Treat all organisms as potential pathogens. Many of the organisms can be opportunistic in their abilities to cause infection.
History The purpose of this chapter is to present an overview of the clinical presentation, diagnosis, and management of a patient who presents with recurrent infections. De finition of Recurrent Infections It is difficult to assign a precise frequency of infections that defines an increased susceptibility to infections that reflects an impaired immune response.
For example, the majority of patients who have intact immune systems may still contract multiple upper respiratory infections each year, usually of viral origin. The frequency of these infections may be related to exposures, as in health care and daycare workers, teachers, and parents, who are routinely exposed to children or other individuals who may transmit viral infections, particularly during the winter months.
The average child may experience up to six to eight upper respiratory infections each year, most commonly of viral origin In addition, individuals who are under high stress, have poor sleep hygiene, tobacco smoke exposure, co-morbid conditions such as diabetes, or need to take chronic immune modulating medications e.
Many patients are treated for suspected bacterial infection, especially of the upper or lower respiratory tract, but may actually have allergic rhinitis or self limited viral infections.
For this reason, patients with suspected sinusitis are commonly treated based upon their presentation, clinical suspicion, and knowledge of bacterial organisms most frequently implicated as causes of sinusitis. Not infrequently the clinician may find it difficult to distinguish patients with an intact immune response and normal pattern of infections or non-infectious etiologies from those with a presentation reflecting primary or secondary immunodeficiency.
In addition to considering the absolute number of infections during a period of time, such as one year or several years, there are other clues which also may signify an impaired immune response.
Ep idemiology Primary immune deficiencies are rare in the general population, with estimates of overall incidence ranging from 1 in 2, to 1 in 10, live births, with a prevalence of 1 in 10, in the general population 53 Primary immunodeficiency results from genetic defects which may arise through various inheritance patterns or may be the result of spontaneous mutation.
The true incidence of these disorders is unknown, as no prospective study has yet to be conducted. The prevalence of secondary immunodeficiency, e. Due to the rarity of immune deficiency in the general population, the negative predictive value of laboratory tests is more optimal than positive predictive value Thus, it is important to carry out diagnostic evaluation of immune function in patients with a history of recurrent, invasive, or opportunistic infections who have a higher pretest probability of impairment in immune function.
Otherwise, a practitioner may be faced with abnormal values that may have no or uncertain clinical significance. Pa thogenesis Immunodeficiencies are classified according to the principal immunologic mechanisms that are abnormal and fall into four main classes Table 2: Humoral immunity, which is part of the adaptive immune response, is largely responsible for clearing bacterial infections.
Patients with primary humoral immune deficiency may present at any age, often not until the 3rd, 4th, or even 5th decade of life Cellular immunodeficiency results from dysfunction of T cells, which are principally involved in host defense for viral, mycobacterial, and fungal infections.
T cells also play a major role in the adaptive immune response and are intimately involved in the recruitment and activation of B cells, providing stimulation of antibody production Some types of humoral immunodeficiency actually result from a defect in T cell signaling, which prevents separate antibody isotypes from forming.
Combined B and T cell deficiency, such as Severe Combined Immunodeficiency, is very rare and often presents in infancy with chronic diarrhea, failure to thrive, and severe, recurrent, opportunistic infections in the first few months of life.
These patients require a bone marrow or stem cell transplant in order to survive, as this immunodeficiency state is often fatal in the first year of life if left untreated.
Phagocytic disorders result from ineffective recruitment or function of neutrophils, phagocytes, and natural killer cells, which are all part of the innate immune response. Phagocytes are responsible for engulfing and destroying bacterial organisms through recognition of certain cell wall constituents.
The complement system is comprised of nine principal proteins, C, as well as a number of regulatory proteins, and is activated by three separate mechanisms, the classical, lectin, and alternative pathways C linical Manifestations Patients with immune deficiency characteristically present with recurrent infections of varying severity and anatomic location Table 3.
However, the same immunologic defect or dysregulation that predisposes the patient to infection may concomitantly lead to autoimmune or inflammatory disease Vasculitic disorders, autoimmune cytopenias, and inflammatory arthropathies are a few examples of autoimmune conditions commonly associated with various types of immune deficiency 1133 In addition, malignancies, such as leukemia and lymphoma, occur with increased frequency in association with common variable immune deficiency T cell deficiencies or dysfunction may predispose patients to recurrent or severe viral, mycobacterial, or fungal infections Hyper IgM syndrome, which is due to a T cell deficiency, is characterized by an impaired humoral immune response due to signaling errors and inefficient antibody recruitment or activation.
Phagocytic disorders are rare and may have variable presentations. Chronic Granulomatous Disease CGD results from a defect in the oxidative burst used by phagocytes in killing engulfed bacteria.
These patients may also have a history of gastrointestinal or bladder disturbance due to the formation of granulomas along the intestinal or genitourinary tract.
Leukocyte Adhesion Deficiency results from a defect in an adhesion protein utilized in the recruitment of phagocytes during times of inflammation or infection.
These patients may have extremely elevated peripheral white blood cell counts abovedue to the inability of the white blood cells to extravasate through the vascular endothelium to sites of infection.
Patients with LAD cannot produce pus at the site of infection and may have a history of delayed separation of the umbilical cord longer than weeks. Disorders of the complement cascade may or may not result in increased susceptibility to infections.
The most common presentation of complement deficiency is autoimmune disease, especially Systemic Lupus Erythematosis C1 inhibitor deficiency predisposes affected individuals to experience episodic angioedema of the deep dermal tissues in the GI tract, airway, extremities, or facial areas.
This can be hereditary autosomal dominant or acquired.Chapter 7: Asepsis and Infection Control Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition MULTIPLE CHOICE grupobittia.com is true regarding surgical asepsis?
a. It inhibits growth of pathogenic organisms. b. It is known as a cleaning technique. c. It includes hand hygiene. d. It is known as a sterile technique.
ANS: D Surgical asepsis is known as a sterile technique. Surgical Wounds. Local surgical factors such as infection, edema, seroma and hematoma formation, wound tension, wound trauma, wound drainage, the presence of drainage devices, muscle spasticity, and wound dressings all .
What is meningitis? Meningitis is an infection of the membranes (meninges) surrounding the brain and spinal cord. Meningitis can be caused by a bacterial, fungal or viral infection. Meningitis can be acute, with a quick onset of symptoms, it can be chronic, lasting a month or more, or it can be mild or aseptic.
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Download the . Study 15 Lab 2: Aseptic Technique of Bacterial Transfer flashcards from Jessica T. on StudyBlue. Define the following terms: pure culture, sterile medium, inoculum, aseptic technique, and colony.
2. State and define the three types of growth that may be seen in a broth culture.