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Infectious

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Title: Infectious & Communicable Diseases Author: Andrews, Peggy and Jerry Last modified by: greggl Created Date: 2/15/1999 1:00:45 AM Document presentation format – PowerPoint PPT presentation

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Title: Infectious


1
Infectious Communicable Diseases
  • Chemeketa Community College

2
Are we at risk?
  • Patient contact
  • Co-workers
  • Hygiene
  • Hazardous scenes

3
Overview
  • Infectious diseases affect entire populations
  • Important to understand population demographics
  • Their ability to move internationally
  • Age distributions
  • Socioeconomic considerations
  • Genetic factors
  • Study of an infectious disease cluster is
    regional consequences may be international.
  • Think of consequences of person-to-person
    contacts

4
Public Health Agencies
  • Local thats YOU!
  • State
  • Health dept
  • Federal
  • US DHS CDC P
  • Monitors
  • Studies researches
  • Manages
  • OSHA

5
Agency responsibility relative to isolation from
exposure
  • Exposure plan
  • Maintenance and surveillance
  • Appointing a DO
  • Schedule of standards implemented
  • PPE
  • gowns
  • gloves
  • face shields
  • masks
  • protective eyewear

6
  • BSI
  • Procedures for evaluation of circumstances and
    counseling
  • personal, building, vehicular, equipment
    disinfection and storage
  • After action analysis
  • Correct disposal
  • Correct handling

7
Guidelines, Recommendations, Standards, Laws
  • PPE must be available to all employees at high
    risk
  • All employees must be offered HB vaccine
  • All high risk employees must be offered
    protection from bloodborne pathogens including TB
    testing, measles vaccination.

8
Host Defense Mechanisms
  • Nonspecific and surface defense mechanisms
  • Flora
  • Enhances effectiveness of surface barrier by
    interfering with establishment of agents
  • Can be responsible for infection
  • Skin
  • Intact skin defends against infection by
  • Maintaining an acidic pH level
  • Preventing infection

9
  • GI System
  • Resident bacterial flora provides competition
    between colonies of microorganisms for nutrients
    and space helps prevent proliferation of
    pathogenic organisms
  • Stomach acid may destroy some microorganisms
  • Eliminates pathogens through feces

10
  • Upper Respiratory system
  • Turbinates
  • Mucous
  • Mucociliary escalator
  • Normal bacterial flora
  • Lymph tissues of tonsils and adenoids permit
    rapid local immunological response

11
  • GU tract
  • Natural process of urination and bacteriostatic
    properties of urine help prevent establishment
    of microorganisms in GU tract
  • Antibacterial substances in prostatic fluid and
    vaginal fluid help prevent infection in GU system.

12
  • Internal Barriers
  • Protect against pathogenic agents when external
    lines of defense are breached.
  • Include
  • Inflammatory response
  • Imune response

13
Inflammatory response
  • A local reaction to cellular injury
  • Generally protective and beneficial
  • May initiate destruction of the bodys own tissue

14
Three separate stages
  • Cellular response to injury
  • Decreasing energy stores
  • Cell membrane deteriorates, begin to leak
  • Vascular response to injury
  • Capillary permeability increases, edema
  • Leukocytes collect
  • Pagocytosis
  • Leukocytes engulf, digest, destroy invaders

15
Immune response
  • Possesses self-nonself recognition
  • Produces antibodies
  • Some lymphocytes become memory cells
  • Is self-regulated to activate only when invading
    pathogens

IgG IgM IgA IgD IgE
16
  • B-cells
  • Produces antibody
  • T-cells
  • Processes antigen for B-cell,
  • Killer T cells are stimulated to multiply by
    presence of antigens on abnormal cells
  • Helper T cells turn on activities of killer cells
  • Suppressor T cells turn off action of helper and
    killer T cells
  • Inflammatory T cells stimulate allergic
    reactions, anaphylaxis, autoimmune reactions

17
Approach to call
  • Wear appropriate PPE
  • Patient Assessment
  • Focused history and physical
  • History of present illness
  • Onset - gradual or sudden?
  • Fever
  • Antipyretic usage (ASA, APAP)
  • Neck pain or rigidity?
  • Difficulty swallowing, secretions?
  • How did sx change over time?

18
  • Past medical history
  • Chronic infections, inflammation
  • Use of steroids, antibiotics
  • Organ transplant and associated medicines
  • Diabetes or other endocrine disorders
  • COPD or respiratory complications

19
Detailed history and physical
  • Assess skin for temperature, hydration, color,
    mottling, rashes, and petechiae
  • Assess sclera for icterus
  • Assess patient reaction to neck flexion
  • Assess for lymphadenopathy in neck
  • Assess digits and extremities for purulent
    lesions

20
  • Upon disposition of patient, dispose of supplies,
    bag linen, disinfect ambulance and equipment
  • Reprocessing methods for EMS durable equipt.
  • Sterilization
  • High-level disinfection
  • Intermediate-level disinfection
  • Low-level disinfection

21
Stages of an infectious disease
Stage of Disease Begins Ends
Latent period With invasion When agent can be shed
Communicable period When latent period ends Continues as long as agent is present
Disease period Follows incubation period Of variable duration
22
The Ryan White Act
  • Ryan Wayne White - 1971 1990
  • Dx /c Hemophilia at 3 days old
  • Tx /c Factor VIII and blood transfusions
  • 1984 Dx /c AIDS
  • 1990, 1996 Ryan White law passed

23
What does it mean?
  • Employees must be notified within 48 hours if an
    exposure is found to have occurred.
  • Employers must name a DO to coordinate
    communications between hospital and agency

24
  • Federal funding available for AIDS education,
    support

25
Individual Responsibilities
  • Be familiar with laws, regulations
  • Proactive attitude infection control
  • Maintain personal hygiene
  • Attend to wounds
  • Effective hand washing after every patient
    contact
  • Remove or dispose of work garments- handle
    uniforms properly

26
  • Handle and launder soiled work clothes properly
  • Prepare food and eat in appropriate areas
  • Maintain general and psychological health
  • Dispose of needles and sharps appropriately
  • Dont wipe face and/or rub eyes, nose, mouth etc.

27
Pathophysiology
28
  • Exposure does not necessarily equal infection
  • The chain of elements must be intact
  • Transmission can be controlled

29
Well talk about...
  • HIV
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis non-ABC
  • Tuberculosis
  • Mengococcal meningitis
  • Pneumonia
  • Rabies
  • Hantavirus
  • Chicken pox
  • Mumps

30
And these too
  • Rubella
  • Measles
  • Whooping cough
  • Influenza
  • Mononucleosis
  • Herpes simplex 1 2
  • Syphilis
  • Gonorrhea
  • Chlamydia
  • Scabies Lice
  • Lyme disease
  • Gastroenteritis

31
Infectious agents
  • Bacteria
  • Prokaryotic
  • Nuclear material is not contained within a
    distinctive envelope
  • self-reproducing without host cell BUT require
    host for food, support
  • s/s depend on cells and tissues infected

32
  • Toxins - often more lethal than bacterium
  • Endotoxins
  • Exotoxins
  • Can be localized or systemic infection

33
  • Viruses
  • Eukaryotic
  • Nuclear material contained within a distinct
    envelope
  • must invade host cells to reproduce
  • Cant survive outside of host cell

34
Other Microorganisms
  • Prions
  • Slow viruses particles of protein
  • Accumulate in nervous tissue and brain tissue
  • Mad Cow Disease
  • Fatal familial insomnia
  • Alzheimers Disease
  • Parkinsons Disease

35
  • Fungi
  • Protective capsules surround the cell wall and
    protect fungi from phagocytes
  • Broad-spectrum antibiotics can cause fungal
    infections
  • Pneumonia, Yeast infections

36
ProtozoansSingle-celled microorganismsMore
complex than bacteria
  • Live in soil opportunistic infections
    fecal-oral or mosquito bites
  • Malaria
  • Some forms of Gastroenteritis
  • trichomoniasis

37
Parasites Helminths (worms)
  • Roundworms
  • Live in intestinal mucosa
  • S/S abdominal cramping, fever, cough
  • Pinworms
  • Common in US
  • 20 of children in temperate
  • climates are infected
  • Live in distal colon
  • S/S anal itching
  • Hookworms
  • 25 world population rare in US
  • Walking barefoot in contaminated area
  • S/S epigastric pain, anemia

38
Human immunodeficiency virus (HIV) Slim disease
  • Present in blood and serum-derived body fluids
  • Directly transmitted person-person
  • Indirectly transmitted via
  • blood transfusion, organ transplant, contaminated
    needles

39
Statistics
  • US- 850,000 950,000
  • gt180,000 undiagnosed
  • Oregon 5,599 (12/03)

40
  • International Travel
  • 'Patient Zero - Gaetan Dugas
  • Analysis of several of the early cases of AIDS
    -infected individuals were either direct or
    indirect sexual contacts of the flight attendant.
  • The Blood Industry
  • In some countries such as the USA paid donors
    were used, including intravenous drug users.
  • This blood sent worldwide.
  • Also, in the late 1960's hemophiliacs benefit
    from Factor VIII. To produce the coagulant, blood
    from thousands of individual donors had to be
    pooled.

41
  • Drug Use
  • The 1970s - increase in availability of heroin
    following the Vietnam War and other conflicts in
    the Middle East,
  • the development of disposable syringes and the
    establishment of 'shooting galleries' provided
    another route.
  • What other theories have there been about the
    origin of HIV?
  • conspiracy theories - manufactured by the CIA vs
    genetically engineered.

42
  • Occurrence highest
  • High-risk sexual behavior
  • IV drug abuse
  • Transfusion recipient between 1978-1985
  • Hemophilia or other coagulation disorders
    requiring blood products
  • Infant born from HIV-pos. mother
  • Other factors
  • Coexisting STDs (esp. with ulceration)
  • Penile foreskin

43
  • Causative agent - HIV-1 HIV-2
  • Seeks cell receptor CD4 T cells
  • Found on surface of T helper cells
  • Both types are seriologically distinct but share
    similar characteristics

HIV infected T-cell
44
  • HIV-1 is far more pathogenic most cases
    world-wide are HIV-1, Group M
  • first case in US of HIV-1, Group O, identified in
    6/96
  • Est. AIDS dx through 2003 in US- 929,985. Adult
    and adolescent 920,566
  • Males 749,887
  • Females 170,679
  • Children 9,419
  • HIV-antibody tests in US detect HIV-1 Group M,
    with 99 accuracy HIV-1 Group O with 50-90.
  • HIV-2 milder sx, slower development mainly in
    West Africa. US cases 79

45
  • Initial case definition established by CDC in
    1982.
  • 1987 1993 s/s include tuberculosis, recurrent
    pneumonia, wasting syndrome, HIV dementia,
    sensory neuropathy.

46
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47
Classifications Categories
  • Category A
  • Acute retroviral infection
  • 2-4 weeks after exposure
  • Mono-like illness lasts 1 2 weeks
  • Fever
  • Adenopathy
  • Sore throat

48
  • Transient decrease in CD4T cell counts
  • Seroconversion 6-12 weeks after transmission
  • CD4T cell count return to normal levels
  • Asymptomatic infection persistent generalized
    lymphadenopathy gradual decline in CD4T cell
    count

49
  • Category B
  • Early symptomatic HIV
  • Decreased CD4T cell count
  • Common complications
  • Localized Candida infections
  • Oral lesions
  • Shingles
  • PID
  • Peripheral neuropathy
  • Fever/Diarrhea lasting more than one month

50
  • Category C
  • Late symptomatic HIV
  • Represents all AIDS-defining diagnoses
  • CD4T cell count 0 to 200 per uL
  • Severe opportunistic infections
  • Bacterial pneumonia (Pneumocystis Carinii
    Pneumonia)
  • Pulmonary tuberculosis
  • Debilitating diarrhea
  • Tumors in any body system, including Kaposis
    sarcoma
  • HIV-associated dementia
  • Advanced HIV CD4T cell counts 0-50 per uL.

51
  • Nervous system - toxoplasmosis of CNS
  • Immune system - major site of compromise
  • Respiratory system - pneumocystis carinii
    pneumonia
  • Integumentary system - Karposis sarcoma

52
  • 13-30 transmission to infants born to
    HIV-infected mothers
  • Breast feeding can result in HIV transmission
  • Virus has occasionally been found in saliva,
    tears, urine, bronchial secretions.
  • Vector transmission has not been known to occur.
  • Risk of oral sex is not quantified believed low.

53
Patient management
  • Out-of-hospital care - supportive.
  • BSI as appropriate
  • effective hand washing
  • Use of eye protection, masks and gowns highly
    recommended when exposure to large volumes of
    body fluids.

54
  • HCW infection
  • Nonintact skin exposure (6/2000) 56

  • 138 ?
  • Susceptibility and resistance
  • Infectiousness may be high during initial period
    after infection and at end-stage
  • Race and gender are not risk factors for
    susceptibility.

55
  • Care in use of medical equipment mandatory
  • Disinfection of equipment mandatory
  • Early diagnosis, treatment, counseling for
    health-care providers is mandatory.

56
HIV testing
  • OraQuick Rapid HIV 1 / 2 test
  • Oral fluid, plasma, whole blood
  • 20 40 minutes
  • Accuracy
  • Positive 99.3
  • Negative 99.8

57
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58
Post-exposure prophylaxis
  • lt 72 hours non-occupational exposure
  • highly active antiretroviral therapy (HAART)
  • PMPA (tenofovir) 28 days
  • Repeat testing 4-6 weeks after exposure again at
    3 months, 6 months, 1 year

59
WHO Recommendations for a First Line Regimen in
Adults and Adolescents
  • d4T3TCNVP
  • ZDV3TCNVP
  • d4T3TCEFZ
  • ZDV3TCEFZ
  • d4T (NRTI) alternative name Stavudine
  • ZDV (NRTI) alternative names Zidovudine or AZT
  • EFZ (NNRTI) alternative name Efavirenz
  • NVP (NNRTI) alternative name Nevirapine
  • 3TC (NRTI) alternative name Lamivudine

60
Hepatitis
  • A viral disease
  • Produces pathologic alterations in the liver

61
Hepatitis-A
  • Causative agent-Hepatitis A virus
  • Most common type of viral hepatitis
  • Once infected, person is immune to HAV for life

62
Statistics
  • Oregon 1994 2003 6650 cases
  • Marion Cty 632
  • Multnomah Cty 1,512

63
  • Many infections asymptomatic
  • Liver may be affected
  • Often occurs without jaundice, esp. children
  • Only recognizable by liver function studies
  • Only hepatitis virus that does not lead to
    chronic liver disease or chronic carrier state.

64
  • Routes of transmission
  • stool of infected person
  • contaminated water, ice or food
  • Sexual and household contact can spread virus
  • Can survive on unwashed hands for 4 hours

65
Susceptibility and resistance
  • No clearly defined populations at increased risk.
  • 75 of people with H-A have sx.
  • In developing nations with poor sanitation,
    infection is common
  • In developed nations, often associated with day
    care, nursing homes

66
S/S
  • Onset is abrupt with fever, weakness, anorexia,
    abdominal discomfort, nausea and darkening of
    urine, sometimes followed w/in a few days by
    jaundice/icterus.
  • Mild severity lasting 2-6 weeks.
  • Rarely serious.

67
Patient management
  • Care is supportive for fluid intake and
    prevention of shock.
  • Person is most infectious during first week of
    sx.
  • BSI mandatory.

68
Immunization
  • Prophylactic IG may be administered within two
    weeks after exposure
  • If traveling to Africa, the Middle East, Central
    and South America, Asia - get immunized.

69
  • Hepatitis A vaccine available for 2 y/o or older
  • Close contact with people who live in areas with
    poor sanitary conditions
  • Male-male sex
  • Illicit drugs
  • Children in populations with repeated epidemics
  • Chronic liver disease or clotting factors
    disorders

70
Hepatitis-B
  • Causative agent - H-B virus.
  • Potential secondary complication - liver necrosis
  • HBV usually lasts lt 6 months
  • Carrier state may persist for years

71
Statistics
  • Oregon 1994 2003 1,578 cases
  • Marion Cty 195
  • Multnomah Cty 556

72
Routes of transmission
  • Blood, semen, vaginal fluids, saliva, blood
    transfusion, dialysis, needle and syringe
    sharing, tattooing, sexual contact, acupuncture,
    communally-used razors and toothbrushes.
  • HBV stable on environmental surfaces gt 7 days
  • Transmission by insects and fecal-oral route not
    demonstrated.

73
S/S
  • Within 2-3 months, infected persons gradually
    develop non-specific symptoms such as anorexia,
    n/v, fever, joint pain, generalized rashes,
    sometimes jaundice.
  • Risk of developing chronic infection varies
    inversely with age.

74
  • 1 of patients develop full-blown liver crises
    and die with mortality increasing gt 40 y/o.
  • 5-10 infected people become asymptomatic
    carriers.

75
Patient management
  • out-of-hospital - supportive
  • BSI
  • Effective handwashing
  • care in use of equipment.
  • Careful handling of sharps
  • high-level disinfection of equipment esp.
    laryngoscopy blades is mandatory.

76
Immunizations
  • Recombivax HB and
  • Engerix B are effective.
  • Vaccines initial, one-month, six-month provide
    long-lasting immunity in 95-98 of cases.
  • Postexposure prophylaxis
  • HBV vaccine
  • HB IG

77
Hepatitis C
  • Causative agent - H-C virus.
  • Organ affected - liver.
  • Most frequent infection 2ndary to needlestick
    sharp injury
  • 85 infected healthcare workers become chronic
    carriers

78
  • Health care workers - 2.7 - 10 probability of
    infection when exposed to contaminated blood.
    Transmission by household and sexual contact low.
  • Cant occur from food and water.

79
Statistics
  • Oregon 1994 2003 142
  • Marion Cty 4
  • Multnomah Cty 17

80
S/S
  • same as for HBV but less progression to jaundice
  • chronic liver disease common with gt80 developing
    chronic liver disease.
  • Apparent association between HCV infection and
    liver cancer

81
  • Patient management
  • Same as for HBV
  • Immunization
  • Prophylactic administration of IG not supported
    by current data
  • Post exposure testing important
  • Vaccine may be available

82
Hepatitis non-ABC
  • Hepatitis D infects a cell with other hepatitis
    virus
  • when virus active in HBV patients, resulting
    disease extremely pathogenic
  • Hepatitis E not bloodborne is spread like H-A

83
  • Hepatitis G - newly identified
  • Major epidemics documented in young adults.
  • Women in 3rd trimester especially susceptible to
    liver disease

84
S/S
  • Onset abrupt with s/s resembling HBV
  • Always associated with HBV
  • Patient management
  • Same as for HBV
  • Immunization
  • HB vaccine can indirectly prevent H-D, but has no
    effect on H-E.

85
Tuberculosis
  • Causative agent - mycobacterium tuberculosis
  • 8 million new TB/yr worldwide
  • 3 million die of disease

86
  • TB Epidemic in US
  • Immigration
  • Transmission in high-risk environments
  • Prisons, homeless shelters, hospitals, nursing
    homes
  • Oregon 106/100,000 (11/03)

87
  • Rate of TB for HIV patients 40x rate of TB for
    non-HIV persons
  • Routes of transmission
  • airborne droplet
  • prolonged exposure to infected person
  • Reservoirs include some cattle, badgers, swine

88
Susceptibility and resistance
  • period of incubation 4-12 weeks.
  • Period for development of disease 6-12 months
    after infection.
  • Risk of developing disease highest in children lt
    3, lowest in later childhood and high among
    adolescents, young adults and elders.
  • High in immuno-compromised patients
    HIV-infected, underweight, undernourished.

89
S/S
  • First infection usually subclinical
  • These bacteria lie dormant but can reactivate
    into secondary TB
  • Most common site of reactivation TB is in apices
    of lungs.
  • Patients present with
  • chronic productive/non-productive cough
    (persistent for 2-3 weeks),
  • low-grade fevers,
  • night sweats,
  • weight loss, fatigue
  • Hemoptysis common.

90
  • Body systems affected
  • indirectly affects respiratory system including
    larynx
  • Left untreated, TB can spread to other organ
    systems and cause other sx.
  • Cardiovascular pericardial effusions may develop
  • Skeletal
  • Generally affects thoracic and lumbar spine,
    destroying intervertebral discs
  • Chronic arthritis of one joint is common
  • CNS
  • causes a subacute meningitis and forms granulomas
    in brain

91
Patient care
  • Primarily supportive
  • Prevent shock

92
  • Routine evaluation of Health care workers
  • PPD (purified protein derivative)
  • Positive reaction indicates past infection
  • CXR
  • Sputum stain and culture
  • Remember TB is communicable with prolonged
    exposure to droplet infection.

93
Drug therapy
  • prophylactic INH recommended routinely for
    persons lt35 y/o who are PPD positive not
    recommended gt 35 due to hepatic complic.
  • Therapeutic Isoniazid, Rifampin, Pyrazinamide,
    Streptomycin
  • Side effects of INH
  • Paresthesias, seizures, orthostatic hypotension,
    N/V, Hepatitis

94
Meningococcal meningitis
  • Causative organism Neisseria meningitidis,
    meningococcus
  • Tissues affected
  • Colonize lining of throat and spread easily
    through resp. secretions
  • Est. 2-10 of population carriers, but are
    prevented from illness by throats epithelial
    lining.

95
Statistics
  • Oregon 1994 2003 887
  • Marion Cty 111
  • Multnomah Cty 182

96
  • Modes of transmission direct contact w/
    secretions during intubation, suctioning, CPR
    etc.

97
S/S
  • onset is rapid
  • fever,
  • chills,
  • joint pain,
  • neck stiffness or nuchal rigidity,
  • petechial rash,
  • projectile vomiting,
  • headache

98
  • _at_ 10 may develop septic shock acute adrenal
    insufficiency, DIC, coma may result. Death may
    occur in 6-8 hours.

99
  • Pediatric patients infants 6 mo - 2 y/o esp.
    susceptible maternal antibodies protect neonates
    to 6 mo.
  • Infants display nonspecific s/s
  • Fever,
  • Vomiting,
  • Irritability,
  • Lethargy,
  • Bulging fontanelle
  • High-pitched cry

100
  • Patient management
  • protective measures with surgical masks to
    patient.
  • Prophylactic tx available rifampin, etc.
  • Immunizations esp. for older children and adults.

101
Other infectious agents cause meningitis
  • Streptococcus pneumoniae (bacterial)
  • 2nd most common cause in adults
  • most common cause of pneumonia in adults and OM
    in children
  • spread by droplets, prolonged contact or soiled
    linen.

102
  • Hemophilus influenza type B (bacterial)
  • gram negative rods. Prior to 1981, leading cause
    of meningitis in children 6 mo-3 y/o.
  • Although tx with antibiotics very effective, gt50
    infected children have long-term neurological
    deficits.
  • Implicated in epiglottitis, septic arthritis,
    generalized sepsis.

103
  • Viruses (aseptic meningitis)
  • A variety known to cause meningitis
  • not considered communicable

104
Pneumonia
  • Causative organisms
  • Bacterial
  • Viral
  • Fungal

105
  • Systems affected
  • Respiratory - pneumonia
  • CNS - meningitis
  • ENT - otitis, pharyngitis media
  • Routes of transmission
  • Droplet, Direct contact, Soiled linen

106
Susceptibility
  • pulmonary edema
  • Flue
  • exposure to inhaled toxins
  • chronic lung disease and aspiration
  • Geriatrics
  • Pediatrics with low birth weight and
    malnourishment

107
Other high-risk groups
  • sickle cell disease
  • cardiac disease
  • Diabetes
  • kidney disease
  • HIV
  • organ transplants
  • Hodgkins disease
  • Asplenia

108
S/S
  • Sudden onset chills, high-grade fevers, chest
    pain with respirations, dyspnea.
  • PEDS fever, tachypnea, chest retractions are
    ominous.
  • Purulent exudates may develop in one or more
    lobes.
  • Patient may have productive cough with
    yellow-green phlegm.

109
Patient management
  • several antibiotics effective to treat bacterial
    pneumonia
  • Protective measures for health-care workers.
  • Immunizations
  • vaccine exists for some causes

110
Tetanus
  • Causative organism
  • Clostridium tetani
  • Live mainly in soil and manure
  • Also found in human intestine

111
Statistics
  • 500,000 cases/year worldwide
  • 45 mortality
  • 100 cases/year in U.S.
  • Patients gt 50 y/o
  • Oregon 1992-2001 6
  • Marion Cty 1997 1

112
  • Affects musculoskeletal system
  • Mode of transmission
  • wounds, burns, other disruptions in skin.
  • Puncture wounds introducing soil, street dust and
    animal or human feces.
  • Dead or necrotic tissue favorable environment.

113
S/S
  • muscular tetany
  • Painful contractions, esp. trismas or locklaw and
    neck muscles secondarily of trunk muscles.
  • PEDS abnormal rigidity may be first sign.
  • Painful spasms with risus sardonicus
  • Can lead to respiratory failure.

114
Patient management
  • Support vital functions
  • Valium for muscle spasms
  • Consider paralytics
  • Magnesium sulfate
  • Narcotics
  • Antidysrhythmics
  • Administration of antitoxin - TIG

115
  • post exposure of tetanus immune globulin - keep
    immunizations UTD.
  • Immunizations Booster before elementary school,
    every ten years thereafter.

116
Rabies - hydrophobia
  • Acute viral infection of the CNS
  • Causative organism - rabies virus
  • Affects nervous system
  • Route of transmission
  • saliva from bite or scratch of infected animal.
  • Person-person transmission theoretically
    possible.
  • Airborne spread in bat caves - rare

117
Statistics
  • Oregon 1994 2003 77
  • Marion Cty
  • 1996 2
  • 1998 2
  • 2001 1

118
  • Hawaii is only area in US that is rabies-free.
  • Wildlife rabies (in US) common in
  • skunks,
  • raccoons,
  • bats,
  • foxes,
  • dogs,
  • wolves,
  • jackals,
  • mongoose,
  • coyotes.

119
  • Susceptibility Mammals highly susceptible.
  • Incubation period usually 3-8 weeks (rare 9 days
    - can be as long as 7 years).

120
S/S
  • sense of apprehension
  • H/A
  • Fever
  • Malaise
  • poorly defined sensory changes.
  • Progresses to weakness or paralysis
  • spasm of swallowing muscles (causes hydrophobia),
  • delirium,
  • convulsions
  • w/o medical care, disease lasts 2-6 days often
    results in death.

121
Patient management
  • EMS workers transmission never documented.
  • After bite
  • thorough debridement of wound
  • free bleeding and drainage.
  • Vigorously clean wound with soap and water and
    irrigate with 70 alcohol.
  • Prophylactic Tetanus vaccine
  • Administration of human rabies immune globulin
  • Over several weeks

122
Hantavirus
  • Known to be associated with hemorrhagic fever
    with renal syndrome occurs in Asia.
  • Also associated with a syndrome of severe
    respiratory distress shock in Southwestern U.S.
  • Deermouse
  • Transmitted via inhalation of aerosols of rodent
    urine and feces

123
Statistics
  • Oregon 1993 2003 5 cases

124
S/S
  • Typically healthy adults
  • Onset of fever and malaise 1 5 weeks later
  • Followed several days later by respiratory
    distress
  • fever,
  • Chills
  • H/A
  • GI upset
  • Capillary hemorrhage
  • Kidney failure, hypotension, severe infection may
    ensue
  • Death from poor cardiac output

125
Patient management
  • Supportive
  • BSI

126
Chickenpox
  • Causative agent variella-zoster virus (member of
    the Herpes virus group).
  • System affected primarily integumentary

127
  • Shingles is a local manifestation of reactivation
    of latent viral infection
  • Mainly airborne
  • soiled linen implicated.
  • Incubation period 10-21 days

128
S/S
  • more severe in adults
  • Begins with respiratory symptoms, malaise,
    low-grade fever.
  • Rash begins as small red spots that become raised
    blisters on a red base. Eventually dry into
    scabs. Rash is profuse on trunk
  • Itching
  • Patient management
  • Isolation until all lesions are crusted and dry.

129
  • Disease self-limited
  • Complications
  • Secondary bacterial infections
  • Aseptic meningitis
  • Mononucleosis
  • Reye syndrome

130
Mumps
  • Causative agentMumps virus
  • Acute, communicable systemic viral disease
  • Glands most commonly affected
  • Parotid
  • Testes
  • Pancreas

131
S/S
  • Mode of transmission droplet spread, direct
    contact
  • Incubation period 12-25 days.
  • Immunity general after recovery
  • 30 asymptomatic
  • Fever, swelling and tenderness of salivary
    glands, esp. parotid.
  • After onset of puberty
  • Orchitis
  • Testicular atrophy

132
Patient management
  • EMS workers - MMR immunity
  • Patients wear masks
  • Caution with soiled linen

133
Rubella (German measles)
  • Causative agent - rubella virus
  • Mild, febrile, highly communicable disease
  • Systems affected
  • integumentary,
  • musculoskeletal,
  • lymph nodes

134
Mode of transmission
  • maternal transmission gravest risk
  • congenital heart diseases, eye inflammations,
    retardation,
  • deafness (90 of neonates born to mothers
    infected in first trimester develop congenital
    rubella syndrome).

135
  • Congenital anomalies death from heart disease,
    sepsis in first 6 month
  • Mental retardation
  • Deafness
  • Person-person contact via mucous secretions

136
S/S
  • generally mild fever, flue sx, red rash that
    spreads from forehead to face to torso to
    extremities and lasts 3 days.
  • Serious complications do not occur in Rubella.

137
Patient management
  • BSI including mask.
  • All EMS workers, especially females should be
    screened for immunity.
  • No specific treatment.
  • Immunizations known to be 98-99 effective

138
Measles (rubeola, hard measles)
  • Causative organism - measles virus
  • Highly communicable
  • Systems affected respiratory, CNS, pharynx,
    eyes, systemic
  • Mode of transmission - air droplets, direct
    contact.

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140
S/S
  • prodrome - conjunctivitis, swelling of eyelids,
    photophobia, high fevers to 105 degrees, hacking
    cough, malaise

141
  • A day or two before rash, patients develop small,
    red-based lesions with blue-white centers in the
    mouth (Kopliks spots) sometimes disappearing
    with generalized skin rash.
  • Rash is red, slightly bumpy and spreads from
    forehead to face, neck, torso, to feet by 3rd
    day.

142
  • Rash usually lasts for 6 days, initially appears
    thicker over head and shoulders, clears up and
    follows that pattern toward feet.
  • Pneumonia, eye damage and myocarditis are all
    possible but most life-threatening is subacute
    sclerosing panencephalitis
  • Deterioration of mental capacity, muscle
    coordination

143
Patient management
  • BSI, including mask
  • EMS workers should be immunized
  • No specific treatment.

144
Pertussis (Whooping Cough)The 100-day cough
  • Causitive organism - Bordetella pertussis
  • Mainly affects infants and young childred
  • Affects oropharynx
  • Mode of transmission direct contact with
    airborne droplets.

145
S/S
  • Insidious onset of cough which becomes paroxysmal
    in 1-2 weeks, lasts 1-2 months.
  • Paroxysms are violent, inspiratory whoop. Whoop
    often not present in infants lt 6 mo., adults
  • Before pertussis vaccine in 1950s, disease
    killed more children in U.S. than all other
    infectious diseases combined

146
Patient management
  • EMS workers be cautious about handling linens,
    supplies etc. on all patients with hx of recent
    onset of paroxysmal cough
  • Tx patient with mask.
  • Communicable period thought to be greatest before
    onset of coughing.
  • Incubation period 6-20 days.
  • Erythromycin decreases period of communicability,
    but only reduces sx if given during incubation
    period.

147
Influenza the flu
  • Causative organisms influenza viruses types A,
    B, C
  • Affects respiratory system primarily
  • Mode of transmission airborne, direct contact
  • Virus can persist for hours, esp. in low humidity
    and cold temp.
  • Incubation period 1-3 days.

148
S/S
  • URI- type sx which last 2-7 days.
  • Chills
  • Fever
  • Headache
  • Muscle aches
  • Anorexia
  • fatigue
  • Cough often severe, protracted.

149
  • Patient management
  • Supportive
  • Immunizations
  • Health care workers should be immunized by
    mid-Sept. (flu season Nov.-Mar. in US).

150
Mononucleosis
  • Causative organism - Epstein-Barr virus or
    cytomegalovirus (both herpesvirus family)
  • Body regions affected oropharynx, tonsils

151
  • Modes of transmission
  • person-to-person spread by saliva
  • kissing
  • care providers to young children is common

152
S/S
  • Appear gradually
  • Fever
  • sore throat
  • oropharyngeal discharges
  • Lymphadenopathy
  • splenomegaly
  • Recovery usually in a few weeks, but may take
    months

153
Patient management
  • No specific treatment
  • No immunization available.

154
Herpes simplex virus type 1
  • Causative organism HSV 1
  • Affects oropharynx, face, lips, skin, fingers,
    toes, CNS in infants
  • Mode of transmission
  • Saliva
  • Skin skin contact

155
S/S
  • cold sores, fever blisters
  • Tx with acyclovir (Zovirax) helpful.

156
Patient management
  • BSI, including mask
  • Lesions are highly contagious

157
Herpes simplex virus type 2
  • Causative organism - HSV 2
  • Mode of transmission - sexual activity
  • S/S - Males
  • Lesions of penis, anus, rectum, and/or mouth

158
  • S/S - Females
  • Sometimes asymptomatic lesions of cervix, vulva,
    anus, rectum and mouth recurrent disease
    generally affects vulva, buttocks, legs, perineal
    skin.

159
Syphilis
  • Causative organism Treponema pallidum, a
    spirochete
  • Affects
  • skin,
  • CNS,
  • eyes,
  • joints,
  • skeletal system,
  • kidneys,
  • cardiovascular

160
Mode of transmission
  • Direct contact with exudates from moist, early,
    obvious or concealed lesions of skin and mucous
    membranes
  • semen,
  • blood,
  • saliva,
  • vaginal discharges,
  • blood transfusions,
  • needle sticks
  • Congenital transmission

161
S/S Occurs in 4 stages
  • Primary stage - painless lesion develops at point
    of entry called a chancre, 10-90 days after
    initial contact.
  • Lesion heals spontaneously within 1-5 weeks
  • Highly communicable at this stage

162
  • Secondary stage - bacteremia stage begins 2-10
    weeks after appearance of primary lesion
  • H/A
  • Malaise
  • Anorexia
  • Fever
  • Sore throat
  • Lymphadenopathy
  • Rash, (small, red, flat lesions) on palms and
    soles of feet, lasts about 6 weeks.

163
  • Condyloma latum - painless wart-like lesion found
    on moist, warm sites like inguinal area.
    Extremely infectious, lasts _at_ 6 weeks.
  • Skin infection in areas of hair growth results in
    bald spots and/or loss of eyebrows.
  • CNS - eyes, bone and joints or kidneys may become
    involved.

164
  • Third stage - latent syphilis 1 40 years
  • 25 may relaps and develop secondary stage
    symptoms again.
  • After 4 years, there are generally no more
    relapses
  • 33 of patients will progress to tertiary
    syphilis the rest will remain asymptomatic.

165
  • Tertiary syphilis
  • Granulomatous lesions (gummas) found on skin and
    bones skin gummas are painless with sharp
    borders bone lesions cause a deep, growing pain.
  • Cardiovascular syphilis occurs 10 years after
    primary infection generally results in
    dissecting aneurysm of ascending aorta or aortic
    arch. Antibiotics dont reverse this disease
    process.

166
  • Neurosyphilis asymptomatic, develop menengitis,
  • spinal cord disease that results in loss of
    reflexes and loss of pain and temperature
    sensation.
  • Tabes dorsalis spinal column degeneration wide
    gait and ataxia
  • Spirochetes attack cerebral blood vessels and
    cause CVA.
  • Psychosis, Insanity

167
  • Patient management
  • BSI
  • Causative agent extremely fragile and is easily
    killed by heat, drying, or soap and water.
  • Treatment is effective with penicillin,
    erythromycin, doxycycline.

168
Statistics
  • Oregon 2002 47 cases reported
  • 115 increase over 2001

169
Gonorrhea
  • Causative agent Neisseria gonorrheae
  • Affect genital organs and associated structures
  • Mode of transmission direct contact with
    exudates of mucous membranes unprotected sex.

170
Statistics
  • Oregon
  • 1980 11,162
  • 1995 854
  • 2001 1,039

171
  • S/S - males
  • Initial inflammation of urethra with dysuria and
    purulent urinary discharge . Left untreated, can
    progress to epididymitis, prostitis, and
    strictures of urethra.

172
  • S/S - females
  • Dysuria and purulent vaginal discharge may occur.
  • Most females have no pain and minimal urethral
    discharge.

173
  • Infection of uterus can progress to PID fever,
    lower abdominal pain, abnormal menstrual
    bleeding, cervical motion tenderness.
  • Menstruation allows bacterial spread from cervix
    to upper genital tract - 50 of PID occurs within
    1 week of onset of menstruation.

174
  • Females at increased risk for sterility, ectopic
    pregnancy, abscesses of fallopian tubes, ovaries,
    peritoneum, and peritonitis.

175
  • Males and females
  • in rare cases, systemic bacteremia
  • septic arthritis with fever, pain, swelling of 1
    or 2 joints can occur.
  • Patient management
  • BSI
  • antibiotics

176
Chlamydia
  • Causative organism Chlamydia trachomatis
  • Affects eyes, genital area and associated
    organs, respiratory system

177
Statistics
  • Most common reported STD in Oregon
  • 2002 7,200

178
  • Mode of transmission - sexual activity, sharing
    contaminated clothing or towels.
  • S/S similar to gonorrhea
  • Conjunctivitis may occur leading cause of
    preventable blindness in the world.
  • Infant pneumonia known to occur.

179
Scabies
  • Scabies a mite a parasite
  • Female burrows into epidermis to lay eggs
    remains in burrow for 1 month.
  • Affects skin
  • Modes of transmission skin-skin contact
  • Bedding only if within 24 hours.
  • Mite can burrow into skin in 2.5 minutes.

180
S/S
  • intense itching, esp. at night with vesicles,
    papules, linear burrows.
  • Males lesions prominent around finger webs,
    anterior surfaces of wrists and elbows, armpits,
    belt line, thighs, external genitalia
  • Females lesions prominent on nipples, abdomen,
    lower portion of buttocks.
  • Infants head, neck, palms, soles.

181
Patient management
  • BSI
  • Personal - launder everything used in last 48
    hours in hot water. Tx with Kwell

182
Lice
  • Infesting agents
  • head louse, body louse
  • (responsible for outbreaks of epidemic typhus
    trench fever in WWI)
  • Modes of transmission
  • head lice and body lice - direct contact
  • Body lice - indirect contact, esp. shared
    clothing
  • Crab lice - sexual contact

183
Head Louse infestation
184
  • 3 stage life cycle eggs, nymphs, adults
  • eggs hatch in 7-10 days
  • Nymph stage lasts _at_ 7-13 days
  • Egg-egg cycle lasts 3 weeks.

185
S/S Itching
  • Infestation of Head lice is of hair, eyebrows,
    eyelashes, mustache, beards.
  • Infestation of body lice is of clothing,
    especially along seams of inner surfaces.

186
Patient management
  • Personal treatment - Kwell, etc. repeat in 7-10
    days.
  • Wash all bedding, clothing, etc. in hot water, or
    place in dryer on hot cycle.
  • EMS workers - clean patient area well.

187
Lyme Disease
  • Causative organisms Borrelia burgdorferi
  • Affects skin, CNS, cardiovascular system, joints
  • Mode of transmission tick borne with reservoirs
    in mice and deer
  • Western Black-legged Tick

188
Statistics
  • Oregon 1994 2003 151 Cases
  • Marion Cty 5
  • Jackson Cty 26
  • Month - July

189
S/S
  • Early, localized stage with painless skin lesion
    at site of bite (starts out as red, flat, round
    rash which spreads out.

190
  • Border remains bright red, center becomes clear,
    blue or necrose and black, flu-like syndrome with
    malaise, myalgia, stiff neck.

191
  • Early disseminated stage invades skin, nervous
    system, heart, joints
  • skin - multiple lesions
  • Nervous system - meningitis, Bells palsy,
    peripheral neuropathy
  • Cardiac AV block, Myocarditis

192
  • Joint and muscle pain - can occur 6 months after
    bite
  • Late stage
  • _at_ 10 develop chronic arthritis
  • Encephalopathy can develop cognitive deficits,
    depression, sleep disorders.

193
Almost time to go.
194
Body fluids to which universal precautions apply
  • Blood, other body fluids containing blood
  • Semen, vaginal secretions
  • Human tissue
  • Human fluids
  • CSF
  • Synovial
  • Pleural
  • Peritoneal
  • Pericardial
  • Amniotic

195
Body fluids to which universal precautions do not
apply
  • In the absence of blood
  • Feces
  • Nasal secretions
  • Sputum
  • Sweat
  • Tears
  • Urine
  • Vomitus

196
Precautions for other body fluids in special
settings
  • Human breast milk if mother HIV positive
  • Saliva if person HBV or HIV positive

197
Remember!
  • Prepare food and eat in appropriate areas
  • Maintain general and psychological health
  • Dispose of needles and sharps appropriately
  • Dont wipe face and/or rub eyes, nose, mouth etc.

198
Bye Bye now...
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