Transcript Signs & Symptoms


Analyze issues of public health, infectious
diseases, & bioterrorism.
INFECTIOUS DISEASES IN THE WORLD

They remain the leading cause of death!
Public Health can be improved with biomedical
research!
How??
Read on….
INFECTIOUS DISEASE PROCESS
A.
Nature of infectious diseases
1. Pathogens- Microorganisms
that are capable of causing
disease.
2. Infection- results when a
pathogen invades and begins
growing within the host.
3. Disease- results only if and
when tissue function is impaired
(I.e. burns, skin lesions)
INFECTIOUS DISEASE PROCESS CONT…
4. The body has defense mechanisms
to prevent infection – normal flora,
physical attributes (nasal passages)
5. In order to cause a disease,
pathogens must be able to enter,
adhere, invade, colonize, and inflict
damage.
6. Entrance to the host -- mouth, eyes,
genital openings, wounds.
INFECTIOUS DISEASE PROCESS CONT’D
7. Growth of pathogens or the production of
toxins/enzymes cause disease (impairment
of tissue function).
8. Some normal flora prevents disease
Infectious Disease Process
B. MICROBES THAT CAUSE INFECTIOUS DISEASES.
1. Bacteria- i.e.Salmonella typhi, Staphylococcus
aureus (may lead to MRSA)
2. Viruses - apart from the host cell, have no
metabolism and cannot reproduce.
3. Fungi- form spores (i.e. ringworm, athletes foot)
4. Protozoa- acquired through contaminated food or
water,
or bite of an arthropod (mosquito)
*** Occurs more in tropical environment!!!!
***
5. Helminths - simple, invertebrate animals,
some infectious parasites- symptoms:
abdominal pain and diarrhea
6. Prions- i.e. Creutzfeldt-Jakob disease –
causes holes in brain
7. Trichinella spiralis – Fatal cases due to
respiratory paralysis.
C. OCCURRENCE OF INFECTIOUS DISEASES
1. Epidemiology- study of the occurrence of
disease in populations
2. Disease reservoirs- where the infectious
agent survives (humans, rodents)
example= yersinia pestis
3. Modes of transmission
(direct contact, airborne, etc).
D. HOST DEFENSE AGAINST INFECTIOUS
DISEASES
1. Nonspecific mechanisms are the body’s
defenses against disease- anatomical barriers,
physiological deterrents and presence of
normal flora (skin, low Ph and high salinity)
2. Specific mechanisms - immunity
3. Vaccination- produces immunity

What symptoms might a patient exhibit if
they developed the infectious disease
previouslyHow
recognized
to 1983 as being
does prior
biomedical
noninfectious.
research help the
Gastric ulcers caused
by H-pylori (bacterium)
population?
have symptoms of abdominal pain and
indigestion.

What is the role of public health in the
prevention of infectious disease?
PUBLIC HEALTH MEASURES TOWARD
PREVENTION.
1.
Safe water- US water is purified through
settling, filtration, and chlorination
2. Sewage treatment and disposal is
mandated by the federal government.
This is a public health concern!!!!
After a hurricane the safety of the water supply
is often in jeopardy.
STEPS THAT ASSURE CLEAN H2O
Settling
 Filtration
 Chlorination

3. Food Safety- US has many standards,
inspection plans and regulations dealing
food preparation, handling, and distribution.
Pasteurizing milk & dating it for sale
demonstrates food safety.
4. Animal control programs - Domestic herds
are inspected, rabid animals are destroyed,
rat control programs in place in urban areas.
i.e. Rabies primarily spread by direct contact.
5. Vaccination programs mandate that children
be vaccinated prior to school. The reason
vaccinations work, is a pathogen cannot
reproduce itself enough to maintain disease
in population.
6. Pesticides to block vectorborne diseasethose carried by mosquitoes. Mosquitoe
spraying kills the insect with pesticides
therefore decreasing / eliminating
vectorborne disease i.e. malaria
PUBLIC HEALTH ORGANIZATIONS ENFORCE
REGULATION, PROVIDE PUBLIC HEALTH
SERVICES
1. National Institutes of
Health (NIH) - supports
health-related research
2. Centers for Disease Control (CDC) investigates disease outbreaks, publishes
reports, sponsors education/research,
reference labs
3. Food and Drug Administration (FDA)monitors safety of food, medicines and other
products
4. World Health Organization (WHO) - provides
global surveillance and control of diseases.
WHICH AGENCIES ARE BRANCHES OF U.S.
PUBLIC HEALTH SERVICE?
FDA
 NIH
 CDC

BENEFITS OF PUBLIC HEALTH RESEARCH
1.
2.
3.
4.
New research techniqueshas lead way to rapid
identification.
HIV protease inhibitors
Vaccine research
Identification of better
preventative measures.
What
is the treatment for
infectious diseases?
DRUGS USED TO TREATMENT OF
BACTERIAL DISEASES CAN BE GROUPED
INTO CATEGORIES BASED ON THEIR
MODES OF ACTION.
1. Penicillin’s / cephalosporin's interfere with
certain layers of cell wall synthesis.
2. Chloramphenicol, tetracyclines, and
erythromycins- may be toxic when used in
high doses or prolonged periods of time.
3. Rifampin- used for treatment of Tuberculosis.
(TB)…is considered re-emerging because of
antibiotic resistance.
DRUGS THAT EFFECTIVELY INHIBIT VIRAL
INFECTIONS ARE HIGHLY TOXIC TO HOST CELLS
BECAUSE VIRUSES USE THE HOST’S METABOLIC
ENZYMES IN REPRODUCTION.
1. Antiviral drugs target virus - specific
enzymes.
2. Acyclovir- used in treatment of genital herpes
3. Amantadine- used to prevent or moderate
influenza.
4. AZT- inhibit replication of HIV genome.
ANTIMICROBIAL RESISTANCE PRESENTS
ONGOING PROBLEMS IN THE FIGHT
AGAINST INFECTIOUS DISEASES.
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1. Penicillin resistance noted as early as 1943.
2. Mycobacterium tuberculosis - some strains
resistant to all drugs.
3. Resistance to antibiotics - result of changes in
genetic information of bacteria.
4. Indiscriminate (random) use of antibiotics
increases drug resistance.
** GLOBALLY, INFECTIOUS DISEASES
REMAIN THE LEADING CAUSE OF DEATH,
AND THEY ARE THE 3RD LEADING CAUSE
OF DEATH IN THE US
A.
Emerging infectious diseases
1. Have not occurred in humans before,
2. Have occurred previously but affected only
small numbers,
3. Or have occurred throughout human history,
but only recently recognized as disease due to
infectious agent (i.e. H. Pylori)
RE-EMERGING INFECTIOUS DISEASES
Once were major health problems globally or
in a particular country, then declined
dramatically, but are again becoming health
problems for a significant proportion of the
population
An infectious disease is considered to be
Re-emerging once occurred, greatly
declined,
then increases in incidence.
What about bioterrorism???
AGENTS
1. Bacterial - Anthrax and Plague
AGENTS CONT…
2. Viral- Smallpox
3. Toxins - Botulism and Ricin
(Saddam used it to “practice”
bioterrorism in his own country)
CONTAINMENT OF BIOTERRORISM AGENTS
1.
2.
3.
4.
5.
Isolation practices
Patient placement
Patient transport - limited to movement that is
essential
Cleaning, disinfection and sterilization of
equipment and environment - follow standard
precautions
Discharge management – lots of teaching
before going home.
6. Post-mortem care - should you tell the
funeral director what the pt died of if it is
from an infectious disease? Yes to ensure it
is not spread!
7. Do you know how to wash your hand?
The best water temperature to use is warm.
BIOTERRORISM
Terrorism is defined in the United States code,
Title 18, section 2331 (18 USC 2331) as:
Violent acts or acts dangerous to human life
that…appear to be intended
POINTS TO REMEMBER!!
1. Healthcare facilities would group affected victims
together in the same facility if there were a large
scale bioterrorism attack.
2. If we were in a foreign country we would be kept
there until we were noninfectious.
3. Victims least symptomatic will be sent home and
instructed on barrier precautions, handwashing,
and cleaning.
Purpose of bioterrorism…
1.
2.
3.
To intimidate or coerce a civilian
population.
To influence the policy of a government by
intimidation or coercion; or
To affect the conduct of a government by
assassination or kidnapping.
Biological weapons used in bioterrorism are
living microorganisms such as bacteria,
viruses, fungi, that can kill or incapacitate.
FUNERAL DIRECTOR

Funeral director would need to know the cause
of death from a bioterrorist attack because
special post-mortem precautions must be
taken.
Health care facilities may be the initial site of
recognition and response to bioterrorism
activity. Because of this, the names and
telephone numbers for internal and external
departments or agencies that need to be
contacted should be kept by each facility in
its bioterrorism readiness plan.
STANDARD PRECAUTIONS

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By following standard precautions the general
public could protect themselves from bioterrorism
agents.
The guideline recommends wearing gloves when
collecting or handling blood and body fluids
contaminated with blood and wearing face shields
when there is danger of blood splashing on
mucous membranes and when disposing of all
needles and sharp objects in puncture-resistant
containers.
RESPONSE TO BIOTERRORISM AGENTS:
1.
Internal reporting requirements (within a
facility):
a. Infection control personnel
b. Epidemiologist (local and state)
c. Administration (health care facility and
health department)
d. Office of public affairs in the health
facility
2. EXTERNAL CONTACTS (OUTSIDE OF
FACILITY)
a. Local health department
b. State Health Department
c. FBI
d. CDC
e. Local police
f. EMS
3. AGENTS
a. Bacterial- Anthrax and Plague
b. Viral- Small Pox
c. Toxins- Botulism and Ricin
ANTHRAX
Acute infectious disease caused by bacillus
anthracis.
Was sent through the mail to federal agencies in
Washington D.C. in October 2001.
Infections in humans:
 Skin contact- cutaneous, ingestion-gastrointestinal,
inhalation-pulmonary
 Person-to-person transmission of inhalation
disease does not occur.*
*direct exposure to vesicle secretions of cutaneous
anthrax can result in a secondary infection.
Pulmonary signs and symptoms:
 Flu-like symptoms that may briefly improve
two to four days after initial symptoms
 Abrupt onset of respiratory failure
 Hemodynamic collapse
 Thoracic edema
 Widened mediastinum on xray
 Positive blood culture in 2-3 days of illness
Prognosis:
Good if treated early. Increased mortality rate if
treated after respiratory onset.
Cutaneous signs and symptoms:


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Local skin
involvement with
direct contact
Commonly seen on
head, forearms, or
hands
Localized itching
followed by popular
lesion that turns
vescular within 2-6
days- develops into
depressed black
eschar
Prognosis:
Good if treated with antibiotics.
Gastrointestinal signs and symptoms:
Abdominal pain, nausea, vomiting, fever
 Bloody diarrhea, hematemesis
 Positive culture after 2-3 days

Prognosis:
If progression to toxemia and sepsis, prognosis
is poor.
Modes of transmission:
Inhalation of spores
 Skin contact
 Ingestion of contaminated food

INCUBATION PERIOD:
Pulmonary: 2-60 days
 Cutaneous: 1-7 days
 Gastrointestinal: 1-7 days

Transmission:
Anthrax is not airborne, person to person.
Direct contact with infectious skin lesions can
transmit infection.
PREVENTION:
Vaccine available
in limited quantities.
BOTULISM
Potent neurotoxin caused by an anaerobic
bacillus-colstridium botulinum.
Transmission:
 Contaminated food
 Inhalation
Signs and symptoms:
 Gastrointestinal symptoms
 Drooping eyelids
 Weakened jaw clench
 Difficulty swallowing or speaking
 Blurred vision
 Respiratory distress
Incubation period:
 Neurological S/S for food
borne botulism – 12-36
hours after ingestion
 Neurological S/S for
inhalation botulism- 24-72
hours after exposure
Prevention:
 Vaccine available
Botulism cannot be
transmitted person to
person
BOTOX

It is one of the most
poisonous naturally occurring
substances, and it is the most
toxic protein. Though it is
highly toxic, it is used in
minute doses both to treat
painful muscle spasms, and
as a cosmetic treatment in
some parts of the world. It is
sold commercially under the
brand names Botox, Dysport,
and Myobloc for this purpose.
PLAGUE
Plague is an acute bacterial disease caused by yersinia pestis.
There are three major manifestations Bubonic plague;
Septicemic plague; Pneumonic plague; Any bubo-causing
disease; A pandemic caused by such a disease; Any
pestilence, a virulent and highly infectious disease
Signs and symptoms:
 Fever
 Cough
 Chest pain
 Hemoptysis
 Watery sputum
 Bronchopneumonia on xray
MODE OF TRANSMISSION
Plague normally
transmitted from an
infected flea.
 Can be aerosolprobable use in
bioterrorism.
 Can be transmitted
person to person.
In 1563, London experienced
another outbreak of plague,
considered one of the worst
incidences of plague ever seen in
the city. The bubonic plague took
almost 80,000 lives.
RICIN

A potent protein toxin derived from Castor
beans. Castor beans are found easily all over
the world & the toxin is fairly easily produced.
For this reason ricin could be used as a
biological weapon with relative ease.
Infections in Humans
Aerosol
 Ingestion
Signs & Symptoms
18-24 hours-weakness, fever, cough, pulmonary
edema
36-72 hours-severe respiratory distress & then death
from hypoxemia.
Incubation period
8-18 hours
Prognosis
Poor-no vaccine available
Ricin does not spread easily person to person.

SMALLPOX
Smallpox is an acute viral
illness caused by the
variola virus.
 Mode of transmissionAirborne, droplets
 Signs/Symptoms-Flu like
symptoms-fever, myalgia.
*Skin lesions appear quickly
progressing from macules
to papules to vesicles.
*Rash scabs over in 1-2
weeks.
*Rash occurs in all areas at
once, not in crops

SMALLPOX HAS A HIGH MORTALITY RATE………….
The "white man"
diseases…measles, chicken
pox, typhus, typhoid fever,
dysentery, scarlet fever,
diphtheria, and after 1832,
cholera…were devastating
to the American Indian.
Lumped together, these
diseases did not equal the
havoc of smallpox in terms
of number of deaths,
realignment of tribal
alliances, and subsequent
changes in Canadian and
American Indian Cultures.
AIDS

A virus that has a long latent period that uses
an enzyme to copy itself into a host cell.
MALARIA

Malaria is classified as a re-emerging infectious
disease because it is drug resistant and fear of
vaccination.

It is a vector-borne infectious disease caused
by protozoan parasites. It is widespread in
tropical and subtropical regions, including parts
of the Americas, Asia, and Africa.
TETANUS
Organisms usually found in the dirt.
 Is a medical condition that is characterized by a
prolonged contraction of skeletal muscle fibers.
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PERTUSSIS

Is a re-emerging infectious disease because
people refuse to be vaccinated.
FLU


Amantadine- it prevents or shortens
episodes of influenza.
In humans, common symptoms of the
disease are the chills, then fever, sore
throat, muscle pains, severe
headache, coughing, weakness and
general discomfort. In more serious
cases, influenza causes pneumonia,
which can be fatal, particularly in
young children and the elderly.
CANDIDA-AN OPPORTUNISTIC INFECTION

An adult on antibiotics!
LEGIONNAIRES
LEGIONELLA BACTERIUM
A contributing factor to the emerging disease is
cooling & plumbing systems.
 Is the more severe form of the infection and
produces pneumonia. Any infected water
source.

SARS
SEVERE ACUTE RESPIRATORY SYNDROME
A severe and highly contagious type of
pneumonia.
 First recognized in 2003, making it a Emerging
disease.
