Yersiniosis - Y3 PDF

LWBK720-Part-II-Y_p352-358.qxd 9/23/10 1:43 PM Page 356 Aptara Inc 356 Yersiniosis ▼ C ONTACT PRECAUTIONS Other U.S. government agencies that monitor...

LWBK720-Part-II-Y_p352-358.qxd 9/23/10 1:43 PM Page 356 Aptara Inc 356 Yersiniosis ▼ C ONTACT PRECAUTIONS Other U.S. government agencies that monitor food safety include the Food and Y3- Yersiniosis Drug Administration, which inspects im- ported food and milk pasteurization plants; the Department of Agriculture, Yersiniosis is a rare infectious disease that which monitors the health of food animals causes bacterial gastroenteritis. Symptoms and the quality of slaughtered and vary according to the age of the infected per- processed meat; and the Environmental son. It mostly affects young children, predom- Protection Agency, which monitors the inantly those under age 12 months. Yersinio- safety of drinking water. sis occurs more frequently in cooler climates. The Centers of Disease Control and Preven- COMPLICATIONS tion (CDC) estimates that 17,000 cases occur Complications of yersiniosis are rare but in the United States each year. The disease is may include joint pain, most commonly in more common in Japan, Scandinavia, and the knees, ankles, or wrists, which usually re- Europe. solves within 6 months. Erythema nodosum, a rash, may develop on the legs and trunk CAUSES and resolves within a month. More serious Yersinia enterocolitica, a rod-shaped bacteri- complications include bacteremia, enterocol- um, causes yersiniosis. Pigs are a reservoir itis, pseudoappendicitis, mesenteric adenitis, for some strains of this bacterium, with oth- reactive arthritis, septicemia, pharyngitis, er strains being found in rodents, rabbits, dermatitis, myocarditis, and glomeru- sheep, cattle, horses, dogs, and cats. Trans- lonephritis. Death may occur as a result of mission is through ingestion of contaminat- bacteremia, which affects older patients ed food, especially raw or undercooked pork more often than younger patients. products, including chitterlings (pig intes- tines), as well as tofu, meats, oysters, and ASSESSMENT FINDINGS fish. It may also be transmitted after han- In children, the symptoms of yersiniosis de- dling contaminated food, not cleaning the velop 4 to 7 days after exposure and include hands properly, and then touching toys, bot- low-grade fever, abdominal pain, diarrhea tles, or pacifiers. Transmission may also oc- and, occasionally, vomiting. These symptoms cur through drinking contaminated unpas- may last 2 to 3 weeks. With severe illness, di- teurized milk or untreated water. Rarely, arrhea may become bloody. In adults and yersiniosis can be transmitted by the older children, signs and symptoms of fecal-oral route as a result of poor hand- yersiniosis often mimic those of appendici- washing after defecation. Blood trans- tis, with right-sided abdominal pain, fever, fusion can cause direct inoculation of and leukocytosis. the bacteria. PREVENTION The Foodborne Diseases Ac- DIAGNOSTIC TESTS tive Surveillance Network (FoodNet) con- ◗ Stool culture identifies the organism, but ducts investigations of yersiniosis out- the laboratory may need to be asked to test breaks. Their results are also monitored by specifically for Y. enterocolitica. the CDC. Together, FoodNet and the CDC ◗ Throat, lymph node, synovial fluid, urine, look for ways to control and prevent out- bile, and blood cultures may identify breaks. An educational campaign has Y. enterocolitica. been instituted to increase awareness of ◗ Stool samples are positive for leukocytes. preventive measures the public can follow ◗ Computed tomography or ultrasonography to prevent Y. enterocolitica infection. of the abdomen may rule out appendicitis. LWBK720-Part-II-Y_p352-358.qxd 9/23/10 1:43 PM Page 357 Aptara Inc Yersiniosis 357 ◗ Colonoscopy may show exudates and PREVENTION To prevent yersiniosis, tell left-sided colitis, but findings are usually the patient and family to avoid eating raw nonspecific. or undercooked pork as well as unpas- teurized milk or milk products. Stress the TREATMENT importance of washing hands with soap Although most cases of yersiniosis resolve and water before handling food, including without treatment, more severe cases may be raw meat; after using the bathroom; and treated with antibiotics, such as aminoglyco- after contact with animals. Be sure to sides, doxycycline (Doryx), trimethoprim- clean all surfaces with hot, soapy water sulfamethoxazole (Bactrim), or fluoro- after preparing raw meat. quinolones. Fluids and electrolytes should be After preparing chitterlings (pig intes- provided as needed. Complications should tines), be sure to wash hands thoroughly, be treated symptomatically. Analgesia may including under the fingernails, before be administered for pain. Skin care should be touching infants or their belongings. provided. NURSING CONSIDERATIONS ▼ Initiate contact precautions for patients who are diapered or incontinent; for all oth- er patients, use standard precautions. ◗ Be sure to wash hands thoroughly after contact with an infected patient. ◗ Administer pain medications as ordered, and evaluate their effects after 30 minutes. ◗ Send stool specimens to the laboratory as ordered for testing. Assist with acquiring other samples, such as synovial fluid via joint aspiration, as appropriate. ◗ Provide good skin care, especially in pa- tients with frequent diarrhea. ◗ Monitor laboratory values. Administer electrolyte replacement therapy as ordered. ◗ Encourage oral fluids. If the patient is un- able to tolerate oral fluids, administer I.V. fluids as ordered. Patient teaching ◗ Teach the patient and family about the in- fection, including its cause, diagnosis, and treatment. ◗ Review how the infection is transmitted. Stress the importance of proper handwashing.