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84 Cards in this Set
- Front
- Back
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Describe Diphtheria?
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Diptheria is an acute, toxin-mediated disease cause by the bacterium C. diphtheriae. Only toxigenic strains cause severe disease. Respiratory diphtheria is caused by toxigenic stains of C. diphtheriae.
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Describe the mode of transmission of Diphtheria?
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1)The spread of diphtheria occurs primarily via person to peron spread from the respiratory tracts of infected individuals.
2) Rarely through direct contact with skin lesions or articles soiled with discharges from lesions of infected persons. 3) vacterium usually infects the nasopharnx or the skin. 4)transmission can occur as long as the organism is present. W/o antibiotic treatment, the organism usually persists for 2 wks or less and seldom more than 4wks. Chronic carriers may transmit for 6 months or more. Effective antibiotic therapy terminates shedding. |
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Describe the clinical presentation of Diphtheria?
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Incubation period is 2 to 5 days(range of 1-10 days). The toxin causes local tissue destruction and membrane formation. Systemic toxin absorption can result in serious complications.
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What is the site of Diphtheria?
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Can involve almost any mucous membrane, but the most common sites of infection are the tonsils or pharynx. May also infect the nose, larynx and skin, causing skin lesions.
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Mechansisms of Infection for Diptheria
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C. Diphtheriae produces a toxin that inhibits cellular protein synthesis and causes local issue destruction and membrane formation.
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What are the toxic effects of Diptheria?
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The toxin is absorbed in the bloodstream and carried to other tissues; this can result in damage to the heart, nervious system and kidney and also low platelet counts.
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What is the incubation period of Diphtheria?
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2 to 5 days (range of 1-10 days).
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Clincal symptoms of Diphtheria?
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Initial symptoms include malaise, sore throat, anorexia and low-grade fever.
If the larynx is infected, patient may experience a barking cough and hoarse voice. |
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What is tetanus?
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is an acute often fatal dx caused by exotoxin produced by the bacterium Clostridium tetani
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three different forms of Tetanus?
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generalized local and cephalic. 80% is generalized. Generalized characterized lockjaw, neck stiffness, difficulty swallowing,rigidity of abdominal muscles.
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incidence and reported cases?
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majority of cases in patients over 40(70%) and that are not vaccinated or did not have a booster in previous 10 years
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How is tetanus spread?
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only vaccine-preventable disease that is infectious but not contagious. infectious through wound, puncture, laceration, or abrasion to the skin. Soread through the body through the blood and lymph system. causing CNS issues.
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Mech of infection?
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one of two exotoxins called tetanospasmin blocks nerve cells from the spinal cord to the nerve cells. causing unopposed muscle contractions.
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Describe a the "bullneck" apperance in Diptheria?
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Soft-tissue swelling and cervical lymph node inflammation give a characteristic "bullneck" apperance and are signs of moderate to severe disease.
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Disease presentation of Diphtheria?
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The toxin causes local tissue destruction and membrane formation. The membrane is grayish-colored and adheres in the throat, palate or nasal mucosa. Extensive membrane formation can obstruct the airway and cause breathing problems.
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Complications of Diptheria.
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In past cases, the most frequent complications were neuritis, mostly of the motor nerves, which can cause paralysis of the sfot palate, eye muscles, limbs and diaphragm. Secondary pneumonia and respiratory failure may result from paralysis of the diaphragm.
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Overall case fatality rate for Diptheria?
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5%to 10% with higher death rates(up to 20%) in persons younger than 5yrs and older than 40 years.
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Treatment of Diaptheria?
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Antibiotics and antitoxin in adequate dosage and placed in isolation after the provisional clincal diagnosis is made and appropriate cultures are obtained.
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What are the 4 areas of treatments with Diphtheria?
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Nonpharmacologic Management, Neutralization of Toxin, Stop Further toxin production and Prevention of Transmisson
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Describe the treatment of nonpharmacologic management
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Respiratory support and airway maintenance should be adminstered as needed.
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Describe the treatment of neutralizing the Toxin.
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1) Prompt admin. of diphteria antitoxin. 2) Antitoxin should be given w/o waiting for lab confirmation of diagnosis.
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Describe the treatment of neutralizing the Toxin.
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3) Antitoxin will not neutralize toxin that is already fixed to tissue bt it will neutralize circulating toxin and will prevent progression of disease. 4) The recommended dosage and route of administration are based on : Extend of disease and duration of illness.
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Treatment in stopping further toxin production.
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Antmicrobial therapy(antibiotics) should be administered.
A 14 day course of either penicillin or erythromycin is recommended for treatment. Elimination of the organism should be documented by 2 consecutive negative cultures after therapy is completed. |
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Describe Tetanus?
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tetanus is an acute and often fatal disease caused by an exotoxin produced by the bacterium Clostridium tetani. It is an anaerobi gram positive, spore-forming bacterium. Primarily found in the soil and in the intestines and feces of animals and humans.
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Prevention of Transmission:
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1) After 3 days of treatment, it is safe to resume work while taking antibiotics 2) Cultures should be repeated: 24hrs after completion of antimicrobial therapy, 2 consecutive culture sets of the nose and throuat should be collected 24 hrs apart.
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Prevention of Transmission:
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3) All those in close contact with the patient, including hospital personnel should receive updated immunization, be examined and undergo nasopharyngeal and/or throat cultures for C. Dip regardless of immunization status and surveillance for evidence of disease should be maintained for 7 days. 4) Asymptomatic contacts should be treated with antibiotics.
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What are the 3 types of tetanus?
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Local, Cephalic and Generalized.
About 80% of reported tetanus is generalized tetanus. |
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Talk about Generalized Tetanus, including Obsteric and Neonatal
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Usually presents with a descending pattern. The first sign is lockjaw followed by stiffness of the neck, difficulty in swallowing and rigidity of abdominal muscles. Other symptoms inclde elevated temperature, sweating, elevated blodd pressure and episodic rapid heart rate. Spasms may occur often and last for several minutes. Spasms continue for 3 to 4wks. Complete recovery may take months.
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Talk about Generalized Tetanus, including Obsteric and Neonatal
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G. Tetanus can be either obstetric or neonatal. Obsteric tetanus is defined as tetanus during pregnancy or w/onset within 6wks after the terminatin of pregnancy.
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Talk about Generalized Tetanus, including Obsteric and Neonatal
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Neonatal tetanus is associated with infection of the unhealed umbilical stump and typically occurs because the mother is not immune. Onset is usually within the first month of life. Neonatal tetanus is common in some developing countries but is very rare in the US.
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Localized Tetatnus
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Is an uncommon form, indivisual with this form exp0erience persistent muscle contractions at the site of injury. Is a milder form of tetanus and may precede the onset of generalized tetanus.
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Cephalic Tetanus
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C. tetanus is a rare form that occasionally occurs either after a head injury or with Otitis media, where C. tetani is present in the middle ear. Cranial nerves, esp. facial are also involved.
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What is the incidence of Tetanus?
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Following widespread vaccination programs, tetanus is uncommon in the US, esp. in young people.
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Prevalence of Tetanus?
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Tetanus is almost entirely preventable by vaccination. Tetanus is found worldwide, but most frequently in densely populated regions in hot, damp climates that have soil rich in organic matter.
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Pathogenesis of Tetanus
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Often fatal, noncommunicable disease of the CNS caused by an exotoxin. Bacteria enter the body through open wounds and the exotoxin produced by the organism spreads via the blood and lymphatics. The toxins act at the several sites within the CNS. Clinical manifestations include muscle contractions and spasms.
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Transmission of Tetanus
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Tetanus is the ONLY vaccine-preventable disease that is infectious buy not contagious. C. tetani spores enter the body through a wound.
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Sites of infection with Tetanus.
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The toxins produced by C. tetani spread through the body via blood and lymphatics and act at several sites within the CNS, including the peripheral and motor end plates, spinal cord, and brain, and in the sympathetic nervous system.
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Mechanism of Infection
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Clincal manifestations of tetanus are caused by an exotoxin. C. tetani spores germinate and develop into bacteria that produce toxins.
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Mechanism of Infection
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C. tetani produces 2 exotoxins. One toxin, tetanospasmin is a neurotoxin that causes the clinical manifestations of tetanus. The function of the second toxin, tetanolysin, is not yet understood. Tetanospasmin blocks nerve signals from the spinal cord to the muscles, causin unopposed muscle contraction and spasm. Seizures may occur and the autonomic nervous system may also be affected.
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Clinical Presentation of Generalized Tetanus.
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Generalized tetanus develops after C. tetani s pores enter a wound. Incubation period ranges from 3 to 21 days and is usually about 8 days. The farther the injury site is from the CNS, the longer incubation period. Shorter incubation period, the higher incidence of death.
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Symptoms of Generalized Tetanus.
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Presents in a descending pattern. First lockjaw, followed by stiffness of the neck, difficulty in swallowing and rigidity of abdominal muscles. Spasms may occur often, last several minutes and continue for 3 to 4 months.
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Symptoms of Generalized Tetanus
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Other symptoms include: Elevated temperature, sweating elevated blood pressure and episodic, rapid heart beat.
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Complications of Generalized Tetanus
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Spasm of the vocal cords and/or spasm of the muscles of respiration can lead to difficulty in breathing. Fractures of the spine or lone bones. Hyperactivity of the autonomic nervous system may lead to hypertension (high blood pressure) and/or an abnormal heart rhythm.
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Recovery and Death from Generalized Tetanus
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Complete recovery may take months. In recent years, fatality rates have been 11%. In the US, cases most likely to be fatal are in persons aged 60yrs and older and in unvaccinated person. About 20% of deaths have no obvious pathology and death is attributed to the direct effects of the tetanus toxin.
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Medical Management of Tetanus
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Tetanus immune Globulin should be given for person infected with tetanus. Intravenous immune globulin may be used if TIG is unavailable.
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Medical Management of Tetanus- Immunization
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Tetanus disease does not result in tetanus immunity; therefore, immunization should be begin or continue as soon as the person's condition has stabilized.
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Medical Management of Tetanus- wound management
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All wounds should be cleaned, with necrotic tissue and foreign materials removed. Patients with wounds that are neither clean or minor should received TIG as well as Td or Tdap.
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What is Pertussis?
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1)An acute infectious disease caused by the bacterium Bordetella pertussis. 2)Rates of complications and fatalities are highest in early infancy. 3) Characterized by prolonged paroxysmal cough accompanied by an inspiratory whoop.
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What is Pertussis?
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4) The clinical course of the disease is divided into 3 stages: catarrhal, paroxysmal and convalescent. 5) Children are routinely vaccinated for this disease.
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Incidence and Prevalence of Pertussis
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In the 20th century, pertussis was one of the most common childhood diseases and a major cause of childhood mortality in the US. It is a cyclical disease with out breaks occurring every 3 to 4 yrs. Infants who aer less than 6 months old are at the greatest risk for severe disease and death.
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Overview of Pathogenesis for Pertussis
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Very contagious and can affect people of an age, regardless of vaccinatin status. Spread to the respiratory tract of susceptible subject in airborne droplets produced when infected people cough and sneeze. People are most infectious during the catarrhal period and the first 2wks after cough onset. (ie 21 days)
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Pathogenesis of Pertussis- Transmission
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Parents with pertussis, including new moms, are the identified source of B. Pertussis infection in 25% or moer of cases in early infancy, he age when rates for complications and fatalities are highest.
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Sites of infection for Pertussis
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Locally, B. pertussis produces toxins that damage the respiratory tract but pertussis toxin has systemic effects.
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Mechansim of Infection with Pertussis
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Primarily a toxin-mediated disease. The bacteria attach to the respiratory cilia, produce toxins that paralyze the cilia and cause inflammation of the respiratory tract; this interferes with the clearing of pulmonary secretions from the airways.
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Mechansim of Infection with Pertussis
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B. pettussis produces muliple antigenic and biologically active products. These pertussis antigens appear to allow the organism to evade the human immune response. These antigens are responsible for the clinical disease and immune response however this immunity is not permanent.
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Name some of the pertussis antigenic and biologically active products.
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Pertussis toxin(PT), filamentous hemagglutinin(FHA), agglutinogens, adenylate cyclase, pertactin(PRN) and tracheal cytotoxin.
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Clinical Presentation of Pertussis:Timing
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The first signs and symptoms appear after an incubation period of 7 to 10 days(range 4-21 days) but in rare instances may be as long as 42 days.
Average duration of illnessis about 7wks. (range 3wks to 3 months) but symptoms can last for months. |
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3 stages of Pertussis and how long does it last
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Catarrhal, paroxysmal and convalescent. Last about 6 to 10 weeks
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Describe the Catarrhal Stage.
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Difficult to diagnose because the initial symptoms resemble a common cold and can be mistaken for bronchitis or flu. Symptoms include runny nose, sneezing, low-grade fever and mild occasional cough. The cough gradually becomes more severe and after 1 to 2 wks, the 2nd or paroxysmal stage begins.
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Describe the Paroxysmal Stage
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Patients in the 2nd stage can present with bursts of numerous rapid coughs called paroxysm; followed by an inspiratory gasp that is usually accompanied by a long inspiratory "whoop". Coughing episodes occur more frequently at night with an average of 15 attacks per 24hrs. Druing and attack, the person may turn blue and often vomit.
*In infants choking spells may be more common than whoops. |
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Desribe the Convalescent Stage
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Recovery is gradual. The cough becomes less paroxysmal and disappears in 2 to 3 wks. However paroxysms often recur with subsequent respiratory infection for many months after the disease..
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What is the most common complication to Petussis infection?
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Pneumonia and the cause of most pertussis-related deaths among all age groups. 5.2% in all groups and 11.8% of infants younger than 6 months of age.
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Complications in Children with Pertussis
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Infants under 12 months are more likley to have complications or be hospitalized during their illness. Neurologic complications such as seizures and encephalopathy, may occur due to lack of oxygen to the brain from couging or from effects of the toxin.
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Complications in Children with Pertussis
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Otits Media, anorexia and dhydration. Also rib fracture, collapsed lung, nose bleed, subdural hematomas, hernias and retal prolapse from pressure effects of sever coughing paroxysms.
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Complications in Adoescents and Adults from Pertussis.
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Difficulty sleeping, urinary incontinence, pneumonia and rib fracture. Other complications include weight loss, collapsed lung, seizures or stroke and a documented case of encephalopathy.
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Treatment - Pertussis
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The medical managment of Pertussis is primarily supportive with antibiotics have some value.
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Treatment Pertussis-Nonpharmacologic Management
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Hospitalization with respiratory isolation is recommended for seriously ill infants. Isolation should be continued until antibiotics have been given for 5 days. In infants., suction to remove excess mucus from the throat may be life saving.
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Treatment of Pertussis-Antibiotics
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When antibiotics re given in the catharrhal stage, they may help with the disease. Their clinical effect is lost in the paroxysmal stage. Also should be used fro bacterial complications such as bronchopneumonia and otitis media. Preferred drugs include erythromycin, azithromycin or trimethoprim-sulfamethoxazole.
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Treatment of Pertussis- Preventing the spread of infections
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Antibiotics eradicate the organism from secretions, thereby decreasing communicability. Antiobiotics should be admin. to all close contacts of person with pertussisregardless of age and vaccinatin status.
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What is Poliomyelitis?
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A highly contagious acute infection caused by the poliovirus. Although most infections are asymptomatic, its clinical manifestation ranges from a nonspecific illness to flaccid paralysis.
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What is Poliomyelitis?
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There are 3 poliovirus serotypes: P1,P2 and P3. Diagnosis is clinical although laboratory diagnosis is possible. Vaccination for polio is a global health initative.
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Incidence and Prevalence Of Polio
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Elimated in the US. Humans are the only reservoir. At risk populations are older people, pregnant women, people who hav eundergone a tonsillectomey and polioviurs-infected patient who are administered IM injections during infection.
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Describe the transmission of Polio
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Person to person spread of polio via the fecal-oral route is the most important route of transmission. Oral-oral route may account for some cases.
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Transmission-Polio, How infectioius is polio?
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Poliovirus is highly infectious(nearly 100% seroconversion rates among susceptible household contact of children; greater than 90% seroconversion rates among susceptible household contacts of adults).
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What is the duration of infection with Polio?
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Persons infected with poliovirus are most infectious from 7 to 10 days before and after the onset of symptoms, but poliovirus may be present in the stool from 3 to 6 wks.
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What are the sites of infection for poliovirus?
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Enters the body through the mouth and starts to multiply in the pharynx and gastrointestinal tract. It is usually present in the throat and stool before the onset of illness and continues to be present in the stool for several weeks.
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Mechansim of Infection for Poliomyelitis?
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1) Once in the body, the virus invades local lymphoid tissue and enters the bloodstream; it may also infect the CNS. Its replication in the CNS is what causes the typical manifestations of polio.
2)VAPP is believed to be caused by a mutation , or reversion , of the vaccine virus to a more neurotropic form. These mutated viruses are called revertants. Reversion is believed to occur in almost all vaccine recipients, but it only rarely results in paralytic disease. |
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Clinical Presentation of Poliomyelits: Timing?
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Poliovirus infection typically peaks in the summer in temperate climates. There is no seasonal pattern in tropical climates. The incubation period for poliomyelitis is commonly 6 to 20 days, with a range of 3 to 35 days.
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Symptoms of Poliomyelitis?
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The manifestation of poliovirus infection is highly variable and has been categorized on the basis of the severity of clinical presentation. They are Inapparent/Asymptomatic, Abortive Poliomyelitis, Nonparalytic Aseptic Meningitis and Flaccid(Paralytic) Poliomyelitis.
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What are the symptoms for Inapparent\Asymptomatic Polio?
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Up to 95% of all polio infections are inapparent or asymptomatic. Infected person without symptoms shed virus in the stool and are able to transmit the virus to others.
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What are the symptoms for Abortive Poliomyelitis?
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Approx. 4% to 8% of polio infections are known as abortive poliomyelitis, consisting of a minor, nonspecific illness w/o clinical or lab evidence of CNS invasion. 3 syndromes are observed with this form of polio, all of which are indistinguishable from other viral illnesses. They are upper respiratory tract infection (sore throat and fever), gastrointestinal disturbances(nausea, vomiting) and flu like illness. Patients can have complete recovery in less then a week.
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Whay are the symptoms for Nonparalytic Aseptic Meningitis?
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Stiffness of the neck, back and /or legs which usually following several days after a prodrome similar to that of minor illness, occurs in 1% to 2% of polio infections. Increase or abnormal sensations can also occur. Typically these symptoms will last from 2 to 10 days, followed by complete recovery
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What are the symptoms of Flaccid(Paralytic) Poliomyelitis?
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Fewer than 1% of all polio infections. Paralytic symptoms gerally begin 1 to 10 days from prodromal symptoms and progress for 2 to 3 days. Generally, no further paralysis occurs after the temperature returns to normal.
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What are the symptoms of Flaccid(Paralytic) Poliomyelitis?
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The illness progresses to faccid paralysis with diminished deep tendon reflexes, reaches a plateau without change for days to weeks, and is usually asymmetrical. Strengh then begins to return. Patients do not experience sensory losses or changes in cognition. Many person recover completely and, in most, muscle function returns to some degree.
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