Superinfections

Influenza is an acute viral disease caused by Influenza A (sporadic, epidemic, and pandemic) or B (sporadic outbreaks) virus. Symptoms typically occur suddenly and include high fever, chills, headache, muscle aches, sore throat, and malaise. Serious complications can be caused by bacterial superinfection of the respiratory tract. 

Candida fungal superinfections also occur in the mouth and around die anal and genital areas. Signs and symptoms include lesions in the mouth or anal/genital itching. 

Additional culture and sensitivity tests may be performed during therapy because microorganisms causing the infection may become resistant to penicillin, or a superinfection may have occurred. A urinalysis, complete blood count, and renal and hepatic function tests also may be performed at intervals during therapy. 

IM PA I RED ORAL M UCOUS M EM 0 RAN ES. The administration of oral penicillin may result in a fungal superinfection in tiie oral cavity. With impaired oral mucous membranes there will be varying degrees of inflamed oral mucous membranes, swollen and red tongue, swollen gums, and pain in tiie mouth and throat. To detect this problem early, tiie nurse inspects tiie patient s mouth... 

To reduce the risk of superinfection, take yogurt, buttermilk, or acidophilus capsules. 

Therapy with cephalosporins may result in a bacterial or fungal superinfection. Diarrhea may be an indication of pseudomembranous colitis, which is one type of bacterial superinfection. See Chapter 7 for a discussion of bacterial and fungal superinfections and pseudomembranous colitis. 

DIARRHEA. Frequent liquid stools may be an indication of a superinfection or pseudomembranous colitis. If pseudomembranous colitis occurs, it is usually seen 4 to 10 days after treatment is started. 

The nurse inspects each bowel movement and immediately reports to the primary health care provider the occurrence of diarrhea or loose stools containing blood and mucus because it may be necessary to discontinue the drug use and institute treatment for diarrhea, a superinfection, or pseudomembranous colitis. 

DIARRH EA. Diarrhea may be an indication of a superinfection or pseudomembranous colitis, both of which can be serious. The nurse should inspect all stools for the presence of blood or mucus. If diarrhea does occur and there appears to be blood and mucus in the stool, the nurse saves a sample of the stool and tests for occult blood using a test such as Hemoccult. If the stool tests positive for blood, the nurse saves the stool for possible further laboratory analysis. 

Bacterial or fungal superinfections and pseudomembranous colitis (see Chap. 7) may occur with the use of both of these drugs. The administration of any drug may result in a hypersensitivity reaction, which can... 

Serious and sometimes fatal blood dyscrasias (patiiologic condition of blood disorder of cellular elements of blood) are die chief adverse reaction seen witii the adiniiiistration of chloramphenicol, hi addition to blood dyscrasias superinfection, hypersensitivity reactions, nausea, vomiting, and headache may be seen. It is recommended that patients receiving oral chloramphenicol be hospitalized so that patient observation and frequent blood studies can be performed during treatment witii this drug. 

The most common adverse reactions widi meropenem include headache, nausea, vomiting, diarrhea, anorexia, abdominal pain, generalized pain, flatulence, rash, and superinfections. This drug also can cause an abscess or phlebitis at die injection site An abscess is suspected if die injection site appears red or is tender and warm to die touch. Tissue sloughing at die injection site also may occur. 

Promoting an Optimal Response to Therapy Monitoring each patient for response to drug therapy and for the appearance of adverse reactions is an integral part of promoting an optimal response to therapy. The nurse immediately reports serious adverse reactions, such as signs and symptoms of a hypersensitivity reaction or superinfection, respiratory difficulty, or a marked drop in blood pressure... 

MANAGING DIARRHEA. Diarrhea may be a sign of a superinfection or pseudomembranous colitis, both of which are adverse reactions tiiat may be seen with the administration of any anti-infective. The nurse checks each stool and reports any changes in color or consistency. When vancomycin is given as part of the treatment for pseudomembranous colitis, it is important to record the color and consistency of each stool to determine the effectiveness of therapy. 

The antibiotic and sulfonamide ophthalmics are usually well tolerated, and few adverse reactions are seen. Occasional transient irritation, burning, itching, stinging, inflammation, or blurring of vision may occur. With prolonged or repeated use, a superinfection may occur. 

Third, an accumulation of unintegrated HlV-1 cDNA can promote apoptosis under certain experimental conditions in vitro (Temin 1980 Li et al. 2001). It has been hypothesized that an INSTl could induce the destruction of long-lived, productively infected cells such as macrophages in vivo by accumulation of episomal HIV-1 cD-NAs following superinfection. 

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