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Reportable Infectious Diseases

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Invasive diseases are: meningitis, bacteremia, epiglottitis, or pneumonia ... plague: pneumonia from inhaled ... Diseases include: pneumonia, bactermia assoc. ... – PowerPoint PPT presentation

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Title: Reportable Infectious Diseases


1
Reportable Infectious Diseases
  • Chp. 153.
  • 1/19/06 Dr. Batizy
  • Bogdan Irimies PGY-3

2
Introduction
  • CDC in Atlanta publishes a list of notifiable
    infectious diseases.
  • Requirement to report these diseases is mandated
    by state or territory laws and regulations.
    Therefore, the list differs from state to state
  • The following case definitions establish uniform
    criteria.

3
AIDS
  • For patients 13 years or older reporting is
    required if the patient demonstrates
  • 1. CD4 T-cell count
  • 2. CD4 T-cell percentage of total lymphocyte
  • 3. Any of the following pulmonary TB, recurrent
    pneumonia, cervical cancer or the 23 other AIDS
    defining conditions.

4
Anthrax
  • Caused by Bacillus anthracis
  • Cutaneous form is characterized by a skin lesion
    evolving over 2-6 days from papule to vesicle to
    depressed black eschar.
  • Inhalation form characterized by brief URI,
    hypoxia, dyspnea, mediastinal widening from
    adenopathy on CXR.

5
Anthrax
  • Intestinal form is characterized by fever,
    sepsis, crampy abdominal pain.
  • Oropharyngeal form characterized by mucosal
    lesion in oral cavity, cervical adenopathy,
    edema, fever.
  • Lab diagnosis (Dx)
  • 1. Isolation of B. anthracis from clinical
    specimen
  • 2. anthrax electrophoresis/immunoflurescence

6
Botulism 3 forms
  • Foodborne acute illness manifested by diplopia,
    blurred vision, bulbar weakness or symmetric
    paralysis of rapid onset.
  • Infant constellation of symptoms in infant under
    1 y/o including constipation, poor feeding,
    failure to thrive, progressive weakness, impaired
    respirations and death

7
Botulism
  • Wound symptoms similar as for food borne.
  • Lab Dx
  • botulinum toxin in serum, stool, food.
  • Positive culture for C. botulinum from stool

8
Brucellosis
  • Infection w/Brucella characterized by fever,
    night sweats, fatigue, anorexia, weight loss,
    headache (HA), arthralgias.
  • Lab Dx
  • Culture positive from specimen
  • Increase in Brucella agglutination titers
  • Positive immunofluorescence of Brucella in
    clinical specimen

9
Chancroid
  • STD caused by Haemophilus ducreyi
  • Painful genital ulcer w/inflamed inguinal lymph
    nodes.
  • Isolation from clinical specimen confirms Dx.

10
Chlamydia Trachomatis
  • Causes urethritis, epididymitis, cervicitis,
    salpingitis, conjunctivitis, pneumonia, or maybe
    asymptomatic.
  • Lab Dx
  • Positive culture
  • Detection of the antigen or nucleic acid on
    immunofluorescence.

11
Cholera
  • Manifested by diarrhea and vomiting
  • Lab dx
  • Isolation of toxigenic Vibrio cholerae O1 or O139
    from stool or emesis

12
Coccidioidomycosis
  • Caused by fungus Coccidioides immitis, endemic to
    SW U.S.
  • Causes influenza like respiratory illness
  • -Fever, cough, chest pain, myalgias,
    arthralgias, HA, pneumonia on CXR, erythema
    nodosum or erythema multiforme rash, meningitis,
    or involvement of bones, joints, viscera or lymph
    nodes.

13
Coccidioidomycosis
  • Lab Dx
  • Culture, histopathology, or molecular evidence of
    C. immitis
  • Serologic tests such as IgM by immunodiffusion,
    ELISA, latex agglutination
  • Coccidiodal skin test conversion after onset of
    symptoms

14
Cryptosporidiosis
  • Caused by protozoa Cryptosporidium parvum
  • Signs Symptoms (S/Sx)
  • Fever, nausea, vomiting, abdominal cramps, loss
    of appetite
  • Lab Dx
  • Detection of oocysts in stool
  • demonstration of organism in intestinal fluid or
    small bowel biopsy
  • detection of Cryptosporidium antigen in stool

15
Cyclosporaisis
  • Intestinal illness caused by protozoa Cyclospora
    cayetanensis
  • S/Sx
  • watery diarrhea, weight loss, flatus, nausea,
    fatigue, vomiting, anorexia, abdominal cramping
    and fever

16
Cyclosporaisis
  • Lab Dx
  • Detection of oocysts in stool
  • Detection of Cyclospora in intestinal fluid or
    small bowel biopsy
  • Demonstration of sporulation
  • Detection of DNA by PCR

17
Diptheria
  • Caused by Cornynebacterium diptheriae
  • S/Sx URI like, sore throat, fever, adherent
    membrane to tonsils, pharynx or nose.
  • Lab dx
  • Isolation of organism from specimen or
    histopathologic diagnosis

18
Ehrlichiosis
  • Tick borne illness presents as flu-like illness
    w/fever, HA, myalgias, malaise, nausea, vomiting
    or rash.
  • May see thrombocytopenia, leukopenia, elevated
    LFTs
  • Three categories need to be reported
  • 1. HME caused by Ehrlichia chaffeensis 2.
    HGE caused by E. phagocytophila 3.
    Ehrlichiosis, Human

19
Arboviral Encephalitis/Meningitis
  • S/Sx
  • Arboviral meningitis fever, HA, stiff neck,
    pleocytosis.
  • Arboviral encephalitis febrile illness assoc
    w/neurologic s/sxs such as HA, mental status
    change, confusion, nausea/vomiting, meningismus,
    CN palsy, paresis or paralysis, sensory deficit,
    seizures, or coma.

20
Arboviral Encephalitis/Meningitis
  • Lab Dx
  • Fourfold rise in antibody titer
  • Isolation of virus or viral antigen from tissue,
    serum or CSF
  • IgM antibody detection

21
Enterohemorrhagic E. Coli
  • S/Sx caused by E. Coli 0157H7 in foodborne
    outbreaks
  • Enterohemorrhagic illness w/bloody diarrhea,
    abdominal cramping and may have HUS or TTP
  • Lab Dx isolation of E. coli 0157H7 or a shiga
    toxin producing E. coli

22
Giardiasis
  • Caused by protozoan Giardia lamblia
  • S/Sxs diarrhea, abdominal cramps, weight loss,
    malabsorption
  • Lab Dx G. lamblia cysts or trophozoites in stool
    or antigen in stool by specific immunodiagnostic
    test

23
Gonorrhea
  • Caused urethritis, cervicitis, salpingitis,
    disseminated disease or maybe asymptomatic
  • Observation of gram neg. intracellular
    diplococci

24
Haemophilus Influenzae Invasive Disease
  • Invasive diseases are meningitis, bacteremia,
    epiglottitis, or pneumonia
  • Lab Dx isolation of H. Flu from blood CSF or
    joint fluid

25
Hansen Disease(Leprosy)
  • Caused by organism Mycobacterium leprae
  • Four clinical forms of disease
  • Tuberculoid leprosy one or few well demarcated,
    hypopigmented and anesthetic skin lesions
  • Lepromatous form number of erythematous papules
    nodules that affect the face, hands and feet in
    a symmetric pattern

26
Hansen Disease(Leprosy)
  • Dimorphous form skin lesions characteristic of
    the tuberculoid and lepromatous forms
  • Indeterminate form hypopigmented macules that do
    not have characteristics of tuberculoid or
    lepromatous forms
  • Lab Dx demonstration of acid fast bacilli in
    skin or dermal nerves requiring a skin biopsy.

27
Hantavirus Pulmonary Syndrome
  • S/Sxs prodrome of fever, chills, myalgias, HA,
    and GI symptoms that progress to bilateral
    pulmonary infiltrates, respiratory compromise,
    ARDS. May see hemoconcentration, WBC count w/left
    shift, neutrophilic leukocytosis
    thrombocytopenia
  • Lab Dx Hantavirus specific IgM or rising titers
    of IgG, PCR, or Hanta virus antigen

28
HUS, Postdiarrheal
  • HUS present as acute onset of microangiopathic
    hemolytic anemia, renal injury and
    thrombocytopenia usually w/in 3 weeks of
    diarrheal illness.
  • TTP w/similar features but also fever and CNS
    involvement
  • Lab Dx anemia of microangiopathic
    changes(schistocytes, burr cells, helmet cells)
    and renal failure.

29
Legionella
  • Causes 2 diseases Legionaires disease and
    Pontiac fever.
  • Fever,myalgias, cough, pneumonia.
  • Lab dx
  • Isolation of Legionella from respiratory
    secretions, lung tissue, pleural fluid or sterile
    bodily tissue
  • Demonstration of rising antibody titer
  • Detection of L. pneumophilia serotype 1 in body
    fluids
  • Detection of L. pneumophilia serotype 1 antigen
    in urine

30
Listeriosis
  • Listeria monocytogenes caused meningitis and/or
    bacteremia
  • Lab Dx
  • Isolation of L. monocytogenes from sterile body
    fluids, fetal tissue or placenta

31
Lyme Disease
  • Tick borne illness caused by Borrelia burgdorferi
  • S/Sx fever, fatigue, HA, stiff neck,
    arthralgias/myalgias, erythema migrans, high
    degree heart block, myocarditis,
    meningitis/encephalitis
  • Lab Dx isolation of organism or identification
    of antibody(IgM or IgG) in serum or CSF

32
Malaria
  • Caused by Plasmodium species, present w/fever,
    HA, chills, myalgias, nausea/vomiting, diarrhea,
    cough, renal failure, pulmonary edema and
    coma/death
  • Malaria parasites can be seen on blood smear.

33
Measles(Rubeola)
  • S/Sx Generalized rash 3 days, temp. 38.3,
    cough, coryza, conjunctivitis
  • Lab Dx
  • Positive serology for IgM
  • Rise in measles antibody titer
  • Isolation of measles virus from specimen

34
Meningococcal Disease
  • S/Sxs meningitis, meningococcemia, purpura
    fulminans, shock, death
  • Lab Dx
  • Isolation of Neisseria meningitidis from blood or
    CSF

35
Mumps
  • S/Sx unilateral or bilateral tender,
    self-limited swelling of parotid or other
    salivary gland for 2 days w/out other cause.
  • Lab Dx
  • Isolation of mumps virus from specimen
  • Rise in serum IgG or IgM

36
Pertussis
  • S/Sx 2 week history of paroxysmal cough,
    inspiratory whoop or posttussive vomiting.
  • Lab Dx
  • Isolation of Bordetella pertussis from clinical
    specimen
  • Positive PCR for B. pertussis

37
Plague
  • S/Sx fever, chills, HA, malaise, prostration ,
    leukocytosis.
  • Different forms
  • Bubonic plague regional lymphadenitis
  • Septicemic plague sepsis
  • Pneumonic plague pneumonia from inhaled droplets
  • Pharyngeal plague pharyngitis and cervical
    lymphadenitis

38
Plague
  • Lab Dx
  • Increase in serum antibody titers to Yersinia
    pestis fraction 1 antigen
  • Detection of fraction 1 antigen by fluorescent
    assay
  • Confirmation w/isolation of Y. pestis in clinical
    specimen

39
Paralytic Poliomyelitis
  • S/Sx illness of acute onset characterized by
    flaccid paralysis of one or more limbs, DTRs are
    absent, no sensory abnormalities, and no other
    apparent cause for above.
  • Clinical case definition is sufficient for
    reporting

40
Psittacosis
  • S/Sx disease of birdhandlers, fever, chills, HA,
    photophobia, cough, myalgia
  • Lab dx
  • Isolation of Chlamydia psittaci from respiratory
    secretions
  • 4 fold rise in serum antibody titers
  • Detection of serum IgM to C. psittacci

41
Q Fever
  • S/Sxs acute infection with Coxiella burnetti,
    fever, myalgias, malaise, retrobulbar HA,
    hepatitis, pneumonia, meningoencephalitis
  • Lab Dx
  • fourfold rise in antibody titer
  • Isolation of C. burnetti from specimen
  • Demonstration of C. burnetti by antigen or
    nulceic acid testing

42
Rabies
  • S/Sx acute encephalomyelitis, coma, death w/in
    first 10 days of first symptom
  • Lab Dx
  • Direct fluorescent antibody of viral antigen
  • Isolation in cell culture or lab animal of rabies
    virus from saliva, CSF, or CNS tissue
  • Identification of rabies neutralizing antibody
    titer in serum or CSF in a previous unvaccinated
    person

43
Rocky Mountain Spotted Fever
  • S/Sx tick born disease characterized by HA,
    myalgia, fever, petechial rash on palms and soles
  • Lab Dx
  • Rise in antibody titer to Rickettsia rickettsii
    antigen
  • Positive PCR
  • Positive immunoflourescence of skin lesion biopsy
    or organ tissue biopsy
  • Isolation of R. rickettsii from clinical specimen

44
Rubella
  • S/Sx acute onset of generalized maculopapular
    rash, temp.37.2, arthralgias, arthritis,
    lymphadenopathy, conjunctivitis.
  • Lab Dx
  • Isolation of rubella virus
  • Rise in serum IgG titers
  • Positive IgM

45
Salmonellosis
  • S/Sx Salmonella causes nausea, vomiting,
    abdominal pain and diarrhea
  • Lab Dx
  • Isolation of Salmonella from specimen

46
Shigellosis
  • S/Sx same as Salmonella
  • Lab Dx
  • Isolation of Shigella from specimen

47
Invasive Group A Streptococcal Disease
  • Diseases include pneumonia, bactermia assoc.
    with cutaneous infection(cellulitis, wound
    infection), myositis/necrotizing fasciitis,
    meningitis, peritonitis, osteomyelitis, septic
    arthritis, postpartum sepsis, neonatal sepsis
  • Lab Dx
  • Isolation of Group A Streptococci (Strep.
    Pyogenes)

48
Streptococcal Toxic Shock Syndrome
  • S/Sx Group A strep infection associated w/a
    cutaneous lesion
  • All of following must be present w/in 48 hrs.
    hypotension, two or more multiorgan involvement
    such as renal failure, coagulopathy/DIC, LFTs 2
    x normal, ARDS, generalized maculopapular
    rash/desqumation, necrotizing fasciitis or
    gangrene
  • Lab Dx isolate Group A Strep from sterile site

49
Syphilis
  • S/Sx primary (genital chancres), secondary
    mucocutaneous lesions, tertiary neurosyphilis,
    skin, bone and cardiovascular
  • Lab Dx
  • Primary or secondary syphilis demonstrate
    Treponema pallidum on dark field microscopy or
    direct fluorescent antibody(DFA-TP)

50
Syphilis
  • Latent or Tertiary syphilis lab Dx
  • Reactive VDRL or RPR
  • Reactive treponemal test(FTA-ABS or MHA-TP)
  • History of syphilis therapy w/a fourfold rise in
    antibody titer

51
Tetanus
  • S/Sx acute onset of hypertonia, painful muscular
    contractions of body and jaw
  • Clinical diagnosis is sufficient

52
Toxic Shock Syndrome
  • Caused by Staph aureus
  • S/Sx temp. 38.8, hypotension, diffuse macular
    erythroderma, desquamation, 3 or more multisystem
    involvment such as vomiting or diarrhea,
    myalgias/CPK increase, mucous membrane
    involvement, increase in renal function, increase
    LFTs , thrombocytopenia, CNS effects(MS change)
  • Dx clinical case

53
Trichinosis
  • S/Sx caused by ingestion of Trichinella larvae.
    May see fever, myalgia, periorbital edema,
    eosinophilia
  • Lab Dx
  • Trichinella larvae in tissue muscle biopsy
  • Serologic test is positive

54
Tuberculosis
  • Following criteria must be met
  • Positive tuberculin skin test
  • Clinical evidence of disease w/positive CXR
  • Treatment w/2 or more anti-TB drugs
  • Completed diagnostic evaluation
  • Isolation of TB from clinical specimen
  • Detection of TB by nucleic acid test
  • Acid fast bacilli from clinical specimen

55
Tularemia
  • S/Sx caused by Francisella tularensis. Several
    different forms
  • Ulceroglandular cutaneous ulcer w/regional
    lymphadenopathy
  • Glandular regional lymphadenopathy w/out ulcer
  • Oculoglandular conjunctivitis w/preauricular
    lymphadenopathy

56
Tularemia
  • Oropharyngeal tonsillitis, stomatitis,
    pharyngitis, cervical lymphadenopathy
  • Intestinal abd. Pain, vomiting, diarrhea
  • Pneumonic primary pleuropulmonary disease
  • Thyroidal febrile illness w/out local S/Sxs.
  • Lab Dx isolation of F. tularemia in clinical
    specimen or rise in antibody titer to F.
    tularemia antigen

57
Typhoid Fever
  • S/Sx Caused by bacteria, Salmonella typhi, acute
    onset of fever, HA, malaise, anorexia,
    bradycardia, GI symptoms, cough
  • Lab dx
  • Isolation of S. typhi from blood, stool or other
    clinical specimen.

58
Yellow Fever
  • S/Sx mosquito born viral illness characterized
    by acute onset of fever, HA, myalgias,
    conjunctivitis, hepatitis, albuminuria,
    jaundice, renal failure, generalized hemorrhage
  • Lab Dx
  • Fourfold rise in yellow fever antibody titer
  • Yellow fever virus antigen in tissues or other
    bodily fluids

59
Questions
  • 1. AIDS case reporting is required if which of
    the following are present
  • A. CD4 T-cell count
  • B. CD4 T-cell percentage of total lymphocyte
  • C. Any of the 23 AIDS defining conditions
  • D. All of the above

60
Questions
  • 2. Which of the following are forms of Botulism
  • A. Food borne
  • B. Infant
  • C. Wound
  • D. All of above

61
Questions
  • 3. If Dr. Batizy just returned from visiting his
    family in Arizona and he developed a influenza
    like febrile respiratory illness, which of the
    following would be on your D/Dx
  • A. Coccidioidomycosis
  • B. Giardiasis
  • C. Malaria
  • D. Lyme disease

62
Questions
  • 4. True or False Group A strep and S. Aureus can
    cause Toxic Shock syndrome?

63
Answers
  • 1.D
  • 2. D
  • 3. A
  • 4. True

64
Occupational Exposures, Infection Control and
Standard Precautions
  • Chp. 154 Tintinalli
  • Dr. Batizy
  • Slides by Bogdan
  • 1/19/06

65
Occupational Exposures
  • OSHA definition of occupational exposures
  • Reasonably anticipated skin, eye, mucous
    membrane, or parenteral contact with blood or
    other potential infectious materials that may
    result from the performance of the employees
    duties.

66
Occupational Exposures
  • Since health care workers cannot readily identify
    those who are infected or risky, it is prudent to
    employ infection control practices and utilize
    personal protective equipment(PPE) during all
    patient care activities.
  • Portals for infectious disease entry are
    percutaneous, mucous membrane (oral, ocular,
    nasal or rectal), respiratory, and dermal.

67
Occupational Exposures
  • The risk of infection in an exposed health care
    worker depends on the following factors
  • Route(portal) of exposure
  • Concentration( of organisms) of pathogens in the
    infectious material
  • Infectious characteristics(virility) of the
    pathogen
  • Volume (dose) of infectious material
  • Immunocompetence (susceptibility) of the exposed
    individual

68
Occupational Exposures
  • Percutaneous exposures have the greatest
    potential for infection than do mucous membrane
    exposures, respiratory exposures, or dermal
    exposures.

69
Management of Health Care Personnel Potentially
Exposed to HBV,HCV, HIV
  • Once an infectious exposure has occurred, a plan
    for post-exposure prophylaxis (PEP)medical
    management should be available to health care
    providers 24 hrs. a day.
  • The ER physician is usually the first to examine
    the exposed person and make an assessment of the
    relative risk of the transmission.
  • See Table 154-3

70
Table 154-3
71
Management of Health Care Personnel Potentially
Exposed to HBV,HCV, HIV
  • The exposure event should be evaluated for the
    potential to transmit HBV, HCV, and HIV based on
    the type of body substance involved and the route
    and severity of the exposure.
  • See Table 154-5

72
Table 154-5
73
Management of Health Care Personnel Potentially
Exposed to HBV,HCV, HIV
  • Testing to determine the HBV, HCV, and HIV status
    of an exposure source should be performed as soon
    as possible.
  • See Table 154-6

74
Table 154-6
75
HBV Exposure
  • Factors to consider in HBV exposure include HBsAg
    status of source and HBV vaccination status and
    vaccine response of the exposed person
  • Unvaccinated health care workers exposed to HBV
    should receive Hep. B vaccine series
  • See Table 154-7

76
Table 154-7
77
HCV Exposure
  • For occupational HCV exposures, the CDC
    recommends anti-HCV testing of source patient.
  • Immunoglobulin and antivirals are not recommended
    for PEP after exposure to HCV positive blood

78
HIV Exposure
  • Health care personnel exposed to HIV should
    receive expedited evaluation(tested for HIV at baseline
  • If source patient is HIV negative, baseline
    testing or further follow-up for exposed persons
    is not necessary.
  • Factors to consider in HIV exposure include the
    type of exposure (percutaneous, mucous membrane
    or dermal), volume of the exposure, and the HIV
    status of the source patient.
  • See Table 154-8 and Table 154-9

79
Table 154-8
80
Table 154-9
81
HIV Exposure PEP
  • CDC recommends 4 wks of PEP drug treatment.
  • Basic 2 drug regimen is appropriate for most
    exposures
  • 3 drug regimen is recommended for exposures
    determined to be at increased risk of
    transmission
  • See Table 154-10 and Table 154-11

82
Table 154-10
83
Table 154-11
84
Standard Precautions
  • Standard precautions are exercised when caring
    for all patients and include hand washing,
    gloves, mask and eye protection or face shield,
    gowns, handling of patient care equipment and
    linens, environmental controls, workplace
    controls and patient location or placement.

85
Questions
  • 1. T/F standard precautions should be used when
    caring for all patients.
  • 2. T/F If the source patient is HIV negative,
    all further testing for HIV can be stopped.
  • 3. T/F all health care workers should be
    vaccinated against HBV.
  • 4. Answers all T!

86
CT of Cervical Spine
  • Indications
  • Unconscious patient w/suspicious or inadequate
    c-spine xrays
  • CT is indicated w/all cervical fractures or
    suspected fractures on initial plain films
  • Delineating injuries to atlantoaxial complex,
    esp. rotatory subluxation and C-1 ring fractures
  • Used to examine Jefferson Fx, Rotatory
    dislocation, burst fractures, C-T level injuries

87
CT Cervical Spine
88
CT of Cervical Spine
89
CT Cervical Spine
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