Pathology - Chap. 4

13 factors for the surge in new infectious and communicable diseases

1. Microbial adaptation and change 2. Human susceptibility to infection 3. Climate and weather 4. Changing ecosystems 5. Human demographics and behavior 6. Economic development and land use 7. International travel and commerce 8. Technology and industry 9. Breakdown of public health measures 10. Poverty and social inequality 11. War and famine 12. Lack of political will and/or clout 13. Biological warfare

Common Cold (coryza)

Acute infection that causes inflammation of the upper respiratory tract. Occur more often with children (as often as 6-10 times a year) and are the leading cause of time lost from school. Adults may have as many as 2-4 times a year. Most cases are seen during the fall or winter. Caused by hundreds of different viruses. Most common and most contagious is rhinovirus. Transmitted by airborne droplets or hand to hand contact (ex. sharing items) The onset of symptoms is gradual and may include nasal congestion, pharyngitis, headache, malaise, burning and watery eyes, and low-grade fever (in children). A cough, either productive or nonproductive, may be present. The symptoms commonly last from 2 to 4 days, but nasal congestion may persist for an indefinite period. Reinfection is common, but complications are rare. No diagnostic test goal is to rule out disorders that produce similar symptoms. Treatment is symptomatic and includes mild analgesics, ample fluid intake, and rest. Decongestants, nasal sprays, throat lozenges, and a cool-mist humidifier may be helpful. Acetaminophen is used if there is a fever. A person will find it helpful to get extra sleep and drink large amounts of water and herbal teas, vegetable juices, and broths. Chicken soup, saline nasal sprays, vitamin C, andrographis or zinc lozenges (to lessen severity and duration). Baths with eucalyptus, lavender, lemon, or peppermint can be soothing to someone with a cold. Foods such as yogurt, cheese, miso, some juices and soy drinks that contain beneficial bacteria or probiotics can reduce the risk and severity of the common cold. Also avoid stress because it can make someone more susceptible. Can lead to secondary bacterial infection. Possible complications include otitis media (especially in children), sinusitis, and wheezing in individuals with asthma Wash hands and avoid crowds lessens the likelihood

Common cold (coryza)

Airborne respiratory droplets; hand-to-hand contact; contact with contaminated items 2-5 days from exposure

Viral hemorrhagic fevers

Airborne transmission; contact with infected hosts (animals, flies, mosquitoes) 2-21 days

Anthrax

Break in skin; inhaled from air; consumed from contaminated meat Varies depending on strength and amount of exposure; 1-43 days

Influenza (flu)

Caused by viruses that are members of the Orthomyxoviridae family. Classified as type A, B, or C. The A and B viruses commonly cause seasonal epidemics most winters. The C virus causes a mild respiratory infection that is rarely epidemic. they frequently mutate. Transmission generally occurs via cough, sneeze, hand-to-hand contact, and other personal contact. The onset generally is abrupt, with fever, chills, croup (in children), malaise, muscle aches, headache, nasal congestion, laryngitis, and a cough A throat culture may be performed to isolate the virus or to rule out bacteria. Various immunofluorescence techniques may be performed to detect viral antigens Treatment consists of bed rest, adequate fluid intake, analgesics, and antipyretics. Same complementary therapies used for colds. Warm baths may relieve myalgia The prognosis is good with proper care. Complications include sinusitis, otitis media, bronchitis, and pneumonia. A large number of deaths occur each year Vaccines prepared from the most recent strains of A- and B-type viruses are useful in preventing these particular strains. Frequent handwashing is important. Some vaccinated individuals may get it but symptoms will be milder

Plague (pneumonic)

Close contact with infected individuals; respiratory droplets 1-6 days

Methicillin-resistant Staphylococcus aureus (MRSA) infection

Close contact with infected persons; indirect contact with towels, wound dressings; sports equipment Very unpredictable; usually 1-10 days after MRSA enters the bloodstream

Pertussis (whooping cough)

Droplets of respiratory secretions; contact with contaminated items 7-10 days

Mumps

Droplets of saliva; airborne route 18 days

Botulism

Eating contaminated food; wound or break in the skin 6 hours-10 days from exposure

E. coli (O157:H7)

Eating/drinking contaminated food/water; swimming in sewage contaminated water Between 1 and 8 days

Chronic Fatigue Syndrome (CFS)

Individuals suffer from debilitating chronic fatigue that does not improve with rest and a host of other symptoms. Another name for the illness is benign myalgic encephalomyelitis. There are many symptoms and they vary. Some suffer for weeks or even years. Twice as prevalent in women. Affects people aged 25-45. Recent studies indicate that it may be an organic brain-based condition. No agreement on the cause but is most likely multifactorial. Two major criteria must be met: persistent/relapsing fatigue (1) for at least 6 months that does not resolve with bed rest and (2) that is severe enough to reduce daily activity by at least 50%. In addition, at least four of the nine following minor criteria must be present: • Fever or chills • Sore throat; nonexudative pharyngitis • Painful cervical or axillary lymph nodes • Unexplained generalized muscle weakness • Muscle discomfort and myalgia • Migratory arthralgia or joint pain without joint swelling or redness • Neuropsychological symptoms, including photophobia, forgetfulness, transient visual scotomata (an islandlike blind spot on the visual field of the eye), irritability, confusion, depression, inability to concentrate, difficulty thinking, brain fog • Sleep disturbance • Acute or subacute initial onset Treatment is supportive and holistic approach is essential. Adjusting diet to concentrate on high-nutrition, high-protein, and complex carbohydrate foods. A basic multivitamin is beneficial. Acupuncture is also promising The disease is debilitating and lengthy in duration

Diphtheria

Intimate contact with discharges from nose, throat, eye, and skin lesions 2-5 days from exposure

AIDS (acquired immune deficiency syndrome)

Intimate sexual contact, semen, blood, blood products, contaminated needles, placental transmission, breast milk Uncertain; antibodies appear within 1-3 months of infection

Infectious diarrheal diseases

Oral-fecal route of transmission; possibly respiratory 48 hours

H1N1 Flu (Swine Flu)

Reportable Disease Mixture of viruses typical among pigs, birds, and humans Just over 30,000 cases were reported in 2013 by the CDC The symptoms are the same as for seasonal flu. They include fever, cough, sore throat, nasal congestion, body aches, fatigue, and headaches. Some experience diarrhea and vomiting. one of the following tests is necessary for diagnosis: (1) real-time polymerase chain reaction, (2) viral culture to measure the amount of virus in the blood, and (3) a fourfold increase in the H1N1-specific neutralizing antibodies Antiviral medications Zanamivir (Relenza) and Oseltamivir (Tamiflu) have been beneficial in treatment when caught early. Rest, sufficient hydration, hot chamomile tea, hot chicken soup, nasal saline, and vitamin C supplements can complement antiviral medications Symptom relief in 7 to 10 days. There is a vaccine to prevent it (nasal and injection)

Escherichia coli O157:H7 (E.coli)

Reportable Disease Most strains are harmless and live in the intestinal tract of healthy humans and animals, but the O157:H7 strain produces a powerful toxin and can cause serious illness. Emergine cause of food-borne illness. 20,000 cases in the US each year. The infection causes bloody diarrhea, nausea and vomiting, and abdominal cramps, although in some cases, the person is asymptomatic. Usually, no fever is present and the illness will resolve in 5 to 10 days. Elderly and children can develop hemolytic uremic syndrome (the red blood cells are destroyed, creating low platelet counts that can lead to acute kidney failure. Complications of the syndrome include end-stage renal disease, hypertension, seizures, blindness, and paralysis) as a complication. These complications cause death and long term difficulties for a small percentage of individuals. diagnosed by detecting the bacteria in the stool Persons with only diarrhea usually recover without specific treatment in 5 to 10 days. However, hospitalization may be necessary for those with hemolytic uremic syndrome, which is life-threatening and is treated aggressively. Blood transfusions and kidney dialysis are usually required. Rest, eating a balanced diet, and drinking ample fluids is also recommended. 1/3 with the syndrome develop abnormal kidney function or require long term dialysis Cook all beef thoroughly to 160°F. Consume pasteurized milk and fruit juice. Wash hands, counters, utensils, and where ever raw meat has been prepared. Also was fruits and vegetables. Do not swallow water while swimming anywhere

Coronaviruses: Severe Acute Respiratory Syndrome (SARS) & Middle East Respiratory Syndrome

Reportable Disease SARS was first reported in Asia in 2003. MERS was first reported in Saudi Arabia in 2012. First case of MERS in the US was on May 2, 2014 SARS may be asymptomatic or may experience a mild respiratory illness The moderate form of SARS begins with a temperature greater than 100.4°F. Additionally, some symptoms may include headache, an overall feeling of discomfort, and body aches. With the more severe forms of SARS, people develop a dry cough, have trouble breathing, and may show evidence of pneumonia or respiratory distress syndrome (severe impairment of respiratory function). The onset of symptoms in the moderate and severe forms is generally 2 to 7 days after exposure. Most people who have been confirmed to have MERS-CoV developed severe acute respiratory illness. They had fever, cough, and shortness of breath. About 30% of these people died Testing should include chest x-ray, pulse oximetry, blood and sputum cultures, and testing for viral respiratory pathogens. The CDC has developed diagnostic tests to allow scientists to detect antibodies to the MERS virus The CDC recommends that persons infected receive the same treatment used for anyone with a community acquired atypical pneumonia. Otherwise, treatment choices generally are symptomatic and may be influenced by the severity of the illness. For example, oxygen therapy and bed rest may be required. Complementary therapy includes additional fluids, proper nutrition with some additional supplements, and supportive measures Good hygiene is important and staying away from people who are or may be infected. Wear gloves and eye protection

Malaria

Reportable Disease 1,925 cases in the US in 2011. In the world 207 million cases were reported & 650,000 people died (mostly children) Greatest amount of cases occurs in Africa south of the Sahara It is transmitted form infected mosquitoes. It travels to the liver where it multiplies and changes to a parasite called merozoites. Symptoms are fever and flulike illness, including shaking chills, headache, muscle aches, and malaise. Nausea, vomiting, and diarrhea may also occur. May cause anemia and jaundice The presence of the parasites in the RBCs on blood smears confirms the diagnosis. Also rapid diagnostic tests (RDTs) that detect antigens have been developed and approved. RDTs reduce the amount of time for a diagnosis Medications that are effective against it depend on the strain diagnosed, the age of the person infected, and the severity of the illness. Antimalarial prescription medications can cure the disease. Many strains are becoming resistant to treatment If someone is treated promptly prognosis is good. But in developing countries it is a leading cause of death. Use insect repellent and wear long sleeves and pants. If you are going to a country where there is a risk of malaria see your doctor 4-6 weeks before for an antimalaria prescription

Plague

Reportable Disease A communicable disease identified in two forms: Bubonic plague is transmitted through the bite of an infected flea or exposure to infected material through a break in the skin. Pneumonic plague is spread through close contact with infected individuals and affects the lungs Fever, weakness, shortness of breath, chest pain, cough, and pneumonia are evident. There may be bloody or watery sputum, nausea and vomiting, and abdominal pain A blood or sputum sample sent to the laboratory for testing is the definitive diagnosis (can take 24 to 48) Prompt treatment with antibiotic therapy is important— best within 24 hours of the first symptoms. There are large supplies of antibiotics available in the United States in case of a bioterrorism attack. Use cool compresses to lower a fever. Drinking chamomile tea or inhaling the vapors from the flowering tops of chamomile may be helpful Can lead to respiratory failure, shock, and death

Viral Hemorrhagic Fevers

Reportable Disease A group of viral illnesses that affect multiple organ systems in the body. The body's vascular system is damaged, and the body is unable to regulate itself. These agents are highly infectious and very stable via the aerosol route 4 main groups: 1. Arenaviruses—Lassa and Argentine, Bolivian, Venezuelan 2. Filoviruses—Hantavirus genus, Congo-Crimean, Rift Valley, Ebola, and Marburg 3. Bunyaviruses—Ebola and Marburg 4. Flaviviruses—Dengue and yellow fever, tick-borne encephalitis, Omsk hemorrhagic and Kyasanur Forest The viruses are generally derived from certain animals (mice and rats) and insects (ticks and mosquitoes) and are mostly restricted to the geographical location where their host species live Symptoms include high fever, fatigue, muscle aches, and dizziness. There may be bleeding under the skin and from the mouth, eyes, and ears. Severely ill individuals suffer kidney failure, shock, coma, or seizures Laboratory findings can be helpful if infectious virus and viral antigens can be detected and identified by a number of tests such as ELISA using fresh or frozen serum or plasma samples. Diagnosis from cultivated virus samples can take 3 to 10 days Close supervision is required. Treatment is largely supportive and is basically the same as is provided to any person with multisystem failure. If clients are able, encourage fluids and nutrition. Rest and medications to alleviate pain can be helpful. The antiviral drug ribavirin may be helpful in some cases, especially if begun in the first 7 days of onset. Hot tea may be soothing. Music and aroma therapy may be beneficial There is no cure. Best prevention is to control rodent populations and spray for mosquitos. Wash hands and double gloves. For airborne precautions wear respirator.

HIV Infection / AIDS

Reportable Disease AIDS is a severe illness associated with HIV infection. In 2013 it was reported that there were more than 35 million people living with AIDS in the world and 2.1 million are children. 2/3 people living with it are in sub-Saharan Africa. After exposure many experience no recognizable symptoms. However some may develop a mononucleosis-like syndrome characterized by fever and flulike symptoms. It resolves spontaneously, with seroconversion usually occurring 8 to 10 weeks later. When symptoms occur later the most common are generalized, persistent lymphadenopathy; weight loss; fever; fatigue; neurological symptoms; and malignancy. The pulmonary, gastrointestinal, and neurological systems may be involved, and several forms of malignancy and chronic illnesses may result, presenting specific symptoms. There are 4 rapid tests approved by the FDA that return results the same day: OraQuick Advance Rapid HIV-1/2 Antibody Test, Reveal G2 Rapid HIV-1 Antibody Test, Uni-Gold Recombigen HIV Test, and Multispot HIV-1/HIV-2 Rapid Test. Also, ELISA, followed by the Western blot test for confirmation. These two tests can take several days for results, however There is no cure and no effective treatment to stop the infection. however, there are 31 antiretroviral drugs approved by the FDA. They can suppress the virus. HIV resistance to some antiviral agents prompts the need for highly active antiretroviral therapy (HAART) medications given daily. Vitamin supplementation with herbal medicines may be tried. Also, acupuncture, mind-body therapies, spiritual practices, and massage can help Recurrent bouts of opportunistic infections, with or without malignancies, usually cause the death of individuals. The use of HAART therapy have greatly increased the years a person may live following diagnosis. There is no vaccine but one can avoid it by practicing safer sex and to be careful when handling blood or bodily fluids

Tetanus (Lockjaw)

Reportable Disease Acute, life-threatening infectious disease characterized by persistent, painful contractions of skeletal muscles. Can affect any person at any time. Puncture are prone to it and sores can become infected as well. Acquired from environment. Caused by Clostridium tetani (found in soil). The spores produce a powerful toxin that attacks the central nervous system. Onset of symptoms may be either gradual or abrupt. Stiffness of the jaw, esophageal muscles, and some neck muscles is often the first sign. Later, the jaws become rigidly fixed (lockjaw), the voice is altered, and the facial muscles contract, contorting the individual's face into a grimace. Finally, the muscles of the back and the extremities may become rigid, or the individual may experience extremely severe convulsive muscle spasms. The final phase often is accompanied by high fever, profuse sweating, tachycardia, dysphagia, and intense pain Diagnosed on the basis of its classic symptomatology Vaccine administered within first 24 hours. Site of wound/infection is cleaned and debrided. Then antibiotics are given sometimes muscle relaxants too. Meticulous care and support are required to maintain adequate nutrition and hydration and to avoid the development of decubitus ulcers. Tracheostomy is routinely performed in moderate to severe cases of tetanus to prevent choking Rarely produces lasting disability. However it is frequently fatal. Death may result from asphyxiation, a host of possible complications, and sometimes from sheer exhaustion To prevent get the vaccine also clean wounds.

Diphtheria

Reportable Disease Acute, life-threatening infectious disease. It is characterized by a gray to black membrane-like coating that forms over mucous membrane surfaces, particularly along the respiratory tract, which can block airways. It can cause a toxic reaction that primarily affects the heart and peripheral nerves. The disease may occasionally involve the skin. Most cases occur in children under age 10, but people above that age may be affected. Caused by Corynebacterium diphtheriae. Transmission is through contact with discharge from the nose, throat, eye, and skin lesions The specific symptoms vary with the site of infection. In typical cases, a slight headache, malaise, and a mild fever (100°F to 101°F) occur. There may be a strong, foul odor to the breath; bluish skin color; bloody, watery nasal drainage; and breathing problems. Some individuals infected with C. diphtheriae remain asymptomatic but become carriers of the disease The appearance of the characteristic membrane may be sufficient to establish a diagnosis. A definitive diagnosis can be made only by identifying the bacterium in nose and throat cultures Administration of sufficient quantities of diphtheria antitoxin as early as possible followed by antibiotics. Bed rest is required and a soft or liquid diet is recommended. Carriers are treated with antibiotics. Vaccine to prevent it

Mumps

Reportable Disease An acute contagious disease characterized by fever and inflammation of the parotid salivary glands. Most common among children and young adults in late winter and spring. Easily preventable by vaccine. Transmitted via little droplets of saliva or the airborne route Symptoms are unilateral or bilateral swollen parotid glands. Headache, malaise, fever, and earache may occur, and other salivary glands may become swollen The clinical picture and a history of recent exposure usually are sufficient for diagnosis. A nasopharyngeal culture is done. A blood test may be ordered Analgesics, antipyretics, and adequate fluid intake are recommended Prognosis is good however there are complications including orchitis, pancreatitis, and various central nervous system manifestations. Orchitis, which causes swelling of the testes in adult men, is extremely uncomfortable but rarely causes sterility, as is often feared

Anthrax

Reportable Disease An acute infection that can occur in three forms: (1) cutaneous or skin (most common), (2) inhalation, and (3) intestinal. First case was reported in 1992. Found mailed to members of the US Senate and journalists in 2001. The cutaneous form causes a raised itchy bump that resembles an insect bite but quickly develops into a vesicle—a painless ulcer that develops within 1 to 2 days. Symptoms of inhalation anthrax resemble those of a cold, with sore throat, mild fever, muscle aches, and malaise. Severe breathing problems and shock can occur. Intestinal anthrax is characterized by acute inflammation of the intestinal tract, causing nausea, vomiting, and severe diarrhea. Laboratory diagnosis consists of isolation and confirmation of B. anthracis from a clinical specimen collected from an affected tissue site. The bacteria can be cultured from blood, a skin lesion, and respiratory secretions. Other laboratory tests include evidence of the B. anthracis DNA by polymerase chain reaction and immunohistochemical staining Individuals with cutaneous anthrax are treated with penicillin or doxycycline antibiotic therapy, regardless of their vaccination status. Broad-spectrum antimicrobial agents are beneficial in the treatment of inhalation anthrax, and antitoxin should be added to the combination antimicrobial treatment for intestinal anthrax. All treatments should be under the strict supervision of a healthcare provider, especially because prolonged treatment is necessary. Rest, ample hydration, and strict adherence to prescribed medications are important Early treatment of cutaneous anthrax is usually curative; the fatality rate without antibiotics is about 20%. Even with appropriate antimicrobial agents to treat inhalation anthrax, the mortality rate can be as high as 75%. Intestinal anthrax causes death in as many as 60% of cases There is a vaccination for the prevention of anthrax

Varicella (Chickenpox)

Reportable Disease Highly contagious disease characterized by the appearance of a distinctive rash that passes through stages of macules, papules, small fluidfilled blisters or vesicles, and crusts. Caused by the varicella-zoster virus, which is a herpesvirus. Spread via respiratory secretion and direct contact pruritic rash, which begins as erythematous macules that produce papules and then clear vesicles. The rash usually contains a combination of papules, vesicles, and scabs in all stages. Anorexia, malaise, and fever may accompany the rash The clinical signs are usually sufficient for the diagnosis. A history that indicates recent exposure helps confirm the diagnosis. Isolation is important until scabs disappear. The only treatment necessary is to reduce the itching. Antihistamines may be given. Calamine lotion, cool bicarbonate of soda, or colloidal oatmeal baths can be very helpful. It is best not to scratch the lesions Prognosis is good. Complications may include secondary bacterial infections of the skin as a result of scratching open lesions, thrombocytopenia, arthritis, hepatitis, and Reye syndrome. However people who have had it or have been vaccinated for it are at risk for developing shingles later in life. Shingles can cause tingling, itching, and pain followed by a rash of red bumps and blisters Best prevention is vaccine

Tularemia

Reportable Disease Referred to as rabbit fever or deer fly fever. It is contracted when skin or mucous membranes come in contact with infected animals or when individuals are bitten by infected ticks, deer flies, or mosquitoes. Also, inhaling contaminated dusts or ingesting contaminated foods or water may cause the disease. Developed as a weapon in the 1950's and 1960's small, rod-shaped, nonmotile bacterium. Can remain infectious in water, soil, animal hides, and even frozen meats. There are six forms Symptoms usually develop within 3 to 4 days of exposure. It spreads through the lymphatic system, multiplying within the macrophages. Fever, cough, shortness of breath, chills, malaise, muscle aches, and fatigue are the most common symptoms Diagnosis is largely based on the signs and symptoms. Antibiotic therapy, with streptomycin or gentamicin, both by injection and by mouth, is the treatment of choice. Encourage rest and adequate nutrition With proper diagnosis and prompt antibiotic treatment, the mortality rate is greatly decreased. There is no vaccine available to the public. People who come into contact with wild animals are advised to take precautions

Smallpox (variola)

Reportable Disease Virus is known to exist in Russia and the United States. The WHO declared it eradicated in 1979 It is caused by the variola poxvirus. It is spread directly via infected respiratory droplets or dried scales of virus-containing lesions or indirectly through contact with contaminated linens and other objects. It is contagious from onset until the last scab is shed. It affects people of all ages fever, abrupt onset of chills (10 to 14 days after exposure), headache, backache, severe malaise, and vomiting. Skin lesions that progress from macular to papular, vesicular, and pustular soon develop. The pustules rupture, eventually dry, and form scabs that leave permanent pitting scars. Two days from onset, symptoms become more severe; thereafter, the person begins to improve. Sore throat with cough ensues. Generally, after 14 days, the symptoms subside A culture of the vesicles and pustules confirms the presence of the virus Treatment goals are to reduce contagion, prevent bacterial complications, and introduce symptomatic and supportive measures for individuals. Antipyretics (drugs that reduce fever) and pain medications may be given during the pustular stage Death occurs in 30% of cases. There is a vaccine to prevent it

Rubeola (Measles)

Reportable Disease highly communicable respiratory infection. Most common in school age children. Outbreaks occurring in winter and spring. It is caused by the Morbillivirus rubeola virus through direct contact with infectious droplets and occasionally through the air. Onset of symptoms is usually gradual. Initial symptoms may include rhinitis (inflammation of the nasal mucosa), cough, cold or coryza, drowsiness, anorexia (loss of appetite), and a slow but progressive rise in temperature to 101°F or 103°F by the second day. Small red spots with bluish white centers, called Koplik spots, appear on the oral mucosa by the second or third day. Photophobia and cough soon follow. By about the fourth day, the fever usually reaches its maximum (as high as 104°F to 106°F) and the characteristic rash appears. The rash first appears on the face as tiny maculopapular lesions that contain both discolored spots of skin called macules and red, raised areas of skin called papules. These rapidly enlarge and spread to other areas of the body. The lesions may be so densely clustered in certain areas that the skin surface appears generally swollen and red The clinical picture of symptoms is usually a sufficient basis for a diagnosis Treatment is symptomatic. Bed rest is indicated, sometimes in a darkened room to alleviate the discomfort of photophobia. Antipyretics and liquids may be recommended. Keep infected children isolated until the rash disappears Usually benign disease. Complications include croup, conjunctivitis, myocarditis, and opportunistic respiratory tract infections from staphylococci, streptococci, or Haemophilus influenzae There is a vaccine to prevent it

West Nile Virus

Reportable Disease spread to humans by the bite of an infected mosquito. It emerged in the US in 1999. Symptom severity ranges from mild to severe and are flulike. A mild infection includes fever, headache, body ache, skin rash, and swollen lymph glands. Severe infections include all of the mild symptoms plus stupor, disorientation, tremors, convulsions, coma, and paralysis. Nearly 80% of individuals infected with the virus show no symptoms The WNV IgM ELISA is the test of choice, using a single serum sample that can give a diagnosis within a few hours. It detects antibodies within the first few days of the infections onset No know treatment or cure. Focuses on alleviating symptoms. Encourage rest and fluids Mild symptoms last a few days; severe symptoms can last several weeks. The neurological effect may be permanent. Fortunately, only about 2 out of every 10 individuals who are infected experience any illness. Persons over age 50 are particularly susceptible to the severe form of the illness Use insect repellent, wear long sleeves and pants, empty standing water, and install window and door screens

Botulism

Reportable disease Food-borne botulism is caused by eating foods contaminated with the botulism toxin. This form is especially dangerous because many people can be poisoned at one time. 15% of cases. Wound botulism accounts for 29% of cases and occurs when a wound is infected with the botulism toxin. Infant botulism occurs when the spores of the botulism toxin grow in the intestines, resulting in 55% of the cases Botulism has been used as a warfare agent since before World War II (it was injected into grenades and loaded into bombs) Rod Shaped bacteria. There are 7 types (A-G) The symptoms usually occur within 12 to 36 hours of eating contaminated food and include blurred or double vision, slurred speech, drooping eyelids, difficulty swallowing, and muscle weakness. Symptoms can appear, however, as early as 6 hours and as late as 10 days from exposure. The muscle weakness moves through the body, paralyzing arms and legs. Death may occur when respiratory muscles become paralyzed The evidence of the botulism toxin in the person's stool or blood serum is necessary for diagnosis Treatment includes the use of an antitoxin derived from healthy horses to block the action of the toxin in the blood. Respiratory paralysis and failure requires the use of a respirator. Wounds usually require surgical removal of the toxin-producing bacteria and antibiotic therapy. A human-derived antitoxin is used to treat infants infected with the toxin. Edemas and inducing vomiting can be beneficial When respiration has been compromised months of recuperation may be needed. fatigue and shortness of breath may continue for years Can be prevented by proper canning and strict hygiene measures. Seek medical attention for infected wounds

Lyme disease

Reportable disease caused by Borrelia burgdorferi, a tiny tick-transmitted spirochete. It is carried by blacklegged ticks. Stage 1 signs include a rash called erythema chronicum migrans (ECM), which appears at the site of the bite and may resemble a bull's eye (not everyone develops it) Other signs of stage 1 include flulike symptoms as fatigue, headache, fever, chills, stiff neck, and joint and muscle pain, which can last from several weeks to several months. Stage 2 symptoms affect the central nervous system, causing such diverse problems as meningitis, nerve damage, and facial palsy. Occurs after several months. Stage 3 symptoms include chronic arthritis and continuing neurological problems. Occurs after several months to years. Diagnosis for stage one is made by appearance of ECM and history of exposure to infected ticks. Blood tests can be used but it can take more than 6 weeks for antibodies to show up in the blood. The enzyme-linked immunosorbent assay (ELISA) test detects antibodies then the Western blot will confirm it Treatment of choice in all three stages is the use of antibiotics, such as doxycycline or amoxicillin. Also avoid alcohol and sugar. Proper nutrition and stress reduction can help. Things that should be avoided in the treatment of Lyme disease: malariotherapy, intracellular hyperthermia therapy, hyperbaric oxygen therapy, colloidal silver, dietary supplements, and herbs Complete recovery occurs with proper treatment. Ways to prevent infection is by covering as much of your body as possible when in the woods and use insect repellent

Rubella (German Measles / 3-day Measles)

Reportable disease Acute infectious disease. Not as infectious as rubeola. Occurs most frequently among teenagers and young adults. The onset of the disease is sometimes characterized by malaise, headache, slight fever, and sore throat. About 25% to 50% of cases are asymptomatic, especially among children. The rash typically appears the first or second day after onset. It may be composed of pale red, slightly elevated, discrete papules, or the rash may be highly diffuse and bright red. The rash begins on the face, spreads rapidly to other portions of the body, and usually fades so rapidly that the face may clear before the extremities are affected. Rash-covered portions of skin may itch or peel Definitive diagnosis can be reached with cultures of the throat, blood, and urine or with antibody titers Treatment is usually not neccessary. Bed rest is indicated. Topical antipruritics or warm water baths may be recommended to relieve itching. Antipyretics may be prescribed Prognosis is usually good. However is dangerous to pregnant women, especially during the first trimester of pregnancy; the virus is capable of producing severe fetal malformation. Vaccine to prevent it

Pertussis (Whooping Cough)

Reportable disease acute, highly infectious respiratory tract disease characterized by a repetitious, paroxysmal cough and a prolonged, harsh, or shrill sound during inspiration. Affects children and infants more frequently and severely than adults. Caused by Bordetella pertussis. It induces a mucopurulent secretion and hampers the natural ability of the respiratory tract to clear such secretions. Consequently, mucus accumulates in the airways and obstructs airflow. The route of transmission for the disease is direct contact with any discharge from the mucous membrane of an infected person The catarrhal stage is marked by the gradual onset of coldlike symptoms—mild fever, running nose, dry cough, irritability, and anorexia. This stage lasts from 1 to 2 weeks, during which the disease is highly communicable. The paroxysmal stage is marked by the onset of the classic cough, consisting of a series of several short, severe coughs in rapid succession followed by a slow, strained inspiration, during which a "whoop" (stridor) may be heard. The coughing occurs in periodic attacks. This stage, lasting 3 to 4 weeks, may be accompanied by weight loss, dehydration, vomiting, epistaxis, and hypoxia. After several weeks, a period of decline begins, marked by the gradual diminishment of coughing A history of exposure to another infected individual and the presence of the classic cough may be sufficient to establish the diagnosis. A very high white blood cell count is another distinguishing feature. A definitive diagnosis depends on a nasopharyngeal culture Antibiotics administered during the catarrhal stage. Antibiotics after this stage have little effects. Requires meticulous care to ensure adequate nutrition, hydration, and clearance of mucous secretions. Fluids and light foods are encouraged. Avoid dairy products. Aromatherapy may be useful. Osteopathic manipulation may be able to reduce the severity of the cough. Prognosis varies case by case. Complications can occur as a result of seizures, apnea, encephalopathy, and pneumonia. Young children can die. Vaccine can help prevent it along with good hygiene

Rubeola (hard measles)

Respiratory droplets from nose and throat 8-13 days from exposure; 14 days until rash appears

Rubella (3-day measles)

Respiratory droplets from nose and throat Ranges from 14-23 days; commonly 16-18 days

Smallpox

Respiratory droplets; infected dried scales from lesions; contact with contaminated items 10-14 days after exposure

Varicella (chickenpox)

Respiratory secretions and direct contact Usually between 13 and 17 days

Erythema infectiosum (fifth disease)

Respiratory secretions; direct contact Generally 4-14 days

H1N1 influenza (swine flu)

Respiratory secretions; hand-to-hand contact 1-7 days from exposure

influenza (flu)

Respiratory secretions; hand-to-hand contact; contact with contaminated items 1-3 days

Methicillian-Resistant Staphylococcus Aureus (MRSA)

The CDC reports that approximately 25% to 30% of population is colonized in the nose with staphylococci at a given time. Generally occurs through close or direct contact with infected individuals. Indirect contact may occur when contaminated objects such as infected towels, wound dressings, clothes, or sports equipment are touched. Signs and symptoms depend on where the infection causes disease. For example, if the infection occurs in a wound, the wound will be painful, reddened, swollen, and warm to the touch. If the skin infection spreads to the lung, causing pneumonia, or to the bloodstream, then the symptoms will be more systemic. Also, any antibiotic therapy prescribed may have little or no effect on the particular illness In 2008, the FDA approved a rapid blood test (StaphSR assay) that can detect the presence of its genetic material in a blood sample in as little as 2 hours Treatment: Draining a skin sore in some cases, but in most cases antibiotics are used. Intravenous vancomycin often is the drug of choice for treatment It can be difficult to treat and can progress to lifethreatening blood or bone infections, lung infections, or skin/tissue infections. The prognosis may also depend on how quickly/aggressively the client is treated and on the client's general health. Individuals with suppressed immune systems/chronic illnesses may have a more difficult road to recovery. Wash hands to prevent it. Some facilities have staff and infected patients use a mask

Infectious Diarrheal Diseases

Usually affects children younger than 5, highly contagious. Occurs frequently in daycare centers. Estimated that more than 20 million cases occur in the US in children under age 5. Transmitted via the oral-fecal route and possible airborne respiratory droplets. The incubation from ingestion to infection generally is 48 hours. Most common causes are rotaviruses and bacteria (including E. coli, Salmonella, Shigella, Campylobacter, and Yersinia) also parasites (Giardia and Cryptosporidium) can cause it Diarrhea may be bloody and may be preceded or accompanied by vomiting, nausea, and abdominal cramping. A low-grade fever may be present. In severe cases, dehydration, electrolyte imbalance, acidosis, and kidney failure may occur Stool is examined for parasites, bacteria, and/or white blood cells Rehydration is most important. If cause by virus there is no medication. If it is bacteria they use antibiotics. Then, for parasites the drug chosen for treatment is determined by the specific parasite involved. The infected child needs to maintain a high caloric intake and should avoid foods high in sugar; however, food may have to be offered slowly and in small amounts at first. Dietary limitations and appropriate nutritional therapy to replace fluid and electrolytes Prognosis is good if detected and treated early. If infection is severe a child can die within hours. Some children, especially those under age 2, may die from such complications as dehydration, shock, and bacteremia. Good hygiene and clean drinking water is important. Swimming in ponds, lakes, or stagnant bodies of water should be avoided.

Vaccine

a suspension of infectious agents, components of the agents, or genetically engineered antigens There are two general classes of vaccines: • Live, generally attenuated, infectious agents (e.g., measles virus) • Inactivated agents or products obtained through genetic recombination (e.g., acellular pertussis vaccines)

Erythema Infectiosum (Fifth Disease)

common infection occurring predominantly in children, with flulike symptoms and diffuse redness of the skin, or erythema. It is called fifth disease because it was classified in the late 19th century as the fifth in a series of six childhood exanthems— rashes that occur on the skin as opposed to rashes that occur on the mucous membranes (or enanthems). It is a mild illness that exhibits a rash and develops quickly. Caused by Parvovirus B19. It is transmitted through respiratory secretions or direct contact. Most prevalent in elementary and junior high school children during winter and spring The child has a low-grade fever, coldlike symptoms, and a red facial rash that looks like a "slapped cheek." Later there is a circumoral pallor and symmetric lacy rash on the trunk and limbs. The rash can recur for weeks with exposure to the sun, heat, stress, or exercise. Between 20% and 60% of the children in outbreaks are symptomatic, and many are asymptomatically infected B19 can be detected in throat swabbings, respiratory tract secretions, and serum. The B19-specific antibodies can be detected with commercially available immunoassay kits No treatment needed except to manage fever Complications include arthralgia and arthritis Way to prevent it is good hygiene

nosocomial infection

hospital acquired infection it's estimated that 10% hospital patients develop an infection and 90,000

HIV/AIDS Symptoms

• Pulmonary symptoms include shortness of breath, dyspnea, coughing, chest pain, and fever, usually caused by a variety of opportunistic infections. The most common pulmonary infection is Pneumocystis jiroveci (formerly P. carinii) pneumonia, which has a high mortality rate. There also is an increased incidence of tuberculosis. • Gastrointestinal symptoms may include loss of appetite, nausea, vomiting, oral and esophageal candidiasis, and chronic diarrhea or gastroenteritis. Diarrhea occurs in more than half of all clients with AIDS. • Neurological symptoms may include memory loss, headache, depression, fever, confusion, and visual disturbances. Dementia and depression may also be seen. • Malignancies commonly associated with AIDS include Kaposi sarcoma, a neoplasm evidenced by multiple vascular nodules in the skin and other organs. This malignant neoplasm is especially prevalent in the lymph nodes, the gastrointestinal tract, and the lungs. The purple lesions characterizing Kaposi sarcoma (ICD-10: C46.X) may appear on the skin and grow rapidly until wounds are produced, which increase the client's susceptibility to infections. Studies show that women infected with HIV experience a higher incidence of cervical cancer. • Chronic illness results because persons with AIDS are often severely immunocompromised. Nearly all infected persons will eventually develop one or more chronic opportunistic infections during the course of the disease. Such illnesses may complicate treatment and produce debilitating symptoms.