Complications Complications are rare in the patient who is treated appropriately:

Cardiovascular: the primary complication is the need for valve replacement in the patient with endocarditis. Bone: residual musculoskeletal complaints may be present in the patient with long-term infection, sacroiliitis and osteomyelitis. Genitourinary: especially epididymo-orchitis. Blood: immune thrombocytopenic purpura has been described as a consequence of brucellosis infection. Neurological: mental state, visual, hearing changes (may be the most common cause of acquired hearing loss in endemic areas), cranial and peripheral nerve dysfunction, cerebellar ataxia, spinal syndromes, etc. Abscess formation: most commonly hepatic but also elsewhere. Chronic fatigue syndrome may be seen. Infection in pregnancy may result in abortion, congenital and neonatal infections and infection of the delivery team.[15]

Prevention

This relies on control of the disease in animals, by a combination of surveillance, slaughtering and vaccination. Pasteurisation of milk and avoidance of consumption of unpasteurised milk products, raw or undercooked meat. Education, protective clothing, adequate ventilation and disinfection of premises and safe disposal of offal, for those exposed occupationally. There is no human vaccine available.

rimary Health Care Intervention In Primary Health Care, the emphasis is on preventing an illness or condition. One of a Nurse's chief duties is Health Education. People must be told to stay away from unpasteurised dairy produce, especially if they intend visiting overseas. A Nurse who gives immunisations and advice to people travelling overseas is ideally placed to discuss Brucellosis prevention, as it is likely she will have to talk to the person about malaria prevention, bilharzia, Listeriosis, dangers of tick bites, tsetse flies and the dangers of water in some parts of the world. Some gourmets prefer "Village" cheese as they say it tastes better. But "Village" cheese has not been

pasteurised, and the person should be advised to ask themselves if a transient taste sensation is worth risking years in bed or in a wheelchair.

Secondary Health Care Intervention Secondary Health Care is used to describe what happens after Primary Health Care has failed and the person is acutely ill. In some cases the infection is so severe and the patient so prostrated that the only option is to be given intravenous antibiotics in a hospital. The patient would need a quiet, darkened room as they tend to suffer from hyperacusis and photophobia. They will need full nursing care - being bathed, fed, having fluids pushed, extra support during febrile rigors, and careful observations for complications such as sacroiliitis, which occurs particularly when the patient is infected with the Melitensis strain. There may be cardiac and respiratory involvement, and brain symptoms suggestive of encephalitis or meningitis, the liver and spleen may be affected as well. Frequently, the patient gets pneumonia as a complication. As temperatures can rise above 41.5 degrees, the patient has to be watched for convulsions and dehydration. The Nurse should take care to act immediately the temperature begins to rise. The most dangerous time of day for fever to show itself, for some reason, is late afternoon/early evening. Even with modern antibiotics, treatment and prostration can be prolonged. There are 6 strains of Brucellosis, and if a nurse encounters a patient with Brucellosis, it is likely to be either Abortus or Melitensis or Suis, or a combination of the three. The Melitensis strain is the most severe, with the worst complications and with a greater tendency to become chronic. This strain is usually carried by goats. Although person to person infection with Brucellosis is exceedingly rare, it has been known to happen, so the nurse should take proper care to protect herself from the patient's bodily fluids.

Tertiary Health Care Intervention This is when the patient has been ill and is needing help to adjust to changes. Brucellosis takes a long time - months or years - to recover from, and in some cases, it becomes chronic and the person is unwell for the rest of their lives. A referral to Social Services may be helpful, as it is likely that the patient's financial status may change for the worse, as they are unlikely to get back to work for several months, if at all. Contact with a lawyer or trade union rep may help, especially in negotiating with the employer and insurance company or with problems paying bills or house repossession if being ill has caused major financial problems.

Patients have to be discharged to a place where they can continue to be supported. If home is a suitable place, with a caring adult to keep an eye on the patient, that would be a good choice. The nurse would have to explain matters to the caring adult and encourage them to ask questions. They should be given phone numbers to call for advice. Possibly the District Nurses could call periodically. If the patient lives alone and is unlikely to cope with caring for himself, a convalescent home should be considered, until the patient is substantially improved in function. A physiotherapist or an occupational therapist may be required to do a Wheelchair Evaluation for the patient, should it be felt by the physician that the patient would benefit from one, or indeed, any other aid to living with a serious illness.

Some people have a fairly mild illness which they recover from within weeks, with a combination of antibiotics. These patients can be looked after at home and can usually go back to work (preferably on a part time basis for some weeks) within 6 to 8 weeks. This is one end of the spectrum, and even a mild case is pretty severe compared to other illnesses such as influenza. However, there is another end to the spectrum, and those patients may never get better and become bedbound and completely dependent on others to do everything for them. CAUTION: As far as serology goes, if a patient has tested positive for Brucellosis once, they have got Brucellosis. Further serology taken over years may show a negative result, but that is deceptive and does not mean that the patient no longer has Brucellosis, as later test results may show positives once again. Brucella is a nasty intracellular parasite and can 'hide' in any system in the body. Although there are false negatives in Brucella serology, there aren't any false positives. Lack of supportive lab results is a problem in modern health professionals, because nurses and doctors want to see their diagnosis confirmed by a positive test of some sort. If they are confronted with a patient who is visibly ill, with a history of a previously positive blood test even if it happened years ago, they should rely on their clinical observations and treat the patient symptomatically rather than falling into the modern fools trap of believing that if they can't get a definitive test result that the patient is not really ill but faking it for attention seeking purposes. Read more: http://wiki.answers.com/Q/What_are_the_nursing_interventions_for_brucellosis#ixzz2hwiH45m K

Methicillin-resistant Staphylococcus aureus From Wikipedia, the free encyclopedia "MRSA" redirects here. For other uses, see MRSA (disambiguation).

A colourised SEM of MRSA Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-totreat infections in humans. It is also calledoxacillin-resistant Staphylococcus aureus (ORSA). MRSA is any strain of Staphylococcus aureus that has developed, through the process of natural selection, resistance to beta-lactam antibiotics, which include the penicillins (methicillin, dicloxacillin, nafcillin, oxacillin, etc.) and the cephalosporins