C H A P T E R 1 2
Antiprotozoal agents
175
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Other protozoal infections include amoebiasis,
leishmaniasis, trypanosomiasis, trichomoniasis,
giardiasis and
Pneumocystis carinii
.
KEY POINTS
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People receiving antiprotozoal agents should be
monitored regularly to detect any serious adverse
effects, including loss of vision, liver toxicity and
so on.
CRITICAL THINKING SCENARIO
Coping with amoebiasis
THE SITUATION
J.C., a 20-year-old male university student, reported to the
university health centre complaining of severe diarrhoea,
abdominal pain and, most recently, blood in his stool. He
had a mild fever and appeared to be dehydrated and very
tired. The young man, who denied he had travelled outside
the country, reported eating most of his meals at the local
café, where he worked in the kitchen each night making
pizza.
A stool sample for ova and parasites (O&P) was
obtained, and a diagnosis of amoebiasis was made.
Metronidazole was prescribed. A public health referral
was sent to find the source of the infection, which was
the kitchen of the café where J.C. worked. The kitchen was
shut down until all the food, utensils and environment
passed state health inspection. Although a potential
epidemic was averted (only three other cases of amoebiasis
were reported), the action of the public health officials
added new stress to this student’s life because he was
unemployed for several months.
CRITICAL THINKING
What are the important care implications for J.C.?
Think
about the usual nutritional state of a university student who
eats most of his meals in a pizza place.
What are the implications for recovery when a person is
malnourished and then has a disease that causes severe
diarrhoea, dehydration and potential malnourishment?
Consider how difficult it will be for J.C. to be a full-time
student while trying to cope with the signs and symptoms of
his disease, as well as the adverse effects associated with his
drug therapy and the need to maintain adequate nutrition
to allow some healing and recovery.
What potential problems could the added stress of being
out of work have for J.C.?
Consider the physiological
impact of stress, as well as the psychological problems of
trying to cope with one more stressor.
DISCUSSION
J.C. needed a great deal of reassurance and an explanation
of his disease. He learned that oral hygiene and small,
frequent meals would help alleviate some of his discomfort
until the metronidazole could control the amoebiasis and
that good hygiene and strict hand washing when the
disease is active would help to prevent transmission. He
was advised to watch for the occurrence of specific adverse
drug effects, such as a possible severe reaction to alcohol
(he was advised to avoid alcoholic beverages while taking
this drug); gastrointestinal upset and a strange metallic
taste (the importance of good nutrition to promote healing
of the gastrointestinal tract was stressed); dizziness or
light-headedness; and superinfections.
J.C. was scheduled for a follow-up examination for
stool O&P and nutritional status. Metronidazole was
continued until the stool sample came back negative.
He needed and received a great deal of support and
encouragement because he was far from home and the
disease and the drug effects were sometimes difficult to
cope with. The effects of stress—decreasing blood flow to
the gastrointestinal tract, for example—can make it more
difficult for people such as J.C. to recover from this disease.
Support and encouragement can be major factors in their
eventual recovery. J.C. was given a telephone number to
call if he needed information or support and a complete set
of written instructions regarding the disease and the drug
therapy.
CARE GUIDE FOR J.C.: METRONIDAZOLE
Assessment: History and examination
Allergies to metronidazole, renal or liver dysfunction
Concurrent use of barbiturates, oral anticoagulants, alcohol
Local: culture of stool for accurate diagnosis of infection
CNS: orientation, affect, vision, reflexes
Skin: colour, lesions, texture
GI: abdominal, liver evaluation
Haematological: FBC, liver function tests
Implementation
Culture infection before beginning therapy.
Provide comfort and safety measures: oral hygiene, safety
precautions, treatment of superinfections, maintenance
of nutrition.
Provide small, frequent meals and monitor nutritional
status.
Provide support and reassurance for dealing with drug
effects and discomfort.
