Infectious DIsease

Question 1

disease surveillance

Answer 1

• “ongoing systematic collection, analysis, interpretation, and dissemination of specific health data for use in public health”
• provides a means for nurses to monitor dz trends in order to reduce morbidity and mortality and to improve health

Question 2

bioterrorism

Answer 2

• intentional or threatened use of viruses, bacteria, fungi, or toxins from living organism to produce death or dz in humans, animals, or plansts

Question 3

biological agents of highest concern

Answer 3

• Variola major (small pox)
  
  • no longer vaccinate
  • live vaccine
• Bacillus anthracis (anthrax)
• Yersinia pesis (plague)
• Francisella tularensis (Tularemia)
• Botulinum toxin (botulism)
• filoviruses and arenaviruses (viral hemorrhagic fevers)
  
  • all suspected or confirmed cases should be reported to authorities immediately

Question 4

advantageous of biologics as weapons

Answer 4

• infectious via aerosol
• organisms fairly stable in environment
• susceptible civilian populations
• high morbidity and mortality
• person to person transmission (smallpox, plague)
• difficult to dx and tx
• easy to obtain
• inexpensive to produce
• potential for dissemination over large geographic area
• creates panic
• can overwhelm medical services
• perpetrators escape easily

Question 5

smallpox

Answer 5

• successful worldwide vaccination program
  
  • used a 2 pronged/bifurcated needle
• last case in US was in 1949
  
  • last naturally occurring case in world was Somalia in 1977
• in 1972, the routine childhood vaccination was discontinues, meaning that approx half of the US population was never vaccinated
• small pox is caused by the variola virus
  
  • except for lab stockpiles, the variola virus has been eliminated
  • however, since the events of Sept and Oct 2001, there is heightened concern that the virus might be used as an agent of bioterrorism
  • it is a serious, contagious and sometimes fatal, infectious dz
  • no specific tx for dz, and only prevention is vaccination

Question 6

2 clinical forms of small pox

Answer 6

• Variola major: severe, most common form w/ more extensive rash and higher fever
• Variola minor:
  
  • less common presentation of small pox
  • much less levere dz
  • death rates <1%

Question 7

transmission of small pox

Answer 7

• generally, direct and fairly prolonged face to face contact is required to spread smallpox from one person to another
• can also be spread through direct contact with infected bodily fluids or contaminated beddings or clothing
• rarely, has been spread in the air in enclosed settings such as buildings, buses, and trains

Question 8

incubation period of small pox

Answer 8

• duration 7-17 days: time of exposure to time of first symptoms
• not contagious
• no symptoms and may feel fine

Question 9

initial symptoms of small pox

Answer 9

• prodromal
• duration 2-4 days
• sometimes contagious
• first symptoms: fever, malaise, HA, body aches, vomiting
  
  • fever usually high in range of 101-104
• usually too sick to carry on normal activities

Question 10

early rash in small pox

Answer 10

• lasts about 4 days
• most contagious
• a rash first emerges first as small red spots on the tongue and in the mouth
• spots develop into sores that break open and spread large amounts of virus into the mouth and throat
  
  • at this time, the person is the most contagious!

Question 11

pustule rash with small pox

Answer 11

• lasts about 5 days
• bumps become pustules sharply raised usually round and firm to the touch as if there’s a small round object under the skin
  
  • ppl often say the bumps feel like BB pellets embedded in skin

Question 12

resolving scabs with small pox

Answer 12

• lasts about 6 days
• contagious
• scabs begin to fall off, leaving marks on skin that eventually become pitted scars
  
  • most scabs will have fallen off 3 weeks after rash appears
• once the scabs have resolved and fallen off completely, you are no longer contagious

Question 13

post exposure prophylaxis of small pox

Answer 13

• vaccination may be effective in preventing mobidity/mortality if given w/in 2-3 days of exposure
• Cidofovir–an antiviral drug with substantial renal toxicity may improve outcomes if given w/in 1-2 days after exposure
  
  • however, there is no definitive to suggest that it is better than vaccine along

Question 14

vaccination contraindications for small pox

Answer 14

• apply to both potential vaccinees and their household contacts
• eczema or atopic dermatitis and other acute, chronic, or exfoliative skin conditions
• burns
• impetigo
• chicken pox
• contact dermatitis
• shingles
• herpes
• severe acne
• severe diaper dermatitis
• psoriasis
• HIV/AIDs
• solid organ/stem cell transplant
• generalized malignancy
• leukemia/lymphoma
• pregnancy/breastfeeding
  
  • have to ask if they or any of household contacts are pregnant or intend to become pregnant w/in 4 weeks–if yes, then don’t vaccinate
• infants/children

Question 15

small pox emergency

Answer 15

• all contraindications to vaccinate would be reconsidered in the light of the risk of small pox exposure

Question 16

anthrax

Answer 16

• caused by spore forming bacterium bacillus anthracis
  
  • aerosolized spore form
• zoonotic dz in herbivores (sheep, goats, cattle) follows ingestion of spores in soil
• human infection typically acquired through contact w/ anthrax, infected animals, or animal products
  
  • one deep breath at site of release
  • give antimicrobial prophylaxis for those who are potentially exposed
    
    • but often don’t know you are infected
    • abx you are given is usually doxycycline
• 3 clinical forms:
  
  • cutaneous
  • inhalational
    
    • dx by: CXR widened mediastinum, pleural effusions, infiltrates, pulmonary congestion
  • gastrointestinal

Question 17

Tularemia (Francisella tularensis)

Answer 17

• plague like dz in rodents (California)
• deer fly fever (Utah)
• rabbit fever (centralized US)
• not contageious
• dangers, highly virulent organism

Question 18

streptococcus progenies

Answer 18

• flesh eating bacteria
• 1994
• improperly cooked hamburgers
• unpasteurized apple juice

Question 19

mad cow dz

Answer 19

• bovine spongiform encephalopathy BSE
• transferred to humans through beef consumption

Question 20

worldwide and infectious dz

Answer 20

• infectious dz are the leading killer of children and young adults accounting for more than 13 million deaths a year and for half of all deaths in developing countries

Question 21

epidemiologic triangle

Answer 21

• agent
• host: has to be a vulnerable host
• environment: has to be an env that it can grow in

Question 22

data sources for surveillance of infectious dz

Answer 22

• health care supplies (CDC)
  
  • have to report STIs, TB, ebola, etc
• mortality data–vital stats report (death certificants)
• morbidity data

Question 23

approx half of all deaths are caused by which 3 diseases?

Answer 23

• TB
• malaria
• HIV/AIDs

Question 24

what are 3 problems having to do with infectious dz?

Answer 24

• new pathogenic orgs have emerged
• new strains are more virulent
• organisms have become resistant to many abx

Question 25

foodborne diseases

Answer 25

* can involve biological and non-biological agents * can be caused by microorganisms, marine orgs, fungi and toxins, and chemical contaminants * raw and undercooked foods of animal origin are most likely to be contaminated

Question 26

top 5 pathogens contributing to foodborne illness

Answer 26

* norovirus * salmonella * clostridium perfringens * campylobacter * staphylococcus aureus

Question 27

norovirus

Answer 27

* responsible for most cases of GE * spread by fecal oral route * aerosolized vomitus has been implicated in some cases * 12-48 hours incubation period * usually resolves in 48 hours * elderly, children, and those with severe conditions are at inc risk for volume depletion * most cases occur in long term care facilities * prevention: good handwashing, thorough and immediate disinfection, isolation of sick indivs until 72 hours after they are symptom free * tx: oral hydration solns, IVF and electrolyte replacement

Question 28

campylobacter enteritis

Answer 28

* most common cause of bacterial illness * important cause of diarrhea illness thru world regardless of ppl's age * often implicated in traveler's diarrhea * consumption of contaminated poultry is common source * other sources: undercooked meats, ground beef, cheese, eggs, shellfish * incubation period 2-5 days * diarrhea illness last no more than a week * S/S: n/v, abdominal pain, fever, HA, muscle pain * dx: stool culture * tx: antidiarrheal drugs, abx

Question 29

Listeria monocytogenes

Answer 29

* primarily affects older ppl and pregnant women * can result in miscarriage, still birth, or severe illness/death in newborn * risk reduced by recommendations for safe food prep, consumption, storage

Question 30

nontyphoid salmonella

Answer 30

* bacterial dz transmitted by contaminated food/water, or contact w/ infected animals or reptiles * infants, elderly, and immunocompromised at highest risk * S/S: diarrhea, fever, abdominal cramps 12-72 hrs * lasts 4-7 days * tx: not always needed, but dehydration and electrolyte imbalance replacement is essential

Question 31

E. coli

Answer 31

* shiga toxin producing deadly form of E. coli * S/S: severe abdominal cramps, bloody diarrhea, vomiting * usually resolves in 7-10 days * in very young and very old, can cause hemolytic-uremic syndrome leading to renal failure * assoc with commercially packaged foods and fresh produce

Question 32

waterborne dz

Answer 32

* diarrhea dz (like cholera) kill more children than AIDS, malaria, and measles combined, making it the 2nd leading cause of death among children less than 5 * in the US, the gov't establishes and reinforces regulations for protecting recreational water * EPA sets water quality guidelines for nat'l and untreated recreational water

Question 33

the top 5 pathogens for waterborne dz

Answer 33

* norovirus * cryptosporidium * E. coli * pseudomonas * legionella

Question 34

2 criteria must be met for an event to be defined as a water assoc outbreak:

Answer 34

* 2 or more ppl must be linked epidemiologically by time, location of exposure to water, and illness characteristics * epidemiologic evidence must implicate recreational water or volatilization of water assoc cpds into the air surrounding the water as a probable source of illness

Question 35

what do they check in a swimming pool to make sure it can be decontaminated by the chlorine?

Answer 35

* pH * chlorine

Question 36

STDs

Answer 36

* majority of cases b/w 15-24 * affects men and women equally * 8 most common STIs: * chlamydia * gonorrhea * hep B * HSV-2 * HIV * HPV * syphilis * trichomoniasis

Question 37

chlamydia

Answer 37

* give 1 g of azithromycin one time dose * can also do doxycycline but will be for multiple days