Transcript Infectious & Communicable Diseases

Infectious &
Communicable
Diseases
Chemeketa Community College
1
Are we at risk?
Patient
contact
Co-workers
Hygiene
Hazardous
scenes
2
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-toperson contacts
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Public Health Agencies
Local – that’s YOU!
State
Health dept
Federal
US DHS CDC & P
• Monitors
• Studies & researches
• Manages
OSHA
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Agency responsibility relative
to isolation from exposure
Exposure plan
Maintenance and surveillance
Appointing a DO
Schedule of standards implemented
PPE
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gowns
gloves
face shields
masks
protective eyewear
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BSI
Procedures for evaluation of
circumstances and counseling
personal, building, vehicular, equipment
disinfection and storage
After action analysis
Correct disposal
Correct handling
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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.
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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
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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
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Upper Respiratory
system
Turbinates
Mucous
Mucociliary escalator
Normal bacterial flora
Lymph tissues of tonsils
and adenoids permit
rapid local
immunological
response
10
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.
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Internal Barriers
Protect against
pathogenic agents
when external lines of
defense are breached.
Include
Inflammatory response
Imune response
12
Inflammatory response
A local reaction to cellular injury
Generally protective and beneficial
May initiate destruction of the body’s
own tissue
13
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
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Immune response
Possesses selfnonself recognition
Produces antibodies
Some lymphocytes
become memory
cells
Is self-regulated to
activate only when
invading pathogens
IgG
IgM
IgA
IgD
IgE
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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
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Approach to call
Wear appropriate PPE
Patient Assessment:
Focused history and physical
History of present illness
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Onset - gradual or sudden?
Fever
Antipyretic usage (ASA, APAP)
Neck pain or rigidity?
Difficulty swallowing, secretions?
How did sx change over time?
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Past medical history
Chronic infections, inflammation
Use of steroids, antibiotics
Organ transplant and associated
medicines
Diabetes or other endocrine disorders
COPD or respiratory complications
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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
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Upon disposition of patient, dispose
of supplies, bag linen, disinfect
ambulance and equipment
Reprocessing methods for EMS durable
equipt.
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Sterilization
High-level disinfection
Intermediate-level disinfection
Low-level disinfection
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Stages of an infectious
disease
Stage of
Disease
Begins
Ends
With invasion
When agent can
be shed
Communicable
period
When latent
period ends
Continues as
long as agent is
present
Disease period
Follows
Of variable
incubation period duration
Latent period
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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
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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
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Federal funding available for AIDS
education, support
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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
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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
Don’t wipe face and/or rub eyes, nose,
mouth etc.
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Pathophysiology
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Exposure does not necessarily equal
infection
The chain of elements must be intact
Transmission can be controlled
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We’ll talk about...
HIV
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis non-ABC
Tuberculosis
Mengococcal
meningitis
Pneumonia
Rabies
Hantavirus
Chicken pox
Mumps
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And these too
Rubella
Measles
Whooping cough
Influenza
Mononucleosis
Herpes simplex 1 &
2
Syphilis
Gonorrhea
Chlamydia
Scabies & Lice
Lyme disease
Gastroenteritis
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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
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Toxins - often more lethal
than bacterium
• Endotoxins
• Exotoxins
Can be localized or
systemic infection
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Viruses
Eukaryotic
• Nuclear material
contained within a
distinct envelope
must invade host cells to reproduce
Can’t survive outside of host cell
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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
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Fungi
Protective capsules
surround the cell wall
and protect fungi from
phagocytes
Broad-spectrum
antibiotics can cause
fungal infections
Pneumonia, Yeast
infections
35
Protozoans
Single-celled microorganisms
More complex than bacteria
Live in soil – opportunistic
infections – fecal-oral or
mosquito bites
Malaria
Some forms of Gastroenteritis
trichomoniasis
36
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
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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
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Statistics
US- 850,000 – 950,000
>180,000 undiagnosed
Oregon – 5,599 (12/03)
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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.
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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.
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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 STD’s (esp. with ulceration)
Penile foreskin
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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
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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 5090%.
HIV-2 – milder sx, slower development –
mainly in West Africa. US cases: 79
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Initial case definition established by
CDC in 1982.
1987 & 1993; s/s include
tuberculosis, recurrent pneumonia,
wasting syndrome, HIV dementia,
sensory neuropathy.
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Classifications &
Categories
Category A
Acute retroviral infection
2-4 weeks after exposure
Mono-like illness; lasts 1 – 2 weeks
Fever
Adenopathy
Sore throat
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Transient decrease in CD4+T cell counts
Seroconversion; 6-12 weeks after
transmission
CD4+T cell count return to normal levels
Asymptomatic infection; persistent
generalized lymphadenopathy; gradual
decline in CD4+T cell count
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Category B
Early symptomatic HIV
Decreased CD4+T cell count
Common complications
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Localized Candida infections
Oral lesions
Shingles
PID
Peripheral neuropathy
Fever/Diarrhea lasting more than one month
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Category C
Late symptomatic HIV
Represents all AIDS-defining diagnoses
CD4+T 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
Kaposi’s sarcoma
• HIV-associated dementia
Advanced HIV: CD4+T cell counts 0-50
per uL.
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Nervous system - toxoplasmosis of
CNS
Immune system - major site of
compromise
Respiratory system - pneumocystis
carinii pneumonia
Integumentary system - Karposi’s
sarcoma
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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.
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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.
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HCW infection:
Nonintact skin exposure (6/2000) – 56 +
138 ?
Susceptibility and resistance
Infectiousness may be high during
initial period after infection and at endstage
Race and gender are not risk factors for
susceptibility.
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Care in use of medical equipment
mandatory
Disinfection of equipment mandatory
Early diagnosis, treatment, counseling
for health-care providers is mandatory.
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HIV testing
OraQuick Rapid HIV 1 / 2 test
Oral fluid, plasma, whole blood
20 – 40 minutes
Accuracy
• Positive – 99.3%
• Negative – 99.8%
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Post-exposure
prophylaxis
< 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
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WHO Recommendations for a First
Line Regimen in Adults and
Adolescents
• d4T+3TC+NVP
• ZDV+3TC+NVP
• d4T+3TC+EFZ
• ZDV+3TC+EFZ
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
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Hepatitis
A viral disease
Produces pathologic alterations in the
liver
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Hepatitis-A
Causative agentHepatitis A virus
Most common type of
viral hepatitis
Once infected, person
is immune to HAV for
life
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Statistics
Oregon 1994 – 2003 – 6650 cases
Marion Cty: 632
Multnomah Cty: 1,512
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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.
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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
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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
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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.
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Patient management
Care is supportive for fluid intake and
prevention of shock.
Person is most infectious during first
week of sx.
BSI mandatory.
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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.
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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
69
Hepatitis-B
Causative agent - H-B
virus.
Potential secondary
complication - liver
necrosis
HBV usually lasts < 6
months
Carrier state may
persist for years
70
Statistics
Oregon – 1994 – 2003; 1,578 cases
Marion Cty: 195
Multnomah Cty: 556
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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 > 7 days
Transmission by insects and
fecal-oral route not
demonstrated.
72
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.
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1% of patients develop full-blown liver
crises and die with mortality increasing
> 40 y/o.
5-10% infected people become
asymptomatic carriers.
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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.
75
Immunizations:
Recombivax HB and
Engerix B are effective.
Vaccines: initial, onemonth, six-month provide
long-lasting immunity in
95-98% of cases.
Postexposure
prophylaxis
HBV vaccine
HB IG
76
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
77
Health care workers - 2.7 - 10%
probability of infection when
exposed to contaminated blood.
Transmission by household and
sexual contact low.
Can’t occur from food and water.
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Statistics
Oregon: 1994 – 2003; 142
Marion Cty: 4
Multnomah Cty: 17
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S/S
same as for HBV but less
progression to jaundice
chronic liver disease common with
>80% developing chronic liver
disease.
Apparent association between HCV
infection and liver cancer
80
Patient management
Same as for HBV
Immunization:
Prophylactic administration of IG not
supported by current data
Post exposure testing important
Vaccine may be available
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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
82
Hepatitis G - newly identified
Major epidemics documented in young
adults.
Women in 3rd trimester especially
susceptible to liver disease
83
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.
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Tuberculosis
Causative agent mycobacterium
tuberculosis
8 million new TB/yr
worldwide
3 million die of
disease
85
TB Epidemic in US
Immigration
Transmission in high-risk environments
• Prisons, homeless shelters, hospitals,
nursing homes
Oregon: 106/100,000 (11/03)
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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
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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 < 3, lowest in later childhood and
high among adolescents, young adults
and elders.
High in immuno-compromised patients;
HIV-infected, underweight,
undernourished.
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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.
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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
90
Patient care
Primarily supportive
Prevent shock
91
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.
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Drug therapy
prophylactic INH; recommended
routinely for persons <35 y/o who are
PPD positive; not recommended > 35
due to hepatic complic.
Therapeutic: Isoniazid, Rifampin,
Pyrazinamide, Streptomycin
Side effects of INH
Paresthesias, seizures, orthostatic
hypotension, N/V, Hepatitis
93
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 throat’s
epithelial lining.
94
Statistics
Oregon – 1994 – 2003: 887
Marion Cty: 111
Multnomah Cty: 182
95
Modes of transmission: direct
contact w/ secretions during
intubation, suctioning, CPR etc.
96
S/S:
onset is rapid;
fever,
chills,
joint pain,
neck stiffness or nuchal
rigidity,
petechial rash,
projectile vomiting,
headache
97
@ 10% may develop septic shock;
acute adrenal insufficiency, DIC,
coma may result. Death may occur in
6-8 hours.
98
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
99
Patient management:
protective measures with surgical
masks to patient.
Prophylactic tx available; rifampin, etc.
Immunizations: esp. for older children
and adults.
100
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.
101
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, >50% infected children have
long-term neurological deficits.
• Implicated in epiglottitis, septic
arthritis, generalized sepsis.
102
Viruses (aseptic meningitis)
• A variety known to cause meningitis
• not considered communicable
103
Pneumonia
Causative organisms
Bacterial
Viral
Fungal
104
Systems affected
Respiratory - pneumonia
CNS - meningitis
ENT - otitis, pharyngitis media
Routes of transmission
Droplet, Direct contact, Soiled linen
105
Susceptibility
pulmonary edema
Flue
exposure to inhaled toxins
chronic lung disease and aspiration
Geriatrics
Pediatrics with low birth weight and
malnourishment
106
Other high-risk groups
sickle cell disease
cardiac disease
Diabetes
kidney disease
HIV
organ transplants
Hodgkins disease
Asplenia
107
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.
108
Patient management
several antibiotics effective to treat
bacterial pneumonia
Protective measures for health-care
workers.
Immunizations:
vaccine exists for some causes
109
Tetanus
Causative
organism;
Clostridium tetani
Live mainly in soil
and manure
Also found in
human intestine
110
Statistics
500,000 cases/year worldwide
45% mortality
100 cases/year in U.S.
Patients > 50 y/o
Oregon: 1992-2001; 6
Marion Cty – 1997: 1
111
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.
112
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.
113
Patient
management:
Support vital functions
Valium for muscle spasms
Consider paralytics
Magnesium sulfate
Narcotics
Antidysrhythmics
Administration of antitoxin
- TIG
114
post exposure of tetanus immune
globulin - keep immunizations UTD.
Immunizations: Booster before
elementary school, every ten years
thereafter.
115
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
116
Statistics
Oregon; 1994 – 2003; 77
Marion Cty:
1996 – 2
1998 – 2
2001 – 1
117
Hawaii is only area in US
that is rabies-free.
Wildlife rabies (in US)
common in
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skunks,
raccoons,
bats,
foxes,
dogs,
wolves,
jackals,
mongoose,
coyotes.
118
Susceptibility: Mammals highly
susceptible.
Incubation period usually 3-8 weeks
(rare; 9 days - can be as long as 7
years).
119
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.
120
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
121
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
122
Statistics
Oregon: 1993 – 2003; 5 cases
123
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
124
Patient management
Supportive
BSI
125
Chickenpox
Causative agent;
variella-zoster virus
(member of the
Herpes virus group).
System affected;
primarily
integumentary
126
Shingles is a local manifestation of
reactivation of latent viral infection
Mainly airborne
soiled linen implicated.
Incubation period 10-21 days
127
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.
128
Disease self-limited
Complications
Secondary bacterial infections
Aseptic meningitis
Mononucleosis
Reye syndrome
129
Mumps
Causative agent:Mumps virus
Acute, communicable systemic
viral disease
Glands most commonly
affected:
Parotid
Testes
Pancreas
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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
131
Patient management:
EMS workers - MMR immunity
Patients wear masks
Caution with soiled linen
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Rubella (German
measles)
Causative agent - rubella
virus
Mild, febrile, highly
communicable disease
Systems affected;
integumentary,
musculoskeletal,
lymph nodes
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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).
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Congenital anomalies; death from heart
disease, sepsis in first 6 month
Mental retardation
Deafness
Person-person contact via mucous
secretions
135
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.
136
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
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Measles (rubeola,
hard measles)
Causative organism measles virus
Highly communicable
Systems affected:
respiratory, CNS, pharynx,
eyes, systemic
Mode of transmission - air
droplets, direct contact.
138
139
S/S:
prodrome - conjunctivitis, swelling of
eyelids, photophobia, high fevers to 105
degrees, hacking cough, malaise
140
A day or two before rash, patients
develop small, red-based lesions with
blue-white centers in the mouth
(Koplik’s 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.
141
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
142
Patient management:
BSI, including mask
EMS workers should be immunized
No specific treatment.
143
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.
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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 < 6 mo.,
adults
Before pertussis vaccine in 1950’s, disease
killed more children in U.S. than all other
infectious diseases combined
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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.
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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.
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S/S:
URI- type sx which last 2-7
days.
Chills
Fever
Headache
Muscle aches
Anorexia
fatigue
Cough often severe,
protracted.
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Patient management:
Supportive
Immunizations:
Health care workers should
be immunized by mid-Sept.
(flu season Nov.-Mar. in
US).
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Mononucleosis
Causative organism Epstein-Barr virus or
cytomegalovirus (both
herpesvirus family)
Body regions affected:
oropharynx, tonsils
150
Modes of
transmission
person-to-person
spread by saliva
kissing
care providers to
young children is
common
151
S/S:
Appear gradually
Fever
sore throat
oropharyngeal discharges
Lymphadenopathy
splenomegaly
Recovery usually in a few weeks, but
may take months
152
Patient management
No specific treatment
No immunization available.
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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
154
S/S:
cold sores, fever
blisters
Tx with acyclovir
(Zovirax) helpful.
155
Patient management:
BSI, including mask
Lesions are highly contagious
156
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
157
S/S - Females:
Sometimes
asymptomatic; lesions
of cervix, vulva, anus,
rectum and mouth;
recurrent disease
generally affects vulva,
buttocks, legs,
perineal skin.
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Syphilis
Causative organism;
Treponema pallidum, a
spirochete
Affects:
skin,
CNS,
eyes,
joints,
skeletal system,
kidneys,
cardiovascular
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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
160
S/S: Occurs in 4 stages
Primary stage - painless
lesion develops at point of
entry called a chancre, 1090 days after initial
contact.
Lesion heals spontaneously
within 1-5 weeks
Highly communicable at
this stage
161
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.
162
Condyloma latum - painless wart-like
lesion found on moist, warm sites like
inguinal area. Extremely infectious,
lasts @ 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.
163
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.
164
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 don’t reverse this
disease process.
165
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
166
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.
167
Statistics
Oregon: 2002 – 47 cases reported
115% increase over 2001
168
Gonorrhea
Causative agent; Neisseria
gonorrheae
Affect genital organs and associated
structures
Mode of transmission: direct contact
with exudates of mucous
membranes; unprotected sex.
169
Statistics
Oregon:
1980 – 11,162
1995 – 854
2001 – 1,039
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S/S - males:
Initial inflammation of urethra with
dysuria and purulent urinary discharge .
Left untreated, can progress to
epididymitis, prostitis, and strictures of
urethra.
171
S/S - females:
Dysuria and purulent vaginal discharge
may occur.
Most females have no pain and minimal
urethral discharge.
172
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.
173
Females at increased risk for
sterility, ectopic pregnancy,
abscesses of fallopian tubes,
ovaries, peritoneum, and peritonitis.
174
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
175
Chlamydia
Causative organism; Chlamydia
trachomatis
Affects; eyes, genital area and
associated organs, respiratory
system
176
Statistics
Most common reported STD in Oregon
2002 – 7,200
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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.
178
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.
179
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.
180
Patient management:
BSI
Personal - launder everything used in
last 48 hours in hot water. Tx with
Kwell
181
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
182
Head Louse infestation
183
3 stage life cycle; eggs, nymphs,
adults
eggs hatch in 7-10 days
Nymph stage lasts @ 7-13 days
Egg-egg cycle lasts 3 weeks.
184
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.
185
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.
186
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
187
Statistics
Oregon – 1994 – 2003; 151 Cases
Marion Cty: 5
Jackson Cty: 26
Month - July
188
S/S:
Early,
localized stage
with painless
skin lesion at
site of bite
(starts out as
red, flat, round
rash which
spreads out.
189
Border remains
bright red, center
becomes clear, blue
or necrose and
black, flu-like
syndrome with
malaise, myalgia,
stiff neck.
190
Early disseminated stage; invades
skin, nervous system, heart, joints
• skin - multiple lesions
• Nervous system - meningitis, Bell’s palsy,
peripheral neuropathy
• Cardiac; AV block, Myocarditis
191
Joint and muscle pain - can occur 6
months after bite
Late stage:
• @ 10% develop chronic arthritis
• Encephalopathy can develop; cognitive
deficits, depression, sleep disorders.
192
Almost time to go….
193
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
194
Body fluids to which universal
precautions do not apply
In the absence of blood
Feces
Nasal secretions
Sputum
Sweat
Tears
Urine
Vomitus
195
Precautions for other body
fluids in special settings
Human breast milk if mother HIV
positive
Saliva if person HBV or HIV positive
196
Remember!
Prepare food and eat in
appropriate areas
Maintain general and
psychological health
Dispose of needles and
sharps appropriately
Don’t wipe face and/or
rub eyes, nose, mouth
etc.
197
Bye Bye now...
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