sanitation
• AKA itchmite
• Female mite(Sarcoptes scabiei) is visible to
naked eye. He fertilized female makes a
burrow in the layers of the skin
• Multiplies w/ in 4 mos.
• MOT: person to person contact
 S&S
• Itchy papule at the site of infestation
• By scratching, it becomes pustule
• Common in axilla, waist, back of legs, inner
thigh
 TX
• Benzyl benzoate- applied from neck down
after bath and dry, followed on the next day
and on the 6th day.
• Secondary infection is treated w/ penicillin
• Crotamiton for 5 days- suitable for infants bec
it has anti-pruritic action
• Tetmasol 5% soln
 Roundworm/ Ascariasis
• Most common nad most widespread human
intestinal infection.
• C.A.: Ascaris lumbricoides
• MOT: Fecal-oral route
• I.P: about 50 days
 S&S
• Abdominal pain
• malNTN
• Fever, cough, dyspnea
• If circulating larva is present, d/o of the brain, heart
and kidney

• DX:
– Direct exam
– Stool exam/ Scotch test tape
– xray
 TX
• Anti-helminthics
– Metronidazole
– Mebendazole 100 mg BID
• hygiene
 Pinworms
• S&S
– Anal irritation, itching, disturbed sleep
• DX
– same
• TX
– same
 Hookworm
• C.A.: Ancylostoma duodenale, Necator
Americanus
• MOT: infective stage of larva enter through
skin, breastfeeding (hypobiosis)
• I.P.: few weeks to months
• Eggs pass out of the feces
 S&S
• Ground itch, dermatitis
• If in lungs, cough w/ hemoptysis
• GI= NV, epig pain,
• Anemia- if w/ heavy infection, may cause
pulmonary eosinophilia
• HypoCHONemia, altered G and D
 TX
• Same
• FeSO4 if w/anemia
• BT
Protozoan Infection
 Amoebiasis
• Clinical condition w/c harbour Entamoeba
hystolitica irrespective wheter the case is
symptomatic (10%) or asymptomatic (90%)
• At risk: immunosuppressed, malNTN,
pregnancy, children
• MOT: fecal-oral
• I.P.: 15 days to few years
 S&S
• Abdo pain
• alternating diarrhea (6-8/day) and constip

• DX
– Stool exam
 TX
• Metronidazole 800mg q8 x 5 days
• For cystic forms, Diloxanide furoate 500 mg
q8 x 10 days
• Hygiene
• sanitation
Fungal Infection
 Ringworm
• Dermatomycosis due to various species of
fungus
• Infected sites:
– Scalp (tinea capitis)
– Body (tinea corporis)
– Feet (tinea pedis)/ athlete’s foot
• MOT: person to person, may be acquired from
animals or soil
 S&S
• Scaly circumscribed patches on the scalp
• Base of hair shafts are invaded by spores of
the fungus causes hair to break off
alopecia
• Spreads in a circular pattern
• Skin: red-ringed patches of vesicle, pain,
scaling, itching
 TX
• Prevention, isolate
• Antifungal ointment
Infectious d/o on Adults
Integumentary
 Acne Vulgaris
• Skin condition assoc w/ inc production of
sebum from sebaceous glands at puberty
• Frequently on the face, neck, shoulders or back
• InterrelatedFactors include: inc activity of
sebaceous gland, stress, meds, menstrual cycle
• There is no evidence to support the value of
eliminating any foods from the diet; if cause
and effect can be established, a particular food
may be eliminated.
 S&S
• Papule, pustule
• Psychologic problems
– Low self-esteem
– Social w/drawal
– Feeling of being “ugly”
 TX
• OTC products
• Proper hygiene
– Handwashing
– Care of face
– Not to prick lesions

• Ointments, antibiotics if indicated

 Psoriasis
• Chronic type of dermatitis that involve
accelerated turnover rate of the epidermal cells
• Pred fx: stress, trauma, infection, change in
climate, genetics
 S&S
• Mild pruritus
• Sharply circumscribed scaling plaques most
common on the scalp, elbows and knees
• Yellow discoloration of the nails
 TX
• Topical corticosteroids
• Coal tar preparation
– Protect from direct sunlight for 24 hours
• UV light
• Antimetabolites (methotrexate)