Shigellosis

 Shigellosis is a bacterial infection that affects the digestive system.

Etiologic Agent
 caused by a group of bacteria called Shigella.  There are four different species of Shigella:
 Shigella sonnei (the most common species in the United States)
 Shigella flexneri
 Shigella boydii
 Shigella dysenteriae

Mode of Transmission
 Fecal-oral transmission
 Getting Shigella germs on their hands and then touching your food or mouth. You can
get Shigella germs on your hands after:
o Touching surfaces contaminated with germs from stool from a sick person, such as toys,
bathroom fixtures, changing tables or diaper pails
o Changing the diaper of a sick child or caring for a sick person
 Eating food that was prepared by someone who is sick with shigellosis
 Swallowing recreational water (for example, lake or river water) while swimming or drinking
water that is contaminated with stool (poop) containing the germ

Incubation Period- The incubation period depends on the serotype. It varies from 12 hours to 4 days,
but is usually 1–7 days.

Period of Communicability
 During acute infection and until the infectious agent is no longer present in faeces, as determined
by negative culture, usually within 4 weeks after onset of illness. Asymptomatic carriers may
transmit infection. Rarely, the carrier state may persist for months or longer. Appropriate
antimicrobial treatment usually reduces duration of carriage to a few days.

Signs and Symptoms

 Diarrhea (sometimes bloody)
 Fever
 Stomach pain
 Feeling the need to pass stool [poop] even when the bowels are empty

Diagnostic Procedure
 Stool exam- presence of shigella bacteria or their toxins.

Treatment Modalities
 Treatment will usually include antibiotics to eliminate the bacteria from your digestive tract.
 azithromycin (Zithromax)
 ciprofloxacin (Cipro)
 sulfamethoxazole/trimethoprim (Bactrim)
 Fluid and salt replacement- Children may benefit from an oral rehydration solution, such as
Pedialyte

Nursing Management
 Instruct to avoid eating raw foods
  Educate on proper hygiene and disposing human excreta
 Monitor intake and output
 Give antipyretic for fever
 Instruct to increase fluid intake do avoid dehydration

Prevention
 You can prevent shigellosis by practicing good personal hygiene.
 Wash your hands before and after you use the bathroom or change a diaper.
 Discard dirty diapers in a closed bag or trashcan to prevent the spread of the bacteria. Use soap
and warm water every time you wash your hands.
 Wipe down changing tables and kitchen counters with antibacterial wipes before and after use.
 Avoid close personal contact with someone who is infected with Shigella until at least 2 days after
the diarrhea has ended.

Typhoid Fever 
 is an acute illness associated with fever caused by the Salmonella enterica serotype Typhi bacteria. 
 also known as enteric fever

Etiologic Agent- caused by Salmonella typhi bacteria.

Mode of Transmission
 Fecal-oral transmission
 The bacteria that cause typhoid fever spread through contaminated food or water and
occasionally through direct contact with someone who is infected
 People with acute illness can contaminate the surrounding water supply through stool, which
contains a high concentration of the bacteria. Contamination of the water supply can, in turn,
taint the food supply. The bacteria can survive for weeks in water or dried sewage.

Incubation Period- The incubation period is usually 1-2 weeks, and the duration of the illness is about 3-4
weeks.

Period of Communicability- as long as the patient es excreting microorganism, and untreated capable of
infecting others.

Signs and Symptoms

 Fever- The fever pattern is stepwise, characterized by a rising temperature over the course of each
day that drops by the subsequent morning; the peaks and troughs rise progressively over time.
 Gastrointestinal symptoms-Over the course of the first week of illness, the notorious
gastrointestinal manifestations of the disease develop; these include diffuse abdominal pain and
tenderness and, in some cases, fierce colicky right upper quadrant pain.
 Rose spots. The patient develop rose spots, which are salmon-colored, blanching, truncal, maculo-
papules usually 1-4 cm wide and fewer than 5 in number; these generally resolve within 2-5 days.
 Abdominal distention. The abdomen becomes distended, and soft splenomegaly is common; on the
third week, abdominal distention is severe.
 Pea soup diarrhea. Some patients experience foul, green-yellow, liquid diarrhea.

Diagnostic Procedure
 Medical and travel history
 Body fluid or tissue culture
 For the culture, a small sample of your blood, stool, urine or bone marrow is placed on a
special medium that encourages the growth of bacteria. The culture is checked under a
microscope for the presence of typhoid bacteria. A bone marrow culture often is the most
sensitive test for Salmonella typhi.
 detect antibodies to typhoid bacteria in your blood or a test that checks for typhoid DNA in
your blood.
 Typhi-dot test to detect IgG & IgM antibodies in typhoid fever. 

Treatment Modalities
 Ciprofloxacin (Cipro).  doctors often prescribe this for nonpregnant adults. Another similar drug
called ofloxacin also may be used.
 Azithromycin (Zithromax). This may be used if a person is unable to take ciprofloxacin or the
bacteria is resistant to ciprofloxacin.
 Ceftriaxone. This injectable antibiotic is an alternative in more-complicated or serious infections
and for people who may not be candidates for ciprofloxacin, such as children.

Nursing Management
 Diet. Fluids and electrolytes should be monitored and replaced diligently; oral nutrition with a soft
digestible diet is preferable in the absence of abdominal distention or ileus.
 Activity. No specific limitation on activity are indicated for patients with typhoid fever; as with
most systemic diseases, rest is helpful, but mobility should be maintained if tolerable.
 Monitor for fever and the intake and output

Prevention
 Access to safe water and adequate sanitation, hygiene among food handlers and typhoid
vaccination are all effective in preventing typhoid fever.
 Two vaccines have been used for many years to protect people from typhoid fever:
 an injectable vaccine based on the purified antigen for people aged over 2 years
 a live attenuated oral vaccine in capsule formulation for people aged over 5 years
 These vaccines do not provide long-lasting immunity and are not approved for children
younger than 2 years old.
 A new typhoid conjugate vaccine, with longer lasting immunity, was prequalified by WHO
in December 2017 for use in children from the age of 6 months.:
 Ensure food is properly cooked and still hot when served.
 Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
 Avoid ice unless it is made from safe water.
 When the safety of drinking water is questionable, boil it or if this is not possible, disinfect it with
a reliable, slow-release disinfectant agent (usually available at pharmacies).
 Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm
animals, or after having been to the toilet.
 Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and
fruits should be peeled.
Amoebiasis
 is a parasitic infection of the intestines caused by the protozoan Entamoeba histolytica, or E.
histolytica
 It causes diarrhea and colitis. Spread of infection from the intestine can result in liver abscess (via
haemato-genous dissemination).

Etiologic Agent
 Entamoeba histolytica lives in the intestines of infected people.
 Entamoebae are a group of single-celled parasites (living things that live in, or on, other living
organisms) that can infect both humans and some animals.
 There are at least six species of entamoeba that can infect the human gut but only E.
histolytica causes disease.

Mode of Transmission
 Transmission occurs via the fecal–oral route, either directly by person-to-person contact or
indirectly by eating or drinking focally contaminated food or water.
 Sexual transmission by oral-rectal contact is also recognized especially among male homosexuals.
 Vectors such as flies, cockroaches and rodents can also transmit the infection.

Incubation Period- The average incubation period is 2–4 weeks. Patients may, however, present months
to years after the initial infection.

Period of Communicability- Cases are infectious as long as cysts are present in the feces. In some
instances, cyst excretion may persist for years.

Signs and Symptoms

 Acute amoebiasis can present as diarrhea or dysentery with frequent, small and often bloody
stools.
 Chronic amoebiasis can present with gastrointestinal symptoms plus fatigue, weight loss and
occasional fever. Extraintestinal amoebiasis can occur if the parasite spreads to other organs, most
commonly the liver where it causes amoebic liver abscess.
 Amoebic liver abscess presents with fever and right upper quadrant abdominal pain.

Diagnostic Procedure
 stool sample is sent to the laboratory and examined under a microscope. Ideally, three stool
specimens from different days should be examined.
 blood test that looks for evidence of E. histolytica infection in your blood
 biopsy taken at colonoscopy and examined under the microscope can show the parasites

Treatment Modalities
 Amoebic dysentery
 tinidazole PO
Children: 50 mg/kg once daily for 3 days (max. 2 g daily)
Adults: 2 g once daily for 3 days
 metronidazole PO
Children: 15 mg/kg 3 times daily for 5 days
 Adults: 500 mg 3 times daily for 5 days
• If there is no laboratory, first line treatment for dysentery is for shigellosis.
 Oral rehydration salts (ORS) if there is risk of, or if there are signs of dehydration
 Amoebic liver abscess
• tinidazole PO: same treatment for 5 days
• metronidazole PO: same treatment for 5 to 10 days

Nursing Management
 Observe isolation and enteric precaution
 Provide health education about:
 Boil water for drinking or used purified water
 Wash hands before and after defecation or when handling foods
 Provide optimum comfort
 Bland diet without cellulose or bulk-producing food should be maintained.

Prevention
 public education on the importance of personal hygiene
 public education about the importance of hand hygiene after defecation and before preparing or
eating food
 providing information to intending travellers about the risks involved in eating uncooked
vegetables and fruits and drinking potentially contaminated water
 public education about the possibility of transmitting the disease via sexual contact.
 protecting public water supplies from faecal contamination
 investigating the food preparation practices of any implicated local food premises
 boiling and purifying water before consumption in endemic areas.

Cholera
 is an acute diarrheal infection caused by ingestion of food or water contaminated with the
bacterium Vibrio cholerae
 Cholera is an extremely virulent disease that can cause severe acute watery diarrhrea.
  Cholera causes severe diarrhea and dehydration

Etiologic Agent- bacterium Vibrio cholerae

 There are many serogroups of V. cholerae, but only two – O1 and O139 – cause outbreaks.
 V. cholerae O1 has caused all recent outbreaks. 
 V. cholerae O139  first identified in Bangladesh in 1992 – caused outbreaks in the past, but
recently has only been identified in sporadic cases.

Mode of Transmission
 drinking water or eating food contaminated with the cholera bacterium.
 In an epidemic, the source of the contamination is usually the feces of an infected person that
contaminates water and/or food. The disease can spread rapidly in areas with inadequate
treatment of sewage and drinking water.
 Raw or undercooked contaminated seafood.

Incubation Period- It can take anywhere from a few hours to 5 days for symptoms to appear after
infection. Symptoms typically appear in 2-3 days.
Period of Communicability- Patients are infectious from the onset of symptoms until seven days after
resolution of diarrhea. 

Signs and Symptoms

 profuse watery diarrhea
 vomiting
 leg cramps.
 rapid loss of body fluids leads to dehydration and shock.
 loss of skin turgor
 dry mucous membranes
 hypotension and thirst
 Without treatment, death can occur within hours.

Diagnostic Procedure
 Stool examination. Although observed as a gram-negative organism, the characteristic motility of
Vibrio species cannot be identified on a Gram stain, but it is easily seen on direct dark-field
examination of the stool.
 Stool culture. V cholerae is not fastidious in nutritional requirements for growth; however, it
does need an adequate buffering system if fermentable carbohydrate is present because viability
is severely compromised if the pH is less than 6, often resulting in autosterilization of the culture.
 Serotyping and biotyping. Specific antisera can be used in immobilization tests; a positive
immobilization test result (ie, cessation of motility of the organism) is produced only if the
antiserum is specific for the Vibrio type present; the second antiserum serves as a negative
control.
 Hematologic tests. Hematocrit, serum-specific gravity, and serum protein are elevated in
dehydrated patients because of resulting hemoconcentration; when patients are first observed,
they generally have a leukocytosis without a left shift.

Treatment Modalities
 Rehydration. The goal is to replace lost fluids and electrolytes using a simple rehydration solution,
oral rehydration salts (ORS). The ORS solution is available as a powder that can be made with
boiled or bottled water.
 Intravenous fluids. Most people with cholera can be helped by oral rehydration alone, but severely
dehydrated people might also need intravenous fluids.
 Antibiotics. While not a necessary part of cholera treatment, some antibiotics can reduce cholera-
related diarrhea and shorten how long it lasts in severely ill people.
 Zinc supplements. Research has shown that zinc might decrease diarrhea and shorten how long it
lasts in children with cholera.

Nursing Management
 Assess for dehydration.
 Rehydrate the patient, and monitor frequently. Then reassess hydration status.
 Maintain hydration: replace ongoing fluid losses until diarrhea stops.
 Give an oral antibiotic to the patient with severe dehydration.
 Feed the patient.
Prevention
 Drink only bottled, boiled, or chemically treated water or carbonated beverages. When using
bottled drinks, make sure that the seal has not already been broken
 Avoid tap water and ice cubes made from tap water.
 If bottled water is not available, you can disinfect water by boiling it for one minute or filtering it,
and then adding two drops of household bleach or half of an iodine tablet per liter of water.
 Wash your hands with soap and clean water every time you use the bathroom, and before you eat
or prepare food. If soap and water are not available, use an alcohol-based hand cleaner that is at
least 60% alcohol.
 Eat foods that are pre-packaged or that are freshly cooked and served hot. Avoid raw and
undercooked meats and seafood or unpeeled fruits and vegetables.
 Dispose of feces in a place away from water that is used for drinking or food, especially if you have
had cholera.