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Infectious samples
- 1. Infectious Diseases • DirectTransmissions • Indirect Transmissions
- 2. Direct Transmissions Person-to-Person • STDs •Foot and Mouth Disease • Mononucleusis • Herpes Simplex
- 3. Sexually Transmitted Diseases(STD) • An STD (sexually transmitted infection) is a disease acquired through sexual contact with an infected person. • Most STIs have no symptoms • A person can have an STI and not know it
- 4. How can someoneget an STI? Vaginal sex Anal sex Oral sex Transmission from mother to baby during childbirth Skin to Skin contact Sharing equipment Exchange of bodily fluids
- 5. There are 3types of STIs Bacterial Parasitic Viral
- 6. Bacterial STIs • Chlamydia •Gonorrhea • Syphilis
- 7. Chlamydia • Infectious Agent:Chlamydia trachomatis • Signs and Symptoms (S/Sx): Initially no symptoms An abnormal vaginal discharge; A burning sensation when urinating A discharge from their penis; Swelling of Testicles (less common) • Vulnerable Group: Transgender Men (MSM), Bisexuals, young people (14-24yo) sexually active and people with multiple sex partners • MOT: Sexual intercourse in all aspects, less common NSVD for neonates
- 8. Gonorrhea • Infectious Agent:Neisseria gonorrhoeae. • Signs and symptoms: Painful urination Pus-like discharge from the tip of the penis Pain or swelling in one testicle Increased vaginal discharge Vaginal bleeding between periods, such as after vaginal intercourse Abdominal or pelvic pain Rectal: Discharges, Anal itching, Soreness, bleeding and painful bowel movement • Vulnerable Group: Transgender Men (MSM), Bisexuals, young people (15-24yo) sexually active and people with multiple sex partners • MOT: Sexual intercourse in all aspects, less common NSVD for neonates
- 9. Syphilis Infectious Agent: SpirochaeteTreponema Pallidum Signs and Symptoms vary by stage: 1. Primary Stage- one or multiple sores (Changcre) usually on point of entry (Anus or rectum, genitals and throat) which are commonly round and painless that last 3-6 weeks and heals with treatment or not 2. Secondary Stage – rashes (not itchy) just as chancre is healing or weeks after chancre heals. Usually rough, red, or reddish brown spots on both palms and foot sole, seldom on chest, back, armpit and mouth. May relieved with or without treatment. .
- 10. 3. Latent Stage– asymptomatic stage, could be communicable during early latent syphilis a. Early latent syphilis Symptoms that occurs within 12 months b. Late latent syphilis Symptoms occurs by >12 months 4. Tertiary Stage – Late and chronic but life threatening. Occurs 10-30 years from contacting infection which damages multiple organs including nervous system (Neurosyphilis) and ocular (Ocular Syphilis). MOT: Sexual intercourse contact with sores, pregnancy Vulnerable group: p: Transgender Men (MSM), Bisexuals, young people (15-24yo) sexually active and people with multiple sex partners, Pregnancy Syphilis
- 12. Disease Incubation Period Diagnostics Preventionand Management Vaccination and Immunity Chlamydia Usually 7 to 21 days • Nucleic Acid Amplification Test (NAATs) • Culture • PCR-based RDT • EIAs (less sensitive) • Monogamous relationship • Safe sex practices • Antibiotics: Ceftriaxone IV, Azithromycin, Doxycycline • No intercourse 7 days after antibiotic treatment is completed • Sex partners treatment (EPT), 60 days partners • Counselling of sex partners (-) Gonorrhea Usually 2 to 5 days, may take as long as 30 days Same with Chlamydia Same with Chlamydia (-) Syphilis Usually 21 days but could range 10-90 days • Nontreponemal (VDR and RPR) • Treponemal (FTA-ABS, TP- PA, various EIAs, chemiluminescence immunoassays, immunoblots, and rapid • Antibiotics: Pen G IV doses depending on infection stages, Doxycycline and Ceftriaxone • Contact precaution • EPT (-)
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- 14. Pubic lice • InfectiousAgent: Pthirus pubis • S/Sx: Itchy Genital, Visible lice eggs and crawling lice (using a magnifying lens) • MOT: Sexual Intercourse, Sexual child abuse and less common on shared garments with closed contact on infested person • Vulnerability: Adults and young ones
- 15. Scabies Caused bythe itch mite. It burrows just under the skin and lays eggs. The scabies mite can live for 2-4 days away from the human body; it can be transmitted without sexual contact.
- 16. Trichomoniasis Men may notice: •Itching or irritation inside the penis; • Burning after urination or ejaculation; • Discharge from the penis. Infectious Agent: Trichomonas vaginalis Incubation Period: 5 to 28 days. Signs and Symptoms: About 70% of infected people do not have any signs or symptoms. Women may notice: • Itching, burning, redness or soreness of the genitals; • Discomfort with urination; • A change in their vaginal discharge (i.e., thin discharge or increased volume) that can be clear, white, yellowish, or greenish with an unusual fishy smell.
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- 18. How to preventparasitic STIs Trichomoniasis • Condoms will help prevent the spread Pubic lice and Scabies • Avoid sharing towels and clothing that have not been washed • When trying on bathing suits or underwear in the store always wear something underneath
- 19. Signs and symptomsof a parasitic STI • Intense itchiness • Reddish rash • Pain during sex or urination • Vaginal discharge How are parasitic STIs treated? • Shampoo – special shampoo to kill lice or scabies • Lotion - special shampoo to kill lice or scabies • Ointment- special shampoo to kill lice or scabies • Antibiotic – used to treat trich
- 20. Disease Incubation Period Diagnostics Preventionand Management Vaccination and Immunity Pubic Lies • Eggs (Nits) hatched 6- 10 days average of 1 weel • Nymph (2-3 weeks) • Adult (3- 4weeks) • Inspection • 1% permethrin lotion x7 days • Topical Ivermectin • Petrol • Manual removal of lice and eggs • Machine-Laundry with hot water (130o) and hot-dry of garments that were use (2-3) days after exposure • No sharing of garments • Treat partners, no sexual intercourse until infestation is ruled-out, • Evaluate for other STDs (-) Scabies Trichonomiasis
- 21. Viral STIs • HumanPapilloma Virus (HPV) • Herpes • HIV / AIDS • Hepatitis
- 22. Human Papillomavirus (HPV) •Very contagious virus • Some people never get symptoms • HPV is spread through skin to skin contact , oral, anal and vaginal sex with an infected partner • Some types cause genital warts and other types can cause cancer of the cervix Treatment • Treatments remove the warts but does not remove the virus from the blood • Most warts will clear over time • There is no cure for HPV • There is a vaccine to prevent HPV available for students in grade 7
- 23. Genital Herpes • Causedby the Herpes Simplex Virus (HSV) • Spread through skin to skin contact and oral, anal and vaginal sex • Some people with herpes never develop sores, but are still contagious and may spread it to others without knowing • People who have an initial outbreak can have more outbreaks throughout the rest of their life Remember herpes is not CURABLE. It is TREATABLE!
- 24. Human Immunodeficiency Virus(HIV) and Acquired Immunodeficiency Syndrome (AIDS) • HIV is the initial infection • AIDS is the advanced stage of the disease • Over a period of time, the virus attacks and damages the body’s immune and nervous system How is HIV/AIDS spread? • The virus is spread through bodily fluids • Decrease risk with condom use • There is no cure for HIV infection • Once infected, you have HIV for life
- 25. STI Testing Chlamydia andGonorrhea • Urine test for males and females • If symptoms present, swabs may be done Trichomoniasis • Diagnosed by taking a sample of vaginal discharge Genital warts (HPV) • Diagnosed by visual examination Herpes • Usually diagnosed by sight, and by history • A swab of the lesion can be taken to confirm virus Hepatitis B, C, Syphilis and HIV • Diagnosed by blood tests
- 26. Where can someonego for STI testing and treatment? Family Doctor/Nurse Practitioner Walk-In Clinic Health Unit – STI and Birth Control clinic
- 27. What is theonly 100 % effective way of preventing STIs and pregnancy? Abstinence
- 28. What does abstinencemean? •Abstinence means to not do something •Sexual abstinence means to abstain from different levels of sexual activity •Possible choices for sexual abstinence between two people could be: •Avoiding vaginal and anal intercourse •Avoiding oral-genital contact •Avoiding genital contact
- 29. Preventing STIs andpregnancy Delay sexual activity until you are older If you choose to be sexually active, use protective barriers (condoms, dental dams) and birth control
- 31. Hepatitis • Characterized byinflammation and necrosis of hepatic cells. • Severity of symptoms may vary from client to client. Onset of symptoms also varies according to the incubation period of the specific virus. • Hepatitis is a virus that affects your liver • It can cause permanent liver disease and cancer of the liver • Hepatitis A & B can be prevented by vaccines • There is no vaccine for Hepatitis C Remember hepatitis is not CURABLE!
- 32. Three phases: • Pre-Icteric:(also called prodromal) • This is the period of maximal infectivity. • Circulating immune complexes may cause fatigue, anorexia, depression, headache, weight loss, muscle pain, nausea, vomiting, changes in taste and smell, and fever. • Right upper quadrant tenderness may be noted. Icteric: (clinical stage) • Characterized by jaundice. There is a defective uptake, conjugation and/or distribution of bile. Bilirubin is diffusing into the tissues. Urine is darker. Stools are clay colored. • Persistent fatigue. • Liver is enlarged and tender. Post-Icteric: (recovery stage) • Convalescent phase. Jaundice is disappearing, but it does not mean recovery. • It may last weeks to months.
- 33. How is Hepatitistransmitted •Hepatitis A is transmitted through fecal oral route •Hep B is transmitted through blood and bodily fluids •Hep C is transmitted mostly through blood but also through bodily fluids
- 34. Hepatitis-Diagnosis: • Serologic markers:looks at the presence of antigens and antibodies of infected persons. All have antigen serologic markers except Hepatitis E. • Liver function tests…. ALT. AST, Bili show disease stage. The higher they are the more acute the disease is. • WBC count is elevated.
- 35. How can someonelower their chances of getting Hepatitis B and C? • Get vaccinated against Hepatitis B (available for students in grade 7) • Practice safer sex • Do not share instruments used in body-piercing, tattooing or hair removal • Do not share personal items such as toothbrushes, razors and needles
- 36. Hepatitis-Management: • Rest, Rest,Rest -Reduces the metabolic demands of the liver. • Good nutrition- High carbo, high k/cal, moderate protein, low fat. (Except if hepatic encephalopathy present, then moderate protein) Avoid all ETOH!!! • Steroid therapy-always controversial. • Anti -emetics
- 37. Hepatitis-Complications: •Chronic Hepatitis: Delayedconvalescent period…lasting> 6 months. May last for years. No liver necrosis occurs so the prognosis is favorable. •Fulminant Hepatitis: Active necrosis of the liver is occurring. Cells don’t regenerate. Very serious and may progress to liver cirrhosis and liver failure
- 38. Transmission: fecal/ oralroute (infected human waste) • Contaminated food& water (especially shellfish) • May be transmitted sexually and by someone with a sub clinical infection • Can be destroyed by bleach and hot temps > 195 F. Incubation period: (time from infection to the time when symptoms appear) Short 2-6 weeks (15-50 days) Vaccine: yes “Havrix” and Vaqta- inactivtaes Hep A virus Immune serum globulin: effective • (Provides passive immunity for up to 3 months) • May give it before anticipated contact, or within first few days of exposure. Seriousness: No carrier or chronic state • Rarely fulminant/deadly • Dx: Anti – HAV antibodies are found Hepatitis A
- 39. Transmission: Infected blood,and body secretions • sweat, tears, semen, vaginal secretions • Persons at high risk include IV drug users, and fetus of infected mothers. • Health care workers are at high risk! Has a very high titer, which means it’s highly infectious! Incubation period: 25-180 days Vaccine: yes “Heptavax” Given in 3 doses over 6 months (the second follows the first after one month, the third is given 6 months after the initial dose.)Given to babies at birth. This greatly reduces the risk of babies become carriers of the disease. Immune Serum Globulin: Hepatitis B immune globulin • Provides passive immunity for those who were exposed to the HBV • The cost is high. Given only when there was known exposure. Seriousness: Up to 10% develop carrier state, or chronic hepatitis. --hepatocellular CA in US. Most cases do clear the virus and then have immunity. Dx: anti HBc Igm or HBsA Hepatitis B
- 40. “non A, nonB Hepatitis” “post transfusion hepatitis” Transmission: blood, body fluids • Present in 1% of blood donor population. • Due to screening of blood, risk due to transfusion is now less than 1%. Incubation period: average 7 weeks… Vaccine: none Immune serum globulin: not used • Seriousness: Increases the incidence of primary liver CA • Most do not clear the virus and a chronic condition develops. • DX: ELISA - initial screening recombinant immunoblot assay= RIBA (more confirmatory) or anti-HCV Hepatitis C
- 41. “Delta Agent” • Transmission:Parenteral route • Same as Hepatitis B. Must be positive for the HbsA in order to contract Hepatitis D. The HDV is an incomplete strand of RNA that can only affect you if you are a carrier of HBV or have the surface antigen. Incubation period: 14-56 days, but only if HBV present. Vaccine: yes, same as Hepatitis B Immune Serum Globulin: Hepatitis B immune globulin Seriousness: Higher incidence of chronicity and cirrhosis than with Hepatitis B alone. Hepatitis D
- 42. • “Enterically transmitted •Non-A Non-B hepatitis” Transmission: fecal/ oral route Only found in US when individuals have visited underdeveloped countries. (Asia, Africa, India, Central America) Incubation period: 15-64 days Vaccine: none Immune serum globulin: not effective Seriousness: No evidence of chronic or carrier state… Self limiting in its course. Hepatitis E
- 43. DENGUE & DENGUEHEMORRHAGIC FEVER
- 44. What is theDengue Virus? Arbovirus Arthropod, Mosquito-borne, single positive-stranded RNA virus of the family Flaviviridae It is a pathogen that causes Dengue fever (DF) Dengue hemorrhagic fever (DHF) • Can lead to Dengue shock syndrome (DSS) Has four different serotypes (DEN-1,2,3,4) First reported epidemics in 1780 in Asia, Africa, and North America
- 45. Causes: • Aedes aegyptiand Aedes albopictus • The viruses are flavi viruses belong to the Flaviviridae family (RNA). Dengue virus types 1-4 (DENV 1-4). All four serotypes are closely related. However, there are enough antigenic differences between them that if a person becomes immune to one serotype, the person can still be infected by the other three serotypes.
- 46. Dengue Virus Denguefever is a painful, debilitating mosquito-borne disease caused by any one of four closely related dengue viruses. Dengue fever is an acute infectious viral disease, also known as breakbone fever. Few persons who have infected by one dengue serotype develop bleeding and endothelial leak up on infection with another dengue serotype. This syndrome is termed dengue hemorrhagic fever(DHF). Also been termed dengue vasculopathy.(Vascular leakage in these patients results in collapse of circulatory system and subsequently to shock hence termed as Dengue Shock Syndrome (DSS).
- 47. Outbreak ofdengue was recorded since very early days but it draws attention from 1996, outbreak in 2012-2015) An estimated over ½ milion cases of DHF require hospitalization each year, of which a very large proportion are children with mortality less then 1% of cases in diagnosed patient. Improper waste dispose, Lack of drainage and sewage facilities, Favourable environment for mosquito breeding hasten the rise of dengue infection. Dengue Virus
- 48. Classification of Dengue 4Types Undifferentiated fever Classic dengue fever ( Typical S/S). Dengue hemorrhagic fever, or DHF; and Dengue shock syndrome, or DSS.(Lethal). ( Some other are endemic like malaysia, singapore, thailand, North American etc.)
- 50. Target tissues Dengue inducescytokine production in cells Cytotoxic factor effects endothelial cells involved in most of the following: Heart Liver Kidneys Lungs Intestines Spleen Lymph nodes Brain Skin (inflammatory rashes)
- 51. Symptoms: DHF Fever Headache Muscle and joint pain Dehydration Nausea and/or Haematemesis (vomiting of blood) Epistaxis (Bleeding from the nose, mouth, or gums) Haematuria (Blood in Urine) Pain behind the eyes Plasma leakage Respiratory distress Petechia (Skin rash) and/or Purpura (Lesions)
- 53. Diagnostic tests Virusisolation by infection of mice using infected mosquitoes Detection of IgM antibodies in the blood by PCR or Viral isolation (Serology) ELISA (Enzyme-Linked Immunoabsorbent assay) Thrombopenia Raised hematocrit
- 54. Pathogenesis and infectionprocess of Dengue • Humans are initially infected through a mosquito vector • Initial interaction with cell occurs with the viruses ability to infect cell Primary target, Phagocytes • Virus uses cell receptor molecule to enter cell • Cell receptor molecules include: • Glycosaminoglycan Heparan Sulfate (Expressed in almost all cell types) Virus replicates in target organs • Infects white blood cells and lymphatic tissues • Virus is released and circulates in blood • Alternate mosquito then bites host and receives virus
- 55. DHF Treatment: There is nospecific treatment Relieving symptoms and complications: • Plasma volume replacement • Sedatives for restless patients • Blood transfusion with patients with significant blood loss • Aspirin should be avoided Prevention: • All efforts of control are aimed against mosquitoes • Elimination of breeding areas • Actions to prevent mosquito bites (repellant, nets, and vapors) • Vaccinations are pending • Problem is that the vaccination needs to prevent all four serotypes
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- 59. Pneumonia - Definition Pneumonia is an infection in one or both lungs. Pneumonia causes inflammation in the alveoli. The alveoli are filled with fluid or pus, making it difficult to breathe. “inflammation and consolidation of lung tissue due to an infectious agent” • COSOLIDATION = ‘Inflammatory induration of a normally aerated lung due to the presence of cellular exudative in alveoli
- 60. How does Pneumoniadevelop? • Most of the time, the body filters organisms. • This keeps the lungs from becoming infected. • But organisms sometimes enter the lungs and cause infections. • This is more likely to occur when: immune system is weak. organism is very strong. body fails to filter the organisms.
- 61. Etiology • Bacterial • Viral •Mycobacterial • Fungal • Parasitic
- 62. Factors that predisposeto Pneumonia Cigarette smoking Upper respiratory tract infections Alcohol Corticosteroid therapy Old age Recent influenza infection Pre-existing lung disease
- 63. Factors that predisposeto Pneumonia • Reduced immune defences (e.g. corticosteroid treatment, diabetes, malignancy) • Reduced cough reflex (e.g. post-operative) • Disordered mucociliary clearance (e.g. anaesthetic agents) • Bulbar or vocal cord palsy Reduced host defences against bacteria
- 64. Factors that predisposeto Pneumonia Aspiration of nasopharyngeal or gastric secretions • Immobility or reduced conscious level • Vomiting, dysphagia, achalasia or severe reflux • Nasogastric intubation Bacteria introduced into lower respiratory tract •Endotracheal intubation/tracheostomy •Infected ventilators/nebulisers/bronchoscopes •Dental or sinus infection
- 65. Factors that predisposeto Pneumonia • Bacteraemia • Abdominal sepsis • Intravenous cannula infection • Infected emboli
- 66. PATHOLOGY • Presence ofa proteinaceous exudate—and often of bacteria—in the alveoli
- 67.
- 68. ANATOMICAL CLASSIFICATION Broncho pneumoniaaffects the lungs in patches around bronchi Lobar pneumonia is an infection that only involves a single lobe, or section, of a lung. Interstitial pneumonia involves the areas in between the alveoli
- 69. CLINICAL CLASSIFICATION • CommunityAcquired - Typical/Atypical/Aspiration • Pneumonia in Elderly • Nosocomial- HAP,VAP,HCAP • Pneumonia in Immunocompromised host
- 70. Community Acquired Pneumonia (CAP) DEFINITION: •An infection of the pulmonary parenchyma • Associated with symptoms of a/c infection • Presence of a/c infiltrates on CXR or auscultatory findingsconsistent with Pneumonia •In a patient not hospitalized or residing in LTC facility for > 14 days prior
- 71. Hospital Acquired pneumonia- HAP • HAP or (Nosocomial Pneumonia) is defined as pneumonia that occurs 48 hours or more after admission, which was not incubating at the time of admission.
- 72. Ventilator Associated Pneumonia-VAP • VAP refers to pneumonia that arisesnmore than 48–72 hours after bendotracheal intubation.
- 73. Health Care AssociatedPneumonia HCAP HCAP includes any patient •Who was hospitalized in an acute care hospital for 2 or more days within 90 days of the infection •Resided in a nursing home or long-term care facility •Received recent i.v antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection •Attended a hospital or hemodialysis clinic
- 74. ATYPICAL PNEUMONIA -Why ‘Atypical’? Clinically •Subacute onset •Fever less common or intense •Minimal sputum Microbiologically • Sputum does not reveal a predominant microbial etiology on routine smears (Gram’s stain, Ziehl-Neelsen) or cultures Radiologically •Patchy infiltrates or •Interstitial pattern Haemogram •Peripheral leukocytosis are less common or intense
- 75. Aspiration Pneumonia Overt episodeof aspiration or bronchial obstruction by a foreign body. •Seen in - alcoholism, nocturnal esophageal reflux, a prolonged session in the dental chair, epilepsy •Usually Anaerobes
- 76. ELDERLY • Infection hasa more gradual onset, with less fever and cough • Often with a decline in mental status or confusion and generalized weakness • Often with less readily elicited signs of consolidation
- 77. Clinical manifestations: Fever Chills Sweats Pleuritic chest pain Cough Sputum production Hemoptysis Dyspnea Headache &fatigue
- 79. Diagnostic evaluation: • Chestauscultation. • Sputum culture analysis & sensitivity/serologic testing. • Fiber optic bronchoscopy/ Transcutaneous needle aspiration/ biopsy. • Skin tests. • Blood & urine cultures. • Transcutaneous oxygen level analysis/ ABG measurements. • Chest X-ray examination.
- 80. Medical Management: Specificantibiotic therapy: Broad spectrum antibiotics. Respiratory support Administer oxygen Bronchodilator medications Postural drainage Chest physiotherapy Tracheal suctioning Nutritional support. Fluid & electrolyte management.
- 81. Pneumonia At AGlance: Pneumonia is a lung infection that can be caused by different types of microorganisms, including bacteria,viruses, and fungi. Symptoms of pneumonia include cough with sputum production, fever, and sharp chest pain on inspiration(breathing in). Pneumonia is suspected when a doctor hears abnormal sounds in the chest, and the diagnosis is confirmed by a chest x-ray. Bacteria causing pneumonia can be identified by sputum culture.
- 82. Possible complications: Respiratoryfailure. Empyema or lung abscesses. These are infrequent, but serious, complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery. Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body, which may lead to organ failure Acute respiratory distress syndrome (ARDS),a severe form of respiratory failure
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- 84. Definition: • Tuberculosis isthe infectious disease primarily affecting lung parenchyma is most often caused by mycobacterium tuberculosis.it may spread to any part of the body including meninges, kidney, bones and lymphnodes.
- 85. Mycobacterium Tuberculosis Abacterium that resembles a fungus Multiply at varying rates Characterized as acid-fast aerobic organisms Can be killed by heat, sunshine, drying, ultraviolet rays • Transmitted by droplet nucleiusually particles (1 to 5 um in diameter), usually from within the respiratory tract of an infected person who exhales • coughing, sneezing, talking, laughing, singing
- 86. Types: • PULMONARY TUBERCULOSIS •AVIAN TUBERCULOSIS(MICROBACTERIUM AVIUM ;OF BIRDS) • BOVINE TUBERCULOSIS(MYCOBACTERIUM BOVIS ;OF CATTLE) • MILIARY TUBERCULOSIS /DISSEMINATED TUBERCULOSIS
- 87. RISK FACTORS: CLOSECONTACT WITH SOME ONE WHO HAVE ACTIVE TB. IMMUNO COMPROMISED STATUS (ELDERLY,CANCER) DRUG ABUSE AND ALCOHOLISM PEOPLE LACKING ADEQUATE HEALTH CARE PRE EXISTING MEDICAL CONDITIONS (DIABETES MELLITUS, CHRONIC RENAL FAILURE) IMMIGRANTS FROM COUNTRIES WITH HIGHER INCIDENCE OF TB. INSTITUTIONALISATION (LONG TERM CARE FACILITIES) LIVING IN SUBSTANDARD CONDITIONS OCCUPATION(HEALTH CARE WORKERS)
- 90. CLINICAL MANIFESTATION: CONSTITUTIONAL SYMPTOMS • Anorexia •Low grade fever • Night sweats • Fatique • Weight loss PULMONARY SYMPTOMS • Dyspnea • Non resolving bronchopneumonia • Chest tightness • Non productive cough • Mucopurulent sputum with hemoptpysis • Chest pain EXTRA PULMONARY SYMPTOMS • Pain • Inflammation
- 92. ASSESSMENT AND DIAGNOSTICFINDINGS • HISTORY COLLECTION • PHYSICAL EXAMINATION • Clubbing of the fingers or toes (in people with advanced disease) • Swollen or tender lymph nodes in the neck or other areas • Fluid around a lung (pleural effusion) • Unusual breath sounds (crackles)
- 93. IF MILIARY TB Aphysical exam may show: •Swollen liver •Swollen lymph nodes •Swollen spleen
- 94. Tests may include: •Biopsy of the affected tissue (rare) • Bronchoscopy • Chest CT scan • Chest x-ray • Interferon-gamma release blood test such as the QFT-Gold test to test for TB infection • Sputum examination and cultures • Thoracentesis • Tuberculin skin test (also called a PPD test)
- 95. QUANTEFERUM GOLD TEST •QFT-Gold test measures interferon- gamma in the testee's blood after incubating the blood with specific antigens from M. Tuberculosis proteins
- 96. TUBERCULIN SKIN TEST •0.1 ML OF PPD IS INJECTED FOREARM(SC) • AFTER 48-72 HRS CHECK FOR INDURATION AT THE SITE • IF INDURATION IS EQUAL TO AND MORE THAN 10MM POSITIVE
- 97. COMPLICATIONS: • Bones. Spinalpain and joint destruction may result from TB that infects your bones(TB spine or potss spine) • Brain(meningitis) • Liver or kidneys • Heart (cardiac tamponade) • Pleural effusion • Tb pneumonia • Serious reactions to drug therapy (hepatotoxicity; hypersentivity)
- 99. MEDICAL MANAGEMENT • PULMONARYTB is treated primarily with antituberculosis agents for 6 to 12 months. • Pharmacological management First line antitubercular medications: Streptomycin 15mg/kg Isoniazid or INH(Nydrazid) 5 mg/kg(300 mg maxperday) Rifampin 10 mg/kg Pyrazinamide 15 – 30 mg/kg Ethambutol(Myambutol) 15 -25 mg/kg daily for 8weeks and continuing for up to 4 to 7 months
- 100. Second linemedications Capreomycin 12 -15 mg/kg Ethionamide 15mg/kg Paraaminosalycilate sodium 200-300mg/kg Cycloserine 15 mg/kg Vitamin b(pyridoxine) usually adminstered with INH Third line medications Other drugs that may be useful, but are not on the WHO list of SLDs: Rifabutin Macrolides:e.g.,clarithromycin (CLR) Linezolid(LZD) Thioacetazone(T) Thioridazine Arginine
- 101. DOTS • DOTS (directlyobserved treatment, short-course), is the name given to the World Health Organization-recommended tuberculosis control strategy that combines five components: 1. Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training) 2. Case detection by sputum smear microscopy 3. Standardized treatment regimen directly observed by a healthcare worker community health worker for at least the first two months 4. A regular drug supply 5. A standardized recording and reporting system that allows assessment of treatment results • DOT is especially critical for patients with drugresistant TB, HIV-infected patients, and those on intermittent treatment regimens (i.e., 2 or 3 times weekly).
- 102. MULTI DRUG THERAPY Multiple-drugtherapy to treat TB means taking several different antitubercular drugs at the same time. The standard treatment is to take isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months. Treatment is then continued for at least 4 months with fewer medicines
- 103. PREVENTION: •ISOLATION •Ventilate the room •Coverthe mouth •Wear mask •Finish entire course of medication •Vaccinations
- 106. Clinical description Meningitisis the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore the condition is classified as a medical emergency.
- 107. Meninges • The meningesis the system of membranes which envelops the central nervous system. It has 3 layers: 1. Dura mater 2. Arachnoid mater 3. Pia mater Subarachnoid space -is the space which exists between the arachnoid and the pia mater, which is filled with cerebrospinal fluid.
- 108. Causes of Meningitis -Bacterial - Viral - Fungal - Parasitic/ protozoal - Physical injury - Cancer - Certain drugs ( mainly, NSAID’S) - Head injury - Cerebral abscess - Middle ear infection
- 109. Bacterial - Haemophilus influenzae -Listeria - Meningococcus - Mumps - Pneumococcus - Certain Streptococcus
- 110. Viral - Enterovirus (coxsackie,echovirus) - Arboviral (mosquito-borne diseases) - Influenza - Herpes simplex virus type2 (especially in infants) - Varicella zoster - HIV - Mumps - measles
- 111. Fungal - Cryptococcus - Coccidiodes -Histoplasma - Mucormycosis - Aspergillus - Candida (yeasts) Parasitic/ protozoal - Angiostrongylus - Toxoplama - Hydatid - Amoeba - Plasmodium - Cysticercosis
- 112. Risk factors • Age-children younger than 5 years • Use of immunosuppressive drugs • Chronic malnutrition • AIDS • CSF Shunt • Chronic alcoholism • Diabetes • Pneumonia
- 114. Sign and symptoms •Severe headache • Irritability • Restlessness • Stiffness of neck • Malaise • Nausea/vomiting • High grade fever • Tachypnea • Seizures • Disorientation • Tachycardia • Coma • Sleeplessness • Phonophopia • Photophobia • Altered mental status(confusion)
- 117. Diagnostic evaluation • By+ve signs • Physical examination • History collection • CSF evaluation for pressure, proteins, glucose and leukocytes. • Blood test • CBC • Blood culture • MRI • CT scan
- 118. Clinical manifestation Confirmative sign: •Positive kernig’s sign
- 119.
- 120. COMPLICATIONS •Brain damage •Cerebral edema •Hearingloss •Tissue damage
- 121. Treatment • Antibiotics forbacterial meningitis :Type vary depending on the bacteria causing the infection. • Antibiotics are not effective in viral meningitis. • Other medications and intravenous fluids will be used to treat symptoms such as brain swelling, shock, and seizures.
- 122. Prevention • Haemophilus vaccine(HiB vaccine) in children. • The pneumococcal conjugate vaccine is now a routine childhood immunization and is very effective at preventing pneumococcal meningitis. • Household members and others in close contact with people who have meningococcal meningitis should receive preventive antibiotics.
- 123. Nursing managements • Alteredbody temp. related to infectious process. Interventions: • Monitor temperature continuously • Administer antipyretic drugs as prescribed. • Switch on fan and open the windows. • Cold sponge • Ineffective tissue perfusion R/T infectious process and cerebral edema. Interventions: • Assess level of consciousness • Assess inc. ICP signs • Provide calm and quit environment • Prepare patient for LP for CSF evaluation.
- 125. What is Tetanus? •Greek words - “tetanus and teinein”, meaning rigid and stretched. • Tetanus is a serious illness contracted through exposure to the spores of the bacterium, Clostridium tetani, which live in soil, saliva, dust, and animal feces. • The bacteria can enter the body through a deep cuts, wounds or burns affecting the nervous system. • The infection leads to painful muscle contractions, particularly of the jaw and neck muscle, and is commonly known as “lockjaw”.
- 126. Causative Agent: • Causedby CLOSTRIDIUM TETANI • Anaerobic • Motile • Gram positive bacilli • Oval, colorless, terminal spores-tennis racket or drumstick shape Clostridium tetani produces 2 toxins: 1. Tetanolysin (Cause red cell lysis) 2. Tetanospasmin (muscle spasm/rigidity)
- 127. • Tetanus isacquired through contact with the environment; it is not transmitted from person to person. • As the infection progresses, muscle spasms in the jaw develops, hence the common name, lockjaw. • This is followed by difficulty swallowing & general muscle stiffness & spasms in other parts of the body. • Infection can be prevented by proper immunisation & by post-exposure prophylaxis. • Incubation period varies from 1 day to several months. , but is usually about eight days.
- 128. Risk factors Puncturewounds — including from splinters, body piercings, tattoos, injection drugs Gunshot wounds Compound fractures Crush injuries Burns Surgical wounds Tetanus cases have developed from the following types of injuries: Injection drug use Ear infections Animal bites Infected foot ulcers Infected umbilical stumps in newborns born of inadequately immunized mothers
- 129. Certain factors arenecessary for tetanus bacteria to proliferate in your body. These include: Lack of immunization or inadequate immunization — failure to receive timely booster shots — against tetanus. A penetrating injury that results in tetanus spores being introduced to the wound site. The presence of other infective bacteria. Injured tissue. A foreign body, such as a nail or splinter. Swelling around the injury.
- 130. Symptoms Signs and symptomsof tetanus appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to 10 days. Common signs and symptoms of tetanus include: • Spasms and stiffness in your jaw muscles (trismus) • Stiffness of your neck muscles • Difficulty swallowing • Stiffness of your abdominal muscles • Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light Possible other signs and symptoms include: • Fever • Sweating • Elevated blood pressure • Rapid heart rate
- 132. Complications Once tetanus toxinhas bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires new nerve endings to grow, which can take up to several months. Complications of tetanus infection may include: Broken bones. The severity of spasms may cause the spine and other bones to break. Blockage of a lung artery (pulmonary embolism). A blood clot that has traveled from elsewhere in your body can block the main artery of the lung or one of its branches. Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with or stop your breathing. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death.
- 133. Prevention You can easilyprevent tetanus by being vaccinated. The primary vaccine series The tetanus vaccine usually is given to children as part of the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. This vaccination provides protection against three diseases: a throat and respiratory infection (diphtheria), whooping cough (pertussis) and tetanus. The DTaP vaccine is a series of five shots, typically given in the arm or thigh to children at ages: • 2 months • 4 months • 6 months • 15 to 18 months • 4 to 6 years
- 134. The booster • Abooster of the tetanus vaccine is typically given in combination with a booster of diphtheria vaccine (Td). In 2005, a tetanus, diphtheria and pertussis (Tdap) vaccine was approved for use in teens and adults under age 65 to ensure continuing protection against pertussis, too. • It's recommended that adolescents get a dose of Tdap, preferably between the ages of 11 and 12, and a Td booster every 10 years thereafter. If you've never received a dose of Tdap, substitute it for your next Td booster dose and then continue with Td boosters. • If you're traveling internationally, particularly to a developing country where tetanus might be common, make sure your immunity is current. • To stay up to date with all of your vaccinations, ask your doctor to review your vaccination status regularly. • If you weren't vaccinated against tetanus as a child, see your doctor about getting the Tdap vaccine.
- 136. • Rabies, alsoknown as hydrophobia, is a highly fatal viral disease that causes inflammation of the brain in humans and other mammals. • It is caused by Lyssavirus type 1. • Transmission of Rabies to human- Bites (95%), Scratches & Licks from infected animals.
- 137. It is azoonotic disease of warm blooded animals such as – Dogs, Skunk, Cats, Jackals, bats and wolves.
- 138. AGENT • Rhabdovirus • Lyssavirustype 1 • Bullet shaped virus • Size is 180 *75nm • Has a lipoprotein envelope • Knob like spikes or glycoprotein G. • Matrix protein layer • Genome –unsegmented ,linear, negative sense RNA.
- 139. HOST FACTORS • Allwarm blooded animals including man. • Rabies in man is a dead end infection • People at risk-lab workers, veterinarians, dog handlers , hunters etc
- 140. INCUBATION PERIOD • Normally3-8 weeks • Maybe short that is 4 days or maybe prolonged for years. • Depends on site of bite o Severity of bite o Number of wounds o Amount of virus injected o Species of biting animal o Protection provided by clothing o Treatment taken or not.
- 142.
- 143. RABIES IN MAN •Know as hydrophobia (fear of water) • Duration of disease: 2-3 days prolonged to 5-6 days (exceptional cases) • Prodromal symptoms (3-4 days) o Headache o Malaise o Sore throat o Slight fever • Followed by excitation and stimulation off all parts of nervous system o Sensory system o Nervous system o Motor system o Sympathetic system o Mental system
- 144. • Patient becomesintolerant to noise, bright light, cold draught of air(sensory). • Aerophobia (fear of air ) may be present. • Increased reflexes and muscle spasms(motor). • Dilatation of pupil and increased perspiration , salivation , lacrimation.(sympathetic). • Fear of death , irritability , anger and depression (mental changes). • Patient dies abruptly due to convulsions or pass to coma and paralysis. RABIES IN MAN
- 145. TREATMENT • No specifictreatment • Case management - Isolation in a quiet room protected as far as possible from external stimuli to prevent spasms and convulsions – Relieve anxiety and pain by use of sedatives Morphia 30-54 mg – If spastic muscle contractions present use drugs with curare like action – Ensure hydration and diuresis – Intensive therapy in the form of respiratory and cardiac support
- 146. • Patients withrabies are highly infectious virus is present in all secretions like saliva , tears, vomits, urine, and other body fluids. • Nursing personnel should be warned of risks and protect themselves with PPE • Persons with open wounds and cut should not attend the patients • In places where rabies cases are encountered frequently pre exposure prophylaxis (2-3 doses HDC vaccine )recommended.
- 147. Prevention • Health personnelshould wear face masks , gloves , goggles , & aprons (saliva , vomits , tears, urine or other body fluids of rabies patient contain virus ) • Persons having bruises , cut or open wounds not entrusted to look after patient. • Pre-exposure prophylaxis. • Post exposure prophylaxis.