Reportable Infectious Diseases Chp. 153. 1/19/06 Dr. Batizy Bogdan Irimies PGY-3

Reportable Infectious Reportable Infectious DiseasesDiseases

Chp. 153. Chp. 153.

1/19/06 Dr. Batizy1/19/06 Dr. Batizy

Bogdan Irimies PGY-3Bogdan Irimies PGY-3

IntroductionIntroduction

►CDC in Atlanta publishes a list of CDC in Atlanta publishes a list of notifiable infectious diseases.notifiable infectious diseases.

►Requirement to report these diseases Requirement to report these diseases is mandated by state or territory laws is mandated by state or territory laws and regulations. Therefore, the list and regulations. Therefore, the list differs from state to statediffers from state to state

►The following case definitions establish The following case definitions establish uniform criteria. uniform criteria.

AIDSAIDS

►For patients 13 years or older For patients 13 years or older reporting is required if the patient reporting is required if the patient demonstrates:demonstrates: 1. CD4 T-cell count <2001. CD4 T-cell count <200 2. CD4 T-cell percentage of total 2. CD4 T-cell percentage of total

lymphocyte <14%lymphocyte <14% 3. Any of the following: pulmonary TB, 3. Any of the following: pulmonary TB,

recurrent pneumonia, cervical cancer or recurrent pneumonia, cervical cancer or the 23 other AIDS defining conditions.the 23 other AIDS defining conditions.

AnthraxAnthrax

►Caused by Caused by Bacillus anthracisBacillus anthracis►Cutaneous form is characterized by a Cutaneous form is characterized by a

skin lesion evolving over 2-6 days from skin lesion evolving over 2-6 days from papule to vesicle to depressed black papule to vesicle to depressed black eschar.eschar.

► Inhalation form characterized by brief Inhalation form characterized by brief URI, hypoxia, dyspnea, mediastinal URI, hypoxia, dyspnea, mediastinal widening from adenopathy on CXR.widening from adenopathy on CXR.

AnthraxAnthrax

► Intestinal form is characterized by Intestinal form is characterized by fever, sepsis, crampy abdominal pain.fever, sepsis, crampy abdominal pain.

►Oropharyngeal form characterized by Oropharyngeal form characterized by mucosal lesion in oral cavity, cervical mucosal lesion in oral cavity, cervical adenopathy, edema, fever.adenopathy, edema, fever.

►Lab diagnosis (Dx:)Lab diagnosis (Dx:) 1. Isolation of 1. Isolation of B. anthracisB. anthracis from clinical from clinical

specimenspecimen 2. anthrax 2. anthrax

electrophoresis/immunoflurescenceelectrophoresis/immunoflurescence

Botulism: 3 formsBotulism: 3 forms

►Foodborne: acute illness manifested Foodborne: acute illness manifested by diplopia, blurred vision, bulbar by diplopia, blurred vision, bulbar weakness or symmetric paralysis of weakness or symmetric paralysis of rapid onset.rapid onset.

► Infant: constellation of symptoms in Infant: constellation of symptoms in infant under 1 y/o including infant under 1 y/o including constipation, poor feeding, failure to constipation, poor feeding, failure to thrive, progressive weakness, impaired thrive, progressive weakness, impaired respirations and deathrespirations and death

BotulismBotulism

►Wound: symptoms similar as for food Wound: symptoms similar as for food borne.borne.

►Lab Dx: Lab Dx: botulinum toxin in serum, stool, food.botulinum toxin in serum, stool, food. Positive culture for Positive culture for C. botulinumC. botulinum from from

stoolstool

BrucellosisBrucellosis

► Infection w/Infection w/BrucellaBrucella characterized by characterized by fever, night sweats, fatigue, anorexia, fever, night sweats, fatigue, anorexia, weight loss, headache (HA), weight loss, headache (HA), arthralgias.arthralgias.

►Lab Dx:Lab Dx: Culture positive from specimenCulture positive from specimen Increase in Increase in BrucellaBrucella agglutination titers agglutination titers Positive immunofluorescence of Positive immunofluorescence of BrucellaBrucella

in clinical specimenin clinical specimen

ChancroidChancroid

►STD caused by STD caused by Haemophilus ducreyi Haemophilus ducreyi ►Painful genital ulcer w/inflamed Painful genital ulcer w/inflamed

inguinal lymph nodes.inguinal lymph nodes.► Isolation from clinical specimen Isolation from clinical specimen

confirms Dx.confirms Dx.

Chlamydia TrachomatisChlamydia Trachomatis

►Causes urethritis, epididymitis, Causes urethritis, epididymitis, cervicitis, salpingitis, conjunctivitis, cervicitis, salpingitis, conjunctivitis, pneumonia, or maybe asymptomatic.pneumonia, or maybe asymptomatic.

►Lab Dx: Lab Dx: Positive culturePositive culture Detection of the antigen or nucleic acid on Detection of the antigen or nucleic acid on

immunofluorescence.immunofluorescence.

CholeraCholera

►Manifested by diarrhea and vomitingManifested by diarrhea and vomiting►Lab dx:Lab dx:

Isolation of toxigenic Isolation of toxigenic Vibrio cholerae Vibrio cholerae O1 or O1 or O139 from stool or emesisO139 from stool or emesis

CoccidioidomycosisCoccidioidomycosis

►Caused by fungus Caused by fungus Coccidioides immitisCoccidioides immitis, , endemic to SW U.S.endemic to SW U.S.

►Causes influenza like respiratory illness:Causes influenza like respiratory illness:-Fever, cough, chest pain, myalgias, -Fever, cough, chest pain, myalgias, arthralgias, HA, pneumonia on CXR, arthralgias, HA, pneumonia on CXR, erythema nodosum or erythema multiforme erythema nodosum or erythema multiforme rash, meningitis, or involvement of bones, rash, meningitis, or involvement of bones, joints, viscera or lymph nodes.joints, viscera or lymph nodes.

►Lab Dx:Lab Dx: Culture, histopathology, or molecular Culture, histopathology, or molecular

evidence of evidence of C. immitisC. immitis Serologic tests such as IgM by Serologic tests such as IgM by

immunodiffusion, ELISA, latex immunodiffusion, ELISA, latex agglutinationagglutination

Coccidiodal skin test conversion after Coccidiodal skin test conversion after onset of symptomsonset of symptoms

CoccidioidomycosisCoccidioidomycosis

CryptosporidiosisCryptosporidiosis

► Caused by protozoa Caused by protozoa Cryptosporidium Cryptosporidium parvumparvum

► Signs & Symptoms (S/Sx:)Signs & Symptoms (S/Sx:)► Fever, nausea, vomiting, abdominal cramps, Fever, nausea, vomiting, abdominal cramps,

loss of appetite loss of appetite ► Lab Dx: Lab Dx:

Detection of oocysts in stoolDetection of oocysts in stool demonstration of organism in intestinal fluid or demonstration of organism in intestinal fluid or

small bowel biopsysmall bowel biopsy detection of detection of Cryptosporidium Cryptosporidium antigen in stoolantigen in stool

CyclosporaisisCyclosporaisis

► Intestinal illness caused by protozoa Intestinal illness caused by protozoa Cyclospora cayetanensisCyclospora cayetanensis

►S/Sx: S/Sx: watery diarrhea, weight loss, flatus, watery diarrhea, weight loss, flatus,

nausea, fatigue, vomiting, anorexia, nausea, fatigue, vomiting, anorexia, abdominal cramping and feverabdominal cramping and fever

CyclosporaisisCyclosporaisis

►Lab Dx: Lab Dx: Detection of oocysts in stoolDetection of oocysts in stool Detection of Detection of CyclosporaCyclospora in intestinal fluid in intestinal fluid

or small bowel biopsyor small bowel biopsy Demonstration of sporulation Demonstration of sporulation Detection of DNA by PCRDetection of DNA by PCR

DiptheriaDiptheria

►Caused by Caused by Cornynebacterium Cornynebacterium diptheriaediptheriae

►S/Sx: URI like, sore throat, fever, S/Sx: URI like, sore throat, fever, adherent membrane to tonsils, adherent membrane to tonsils, pharynx or nose.pharynx or nose.

►Lab dx:Lab dx: Isolation of organism from specimen or Isolation of organism from specimen or

histopathologic diagnosishistopathologic diagnosis

EhrlichiosisEhrlichiosis

►Tick borne illness presents as flu-like Tick borne illness presents as flu-like illness w/fever, HA, myalgias, malaise, illness w/fever, HA, myalgias, malaise, nausea, vomiting or rash. nausea, vomiting or rash.

►May see thrombocytopenia, leukopenia, May see thrombocytopenia, leukopenia, elevated LFTselevated LFTs

►Three categories need to be reported: Three categories need to be reported: ►1. HME caused by 1. HME caused by Ehrlichia chaffeensis Ehrlichia chaffeensis

2. 2. HGE caused byHGE caused by E. phagocytophila E. phagocytophila 3. Ehrlichiosis, 3. Ehrlichiosis, Human Human

Arboviral Encephalitis/MeningitisArboviral Encephalitis/Meningitis

►S/Sx: S/Sx: Arboviral meningitis: fever, HA, stiff neck, Arboviral meningitis: fever, HA, stiff neck,

pleocytosis.pleocytosis. Arboviral encephalitis: febrile illness assoc Arboviral encephalitis: febrile illness assoc

w/neurologic s/sx’s such as HA, mental w/neurologic s/sx’s such as HA, mental status change, confusion, status change, confusion, nausea/vomiting, meningismus, CN palsy, nausea/vomiting, meningismus, CN palsy, paresis or paralysis, sensory deficit, paresis or paralysis, sensory deficit, seizures, or coma.seizures, or coma.

Arboviral Encephalitis/MeningitisArboviral Encephalitis/Meningitis

►Lab Dx:Lab Dx: Fourfold rise in antibody titerFourfold rise in antibody titer Isolation of virus or viral antigen from Isolation of virus or viral antigen from

tissue, serum or CSFtissue, serum or CSF IgM antibody detectionIgM antibody detection

Enterohemorrhagic E. ColiEnterohemorrhagic E. Coli

►S/Sx: caused by E. Coli 0157:H7 in S/Sx: caused by E. Coli 0157:H7 in foodborne outbreaksfoodborne outbreaks Enterohemorrhagic illness w/bloody Enterohemorrhagic illness w/bloody

diarrhea, abdominal cramping and may diarrhea, abdominal cramping and may have HUS or TTPhave HUS or TTP

►Lab Dx: isolation of E. coli 0157:H7 or Lab Dx: isolation of E. coli 0157:H7 or a shiga toxin producing E. colia shiga toxin producing E. coli

GiardiasisGiardiasis

►Caused by protozoan Caused by protozoan Giardia lambliaGiardia lamblia►S/Sx’s: diarrhea, abdominal cramps, S/Sx’s: diarrhea, abdominal cramps,

weight loss, malabsorptionweight loss, malabsorption►Lab Dx: Lab Dx: G. lambliaG. lamblia cysts or cysts or

trophozoites in stool or antigen in trophozoites in stool or antigen in stool by specific immunodiagnostic stool by specific immunodiagnostic testtest

GonorrheaGonorrhea

Caused urethritis, cervicitis, salpingitis, Caused urethritis, cervicitis, salpingitis, disseminated disease or maybe disseminated disease or maybe asymptomaticasymptomatic

Observation of gram neg. intracellular Observation of gram neg. intracellular diplococcidiplococci

Haemophilus InfluenzaeHaemophilus Influenzae Invasive DiseaseInvasive Disease

► Invasive diseases are: meningitis, Invasive diseases are: meningitis, bacteremia, epiglottitis, or pneumoniabacteremia, epiglottitis, or pneumonia

►Lab Dx: isolation of Lab Dx: isolation of H. Flu H. Flu from blood from blood CSF or joint fluidCSF or joint fluid

Hansen Disease(Leprosy)Hansen Disease(Leprosy)

►Caused by organism Caused by organism Mycobacterium Mycobacterium lepraeleprae

►Four clinical forms of disease:Four clinical forms of disease: Tuberculoid leprosy: one or few well Tuberculoid leprosy: one or few well

demarcated, hypopigmented and anesthetic demarcated, hypopigmented and anesthetic skin lesionsskin lesions

Lepromatous form: number of erythematous Lepromatous form: number of erythematous papules & nodules that affect the face, papules & nodules that affect the face, hands and feet in a symmetric patternhands and feet in a symmetric pattern

►Dimorphous form: skin lesions Dimorphous form: skin lesions characteristic of the tuberculoid and characteristic of the tuberculoid and lepromatous formslepromatous forms

► Indeterminate form: hypopigmented Indeterminate form: hypopigmented macules that do not have macules that do not have characteristics of tuberculoid or characteristics of tuberculoid or lepromatous formslepromatous forms

►Lab Dx: demonstration of acid fast Lab Dx: demonstration of acid fast bacilli in skin or dermal nerves bacilli in skin or dermal nerves requiring a skin biopsy.requiring a skin biopsy.

Hansen Disease(Leprosy)Hansen Disease(Leprosy)

Hantavirus Pulmonary Hantavirus Pulmonary SyndromeSyndrome

►S/Sx’s: prodrome of fever, chills, S/Sx’s: prodrome of fever, chills, myalgias, HA, and GI symptoms that myalgias, HA, and GI symptoms that progress to bilateral pulmonary progress to bilateral pulmonary infiltrates, respiratory compromise, infiltrates, respiratory compromise, ARDS. May see hemoconcentration, ARDS. May see hemoconcentration, WBC count w/left shift, neutrophilic WBC count w/left shift, neutrophilic leukocytosis & thrombocytopenialeukocytosis & thrombocytopenia

►Lab Dx: Hantavirus specific IgM or Lab Dx: Hantavirus specific IgM or rising titers of IgG, PCR, or Hanta virus rising titers of IgG, PCR, or Hanta virus antigenantigen

HUS, PostdiarrhealHUS, Postdiarrheal

►HUS present as acute onset of HUS present as acute onset of microangiopathic hemolytic anemia, microangiopathic hemolytic anemia, renal injury and thrombocytopenia renal injury and thrombocytopenia usually w/in 3 weeks of diarrheal usually w/in 3 weeks of diarrheal illness.illness.

►TTP w/similar features but also fever TTP w/similar features but also fever and CNS involvementand CNS involvement

►Lab Dx: anemia of microangiopathic Lab Dx: anemia of microangiopathic changes(schistocytes, burr cells, changes(schistocytes, burr cells, helmet cells) and renal failure.helmet cells) and renal failure.

LegionellaLegionella

Causes 2 diseases: Legionaires’ disease and Causes 2 diseases: Legionaires’ disease and Pontiac fever. Pontiac fever.

Fever,myalgias, cough, pneumonia.Fever,myalgias, cough, pneumonia. Lab dx: Lab dx:

Isolation of Isolation of LegionellaLegionella from respiratory from respiratory secretions, lung tissue, pleural fluid or sterile secretions, lung tissue, pleural fluid or sterile bodily tissuebodily tissueDemonstration of rising antibody titerDemonstration of rising antibody titerDetection of Detection of L. pneumophilia L. pneumophilia serotype 1 in serotype 1 in body fluidsbody fluidsDetection of Detection of L. pneumophilia L. pneumophilia serotype 1 serotype 1 antigen in urineantigen in urine

ListeriosisListeriosis

►Listeria monocytogenesListeria monocytogenes caused caused meningitis and/or bacteremiameningitis and/or bacteremia

►Lab Dx:Lab Dx: Isolation of Isolation of L. monocytogenesL. monocytogenes from sterile from sterile

body fluids, fetal tissue or placentabody fluids, fetal tissue or placenta

Lyme DiseaseLyme Disease

►Tick borne illness caused by Tick borne illness caused by Borrelia Borrelia burgdorferiburgdorferi

►S/Sx: fever, fatigue, HA, stiff neck, S/Sx: fever, fatigue, HA, stiff neck, arthralgias/myalgias, erythema arthralgias/myalgias, erythema migrans, high degree heart block, migrans, high degree heart block, myocarditis, meningitis/encephalitismyocarditis, meningitis/encephalitis

►Lab Dx: isolation of organism or Lab Dx: isolation of organism or identification of antibody(IgM or IgG) in identification of antibody(IgM or IgG) in serum or CSFserum or CSF

MalariaMalaria

►Caused by Caused by Plasmodium speciesPlasmodium species, , present w/fever, HA, chills, myalgias, present w/fever, HA, chills, myalgias, nausea/vomiting, diarrhea, cough, nausea/vomiting, diarrhea, cough, renal failure, pulmonary edema and renal failure, pulmonary edema and coma/deathcoma/death

►Malaria parasites can be seen on blood Malaria parasites can be seen on blood smear.smear.

Measles(Rubeola)Measles(Rubeola)

►S/Sx: Generalized rash >3 days, temp. S/Sx: Generalized rash >3 days, temp. >38.3, cough, coryza, conjunctivitis>38.3, cough, coryza, conjunctivitis

►Lab Dx: Lab Dx: Positive serology for IgMPositive serology for IgM Rise in measles antibody titerRise in measles antibody titer Isolation of measles virus from specimen Isolation of measles virus from specimen

Meningococcal DiseaseMeningococcal Disease

►S/Sx’s: meningitis, meningococcemia, S/Sx’s: meningitis, meningococcemia, purpura fulminans, shock, deathpurpura fulminans, shock, death

►Lab Dx: Lab Dx: Isolation of Isolation of Neisseria meningitidisNeisseria meningitidis from from

blood or CSFblood or CSF

MumpsMumps

►S/Sx: unilateral or bilateral tender, S/Sx: unilateral or bilateral tender, self-limited swelling of parotid or other self-limited swelling of parotid or other salivary gland for > 2 days w/out other salivary gland for > 2 days w/out other cause.cause.

►Lab Dx:Lab Dx: Isolation of mumps virus from specimenIsolation of mumps virus from specimen Rise in serum IgG or IgMRise in serum IgG or IgM

PertussisPertussis

►S/Sx: 2 week history of paroxysmal S/Sx: 2 week history of paroxysmal cough, inspiratory whoop or cough, inspiratory whoop or posttussive vomiting.posttussive vomiting.

►Lab Dx:Lab Dx: Isolation of Isolation of Bordetella pertussisBordetella pertussis from from

clinical specimenclinical specimen Positive PCR for Positive PCR for B. pertussisB. pertussis

PlaguePlague

►S/Sx: fever, chills, HA, malaise, S/Sx: fever, chills, HA, malaise, prostration , leukocytosis.prostration , leukocytosis.

►Different forms:Different forms: Bubonic plague: regional lymphadenitisBubonic plague: regional lymphadenitis Septicemic plague: sepsisSepticemic plague: sepsis Pneumonic plague: pneumonia from Pneumonic plague: pneumonia from

inhaled dropletsinhaled droplets Pharyngeal plague: pharyngitis and Pharyngeal plague: pharyngitis and

cervical lymphadenitiscervical lymphadenitis

PlaguePlague

►Lab Dx:Lab Dx: Increase in serum antibody titers to Increase in serum antibody titers to

Yersinia pestisYersinia pestis fraction 1 antigen fraction 1 antigen Detection of fraction 1 antigen by Detection of fraction 1 antigen by

fluorescent assayfluorescent assay Confirmation w/isolation of Confirmation w/isolation of Y. pestisY. pestis in in

clinical specimenclinical specimen

Paralytic PoliomyelitisParalytic Poliomyelitis

►S/Sx: illness of acute onset S/Sx: illness of acute onset characterized by flaccid paralysis of characterized by flaccid paralysis of one or more limbs, DTR’s are absent, one or more limbs, DTR’s are absent, no sensory abnormalities, and no other no sensory abnormalities, and no other apparent cause for above.apparent cause for above.

►Clinical case definition is sufficient for Clinical case definition is sufficient for reportingreporting

PsittacosisPsittacosis

►S/Sx: disease of birdhandlers, fever, S/Sx: disease of birdhandlers, fever, chills, HA, photophobia, cough, chills, HA, photophobia, cough, myalgiamyalgia

►Lab dx: Lab dx: Isolation of Isolation of Chlamydia psittaciChlamydia psittaci from from

respiratory secretionsrespiratory secretions 4 fold rise in serum antibody titers4 fold rise in serum antibody titers Detection of serum IgM to Detection of serum IgM to C. psittacciC. psittacci

Q FeverQ Fever

►S/Sx’s: acute infection with S/Sx’s: acute infection with Coxiella Coxiella burnettiburnetti, fever, myalgias, malaise, , fever, myalgias, malaise, retrobulbar HA, hepatitis, pneumonia, retrobulbar HA, hepatitis, pneumonia, meningoencephalitismeningoencephalitis

►Lab Dx:Lab Dx: fourfold rise in antibody titerfourfold rise in antibody titer Isolation of Isolation of C. burnettiC. burnetti from specimen from specimen Demonstration of Demonstration of C. burnettiC. burnetti by antigen or by antigen or

nulceic acid testingnulceic acid testing

RabiesRabies

►S/Sx: acute encephalomyelitis, coma, S/Sx: acute encephalomyelitis, coma, death w/in first 10 days of first symptomdeath w/in first 10 days of first symptom

►Lab Dx:Lab Dx: Direct fluorescent antibody of viral antigenDirect fluorescent antibody of viral antigen Isolation in cell culture or lab animal of rabies Isolation in cell culture or lab animal of rabies

virus from saliva, CSF, or CNS tissuevirus from saliva, CSF, or CNS tissue Identification of rabies neutralizing antibody Identification of rabies neutralizing antibody

titer in serum or CSF in a previous titer in serum or CSF in a previous unvaccinated personunvaccinated person

Rocky Mountain Spotted Rocky Mountain Spotted FeverFever

► S/Sx: tick born disease characterized by HA, S/Sx: tick born disease characterized by HA, myalgia, fever, petechial rash on palms and myalgia, fever, petechial rash on palms and solessoles

► Lab Dx:Lab Dx: Rise in antibody titer to Rise in antibody titer to Rickettsia rickettsiiRickettsia rickettsii

antigenantigen Positive PCR Positive PCR Positive immunoflourescence of skin lesion Positive immunoflourescence of skin lesion

biopsy or organ tissue biopsybiopsy or organ tissue biopsy Isolation of Isolation of R. rickettsiiR. rickettsii from clinical specimen from clinical specimen

RubellaRubella

►S/Sx: acute onset of generalized S/Sx: acute onset of generalized maculopapular rash, temp.>37.2, maculopapular rash, temp.>37.2, arthralgias, arthritis, arthralgias, arthritis, lymphadenopathy, conjunctivitis.lymphadenopathy, conjunctivitis.

►Lab Dx:Lab Dx: Isolation of rubella virusIsolation of rubella virus Rise in serum IgG titersRise in serum IgG titers Positive IgMPositive IgM

SalmonellosisSalmonellosis

►S/Sx:S/Sx: Salmonella Salmonella causes nausea, causes nausea, vomiting, abdominal pain and diarrheavomiting, abdominal pain and diarrhea

►Lab Dx:Lab Dx: Isolation of Isolation of SalmonellaSalmonella from specimen from specimen

ShigellosisShigellosis

►S/Sx: same asS/Sx: same as Salmonella Salmonella►Lab Dx:Lab Dx:

Isolation ofIsolation of Shigella Shigella from specimenfrom specimen

Invasive Group A Streptococcal Invasive Group A Streptococcal DiseaseDisease

►Diseases include: pneumonia, Diseases include: pneumonia, bactermia assoc. with cutaneous bactermia assoc. with cutaneous infection(cellulitis, wound infection), infection(cellulitis, wound infection), myositis/necrotizing fasciitis, myositis/necrotizing fasciitis, meningitis, peritonitis, osteomyelitis, meningitis, peritonitis, osteomyelitis, septic arthritis, postpartum sepsis, septic arthritis, postpartum sepsis, neonatal sepsisneonatal sepsis

►Lab Dx:Lab Dx: Isolation of Group AIsolation of Group A StreptococciStreptococci (Strep. (Strep.

Pyogenes)Pyogenes)

Streptococcal Toxic Shock Streptococcal Toxic Shock SyndromeSyndrome

►S/Sx: Group A strep infection associated S/Sx: Group A strep infection associated w/a cutaneous lesionw/a cutaneous lesion All of following must be present w/in 48 hrs.: All of following must be present w/in 48 hrs.:

hypotension, two or more multiorgan hypotension, two or more multiorgan involvement such as renal failure, involvement such as renal failure, coagulopathy/DIC, LFT’s 2 x normal, ARDS, coagulopathy/DIC, LFT’s 2 x normal, ARDS, generalized maculopapular generalized maculopapular rash/desqumation, necrotizing fasciitis or rash/desqumation, necrotizing fasciitis or gangrenegangrene

Lab Dx: isolate Group A Strep from sterile siteLab Dx: isolate Group A Strep from sterile site

SyphilisSyphilis

►S/Sx: primary (genital chancres), S/Sx: primary (genital chancres), secondary mucocutaneous lesions, secondary mucocutaneous lesions, tertiary neurosyphilis, skin, bone and tertiary neurosyphilis, skin, bone and cardiovascularcardiovascular

►Lab Dx:Lab Dx: Primary or secondary syphilis: Primary or secondary syphilis:

demonstratedemonstrate Treponema pallidum Treponema pallidum on dark on dark field microscopy or direct fluorescent field microscopy or direct fluorescent antibody(DFA-TP)antibody(DFA-TP)

SyphilisSyphilis

►Latent or Tertiary syphilis lab Dx:Latent or Tertiary syphilis lab Dx: Reactive VDRL or RPRReactive VDRL or RPR Reactive treponemal test(FTA-ABS or Reactive treponemal test(FTA-ABS or

MHA-TP)MHA-TP) History of syphilis therapy w/a fourfold History of syphilis therapy w/a fourfold

rise in antibody titerrise in antibody titer

TetanusTetanus

►S/Sx: acute onset of hypertonia, S/Sx: acute onset of hypertonia, painful muscular contractions of body painful muscular contractions of body and jawand jaw

►Clinical diagnosis is sufficientClinical diagnosis is sufficient

Toxic Shock SyndromeToxic Shock Syndrome

►Caused by Caused by Staph aureusStaph aureus►S/Sx: temp. >38.8, hypotension, diffuse S/Sx: temp. >38.8, hypotension, diffuse

macular erythroderma, desquamation, 3 macular erythroderma, desquamation, 3 or more multisystem involvment such as or more multisystem involvment such as vomiting or diarrhea, myalgias/CPK vomiting or diarrhea, myalgias/CPK increase, mucous membrane increase, mucous membrane involvement, increase in renal function, involvement, increase in renal function, increase LFT’s , thrombocytopenia, CNS increase LFT’s , thrombocytopenia, CNS effects(MS change)effects(MS change)

►Dx: clinical caseDx: clinical case

TrichinosisTrichinosis

►S/Sx: caused by ingestion of S/Sx: caused by ingestion of Trichinella Trichinella larvaelarvae. May see fever, myalgia, . May see fever, myalgia, periorbital edema, eosinophiliaperiorbital edema, eosinophilia

►Lab Dx: Lab Dx: Trichinella Trichinella larvae in tissue muscle biopsylarvae in tissue muscle biopsy Serologic test is positiveSerologic test is positive

TuberculosisTuberculosis

►Following criteria must be met:Following criteria must be met: Positive tuberculin skin testPositive tuberculin skin test Clinical evidence of disease w/positive Clinical evidence of disease w/positive

CXRCXR Treatment w/2 or more anti-TB drugsTreatment w/2 or more anti-TB drugs Completed diagnostic evaluationCompleted diagnostic evaluation

►Isolation of TB from clinical specimenIsolation of TB from clinical specimen►Detection of TB by nucleic acid testDetection of TB by nucleic acid test►Acid fast bacilli from clinical specimenAcid fast bacilli from clinical specimen

TularemiaTularemia

►S/Sx: caused by S/Sx: caused by Francisella tularensis.Francisella tularensis. Several different forms:Several different forms: Ulceroglandular: cutaneous ulcer Ulceroglandular: cutaneous ulcer

w/regional lymphadenopathyw/regional lymphadenopathy Glandular: regional lymphadenopathy Glandular: regional lymphadenopathy

w/out ulcerw/out ulcer Oculoglandular: conjunctivitis Oculoglandular: conjunctivitis

w/preauricular lymphadenopathyw/preauricular lymphadenopathy

TularemiaTularemia

►Oropharyngeal: tonsillitis, stomatitis, Oropharyngeal: tonsillitis, stomatitis, pharyngitis, cervical lymphadenopathypharyngitis, cervical lymphadenopathy

► Intestinal: abd. Pain, vomiting, diarrheaIntestinal: abd. Pain, vomiting, diarrhea►Pneumonic: primary pleuropulmonary Pneumonic: primary pleuropulmonary

diseasedisease►Thyroidal: febrile illness w/out local Thyroidal: febrile illness w/out local

S/Sx’s.S/Sx’s.►Lab Dx: isolation of Lab Dx: isolation of F. tularemiaF. tularemia in clinical in clinical

specimen or rise in antibody titer to specimen or rise in antibody titer to F. F. tularemia tularemia antigenantigen

Typhoid FeverTyphoid Fever

►S/Sx: Caused by bacteria, S/Sx: Caused by bacteria, Salmonella Salmonella typhi, typhi, acute onset of fever, HA, acute onset of fever, HA, malaise, anorexia, bradycardia, GI malaise, anorexia, bradycardia, GI symptoms, coughsymptoms, cough

►Lab dx:Lab dx: Isolation of Isolation of S. typhiS. typhi from blood, stool or from blood, stool or

other clinical specimen.other clinical specimen.

Yellow FeverYellow Fever

►S/Sx: mosquito born viral illness S/Sx: mosquito born viral illness characterized by acute onset of fever, characterized by acute onset of fever, HA, myalgia’s, conjunctivitis, hepatitis, HA, myalgia’s, conjunctivitis, hepatitis, albuminuria, jaundice, renal failure, albuminuria, jaundice, renal failure, generalized hemorrhagegeneralized hemorrhage

►Lab Dx: Lab Dx: Fourfold rise in yellow fever antibody titerFourfold rise in yellow fever antibody titer Yellow fever virus antigen in tissues or Yellow fever virus antigen in tissues or

other bodily fluidsother bodily fluids

Questions:Questions:

►1. AIDS case reporting is required if 1. AIDS case reporting is required if which of the following are present:which of the following are present: A. CD4 T-cell count <200A. CD4 T-cell count <200 B. CD4 T-cell percentage of total B. CD4 T-cell percentage of total

lymphocyte <14lymphocyte <14 C. Any of the 23 AIDS defining conditionsC. Any of the 23 AIDS defining conditions D. All of the aboveD. All of the above

QuestionsQuestions

►2. Which of the following are forms of 2. Which of the following are forms of BotulismBotulism A. Food borneA. Food borne B. InfantB. Infant C. WoundC. Wound D. All of aboveD. All of above

QuestionsQuestions

►3. If Dr. Batizy just returned from 3. If Dr. Batizy just returned from visiting his family in Arizona and he visiting his family in Arizona and he developed a influenza like febrile developed a influenza like febrile respiratory illness, which of the respiratory illness, which of the following would be on your D/Dx:following would be on your D/Dx: A. CoccidioidomycosisA. Coccidioidomycosis B. GiardiasisB. Giardiasis C. MalariaC. Malaria D. Lyme diseaseD. Lyme disease

QuestionsQuestions

►4. True or False: Group A strep and S. 4. True or False: Group A strep and S. Aureus can cause Toxic Shock Aureus can cause Toxic Shock syndrome?syndrome?

AnswersAnswers

►1.D1.D►2. D2. D►3. A3. A►4. True4. True

Occupational Exposures, Occupational Exposures, Infection Control and Infection Control and Standard Precautions:Standard Precautions:

Chp. 154 TintinalliChp. 154 TintinalliDr. BatizyDr. Batizy

Slides by BogdanSlides by Bogdan1/19/061/19/06

Occupational Exposures:Occupational Exposures:

►OSHA definition of occupational OSHA definition of occupational exposures: exposures: ““Reasonably anticipated skin, eye, Reasonably anticipated skin, eye,

mucous membrane, or parenteral contact mucous membrane, or parenteral contact with blood or other potential infectious with blood or other potential infectious materials that may result from the materials that may result from the performance of the employee’s duties.”performance of the employee’s duties.”


► Since health care workers cannot readily Since health care workers cannot readily identify those who are infected or risky, it is identify those who are infected or risky, it is prudent to employ infection control prudent to employ infection control practices and utilize personal protective practices and utilize personal protective equipment(PPE) during all patient care equipment(PPE) during all patient care activities.activities.

► Portals for infectious disease entry are Portals for infectious disease entry are percutaneous, mucous membrane (oral, percutaneous, mucous membrane (oral, ocular, nasal or rectal), respiratory, and ocular, nasal or rectal), respiratory, and dermal.dermal.


► The risk of infection in an exposed health The risk of infection in an exposed health care worker depends on the following care worker depends on the following factors:factors: Route(portal) of exposureRoute(portal) of exposure Concentration(# of organisms) of pathogens in Concentration(# of organisms) of pathogens in

the infectious materialthe infectious material Infectious characteristics(virility) of the pathogenInfectious characteristics(virility) of the pathogen Volume (dose) of infectious materialVolume (dose) of infectious material Immunocompetence (susceptibility) of the Immunocompetence (susceptibility) of the

exposed individualexposed individual


►Percutaneous exposures have the Percutaneous exposures have the greatest potential for infection than do greatest potential for infection than do mucous membrane exposures, mucous membrane exposures, respiratory exposures, or dermal respiratory exposures, or dermal exposures.exposures.

Management of Health Care Management of Health Care Personnel Potentially Exposed to Personnel Potentially Exposed to

HBV,HCV, HIV:HBV,HCV, HIV:► Once an infectious exposure has occurred, a Once an infectious exposure has occurred, a

plan for post-exposure prophylaxis plan for post-exposure prophylaxis (PEP)medical management should be (PEP)medical management should be available to health care providers 24 hrs. a available to health care providers 24 hrs. a day.day.

► The ER physician is usually the first to The ER physician is usually the first to examine the exposed person and make an examine the exposed person and make an assessment of the relative risk of the assessment of the relative risk of the transmission.transmission.

► See Table 154-3See Table 154-3

Table 154-3Table 154-3


HBV,HCV, HIV:HBV,HCV, HIV:►The exposure event should be The exposure event should be

evaluated for the potential to transmit evaluated for the potential to transmit HBV, HCV, and HIV based on the type HBV, HCV, and HIV based on the type of body substance involved and the of body substance involved and the route and severity of the exposure. route and severity of the exposure.

►See Table 154-5See Table 154-5



HBV,HCV, HIV:HBV,HCV, HIV:►Testing to determine the HBV, HCV, Testing to determine the HBV, HCV,

and HIV status of an exposure source and HIV status of an exposure source should be performed as soon as should be performed as soon as possible.possible.



HBV Exposure:HBV Exposure:

►Factors to consider in HBV exposure Factors to consider in HBV exposure include HBsAg status of source and include HBsAg status of source and HBV vaccination status and vaccine HBV vaccination status and vaccine response of the exposed personresponse of the exposed person

►Unvaccinated health care workers Unvaccinated health care workers exposed to HBV should receive Hep. B exposed to HBV should receive Hep. B vaccine seriesvaccine series



HCV Exposure:HCV Exposure:

►For occupational HCV exposures, the For occupational HCV exposures, the CDC recommends anti-HCV testing of CDC recommends anti-HCV testing of source patient.source patient.

► Immunoglobulin and antivirals are not Immunoglobulin and antivirals are not recommended for PEP after exposure recommended for PEP after exposure to HCV positive bloodto HCV positive blood

HIV Exposure:HIV Exposure:

►Health care personnel exposed to HIV Health care personnel exposed to HIV should receive expedited evaluation(<1hr) should receive expedited evaluation(<1hr) and should be tested for HIV at baselineand should be tested for HIV at baseline

► If source patient is HIV negative, baseline If source patient is HIV negative, baseline testing or further follow-up for exposed testing or further follow-up for exposed persons is not necessary.persons is not necessary.

► Factors to consider in HIV exposure include Factors to consider in HIV exposure include the type of exposure (percutaneous, mucous the type of exposure (percutaneous, mucous membrane or dermal), volume of the membrane or dermal), volume of the exposure, and the HIV status of the source exposure, and the HIV status of the source patient.patient.

► See Table 154-8 and Table 154-9See Table 154-8 and Table 154-9



HIV Exposure PEP:HIV Exposure PEP:

►CDC recommends 4 wks of PEP drug CDC recommends 4 wks of PEP drug treatment.treatment.

►Basic 2 drug regimen is appropriate for Basic 2 drug regimen is appropriate for most exposuresmost exposures

►3 drug regimen is recommended for 3 drug regimen is recommended for exposures determined to be at exposures determined to be at increased risk of transmissionincreased risk of transmission

►See Table 154-10 and Table 154-11See Table 154-10 and Table 154-11



Standard PrecautionsStandard Precautions

►Standard precautions are exercised Standard precautions are exercised when caring for all patients and when caring for all patients and include hand washing, gloves, mask include hand washing, gloves, mask and eye protection or face shield, and eye protection or face shield, gowns, handling of patient care gowns, handling of patient care equipment and linens, environmental equipment and linens, environmental controls, workplace controls and controls, workplace controls and patient location or placement.patient location or placement.

Questions:Questions:

►1. T/F: standard precautions should be 1. T/F: standard precautions should be used when caring for all patients.used when caring for all patients.

►2. T/F: If the source patient is HIV 2. T/F: If the source patient is HIV negative, all further testing for HIV can negative, all further testing for HIV can be stopped.be stopped.

►3. T/F: all health care workers should 3. T/F: all health care workers should be vaccinated against HBV.be vaccinated against HBV.

►4. Answers: all T!4. Answers: all T!

CT of Cervical Spine:CT of Cervical Spine:

► Indications:Indications: Unconscious patient w/suspicious or Unconscious patient w/suspicious or

inadequate c-spine xraysinadequate c-spine xrays CT is indicated w/all cervical fractures or CT is indicated w/all cervical fractures or

suspected fractures on initial plain filmssuspected fractures on initial plain films Delineating injuries to atlantoaxial complex, Delineating injuries to atlantoaxial complex,

esp. rotatory subluxation and C-1 ring esp. rotatory subluxation and C-1 ring fracturesfractures

Used to examine Jefferson Fx, Rotatory Used to examine Jefferson Fx, Rotatory dislocation, burst fractures, C-T level injuriesdislocation, burst fractures, C-T level injuries

CT Cervical Spine:CT Cervical Spine:

CT of Cervical Spine:CT of Cervical Spine:

CT Cervical Spine:CT Cervical Spine:

Documents

Reportable Infectious Diseases Chp. 153. 1/19/06 Dr. Batizy Bogdan Irimies PGY-3