Question

For this assignment, you will identify a pathogen in a newspaper article or publication of your choice, apply principles learned in BIOS 242, and research the pathogen for its connection to nursing/health care. You must get approval for your chosen article and pathogen. You will then write a paper on their chosen pathogen/topic. Use the template hyperlinked above when writing your paper.

The pathogen can be a bacteria, fungus, protozoa, or virus. In addition to the article, information to include in the paper should include, morphology, gram stain characteristics, virulence factors, susceptibility to antibiotics, host cells, nutritional needs, growth conditions, mechanisms used to evade the immune system and invasion into the host(s), interactions with the hosts and diseases caused and affected body systems. Additionally, students should explain symptoms when the pathogen infects a host, as well as a diagnosis and the therapeutic intervention needed after infection. You may also add information on statistics related to infection (epidemiology) and any new research findings related to the pathogen.

Answer 1

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Public health groups, including the U.S. Centers for Disease Control and Prevention (CDC) and WHO, are monitoring the pandemic and posting updates on their websites. These groups have also issued recommendations for preventing and treating the illness.

Symptoms

Signs and symptoms of coronavirus disease 2019 (COVID-19) may appear two to 14 days after exposure. This time after exposure and before having symptoms is called the incubation period. Common signs and symptoms can include:

• Fever
• Cough
• Tiredness

Early symptoms of COVID-19 may include a loss of taste or smell.

Other symptoms can include:

• Shortness of breath or difficulty breathing
• Muscle aches
• Chills
• Sore throat
• Runny nose
• Headache
• Chest pain

This list is not all inclusive. Other less common symptoms have been reported, such as rash, nausea, vomiting and diarrhea. Children have similar symptoms to adults and generally have mild illness.

The severity of COVID-19 symptoms can range from very mild to severe. Some people may have only a few symptoms, and some people may have no symptoms at all. Some people may experience worsened symptoms, such as worsened shortness of breath and pneumonia, about a week after symptoms start.

People who are older have a higher risk of serious illness from COVID-19, and the risk increases with age. People who have existing chronic medical conditions also may have a higher risk of serious illness. Serious medical conditions that increase the risk of serious illness from COVID-19 include:

• Serious heart diseases, such as heart failure, coronary artery disease or cardiomyopathy
• Cancer
• Chronic obstructive pulmonary disease (COPD)
• Type 2 diabetes
• Severe obesity
• Chronic kidney disease
• Sickle cell disease
• Weakened immune system from solid organ transplants

Other conditions may increase the risk of serious illness, such as:

• Asthma
• Liver disease
• Chronic lung diseases such as cystic fibrosis
• Brain and nervous system conditions
• Weakened immune system from bone marrow transplant, HIV or some medications
• Type 1 diabetes
• High blood pressure

Viral Testing

Diagnosis of COVID-19 requires detection of SARS-CoV-2 RNA by reverse transcription polymerase chain reaction (RT-PCR). Detection of SARS-CoV-2 viral RNA is better in nasopharynx samples compared to throat samples.³ Lower respiratory samples may have better yield than upper respiratory samples. SARS-CoV-2 RNA has also been detected in stool and blood. Detection of SARS-CoV-2 RNA in blood may be a marker of severe illness. Viral RNA shedding may persist over longer periods among older persons and those who had severe illness requiring hospitalization (median range of viral shedding among hospitalized patients 12–20 days).

Infection with both SARS-CoV-2 and with other respiratory viruses has been reported, and detection of another respiratory pathogen does not rule out COVID-19

Clinical Management and Treatment

The National Institutes of Health published guidelines on prophylaxis use, testing, and management of patients with COVID-19. For more information, please visit National Institutes of Health: Coronavirus Disease 2019 (COVID-19) Treatment Guidelinesexternal icon. The recommendations were based on scientific evidence and expert opinion and will be updated as more data become available.

Mild to Moderate Disease

Patients with a mild clinical presentation (absence of viral pneumonia and hypoxia) may not initially require hospitalization, and many patients will be able to manage their illness at home. The decision to monitor a patient in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend on the clinical presentation, requirement for supportive care, potential risk factors for severe disease, and the ability of the patient to self-isolate at home. Patients with risk factors for severe illness (see People Who Are at Higher Risk for Severe Illness) should be monitored closely given the possible risk of progression to severe illness, especially in the second week after symptom onset.^5,6,14,38

For information regarding infection prevention and control recommendations, please see Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.

Severe Disease

Some patients with COVID-19 will have severe disease requiring hospitalization for management. Inpatient management revolves around the supportive management of the most common complications of severe COVID-19: pneumonia, hypoxemic respiratory failure/ARDS, sepsis and septic shock, cardiomyopathy and arrhythmia, acute kidney injury, and complications from prolonged hospitalization, including secondary bacterial infections, thromboembolism, gastrointestinal bleeding, and critical illness polyneuropathy/myopathy.^{1,4-6,14,36,38,70-73}

More information can be found at National Institutes of Health: Coronavirus Disease 2019 (COVID-19) Treatment Guidelinesexternal icon and Healthcare Professionals: Frequently Asked Questions and Answers. Additional resources and guidance documents on the treatment and management of COVID-19, including inpatient management of critically ill patients, are provided below.

Hypercoagulability and COVID-19

Some patients with COVID-19 may develop signs of a hypercoagulable state and be at increased risk for venous and arterial thrombosis of large and small vessels.^74,75  Laboratory abnormalities commonly observed among hospitalized patients with COVID-19-associated coagulopathy include:

• Mild thrombocytopenia
• Increased D-dimer levels
• Increased fibrin degradation products
• Prolonged prothrombin time

Elevated D-dimer levels have been strongly associated with greater risk of death.^74,76-79

There are several reports of hospitalized patients with thrombotic complications, most frequently deep venous thrombosis and pulmonary embolism.^80-82 Other reported manifestations include:

• Microvascular thrombosis of the toes
• Clotting of catheters
• Myocardial injury with ST-segment elevation
• Large vessel strokes^83-86

The pathogenesis for COVID-19-associated hypercoagulability remains unknown. However, hypoxia and systemic inflammation secondary to COVID-19 may lead to high levels of inflammatory cytokines and activation of the coagulation pathway.

There are limited data available to inform clinical management around prophylaxis or treatment of venous thromboembolism in COVID-19 patients.

Several national professional associations provide resources for up-to-date information concerning COVID-19-associated hypercoagulability, including management of anticoagulation. This is a rapidly evolving topic, with new information released often.

More information on hypercoagulability and COVID-19 is available from the American Society of Hematology external iconand National Institutes of Health: Coronavirus Disease 2019 (COVID-19) Treatment Guidelines – Antithrombotic Therapy in Patients with COVID-19external icon.

Pediatric Management

Illness among pediatric patients with COVID-19 is typically milder than among adults. Most children present with symptoms of upper respiratory infection. However, severe outcomes have been reported in children, including deaths. Data suggest that infants (<12 months of age) may be at higher risk for severe illness from COVID-19 compared with older children.¹⁶ CDC and partners are also investigating reports of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.

For expanded guidance on the management of children with COVID-19 and associated complications, see Evaluation and Management Considerations for Neonates At Risk for COVID-19, Information for Pediatric Healthcare Providers, and the Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Childrenexternal icon.

Investigational Therapeutics

The National Institutes of Health have published interim guidelines for the medical management of COVID-19external icon which include information on therapeutic options for COVID-19 currently under investigation. No U.S. Food and Drug Administration (FDA)-approved drugs have demonstrated safety and efficacy in randomized controlled trials when used to treat patients with COVID-19, although FDA has granted an Emergency Use Authorization for the use of remdesivirexternal icon to treat severe cases. Use of investigational therapies for treatment of COVID-19 should ideally be done in the context of enrollment in randomized controlled trials, so that beneficial drugs can be identified. For the latest information, see Information for Clinicians on Therapeutic Options for COVID-19 Patients. For information on registered trials in the United States, see ClinicalTrials.govexternal icon