NR503: Infectious Disease Paper
Infectious diseases are significant health issues because they inflict a massive burden on people and healthcare systems. For instance, their transmission patterns affect population health, increase the costs of care, and result in other adverse consequences, including high mortality rates, prolonged hospitalization, comorbidities, and compromised quality of care. Shigellosis is an ideal example of an infectious disease that poses a significant challenge in current healthcare systems.
According to Mayo Clinic (2020), shigella is a bacterium responsible for an intestinal infection that manifests through diarrhea, fever, nausea, vomiting, and stomach cramps. The bacterium is highly infectious and primarily affects people grappling with poor social determinants of health.
Bajer & The (2018) argue that Shigella-associated diarrhea is responsible for about 1.3 million deaths annually, including approximately 500,000 young children globally. This paper analyzes the epidemiological information about Shigellosis, including causes, symptoms, transmission patterns, complications, and treatment, the demographic breakdown of the at-risk population, determinants of health, epidemiological triad, and the role of nurse practitioners in managing the infectious disease.
Analysis of the Communicable Disease
Shigellosis is a bacterial disease emanating from highly contagious Shigella bacillus. According to the Centers for Disease Control and Prevention [CDC] (2022), various factors increase the individual propensity to the pathogen. These factors include getting into contact with infected surfaces and foods, consuming raw foods, swallowing recreational water, and engaging in unprotected sexual activities.
Cleveland Clinic (2022) contends that uncooked vegetables, contaminated water, and sexual contact with infected persons are the major causes of shigellosis and its subsequent transmission. The knowledge of these risk factors can inform preventive interventions and improve self-management interventions.
The clinical manifestation of shigellosis involves various symptoms that stem from the primary sign; diarrhea. The Centers for Disease Control and Prevention [CDC] (2021) argues that infected people demonstrate shigellosis symptoms within two days after contact with the pathogen. These symptoms include bloody, watery diarrhea, stomach crumbs and pain, fever, and vomiting.
Equally, the disease may result in colicky abdominal pain and tenesmus (Aslam & Okafor, 2022). In children and the elderly, shigellosis can lead to death and other ramifications due to the immune system’s failure to resolve the condition before and after the onset of symptoms.
Mode of Transmission
Shigellosis is a multifactorial condition meaning it has various transmission paths. According to Aslam & Okafor (2022), the primary transmission path for shigellosis is the fecal-oral route during sexual contact with infected persons. in less developing regions, the disease transmits through water-and-food-borne transmission paths.
Based on these transmission patterns, it is essential to note that children, the elderly, and people with poor social determinants of health, including poor housing, food insecurity, poverty, and low-level education attainment are at-risk people for shigellosis.
Often, the immune system combats the Shigella infections to prevent the advancement of symptoms. However, in cases where the immune system fails to protect the body from pathogens, the disease advanced to result in multiple complications that compromise individual health.
Mayo Clinic (2020) identifies dehydration, hemolytic uremic syndrome, rectal prolapse, bacteremia, reactive arthritis, and toxic megacolon as the long-term complications of untreated shigellosis. Dehydration, rectal prolapse, and hemolytic uremic reaction are among the concerns that render Shigella infections deadly, especially in children.
Various pharmacologic and non-pharmacologic interventions are effective in preventing and treating shigellosis. Firstly, medical approaches focus on alleviating the disease’s systems. Islam & Okafor (2022) identify hydration and electrolyte management as profound medical measures for addressing shigella symptoms, including dehydration.
Other pharmacological actions include administering second-generation medications like cephalosporin, ampicillin, and trimethoprim-sulfamethoxazole. For children with Shigella infections, healthcare professionals can administer azithromycin, cefixime, ceftibuten, and other first-line drugs.
On the other hand, non-pharmacologic strategies focus on self-management and improving determinants of health that contribute to individual susceptibility to Shigella infections. Cleveland Clinic (2022) identify hand hygiene, adherence to safe food and water instructions, avoiding sexual contact with infected persons, and disinfecting diaper-changing areas as proven options for preventing Shigellosis. These strategies emphasize the interception of the transmission patterns for disease-causing pathogens. Therefore, they are crucial for reducing the population’s propensity to the disease.
Although everyone is susceptible to Shigella bacillus, the disease results in disproportionate effects on children, the elderly, and people with poor social determinants of health, including poor housing, food insecurity, and poor sanitation. According to Aslam & Okafor (2022), the disease’s incidence is approximately 188 million annual cases with about a million deaths.
In developed countries, the disease’s incidence is around 1.5 million cases annually. Aslam & Okafor (2022) contend that shigella infections are common among young children (≤4 years) with a prevalence rate of 28 cases per 100,000 children.
Similarly, children aged 4-11 years are vulnerable to the disease, whose prevalence rate is about 25 cases per 100,000 children in this age group. The knowledge of age as a core determinant of individual propensity to the disease enables healthcare professionals to implement evidence-based and population-centered interventions for preventing and managing the disease.
Determinants of Health
Social determinants of health are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Healthy People 2030, n.d.).
The five domains of core determinants of health are economic stability, access to quality education, access to quality healthcare, neighborhood and built environment, and social/community contexts. These factors create preventable health inequalities and disparities that expose people to multiple healthcare issues. In the context of Shigella infections, different aspects of these social determinants of health contribute to disproportionate effects and prevalence.
For instance, about 9% of children live in poverty in Alameda County, California (County Health Ranking & Roadmaps, 2022). Further, about 8.8% of people struggle with unemployment, while 8% of Alameda residents grapple with food insecurity. These factors can increase their susceptibility to Shigella infections.
Shigella infections’ prevalence and incidences rely massively upon the interactions between hosts, agents, and environmental aspects like sanitation, overcrowding, and housing. The epidemiological triad enshrines the three components to enable healthcare professionals to understand factors that contribute to the disease’s disproportionate effects, prevalence, and incidences
Humans are the primary natural reservoirs for all four Shigella serotypes. However, the disease’s effects rely massively upon intrinsic factors like immunity and age. According to the Centers for Disease Control and Prevention [CDC] (2021), people with poor underlying health conditions like HIV or undergoing various medical treatment interventions like chemotherapy for cancer are highly susceptible to the disease. In this sense, diseases like HIV and medical treatment options weaken immune systems, affecting the body’s ability to combat Shigella infections.
Shigella bacteria has four serotypes that are responsible for Shigellosis; Shigella dysenteriae, Shigella flexneri, Shigella boydii, and Shigella soneii. According to Aslam & Okafor (2022), these pathogenic serotypes are resistant to acid in the stomach and multiply in the small intestine before entering the colon. Also, these bacteria produce Shigella enterotoxins and serotype toxin 1, causing bloody diarrhea.
Although host and agent factors are responsible for Shigellosis transmission and prevalence, pathogens require appropriate environmental aspects that bridge the chasm between vectors and hosts. Chen et al. (2019) identify climatic factors, such as changes in weather variables like temperature, precipitation, humidity, and wind speed as aspects that impact the three epidemiological components of infections; pathogens, hosts/vectors, and transmission. Poor sanitation, water pollution, overcrowding, and poor housing are equally fundamental in determining Shigellosis transmission, prevalence, and incidences.
Role of the Nurse Practitioner (NP)
Nurse practitioners (NPs) participate in collaborative health interventions and provide multiple healthcare services, including health promotion, disease prevention, health education, counseling, and the diagnosis and management of acute and chronic conditions (American Association of Nursing Practitioners, n.d.). In all-concerted efforts to prevent Shigellosis, nurses can participate in surveillance, data collection, early screening, data analysis, and follow-up.
Equally, they spearhead pharmacological and non-pharmacologic preventive and treatment interventions by administering oral hydration treatment, educating people on hygienic measures like hand washing practices, conducting timely screening of Shigella infections, participating in food safety policies, and assessing social determinants of health that increase people’s susceptibility to the disease.
Finally, nursing practitioners are responsible for incorporating evidence-based interventions for improving individual and community health in response to Shigella infections. John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is among the profound frameworks that enable nurses to enculture evidence-based practice (EBP) and utilize research as a tool for informing practices and decisions.
According to Speroni et al. (2020), this model requires nurses to develop foreground questions using a team approach, select and appraise evidence, and translate theoretical knowledge to practice. The PET (Practice question, Evidence, and Translation) steps are effective as problem-solving and decision-making approaches.
Shigellosis is a highly transmissible disease that results in poor health outcomes and other adverse consequences, including deaths, life-threatening conditions like diarrhea, and prolonged hospitalization. Equally, the disease results in a massive economic burden associated with medications and other clinical processes.
Healthcare professionals should understand the epidemiological triad that enshrines interactions between hosts, agents, and the environment to implement informed and evidence-based preventive interventions. Nurse practitioners should play a forefront role in preventing and managing Shigellosis by surveying and tracking cases of Shigella infections, collecting, analyzing, and reporting data to policymakers, educating at-risk populations, following up on the progress of infected people, and incorporating evidence-based practices for managing the disease.
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