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Everyone is familiar with infections. This can range from a cold or flu to more serious illnesses. Those with spinal cord injury may be familiar with a urinary tract infection as the result of bladder exposure to catheters. Infections can be due to an invasion in the body by an organism that is not compatible and can even be destructive to body tissues. The invaders or pathogens include bacteria, viruses, fungus, worms, and insects (lice and mites).
Pathogens can be transmitted by varying methods such as floating in the air, on surfaces, or transmitted by other humans and animals. They can invade the body by our breathing them in through the lungs, eating contaminated foods or drinks, entering through a break in the skin or through mucous membranes. This also includes the exchange of body fluids like when kissing, engaging in sexual activity and even drinking from the same glass or sharing food. Pathogens enter through the eyes, mouth, nose, ears, urethra, vagina, rectum or a tear in the skin. Surgical openings are created in the skin that can also allow entry of pathogens.
Bacteria are live everywhere on earth. Some bacteria are essential to our body functions such as those ‘good’ bacteria that live in our gut to help breakdown food for digestion. Other bacteria can be dangerous by making us ill. There are bacteria that when entering the body, can be deadly. Bacteria can be treated with antibiotics. They are easiest to neutralize when treatment begins early. However, there are a few bacteria that cannot be treated as they have developed resistance to antibiotics.
Symptoms of a bacterial infection include the classic signs of redness, heat, swelling, fever, and pain. If your infection is in your respiratory system, you could experience coughing, excessive mucous, runny nose or eyes. In the bladder, a bacterial infection may produce urinary frequency, and burning. If you have issues with bladder sensation, you may first notice sediment in urine, a fever, chills, incontinence or autonomic dysreflexia.
Viruses enter the body and attach to your own cells. They take over by use of the replication part of your cell changing it from the ability to create replacement cells to reproducing the virus. These types of infections are difficult to treat. The difficulty of treatment is demonstrated by the coronavirus, COVID-19. There are some antiviral medications that treat specific viruses. Vaccinations are used to control viruses from spreading in populations. Antibiotics to not treat viruses.
Viruses will target specific cell types in any part of the body. Some thrive in the nervous system, others in the respiratory system, still others in the skin. Symptoms will depend on the target of the virus. For example, a virus in the nervous system might result in a stiff neck, a change in function or behavior, seizures, or even level of consciousness. In the respiratory system, you might experience mucous production, a cough, difficulty breathing, fever or chills.
Fungi is a single cell or multicellular parasite that spreads by releasing spores. The good bacteria of the body usually keep fungi in check, but it can overpower and spread. Most fugus is on the skin, however, it can enter the body. When a fungus infection enters the body, it becomes a systemic infection meaning the fungus is affecting an entire body system, several systems or all systems of the body.
Fungus on the skin may look like a rash. In the body, a fungus may present like a pneumonia or other body infection. Antifungal medications treat fungus.
Most often, worms enter the body through impurities or undercooking of food. They are often found in the gut, but they can also enter through openings in the skin, either natural or surgical sites of injury.
Symptoms of worms can include indigestion, itching at the rectum, diarrhea, nausea and vomiting.
Mites and lice spread easily through contact with a contaminated person, object or other contaminated substance. Specialty solutions can rid the body if caught early. If the mites or lice have burrowed under the skin, oral medication may be required to eliminate them.
Mites on or in the skin will appear most often as a rash. The area may itch. Typically, the affected area will spread. Lice are extremely itchy. They can be seen when separating the hair with a toothpick and looking at the scalp and root of the hair. Dispose of the toothpick immediately to avoid spread of lice throughout the head or from one person to another.
Your body will let you know when an infection is present. You do not need to diagnose if you have a virus, bacteria or other pathogen. That will be identified in medical testing which needs to be done to find the correct treatment. The specific cause of your infection should be treated. Randomly taking any medication will do more harm as if it is not the correct treatment, your infection will continue and become stronger making it more difficult to treat.
You may or may not recognize some of the signs of infection if you have issues with sensation or movement. Therefore, it is important that you notice any of the symptoms of infection. Signs and symptoms of any type of infection include redness, heat around the affected area, swelling, fever, and pain. On the skin, you might also see a rash. In the respiratory system, coughing, mucous, fever or difficulty breathing can be symptoms. In the urinary system, frequency, urgency, incontinence, burning, increased sediment, fever or autonomic dysreflexia. Infection in the bowel can be noted by incontinence, fever, diarrhea or mucous discharge.
The skin is the first line of defense against infection. Skin is a living organ of the body. It covers the entirety of the surface of our bodies. There are natural openings to the body such as the mouth, nose, eyes, ears, nipples, urethra, vagina and rectum. Otherwise, the skin is closed to outside entrance of pathogens. Some fungi or insects can burrow through the skin to gain entry but mostly, it is a closed door to pathogens. There have been some instances where bacteria, especially staph, have invaded the body through the skin’s protective layers.
It is very important to maintain your skin to keep pathogens from entry. This includes care of the skin on the outside of the body by good hygiene practices, carefully cleaning natural openings of the body, using good technique for catheterization, bowel programs, and suctioning. Attention and care of surgical openings needs to be provided to these openings such as ostomies, tube feeding openings and drains. Caution should be taken when moving body parts to avoid damage to the body and skin.
Inside the body, the skin functions best by providing hydration and good nutrition so skin can maintain its integrity and fluid. If you have issues with sensation and movement, it is important to perform pressure releases to avoid skin breakdown. Pressure injury starts inside the body where you cannot see. When you see a red spot on lightly pigmented skin or a purple or dark spot on darkly pigmented skin, the pressure injury has already begun within the body. The visible spot is just an indicator or something much larger happening deep within the body.
The respiratory system needs to be working well to fight pathogens that might be inhaled when breathing. The respiratory system uses three sets of muscles, the diaphragm, intercostal muscles (those between the ribs) and the abdominal muscles. When all three sets of muscles are functioning at top form, good inhalation can be accomplished. When one set of these muscles is not working at top capacity, a good deep breath and cleansing coughs might not be efficient. This includes individuals with lumbar and perhaps sacral spinal cord injuries who have weakened abdominal muscles. Without mobilization of the entire lung, the small pouches of the lower lungs can fill with mucous or fluid that cannot be expelled leaving the individual susceptible to infection. If the immune system cannot activate quickly enough, an infection can quickly overwhelm the body.
The bladder is also a frequent system affected by infection after spinal cord injury. Taking care to perform good hand hygiene both before and after catheterization is a first step. Carefully cleaning and rinsing soap and other cleansers from the urethra is important as they can irritate the delicate urethral tissue. Soap and cleanser also dry and crack tissue that should maintain some moisture. Perform catheterization every four to six hours to avoid over distention of the bladder and not catheterizing too soon which can increase your risk of infection. Drink fluids in appropriate amounts for your bladder program, mostly water, to keep urine flowing through the kidneys and bladder. Avoid caffeine and alcohol which tend to dehydrate the body. Stop smoking as the nicotine robs the body of oxygen and is eliminated through the bladder.
Your immune system will respond to an infection by sending white blood cells to the infected site. Sometimes, the pathogen may be working faster than the body can respond, especially if the immune system has been affected by spinal cord injury through the autonomic nervous system. In this case, the infection can take over before a response can be naturally mounted. It is important to treat the infection with medication or other interventions to ensure a quick and safe recovery. If you have a bacterial infection that is treated with antibiotics, it is necessary to take the full prescription even if you feel better. This will ensure all the bacteria has been eliminated.
Infections of all sources, types and amounts can sometimes spread quickly. When other organs of the body are affected, SEPSIS is diagnosed. This is an extremely serious type of infection. Sepsis can be deadly.
Some or all the following symptoms of Sepsis may be present:
- Elevated temperature, greater than 38.30C or 101.30F
- Fast heart rate, greater than 90 beats per minute
- Fast respiratory rate, greater than 20 breaths per minute
- Confusion or coma
- Edema especially in the extremities, neck, face
- Elevated blood sugar without diabetes
- Lower temperature below 36C or 97F
There is a wallet card available on the Christopher and Dana Reeve Paralysis Website that can help you and your healthcare provider guide your care for sepsis.
It is important to keep this card handy as sepsis is an emergency condition. You will need medical attention immediately which you can start by calling 911.
Infection is often not paid too much attention as it is such a frequent occurrence. With spinal cord injury and the resulting immunocompromise that results, it is very important to notice infection and receive medical treatment. You know your body best so if something does not seem right, be sure to get an evaluation to maintain your optimum health. Nurse Linda
Pediatric Consideration: Children who are experiencing an infection might not be able to communicate their specific need to their parent or caregiver due to lack of language skills or developmental level. Isolating an issue can be a challenge for the care providing adults, even more so for children who have not experienced life’s challenges. Children will express discomfort through behavior changes, grumpiness and sometimes withdrawing. They might not want to interrupt their lives with a problem when something fun is happening. These behaviors include teens as well. Sometimes, even adults like to put things off especially when we think they might be uncomfortable. It is up to the adult to notice changes in the child’s body and temperament that might indicate an issue. Parents and caregivers are excellent in noting subtle changes in children.
Another issue with infection in children is that the infection can overwhelm children’s metabolisms quickly. Early warning and detection are critical to ensure the infection does not progress too quickly. This can be a challenge in the night and weekends when medical care might feel awkward. Do not let this deter you from early contact. The healthcare professional will be able to determine what needs immediate attention versus what can wait until morning.
COVID-19 is an infection that does affect people of all ages. Children and teens are vulnerable to this virus. If you notice any symptom of fever, rash, respiratory difficulty, change in mental status or behavior contact your health care professional immediately for quick and assessment. Nurse Linda
Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.
For more resources on the coronavirus, visit the Reeve Foundation COVID-19 Information Center.