Amoebiasis and Leptospirosis Virginia Managa

Presented by:Managa, Virginia C.

BSN III

Mr. Robneil Dylan Sanchez DellosaLecturer

Also known as amoebic dysentery.An acute or chronic protozoal infection caused by

Entamoeba hystolitica, initially involves the colon, but may spread to soft tissues, most commonly to the liver or

lungs.

More common in tropical countries, but does occur in Europe: approximately 200 cases a year are reported in the UK. Infection most common in young adults but is

unusual in pre-school children, especially infants. Increased risk is reported in institutions for the mentally

handicapped, amongst gay men and in travelers to developing countries.

Infectious Agent:Entamoeba histolytica (Trophozoites/vegetative form & Cyst)

Reservoir:Humans are the principal reservoir of infection

Portal of Exit:As the trophozoites are carried slowly toward the rectum, they are

encysted & then excreted in the feces.

Transmission: ( direct; oralsex or direct faeco-oral contact )

( non- direct; ingestion of contaminated food & water )

Portal of Entry:Faeco-oral route

Susceptible Host:Infected person or anyone who can be a susceptible host.

Isolating E. histolytica (cysts and trophozoites) in fresh feces or aspirates from abscesses, ulcers, or tissue confirms acute amoebic dysentery.

Diagnosis must distinguish between cancer and amoebiasis with X-rays, sigmoidoscopy, stool examination for amoeba, and cecum palpation.

DIAGNOSTIC EXAMS:

(a)Stool exam (cyst, white and yellow pus with plenty of amoeba)(b) Blood exam (leukocytosis)(c) Proctoscopy/ Sigmoidoscopy

ACUTE AMOEBIC DYSENTERY:•Sudden high temperature of 104˚F to 105˚F (40˚ to 40.6˚C) accompanied by chills & abdominal cramping, profuse, bloody, mucoid diarrhea with tenesmus; & diffuse abdominal tenderness due to rectosigmoid ulcers.

CHRONIC AMOEBIC DYSENTERY:•Intermittent diarrhea that lasts for 1 to 4 weeks, and recurs several times a year. Such diarrhea produces 4 to 8 (or, in severe diarrhea, up to 18) foul-smelling mucus- and blood-tinged stools daily in a pt. with a mild fever, vague abdominal cramps, possible weight loss, tender over the cecum and ascending colon and, when granulomatous tissue covers the entire circumference of the bowel, causes partial or complete obstruction.

EXTRAINTESTINAL FORMS:•Hepatic; pain at the upper right quadrant with tenderness of the liver, jaundice, intermittent fever, loss of weight or anorexia, and abscess may break through the lungs, patient coughs anchovy-sauce sputum.

Hyperthermia

Risk for deficient fluid volume

Impaired skin integrity

Acute pain

Deficient knowledge (Learning Need) regarding

causative/contributing factors and therapeutic needs

PHARMACOLOGICAL•Metronidazole (Flagyl) 800 mg TID × 5 days•Tetracycline 250 mg q 6H•Ampicillin, quinolones, sulfadiazine

NURSING MANAGEMENT(1)Observe isolation and enteric precaution(2)Provide health education and instruct patient to:a.Boil water for drinking or use purified water;b.Avoid washing food from open drum or pail;c.Cover leftover food;d.Wash hands after defecation or before eating; ande.Avoid ground vegetables (lettuce, carrots, and the like).

(1)Health education

(1)Sanitary disposal of feces

(2)Protect, chlorinate, and purify drinking water

(3)Observe meticulous cleanliness in food preparation and food handling

(4)Detection and treatment of carriers

(5)Fly control (they can serve as vector)

A zoonotic infectious disease carried by animals, both domestic and wild, whose urine

contaminates water or food which is ingested or inoculated through the skin.

In the US, approximately 100-200 cases are identified anually; of these 50% occur in Hawaii. The disease tends

to occur most often in the summer and early autumn months. Leptospirosis is an occupational hazard to those

exposed to urine contaminated water as a result of occupation or recreation, like farmers, sewage workers,

vets, miners, soldiers, swimmers, cannoeists, divers, sailors, etc.

Infectious Agent:A spirochete of genus Leptospira (Leptospira interrogans)

Reservoir:Rats, dogs, mice

Portal of Exit:Excreted in the feces and in the urine of infected animals.

Transmission: ( direct; contact with the skin and mucous membrane of infected

urine or carcasses of wild and domestic animals )( non- direct; ingestion of contaminated food and water)

Portal of Entry:Oral route, eyes, open wounds and exposed blood

Susceptible Host:Infected person or anyone who can be a susceptible host.

Diagnosis is based upon a combination of clinical signs and laboratory tests. Microscopically, leptospirosis is an aerobic, gram-negative spirochete tightly coiled around an axial filament. These motile spirochetes are often bent on one or both ends, producing a hook-like appearance.

DIAGNOSTIC EXAMS:

(a) Examination of body fluids and tissues under dark-field microscopy(b) Warthia-Starry or Geimsa stains will reveal leptospire spirochete © Flourescent antibody and microscopic & macroscopic agglutination tests are serologic methods of detection

Classically there is an abrupt onset with:•Headache•Myalgia•Conjuctival suffusion and•Fever

The combination of leptospirosis with jaundice and uraemia is sometimes known as Weil’s disease.

Death is usually associated with renal failure; however, it may be due to myocarditis or massive blood loss.

(1) The symptoms range from severity to asymptomatic fatal outcome.

(2) Clinical course is generally biphasic and the majority of the cases is unicteric.

(3) Three septic stages can be recognized:

a. SEPTIC stage- marked with febrile lasting for 4-7 days. There is an abrupt onset of remittent fever, chills, headache, anorexia, abdominal pain, and severe prostration. There is also respiratory distress & fever subsides by lysis.

ASSESSMENT FINDINGS

b. IMMUNE or TOXIC stage- this stage can be with or without jaundice, and lasts for 4-30 days.

• iritis, headache, meningeal manifestations like disorientation, convulsions, with CSF findings of asptic meningitis

• Oliguria and anuria with progressive renal failure

• Shock, coma, and congestive heart failure are also seen severe cases. Death may occur between the 9th – 16th day.

c. CONVALESCENCE- relapse may occur during the 4th – the 5th week.

Hyperthermia

Risk for deficient fluid volume

Impaired Skin Integrity

Acute pain

Anxiety

PHARMACOLOGICAL•Penicillin G Na•Tetracycline•Peritoneal dialysis•Administration of fluid and electrolyte and blood as indicated

NURSING MANAGEMENT(1)Isolate the patient, urine must be properly disposed of.(2)Keep patient under close surveillance.(3)For home care, dirty places, pools, and stagnant water must be cleaned.(4)Eradicate rats and rodents.

(1)Sanitation in homes, workplaces, and farms is a must.

(2)There is a need for proper drainage system and control of rodents (40%-60% infected).

(3)Animals must be vaccinated (cattle, dogs, cats, and pigs).

(4)Infected humans and pets should be treated.

(5)Information-dissemination campaign must be conducted effectively.

THANK YOU and GOD BLESS !!!