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Infectious & Communicable Diseases. Chemeketa Community College. Are we at risk?. Patient contact Co-workers Hygiene Hazardous scenes. Overview. Infectious diseases affect entire populations Important to understand population demographics Their ability to move internationally

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infectious communicable diseases

Infectious & Communicable Diseases

Chemeketa Community College

are we at risk
Are we at risk?
  • Patient contact
  • Co-workers
  • Hygiene
  • Hazardous scenes
  • Infectious diseases affect entire populations
  • Important to understand population demographics
    • Their ability to move internationally
    • Age distributions
    • Socioeconomic considerations
    • Genetic factors
  • Study of an infectious disease cluster is regional; consequences may be international.
  • Think of consequences of person-to-person contacts
public health agencies
Public Health Agencies
  • Local – that’s YOU!
  • State
    • Health dept
  • Federal
    • US DHS CDC & P
      • Monitors
      • Studies & researches
      • Manages
    • OSHA
agency responsibility relative to isolation from exposure
Agency responsibility relative to isolation from exposure
  • Exposure plan
    • Maintenance and surveillance
    • Appointing a DO
    • Schedule of standards implemented
    • PPE
      • gowns
      • gloves
      • face shields
      • masks
      • protective eyewear
  • Procedures for evaluation of circumstances and counseling
  • personal, building, vehicular, equipment disinfection and storage
  • After action analysis
  • Correct disposal
  • Correct handling
guidelines recommendations standards laws
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.
host defense mechanisms
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
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
Upper Respiratory system
    • Turbinates
    • Mucous
    • Mucociliary escalator
    • Normal bacterial flora
    • Lymph tissues of tonsils and adenoids permit rapid local immunological response
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.
Internal Barriers
  • Protect against pathogenic agents when external lines of defense are breached.
  • Include
    • Inflammatory response
    • Imune response
inflammatory response
Inflammatory response
  • A local reaction to cellular injury
  • Generally protective and beneficial
  • May initiate destruction of the body’s own tissue
three separate stages
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
immune response
Immune response
  • Possesses self-nonself recognition
  • Produces antibodies
  • Some lymphocytes become memory cells
  • Is self-regulated to activate only when invading pathogens






    • 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
approach to call
Approach to call
  • Wear appropriate PPE
  • Patient Assessment:
    • Focused history and physical
    • History of present illness
      • Onset - gradual or sudden?
      • Fever
      • Antipyretic usage (ASA, APAP)
      • Neck pain or rigidity?
      • Difficulty swallowing, secretions?
      • How did sx change over time?
Past medical history
    • Chronic infections, inflammation
    • Use of steroids, antibiotics
    • Organ transplant and associated medicines
    • Diabetes or other endocrine disorders
    • COPD or respiratory complications
detailed history and physical
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
Upon disposition of patient, dispose of supplies, bag linen, disinfect ambulance and equipment
    • Reprocessing methods for EMS durable equipt.
      • Sterilization
      • High-level disinfection
      • Intermediate-level disinfection
      • Low-level disinfection
the ryan white act
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
what does it mean
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
individual responsibilities
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
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.
Exposure does not necessarily equal infection
  • The chain of elements must be intact
  • Transmission can be controlled
we ll talk about

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis non-ABC


Mengococcal meningitis




Chicken pox


We’ll talk about...
and these too


Whooping cough



Herpes simplex 1 & 2




Scabies & Lice

Lyme disease


And these too
infectious agents
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
Toxins - often more lethal than bacterium
    • Endotoxins
    • Exotoxins
  • Can be localized or systemic infection
    • Eukaryotic
      • Nuclear material contained within a distinct envelope
  • must invade host cells to reproduce
  • Can’t survive outside of host cell
other microorganisms
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
    • Protective capsules surround the cell wall and protect fungi from phagocytes
    • Broad-spectrum antibiotics can cause fungal infections
    • Pneumonia, Yeast infections
protozoans single celled microorganisms more complex than bacteria
ProtozoansSingle-celled microorganismsMore complex than bacteria
  • Live in soil – opportunistic infections – fecal-oral or mosquito bites
    • Malaria
    • Some forms of Gastroenteritis
    • trichomoniasis
parasites helminths worms
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
human immunodeficiency virus hiv slim disease
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
  • US- 850,000 – 950,000
    • >180,000 undiagnosed
  • Oregon – 5,599 (12/03)
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.
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.
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
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

HIV-1 is far more pathogenic; most cases world-wide are HIV-1, Group M
    • first case in US of HIV-1, Group O, identified in 6/96
  • Est. AIDS dx through 2003 in US- 929,985. Adult and adolescent: 920,566

Males: 749,887

Females: 170,679

Children: 9,419

    • HIV-antibody tests in US detect HIV-1 Group M, with 99% accuracy; HIV-1 Group O with 50-90%.
  • HIV-2 – milder sx, slower development – mainly in West Africa. US cases: 79
Initial case definition established by CDC in 1982.
  • 1987 & 1993; s/s include tuberculosis, recurrent pneumonia, wasting syndrome, HIV dementia, sensory neuropathy.
classifications categories
Classifications & Categories

Category A

  • Acute retroviral infection
  • 2-4 weeks after exposure
  • Mono-like illness; lasts 1 – 2 weeks
    • Fever
    • Adenopathy
    • Sore throat
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
Category B
    • Early symptomatic HIV
    • Decreased CD4+T cell count
    • Common complications
      • Localized Candida infections
      • Oral lesions
      • Shingles
      • PID
      • Peripheral neuropathy
      • Fever/Diarrhea lasting more than one month
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.
Nervous system - toxoplasmosis of CNS
  • Immune system - major site of compromise
  • Respiratory system - pneumocystis carinii pneumonia
  • Integumentary system - Karposi’s sarcoma
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.
patient management
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.
HCW infection:
    • Nonintact skin exposure (6/2000) – 56 +

138 ?

  • Susceptibility and resistance
    • Infectiousness may be high during initial period after infection and at end-stage
    • Race and gender are not risk factors for susceptibility.
Care in use of medical equipment mandatory
  • Disinfection of equipment mandatory
  • Early diagnosis, treatment, counseling for health-care providers is mandatory.
hiv testing
HIV testing
  • OraQuick Rapid HIV 1 / 2 test
    • Oral fluid, plasma, whole blood
    • 20 – 40 minutes
    • Accuracy
      • Positive – 99.3%
      • Negative – 99.8%
post exposure prophylaxis
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
who recommendations for a first line regimen in adults and adolescents
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
  • A viral disease
  • Produces pathologic alterations in the liver
hepatitis a
  • Causative agent-Hepatitis A virus
  • Most common type of viral hepatitis
  • Once infected, person is immune to HAV for life
  • Oregon 1994 – 2003 – 6650 cases
  • Marion Cty: 632
  • Multnomah Cty: 1,512
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.
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
susceptibility and resistance
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
  • 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.
patient management1
Patient management
  • Care is supportive for fluid intake and prevention of shock.
  • Person is most infectious during first week of sx.
  • BSI mandatory.
  • Prophylactic IG may be administered within two weeks after exposure
  • If traveling to Africa, the Middle East, Central and South America, Asia - get immunized.
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
hepatitis b
  • Causative agent - H-B virus.
  • Potential secondary complication - liver necrosis
  • HBV usually lasts < 6 months
    • Carrier state may persist for years
  • Oregon – 1994 – 2003; 1,578 cases
  • Marion Cty: 195
  • Multnomah Cty: 556
routes of transmission
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.
  • 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.
1% of patients develop full-blown liver crises and die with mortality increasing > 40 y/o.
  • 5-10% infected people become asymptomatic carriers.
patient management2
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.
  • Recombivax HB and
  • Engerix B are effective.
  • Vaccines: initial, one-month, six-month provide long-lasting immunity in 95-98% of cases.
  • Postexposure prophylaxis
    • HBV vaccine
    • HB IG
hepatitis c
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
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.
  • Oregon: 1994 – 2003; 142
  • Marion Cty: 4
  • Multnomah Cty: 17
  • 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
Patient management
    • Same as for HBV
  • Immunization:
    • Prophylactic administration of IG not supported by current data
    • Post exposure testing important
    • Vaccine may be available
hepatitis non abc
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
Hepatitis G - newly identified
  • Major epidemics documented in young adults.
  • Women in 3rd trimester especially susceptible to liver disease
    • 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.
  • Causative agent - mycobacterium tuberculosis
  • 8 million new TB/yr worldwide
  • 3 million die of disease
TB Epidemic in US
    • Immigration
    • Transmission in high-risk environments
      • Prisons, homeless shelters, hospitals, nursing homes
  • Oregon: 106/100,000 (11/03)
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
susceptibility and resistance1
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.
  • 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.
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
patient care
Patient care
  • Primarily supportive
  • Prevent shock
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.
drug therapy
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
meningococcal meningitis
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.
  • Oregon – 1994 – 2003: 887
  • Marion Cty: 111
  • Multnomah Cty: 182
  • onset is rapid;
    • fever,
    • chills,
    • joint pain,
    • neck stiffness or nuchal rigidity,
    • petechial rash,
    • projectile vomiting,
    • headache
@ 10% may develop septic shock; acute adrenal insufficiency, DIC, coma may result. Death may occur in 6-8 hours.
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
Patient management:
    • protective measures with surgical masks to patient.
    • Prophylactic tx available; rifampin, etc.
    • Immunizations: esp. for older children and adults.
other infectious agents cause meningitis
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.
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.
Viruses (aseptic meningitis)
    • A variety known to cause meningitis
    • not considered communicable
  • Causative organisms
    • Bacterial
    • Viral
    • Fungal
Systems affected
    • Respiratory - pneumonia
    • CNS - meningitis
    • ENT - otitis, pharyngitis media
  • Routes of transmission
    • Droplet, Direct contact, Soiled linen
  • pulmonary edema
  • Flue
  • exposure to inhaled toxins
  • chronic lung disease and aspiration
  • Geriatrics
  • Pediatrics with low birth weight and malnourishment
other high risk groups
Other high-risk groups
  • sickle cell disease
  • cardiac disease
  • Diabetes
  • kidney disease
  • HIV
  • organ transplants
  • Hodgkins disease
  • Asplenia
  • 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.
patient management3
Patient management
    • several antibiotics effective to treat bacterial pneumonia
    • Protective measures for health-care workers.
  • Immunizations:
    • vaccine exists for some causes
  • Causative organism;

Clostridium tetani

    • Live mainly in soil and manure
    • Also found in human intestine
  • 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
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.
  • 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.
patient management4
Patient management:
  • Support vital functions
  • Valium for muscle spasms
  • Consider paralytics
  • Magnesium sulfate
  • Narcotics
  • Antidysrhythmics
  • Administration of antitoxin - TIG
post exposure of tetanus immune globulin - keep immunizations UTD.
  • Immunizations: Booster before elementary school, every ten years thereafter.
rabies hydrophobia
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
  • Oregon; 1994 – 2003; 77
  • Marion Cty:
    • 1996 – 2
    • 1998 – 2
    • 2001 – 1
Hawaii is only area in US that is rabies-free.
  • Wildlife rabies (in US) common in
    • skunks,
    • raccoons,
    • bats,
    • foxes,
    • dogs,
    • wolves,
    • jackals,
    • mongoose,
    • coyotes.
Susceptibility: Mammals highly susceptible.
  • Incubation period usually 3-8 weeks (rare; 9 days - can be as long as 7 years).
    • 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.
patient management5
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
  • 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
  • Oregon: 1993 – 2003; 5 cases
  • 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
patient management6
Patient management
  • Supportive
  • BSI
  • Causative agent; variella-zoster virus (member of the Herpes virus group).
  • System affected; primarily integumentary
Shingles is a local manifestation of reactivation of latent viral infection
  • Mainly airborne
    • soiled linen implicated.
  • Incubation period 10-21 days
    • 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.
Disease self-limited
  • Complications
    • Secondary bacterial infections
    • Aseptic meningitis
    • Mononucleosis
    • Reye syndrome
  • Causative agent:Mumps virus
    • Acute, communicable systemic viral disease
  • Glands most commonly affected:
    • Parotid
    • Testes
    • Pancreas
  • 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
patient management7
Patient management:
  • EMS workers - MMR immunity
  • Patients wear masks
  • Caution with soiled linen
rubella german measles
Rubella (German measles)
  • Causative agent - rubella virus
  • Mild, febrile, highly communicable disease
  • Systems affected;
    • integumentary,
    • musculoskeletal,
    • lymph nodes
mode of transmission
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).
Congenital anomalies; death from heart disease, sepsis in first 6 month
    • Mental retardation
    • Deafness
  • Person-person contact via mucous secretions
  • 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.
patient management8
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
measles rubeola hard measles
Measles (rubeola, hard measles)
  • Causative organism - measles virus
    • Highly communicable
  • Systems affected: respiratory, CNS, pharynx, eyes, systemic
  • Mode of transmission - air droplets, direct contact.
  • prodrome - conjunctivitis, swelling of eyelids, photophobia, high fevers to 105 degrees, hacking cough, malaise
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.
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
patient management9
Patient management:
  • BSI, including mask
  • EMS workers should be immunized
  • No specific treatment.
pertussis whooping cough the 100 day cough
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.
  • 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
patient management10
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.
influenza the flu
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.
  • URI- type sx which last 2-7 days.
    • Chills
    • Fever
    • Headache
    • Muscle aches
    • Anorexia
    • fatigue
    • Cough often severe, protracted.
Patient management:
    • Supportive
  • Immunizations:
    • Health care workers should be immunized by mid-Sept. (flu season Nov.-Mar. in US).
  • Causative organism - Epstein-Barr virus or cytomegalovirus (both herpesvirus family)
  • Body regions affected: oropharynx, tonsils
Modes of transmission
    • person-to-person spread by saliva
    • kissing
    • care providers to young children is common
  • Appear gradually
    • Fever
    • sore throat
    • oropharyngeal discharges
    • Lymphadenopathy
    • splenomegaly
  • Recovery usually in a few weeks, but may take months
patient management11
Patient management
  • No specific treatment
  • No immunization available.
herpes simplex virus type 1
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
  • cold sores, fever blisters
    • Tx with acyclovir (Zovirax) helpful.
patient management12
Patient management:
  • BSI, including mask
  • Lesions are highly contagious
herpes simplex virus type 2
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
S/S - Females:
    • Sometimes asymptomatic; lesions of cervix, vulva, anus, rectum and mouth; recurrent disease generally affects vulva, buttocks, legs, perineal skin.
  • Causative organism; Treponema pallidum, a spirochete
  • Affects:
    • skin,
    • CNS,
    • eyes,
    • joints,
    • skeletal system,
    • kidneys,
    • cardiovascular
mode of transmission1
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
s s occurs in 4 stages
S/S: Occurs in 4 stages
  • Primary stage - painless lesion develops at point of entry called a chancre, 10-90 days after initial contact.
    • Lesion heals spontaneously within 1-5 weeks
    • Highly communicable at this stage
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.
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.
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.
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.
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
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.
  • Oregon: 2002 – 47 cases reported
  • 115% increase over 2001
  • Causative agent; Neisseria gonorrheae
  • Affect genital organs and associated structures
  • Mode of transmission: direct contact with exudates of mucous membranes; unprotected sex.
  • Oregon:
  • 1980 – 11,162
  • 1995 – 854
  • 2001 – 1,039
S/S - males:
    • Initial inflammation of urethra with dysuria and purulent urinary discharge . Left untreated, can progress to epididymitis, prostitis, and strictures of urethra.
S/S - females:
    • Dysuria and purulent vaginal discharge may occur.
    • Most females have no pain and minimal urethral discharge.
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.
Females at increased risk for sterility, ectopic pregnancy, abscesses of fallopian tubes, ovaries, peritoneum, and peritonitis.
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
  • Causative organism; Chlamydia trachomatis
  • Affects; eyes, genital area and associated organs, respiratory system
  • Most common reported STD in Oregon
  • 2002 – 7,200
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.
  • 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.
  • 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.
patient management13
Patient management:
  • BSI
  • Personal - launder everything used in last 48 hours in hot water. Tx with Kwell
  • 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
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.
s s itching
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.
patient management14
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.
lyme disease
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
  • Oregon – 1994 – 2003; 151 Cases
  • Marion Cty: 5
  • Jackson Cty: 26
  • Month - July
  • Early, localized stage with painless skin lesion at site of bite (starts out as red, flat, round rash which spreads out.
Border remains bright red, center becomes clear, blue or necrose and black, flu-like syndrome with malaise, myalgia, stiff neck.
Early disseminated stage; invades skin, nervous system, heart, joints
      • skin - multiple lesions
      • Nervous system - meningitis, Bell’s palsy, peripheral neuropathy
      • Cardiac; AV block, Myocarditis
Joint and muscle pain - can occur 6 months after bite
  • Late stage:
    • @ 10% develop chronic arthritis
    • Encephalopathy can develop; cognitive deficits, depression, sleep disorders.
body fluids to which universal precautions apply
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
body fluids to which universal precautions do not apply
Body fluids to which universal precautions do not apply

In the absence of blood

  • Feces
  • Nasal secretions
  • Sputum
  • Sweat
  • Tears
  • Urine
  • Vomitus
precautions for other body fluids in special settings
Precautions for other body fluids in special settings
  • Human breast milk if mother HIV positive
  • Saliva if person HBV or HIV positive
  • 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.