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Microbiology Chapter 15 Spring 07

Microbiology Chapter 15 Spring 07

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Published by: fallingupward312 on Oct 14, 2008
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Chapter 15. Epidemiology andNosocomial Infections
Epidemiology
Epidemiology: the study of 
when
and
where
diseases occur and
how
they aretransmitted in populations. CDC (Centers for Disease Control and Prevention) isthe epidemiological center of the Untied States that compiles an annual nationallist of "notifiable diseases", i.e.
infectious
disease cases physicians are required toreport. (Epidemiological studies include non-infectious diseases as well, e.g.cancer, heart diseases, mental health and smoking-related diseases.)
Epidemiological measures of disease:
Incidence
(number of 
new
cases per 100,000 people in a period of time, measuring if the disease is still spreading or isdisappearing);
Prevalence
(total number of people having the disease, measuringhow widespread a disease is in a population at a time point);
Mobidity
(number of disease cases in a population per year);
Mortality
(number of death due to adisease in a population per year)
Pioneers of epidemiology: John Snow (made the first epidemiological map thatidentified the source of the 1849 London cholera outbreak); Ignaz Semmelweis(prevented childbirth death by instituting hand-washing); Florence Nightingale(wrote the first statistical study that lowered war-time soldier death frominfection).
Classifying infectious diseases:
epidemic
diseases (diseases that occur in a short period of time, e.g. West Nile virus outbreak in NYC);
endemic
diseases (diseasesthat constantly present in a local population, e.g. Lyme disease);
pandemic
diseases (worldwide occurrence, e.g. flu).
Methods of epidemiological studies
o
Descriptive studies: Careful collection of geographic, demographic, andtemporal information of a disease
o
Analytical studies: Statistical analysis of association and correlation between disease factors and disease cases, in order to identify the diseasecause(s). For example, do a case group-control group comparison
o
Experimental studies: Comparison of a treatment group with a control(untreated, with placebo) group
Modes of disease transmission
o
Direct contact: person-to-person. e.g., AIDS
o
Indirect contact: transmission through a
fomite
(non-living objects, e.g.,shared utensils in hospital).
o
Droplet: coughing, sneezing, etc. Droplets contain "droplet nuclei", whichare dried mucus embedded with microbes.
o
Vehicle transmission: waterborne (e.g., cholera), airborne (e.g., TB;
Aerosols
, e.g, dusts, contain live bacteria, endospores, fungal spores andnaked viruses), and foodborne (e.g., botulinum toxin)
 
o
Vector-borne: mechanical or biological transmission by arthropods androdents (e.g., malaria, Lyme disease)
Disease
reservoir
: the primary source and maintenance host of a pathogen
o
Human reservoirs: e.g, AIDS, polio, HBV, all human-specific pathogens
o
Animal reservoirs: e.g., Rabies, Lyme disease
(Borrelia burgdorferi).
Diseases occur primarily in the wild animals or pets are called
zoonoses
.Humans are accidental (non-maintenance) hosts of zoonoses.
o
 Non-living reservoirs: soil and water, e.g.,
 Bacillus anthracis ( 
anthrax
 )
,
Clostridium tetani ( 
tetanus
 )
Portals of entry: broken or intact skins; mucous membranes in respiratory,digestive, and urogenital tracts; body openings (e.g., mouth, ear, urethra); placenta(e.g., mother-fetus transmission of HIV-1).
Yersinia pestis
causes bubonic plaguewith 50% mortality rate through flea bites, and causes pneumonic plague with a100% mortality when inhaled.
Portals of exit: Respiratory discharges (saliva and droplets from coughing,sneezing); Gastrointestinal tract discharges (feces through diarrhea); Urogenitaltract exits (urine and semen); Blood (e.g., malaria); Milk (known to transmit HIV-1)
Disease control: Isolate (of patients of communicable diseases); Quarantine (of affected population, including non-symptomatic disease carriers from the general public); Large-scale immunization (to achieve
herd immunity
- i.e., groupimmunity, where most people are immune to an infectious disease so that thedisease can only affect a small number of individual, and will not cause anepidemic); Vector control (of arthropods and rodents)
Nosocomial (hospital-acquired) infections
Hospitals are major reservoir of opportunistic pathogens (e.g.
Staphylococcusaureus
,
 E.coli
,
Clostridium difficile
,
Candida albicans
, causing surgical woundinfections, diarrhea and yeast infections) and antibiotic-resistant pathogens (e.g.resistant strains of 
 Pseudomonas aeruginosa
).
Compromised (weakened) status of host, resulting from invasive procedures(surgery, anesthesia, etc.) and suppressed immune systems (caused by drugs,radiations, etc)
Hospital chains of transmission: person-to-person route of transmission; fomiteroute of transmission (through non-living objects, e.g. needles, catheters,respiratory aids, endoscopes, dental drills).
Control and prevention of hospital infections:
o
Vigorous hand-washing
o
Strictly follow aseptic techniques for handling biological samples andhospital equipments and tools
o
Selective antibiotic use (preventive use only for surgery and immune-compromised patients)
o
Follow the Universal Precautions (CDC guidelines for safe-handling of ALL body fluids)

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