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Chapter 39

Infectious and Communicable Diseases

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives

Identify public health principles related to infectious diseases Describe the chain of elements needed for an infectious disease to occur Explain how internal and external barriers affect susceptibility to infection Distinguish between four periods of infectious diseases:

Latent, incubation, communicability, disease
Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives

Describe mode of transmission, pathophysiology, prehospital considerations, and PPE for:

    

HIV Hepatitis TB Meningococcal meningitis Pneumonia SARS

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

2006. and signs and symptoms of:  Rabies  Tetanus  Selected childhood viral illnesses  Influenza  Mononucleosis  Sexually transmitted diseases Copyright © 2007.Objectives  Describe transmission. an affiliate of Elsevier Inc. 2001.. Inc. . 1994 by Mosby. pathophysiology.

Objectives  Identify signs. 1994 by Mosby. 2006. symptoms. . and prehospital considerations related to lice and scabies Outline reporting for exposure to infectious disease Discuss the paramedic’s role in preventing disease transmission   Copyright © 2007. 2001.. Inc. an affiliate of Elsevier Inc.

Inc. 2006. 2001. breathing 8 times per minute.Scenario You recognize the address before the dispatcher tells you to stage until police arrive. and you remember hearing she has hepatitis B and C. Copyright © 2007. When police signal you to approach. Your partner begins to manage her airway and breathing while you control the bleeding and call for a pumper to assist with her care. and feces. vomit. The patient has attempted suicide several times.. you find your patient in the basement in a puddle of blood. She is unconscious. and still bleeding from an apparent razor wound to the brachial artery area. . an affiliate of Elsevier Inc. 1994 by Mosby.

2006. Inc. 2001.  . 1994 by Mosby.. an affiliate of Elsevier Inc.Discussion  What personal protective measures should you take:   Before this call? During this call?  Can you assume your information regarding her disease status is true?  How can these diseases be transmitted? What should you do if think you’ve had an exposure to her blood? Copyright © 2007.

2006. 2001.. Inc.Infectious and Communicable Diseases  Infectious disease  Illness caused by specific microorganism  Communicable disease  Infectious disease transmitted from one person to another Copyright © 2007. . 1994 by Mosby. an affiliate of Elsevier Inc.

2006. Inc. 1994 by Mosby. 2001.Infectious and Communicable Diseases  Public health principles CDC classification of infectious disease    Airborne Bloodborne  Agency responsibility relative to infectious agent exposure Personal responsibilities  Copyright © 2007. .. an affiliate of Elsevier Inc.

an affiliate of Elsevier Inc.. under any circumstances. 2001. 1994 by Mosby. 2006. Inc. .Body Substance Isolation (BSI)  BSI is based on the premise that all exposures to body fluids. are potentially infectious Copyright © 2007.

Decontamination Methods  Cleaning. and other agencies and organizations Copyright © 2007. 2006. OSHA. an affiliate of Elsevier Inc. Inc. Environmental Protection Agency (EPA).. 2001. 1994 by Mosby. disinfection. . and sterilization guidelines have been established by the CDC.

2006. . Inc.Pathophysiology of Infectious Diseases  Depends on:  Virulence • Degree of pathogenicity  Number of infectious agents • Dose  Resistance of host • Immune status  Correct mode of entry Copyright © 2007. 1994 by Mosby. 2001. an affiliate of Elsevier Inc..

Chain of Elements  Pathogenic agent Reservoir Portal of exit from reservoir Environment conducive to transmission Portal of entry into new host Susceptibility of new host to infectious disease Copyright © 2007. Inc. 2001.      . an affiliate of Elsevier Inc.. 2006. 1994 by Mosby.

. Inc. an affiliate of Elsevier Inc. 2006.Chain of Transmission for Infection Transmission controlled by breaking any link in chain Copyright © 2007. 1994 by Mosby. 2001..

Pathogenic Agent  Organism that can create pathological processes in a human host Classified according to:      Morphology Chemical composition Growth requirements Viability Copyright © 2007.. 2006. . Inc. 1994 by Mosby. 2001. an affiliate of Elsevier Inc.

an affiliate of Elsevier Inc. 2001. including tapeworms. Inc.. 1994 by Mosby. roundworms Copyright © 2007. 2006. .Pathogenic Agents  Bacteria Viruses Fungi Protozoa     Helminths  Worms.

Pathogenic Agent  Establishment of an infectious disease depends on:        Ability to invade and reproduce in host Mode in which it does so Speed of reproduction Ability to produce toxin Extent of tissue damage caused Potency Ability to induce immune response in host Copyright © 2007. 2006. an affiliate of Elsevier Inc.. 1994 by Mosby. Inc. . 2001.

1994 by Mosby.. 2006.Reservoir  Environment in which pathogen lives and reproduces in Life cycle of infectious agent depends on:     Demographics of host Genetic factors Therapeutic interventions Copyright © 2007. Inc. . an affiliate of Elsevier Inc. 2001.

Inc. an affiliate of Elsevier Inc. 2001.Portal of Exit  How pathogenic agent leaves one host to invade another  Depends on agent and may involve: • GU tract • Intestinal tract • Oral cavity • Respiratory tract • Open lesion • Wound through which blood escapes Copyright © 2007. 2006. 1994 by Mosby.. .

. 1994 by Mosby. an affiliate of Elsevier Inc. 2001. Inc.Transmission/Portal of Entry  Determined by portal of exit Direct transmission   Physical contact between source and victim  Indirect transmission  Organism survives without human host  Portal of entry  How pathogenic agent enters new host Copyright © 2007. 2006. .

Inc. 2006.Host Susceptibility  Influenced by immune response and by:  Human characteristics  General health status  Immune status  Geographical and environmental conditions  Cultural behaviors  Sexual behaviors Copyright © 2007. . 2001. 1994 by Mosby. an affiliate of Elsevier Inc..

an affiliate of Elsevier Inc.. 2001. Inc. 1994 by Mosby.Human Response to Infection  External barriers      Flora Skin GI system Upper respiratory tract Genitourinary tract Copyright © 2007. 2006. .

. Inc. an affiliate of Elsevier Inc. .First Line of Defense: External Barriers Copyright © 2007. 1994 by Mosby. 2001. 2006.

.Human Response to Infection  Internal barriers  Protect against pathogenic agents when external lines of defense are breached  Include: • Inflammatory response • Immune response Copyright © 2007. 2001. . Inc. an affiliate of Elsevier Inc. 2006. 1994 by Mosby.

1994 by Mosby. Inc.Inflammatory Response  Inflammation  Local reaction to cellular injury  Generally protective and beneficial  Can destroy body tissue if sustained or directed toward host's own antigens  Three stages    Cellular response to injury Vascular response to injury Phagocytosis Copyright © 2007. . an affiliate of Elsevier Inc. 2001. 2006..

Second Line of Defense: Inflammatory Response Copyright © 2007. an affiliate of Elsevier Inc.. 2001. 1994 by Mosby. 2006. Inc. .

. . Inc. 2001. an affiliate of Elsevier Inc.Immune Response  White blood cells are backbone of immune system Humoral immunity component    Time-consuming response Specialized white blood cells (B cells) differentiate into antibodies Copyright © 2007. 2006. 1994 by Mosby.

Inc. 2001. .. 2006. 1994 by Mosby. an affiliate of Elsevier Inc.Immune Response  Cell-mediated immunity   Time-consuming response T cells coordinate other components of immune system to deal with foreign material • Helper T cells • Suppressor T cells • Killer T cells • Inflammatory T cells Copyright © 2007.

. 2006. Inc.Cellular and Humoral Immunity Copyright © 2007. . 1994 by Mosby. 2001. an affiliate of Elsevier Inc.

Inc. 1994 by Mosby.. . an affiliate of Elsevier Inc.Immune Response  Effector cells with no specialized function      Monocytes Neutrophils Eosinophils Basophils Natural killer cells Copyright © 2007. 2001. 2006.

Reticuloendothelial System (RES)  Immune cells in spleen. an affiliate of Elsevier Inc. 1994 by Mosby.. 2006. Inc. . liver. bone marrow. and intestines Works with lymphatic system   Disposes of “garbage” material that results from immune system attack of intruders  Mature B and T cells are stored until immune system is activated by intruders Copyright © 2007. lymph nodes. 2001. lungs.

Complement System  Recognizes and kills invaders on first sight Doesn’t take time to mobilize specialized responses. Inc. 1994 by Mosby. .. 2001. an affiliate of Elsevier Inc. 2006. such as the humoral and cellmediated components of white blood cells  Copyright © 2007.

2001.Stages of Infectious Disease  Latent period Incubation period Communicability period Disease period    Copyright © 2007. . 2006. an affiliate of Elsevier Inc. Inc. 1994 by Mosby..

2006. . Inc. an affiliate of Elsevier Inc.HIV  Blood and serum-derived body fluids  Semen. vaginal. 1994 by Mosby. or cervical secretions  Directly transmitted person to person    Anal or vaginal intercourse Across placenta Contact with infected blood or body fluids on mucous membranes or open wounds Copyright © 2007. 2001..

an affiliate of Elsevier Inc. 1994 by Mosby. Inc.. . 2001. 2006.HIV  HIV is indirectly transmitted by:  Transfusion with contaminated blood or blood products  Transplanted tissues and organs  Contaminated needles or syringes Copyright © 2007.

1994 by Mosby. 2001. an affiliate of Elsevier Inc. Inc. 2006.HIV Risk Factors  High-risk sexual behavior IV drug abuse Transfusion recipient between 1978 and 1985 Coagulation disorders requiring blood products Infant born of HIV-positive mother Other factors Copyright © 2007.      ..

1994 by Mosby. an affiliate of Elsevier Inc.. 2001. . 2006. releasing virus Interferes with immune function  Copyright © 2007.HIV  Retroviral infection Alters cell function to produce virus   Host cell ruptures. Inc.

HIV Complications         Pulmonary TB Pneumonia Pneumocystis carinii pneumonia Kaposi’s sarcoma Wasting syndrome HIV dementia Sensory neuropathy Toxoplasmosis Copyright © 2007. Inc.. an affiliate of Elsevier Inc. . 2006. 2001. 1994 by Mosby.

. 2006. Inc. skin lesions Prolonged fever. diarrhea  Late symptomatic HIV  Severe opportunistic infections Copyright © 2007. adenopathy. 1994 by Mosby. sore throat Seroconversion 6-12 wks  Early symptomatic HIV   Localized infections.HIV—Categories  Acute Retroviral infection    2-4 wks after exposure Fever. . an affiliate of Elsevier Inc. 2001.

. an affiliate of Elsevier Inc. . Inc. 1994 by Mosby. 2006. 2001.Kaposi’s Sarcoma of the Heel and Lateral Foot Copyright © 2007.

2001.Kaposi’s Sarcoma of the Distal Leg and Ankle Copyright © 2007. Inc. 1994 by Mosby. 2006. an affiliate of Elsevier Inc. ..

HIV—PPE  Universal precautions  Standard precautions  Increased risk if exposure to:     Large quantity of blood Device visibly contaminated with blood Deep penetration injury Terminal source patient Copyright © 2007. Inc. 1994 by Mosby.. . 2006. 2001. an affiliate of Elsevier Inc.

1 yr Copyright © 2007.HIV—PEP  Immediate notification If indicated. 1994 by Mosby. 3 and 6 mo. Inc. 2-3 wks. . 2001. PEP drugs may include:   Nucleotide reverse transcriptase inhibitors  Nonnucleotide reverse transcriptase inhibitors  Protease inhibitors  Fusion inhibitors  HIV test postexposure  Immediate.. an affiliate of Elsevier Inc. 2006.

HIV—Psychological Response

May feel anger related to:
   

Pain Early death Social rejection Prejudice

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hepatitis

Viral disease Produces pathological changes in liver

Three main hepatitis viruses
  

Hepatitis A (viral hepatitis) Hepatitis B (serum hepatitis) Hepatitis C (non-A/non-B hepatitis)

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Hepatitis

Hepatitis non-ABC is a fourth class of hepatitis Caused by infection with hepatitis D virus and newer hepatitis viruses

E and G

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

2006. an affiliate of Elsevier Inc. 1994 by Mosby. Inc.. 2001.Hepatitis A Virus (HAV)  Most common Contracted by ingesting food or drink contaminated with HAV Shed in feces Small number have liver failure Does not lead to:       Chronic liver disease Carrier state Copyright © 2007. .

Hepatitis A Virus (HAV)  Vaccine available Immune globulin   Provides temporary immunity  Good hand washing best defense against spread Copyright © 2007. 2006. 2001.. . an affiliate of Elsevier Inc. 1994 by Mosby. Inc.

2001.. . an affiliate of Elsevier Inc. 1994 by Mosby.Hepatitis B Virus (HBV)  Virus in blood and bloody secretions Affects liver Can cause chronic cirrhosis Lasts <6 mos     Carrier state may last years  Signs and symptoms   Flulike Or liver necrosis/death Copyright © 2007. Inc. 2006.

Hepatitis B Virus (HBV)  Complications include:      Coagulation defects Impaired protein production Impaired bilirubin elimination Pancreatitis Hepatic cancer Copyright © 2007.. 2001. 2006. 1994 by Mosby. an affiliate of Elsevier Inc. . Inc.

an affiliate of Elsevier Inc. 2006. mouth • Transplacental  Intercourse Transfer by inanimate objects Copyright © 2007.Hepatitis B Virus (HBV) —Exposure  Percutaneous inoculation Indirect   Skin cuts. 1994 by Mosby.. 2001.  . Inc. tattoos/piercings  Mucosal surfaces • Eyes.

. an affiliate of Elsevier Inc.Hepatitis B Virus—Prevention  Universal precautions Vaccination preexposure   Postexposure if no antibodies   Vaccination Immune globulin Copyright © 2007. 2001. . Inc. 2006. 1994 by Mosby.

2006. an affiliate of Elsevier Inc.. 1994 by Mosby. 2001. . Inc.Hepatitis C Virus (HCV)  Similar to HBV Infected transfusions pre-1992 Most frequent infection from needle stick injury    85% become chronic carriers  Complications    Chronic hepatitis Cirrhosis Liver cancer Copyright © 2007.

2006.Hepatitis C Virus (HCV)  No vaccine No postexposure prophylaxis currently recommended   New guidelines from CDC pending Copyright © 2007. Inc. .. an affiliate of Elsevier Inc. 2001. 1994 by Mosby.

1994 by Mosby.Hepatitis C Virus (HCV)  Transmission similar to HBV  Not easily spread through sex  Signs and symptoms   Most asymptomatic May be similar to HBV Copyright © 2007. an affiliate of Elsevier Inc. Inc.. 2006. 2001. .

1994 by Mosby.Hepatitis—Signs and Symptoms  Flulike illness Jaundice. joint pain. rashes 1% get liver failure and die Copyright © 2007. 2006. nausea. after infection       Anorexia. .. an affiliate of Elsevier Inc. Inc. dark urine First week of symptoms most infectious 2-3 mos. 2001. vomiting Fever.

Inc.. 1994 by Mosby.Prehospital Management  Universal precautions Maintain fluid status Prevent shock Appropriate disposal of wastes    Copyright © 2007. 2006. 2001. . an affiliate of Elsevier Inc.

hospitals.. homeless shelters.Tuberculosis (TB)  8 million cases/year High-risk groups    Immigrants from highly infected area Correctional facilities. nursing homes Copyright © 2007. an affiliate of Elsevier Inc. 2006. 1994 by Mosby. 2001. . Inc.

Tuberculosis (TB)  Chronic pulmonary disease Inhalation   Tubercle bacilli Transmitted by coughing. 2006. . 2001. 1994 by Mosby. Inc.. an affiliate of Elsevier Inc. sneezing    Or direct contact with sputum Rarely. skin or ingestion Copyright © 2007.

2006.. Inc. 2001. . 1994 by Mosby. an affiliate of Elsevier Inc.Tuberculosis (TB)  Produces inflammatory lesions   Most often in lung Can produce cavities  May be dormant for years High-risk groups    Young and old Immunocompromised Copyright © 2007.

1994 by Mosby.Tuberculosis—Signs and Symptoms  Cough Fever Night sweats Weight loss Fatigue Hemoptysis Copyright © 2007.      . Inc. an affiliate of Elsevier Inc.. 2001. 2006.

Tuberculosis—Complications  Pericardial effusions Disk deterioration Chronic arthritis of one joint Subacute meningitis Brain granulomas Systemic distribution in blood Copyright © 2007. an affiliate of Elsevier Inc.      .. 2006. 2001. Inc. 1994 by Mosby.

an affiliate of Elsevier Inc. 2001.. 1994 by Mosby. Inc. 2006.Tuberculosis—Testing  PPD skin test annually More often if:   High incidence of TB  After exposure  If positive:   CXR Acid-fast bacilli sputum culture Copyright © 2007. .

1994 by Mosby.Tuberculosis—PPE  Surgical mask on patient  Nonrebreather if oxygen needed  N-95 HEPA respirator on paramedics Ventilation in ambulance not on recirculate Disinfection of ambulance with tuberculocidal germicidal after care Copyright © 2007. an affiliate of Elsevier Inc.. 2001. Inc. 2006.   .

Inc. an affiliate of Elsevier Inc.HEPA Respirator Copyright © 2007. 2006. 2001.. 1994 by Mosby. .

an affiliate of Elsevier Inc. 2006.Tuberculosis Treatment  If PPD test positive:    CXR Possible treatment with INH • If >35 years of age • Or if high risk conditions met Must avoid alcohol during treatment Copyright © 2007.. 1994 by Mosby. 2001. Inc. .

virus.Meningitis  Inflammation of membranes around spinal cord and brain  Bacteria. an affiliate of Elsevier Inc. 2001. other microorganism  Neisseria meningitidis Airborne spread Usually involves prolonged contact Viral meningitis usually less severe Copyright © 2007.    .. 2006. Inc. 1994 by Mosby.

. 1994 by Mosby. an affiliate of Elsevier Inc. 2006. 2001.Meningitis—Signs and Symptoms  Infants     Irritability Poor feeding or vomiting High-pitched cry Full fontanelle Copyright © 2007.. Inc.

an affiliate of Elsevier Inc. 2001. Inc. 2006.Meningitis—Children and Adults       Malaise Low-grade fever Projectile vomiting Petechial rash Headache Stiff neck      Brudzinski’s sign Kernig’s sign Convulsions Coma Can progress rapidly Copyright © 2007.. . 1994 by Mosby.

.Meningitis—Prevention  Vaccines for:    Hib Some strains of N. pneumoniae Copyright © 2007. 1994 by Mosby. meningitidis S.. Inc. 2006. 2001. an affiliate of Elsevier Inc.

2006.Meningitis—Prehospital Care  Universal precautions Mask paramedics and patient Manage airway and breathing Support circulation     Rapid transport for diagnosis  Antibiotics urgent if bacterial Copyright © 2007. Inc. an affiliate of Elsevier Inc. 1994 by Mosby. . 2001..

. 2006. Inc. 1994 by Mosby.Bacterial Endocarditis  Inflammation of heart and one or more valves Causes by bacteria in blood stream Risk factors:    IV drug use  Dental surgery  Central venous line  History of heart valve problems  20% mortality Variable onset Copyright © 2007. 2001.  . an affiliate of Elsevier Inc.

an affiliate of Elsevier Inc. . 1994 by Mosby. 2006..Bacterial Endocarditis  Signs and symptoms      Flulike Night sweats Red painless spots on palms and soles Heart murmur Dyspnea and chest pain  Diagnosis by blood cultures Treatment    Symptomatic in prehospital setting Antibiotics in hospital Copyright © 2007. 2001. Inc.

2006. an affiliate of Elsevier Inc. 1994 by Mosby. viral. 2001. fungal Affects lungs   Possibly CNS and throat  Airborne transmission Copyright © 2007.Pneumonia  Acute inflammatory process of respiratory bronchioles and alveoli  Causes: Bacterial.. Inc. .

high fever. .. 1994 by Mosby. 2006. dyspnea Chest pain with respiration Tachypnea.Pneumonia  Signs and symptoms      Chills. Inc. chest retractions Congestion Productive cough Copyright © 2007. an affiliate of Elsevier Inc. 2001.

an affiliate of Elsevier Inc. Inc.. .Pneumonia  Susceptibility increased by:  Preexisting pulmonary disease  Smoking  Aspiration  Extremes of age  Diseases compromising immune function Copyright © 2007. 2001. 1994 by Mosby. 2006.

1994 by Mosby.. 2001. 2006. Inc. expectorants Copyright © 2007. analgesics. an affiliate of Elsevier Inc.Pneumonia—Management  Universal precautions Airway support Oxygen and ventilation IV fluids Cardiac monitor Transport for:       Antibiotics. .

an affiliate of Elsevier Inc. Inc.. .S. sometimes fatal disease of CNS Wound infection with spores of bacterium Clostridium tetani Affects nerves that control muscles    Rare in U. due to immunization Copyright © 2007. 2001. 2006. 1994 by Mosby.Tetanus  Serious.

1994 by Mosby.   . 2001. an affiliate of Elsevier Inc.Tetanus—Signs and Symptoms  Muscle tetany Trismus Painful contractions in neck    Move to trunk  Abdominal rigidity Painful spasms of face Respiratory failure Copyright © 2007.. 2006. Inc.

   .. Inc.Tetanus—Prehospital Care  Support vital functions  Aggressive airway management Benzodiazepines   IV fluids Magnesium sulfate Narcotics Antidysrhythmics Copyright © 2007. 1994 by Mosby. 2006. an affiliate of Elsevier Inc. 2001.

   . 1994 by Mosby. 2001. 2006. an affiliate of Elsevier Inc. Inc..Tetanus Immunization  Begin as child Booster routinely every 10 yrs Booster at 5 yrs for a “dirty” wound Tetanus immune globulin after exposure if immunizations not current Copyright © 2007.

. 2006. 1994 by Mosby.. 2001.Rabies (Hydrophobia)  Viral infection of nervous system Animal-human transmission by saliva   Through bite or scratch  Incubation 9 days to 7 years Copyright © 2007. an affiliate of Elsevier Inc. Inc.

headache  Loss of appetite  Hyperactivity. Inc. . 2001. an affiliate of Elsevier Inc. disorientation  Seizures  Intense thirst..Rabies (Hydrophobia)  Symptoms  Low-grade fever. 1994 by Mosby. 2006. drinking causes spasms  Paralysis of eye and facial muscles  Death from respiratory failure 2-6 days Copyright © 2007.

an affiliate of Elsevier Inc. 1994 by Mosby. 2001. Inc.. . 2006.Rabies (Hydrophobia)  After exposure  Wound care  Human rabies immune globulin  Rabies vaccine  Tetanus prophylaxis  Animal evaluation Copyright © 2007.

. 2006. malaise Respiratory distress in several days GI upset. an affiliate of Elsevier Inc. 2001.Hantavirus         Hemorrhagic fever Virus carried by rodents Inhalation of material contaminated with rodent urine or feces Fever. 1994 by Mosby. capillary hemorrhage Kidney failure.. hypotension Care is supportive Copyright © 2007. Inc.

  . 1994 by Mosby.Viral Diseases of Childhood  Rubella (German measles) Rubeola (red measles or hard measles)   Mumps (parotitis) Chickenpox (varicella) Pertussis (whooping cough) Copyright © 2007. 2001. 2006.. an affiliate of Elsevier Inc. Inc.

2006. Inc.Rubella  Virus Febrile Highly communicable       Direct contact with secretions Droplet spray Inanimate objects Maternal-fetal  Diffuse. 2001. . macular rash Copyright © 2007. an affiliate of Elsevier Inc. punctate. 1994 by Mosby..

Rubella  Congenital rubella syndrome    90% of infants infected in first trimester Multiple congenital abnormalities Critical for paramedics to check immune status • Receive vaccination if not immune • Protects patients and paramedics’ families Copyright © 2007.. . an affiliate of Elsevier Inc. 1994 by Mosby. 2001. Inc. 2006.

1994 by Mosby. 2006. 2001. ..Acquired Rubella (German Measles) in an 11-Month-Old Infant Copyright © 2007. Inc. an affiliate of Elsevier Inc.

conjunctivitis. 2001. . maculopapular rash   Spreads from head to torso to feet  Complications   Bacterial Panencephalitis  Immunization Copyright © 2007. bronchitis Red. 1994 by Mosby. 2006. Inc.Rubeola  Highly communicable viral disease  Measles virus  Fever. cough. an affiliate of Elsevier Inc..

. Inc.. 1994 by Mosby. 2001.Rubeola (Measles) Rash on 3rd Day Copyright © 2007. an affiliate of Elsevier Inc. 2006.

Inc. . 2006.Mumps  Mumps virus Edema of salivary glands   Transmitted by saliva droplets May spread to glands or nervous tissue  Copyright © 2007. an affiliate of Elsevier Inc.. 1994 by Mosby. 2001.

. . 2001. 2006. an affiliate of Elsevier Inc.Submaxillary Mumps in an Infant Copyright © 2007. 1994 by Mosby. Inc.

1994 by Mosby. Inc.. malaise Skin rash     Maculopapular for a few hours Vesicular for 3-4 days Forms scabs Copyright © 2007. 2006. 2001. . an affiliate of Elsevier Inc.Chickenpox  Varicella-zoster virus  Droplet contact (usually respiratory) Highly communicable   Low-grade fever.

.Chickenpox  Rash appears on trunk.. Inc. 1994 by Mosby. then extremities Treatment is symptomatic   Complications     Bacterial infections Aseptic meningitis Mononucleosis Reye syndrome Copyright © 2007. 2006. an affiliate of Elsevier Inc. 2001.

2001.. 1994 by Mosby. an affiliate of Elsevier Inc. Inc.Chickenpox  Virus stays latent in body May reactivate during stress Shingles     Lesions along single sensory nerve group Can cause chickenpox if contact with lesions  Chickenpox vaccine available Varicella immune globulin Copyright © 2007.  . 2006.

an affiliate of Elsevier Inc. Inc. ..Chickenpox Skin Lesions Copyright © 2007. 1994 by Mosby. 2006. 2001.

Inc. 2006. an affiliate of Elsevier Inc. 2001.Pertussis  Mainly affects infants and young children Direct contact with infected droplets Inflammation of respiratory tract Cough       Becomes paroxysmal in 1-2 wks Violent “whoop” Lasts 1-2 months  Vaccine Copyright © 2007.. . 1994 by Mosby.

Other Viral Diseases

Influenza Severe acute respiratory syndrome (SARS) Mononucleosis Herpes simplex type 1

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Influenza

Respiratory infection

Influenza viruses A, B, C
Droplet spread Chills, fever, headache Muscle aches, anorexia, fatigue Upper respiratory infection, cough Secondary bacterial infections possible

High-risk groups

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Influenza

Vaccines

Temporary, limited protection Repeat annually

Antivirals FluMist
 

Nasal spray Live vaccine
Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Mononucleosis  Causative agents   Epstein-Barr virus Cytomegalovirus  Oropharyngeal and salivary spread Slow onset and long duration  Copyright © 2007. 1994 by Mosby. Inc. an affiliate of Elsevier Inc.. . 2001. 2006.

Mononucleosis  Fever. mucus Lymphadenopathy Splenomegaly    Risk of rupture  10% have rash  Looks like bruises Copyright © 2007. 2006.. 1994 by Mosby. . 2001. an affiliate of Elsevier Inc. sore throat. Inc.

.  . 2006. death in some Copyright © 2007. 1994 by Mosby. cough Respiratory failure.Severe Acute Respiratory Syndrome (SARS)  Emerged in 2003 Coronavirus Spread     Airborne droplets Contact  Fever. an affiliate of Elsevier Inc. 2001. Inc.

2006. an affiliate of Elsevier Inc. 2001. .. 1994 by Mosby. Inc.SARS  No vaccine 80% improve without care Strict quarantine to prevent spread Transport with minimum number of people in vehicle     Notify receiving facility if SARS suspected Copyright © 2007.

an affiliate of Elsevier Inc. . 2006.. 1994 by Mosby. 2001.SARS  Infection control guidelines Pre-Hospital Emergency Medical Care and Ground Transport of Suspected Severe Acute Respiratory Syndrome Patients   CDC  NASEMSD Copyright © 2007. Inc.

Sexually Transmitted Diseases

Diseases transmitted sexually
   

May not have genital manifestations Agents causing STDs include: • Bacteria, viruses, protozoa, fungi, and ectoparasites Can produce multiple disease syndromes Patients with one STD often have multiple STDs

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Syphilis
     

Systemic disease Primary lesion Secondary skin eruption Long latency periods Late disabling lesions of skin, bone, CNS, CV Transmission

Direct contact with lesions  Sex  Blood transfusion/needle sticks  Congenital
Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Syphilis

Primary stage Secondary stage Latency Treatable with antibiotics No vaccine available
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Inc. 2001. an affiliate of Elsevier Inc.Primary Syphilis Chancre on the Labia Copyright © 2007.. . 2006. 1994 by Mosby.

frequency Purulent urethral discharge No vaccine Copyright © 2007. Inc.   .. 2001.Gonorrhea  Neisseria gonorrhoeae  Bacterium  Transmission   Exudate from infected tissue Congenital  Dysuria. an affiliate of Elsevier Inc. 2006. 1994 by Mosby. urgency.

an affiliate of Elsevier Inc. Inc. 1994 by Mosby. 2001.      . 2006..Chlamydia  Chlamydia trachomatis Sexually transmitted Nonspecific urethritis Leading cause of preventable blindness Penile or vaginal discharge Treated with antibiotics Copyright © 2007.

Herpes Virus Infections  Four types  Herpes simplex virus (HSV) • STD  Cytomegalovirus • Mononucleosis. an affiliate of Elsevier Inc. .. 1994 by Mosby. 2006. hepatitis. Inc. 2001. and severe systemic disease in immunosuppressed host   Epstein-Barr virus • Mononucleosis Varicella-zoster virus • Chickenpox and shingles Copyright © 2007.

2006. 1994 by Mosby.    .. 2001.Herpes Simplex Virus  HSV-1 and HSV-2  Both can infect any body area HSV-1 usually infects above the waist   HSV-2 often genital herpes No immunization Transmission by contact with lesion Painful vesicular lesions Copyright © 2007. an affiliate of Elsevier Inc. Inc.

2001. 1994 by Mosby.Lice and Scabies  Potential health hazards for emergency care providers  Potential vectors of communicable skin disease and systemic illness Copyright © 2007. an affiliate of Elsevier Inc. . 2006. Inc..

Inc. 2001. bedding Copyright © 2007. wingless insects Ectoparasites Pubic or body louse Eggs hatch in 7-10 days Produce red macule and itching Treatment   Eradicate nits Treat body. 1994 by Mosby.Lice       Small. 2006. .. clothes. an affiliate of Elsevier Inc.

Scabies         Mite Parasite Bites concentrated around hands and feet Passed by intimate contact Contact with infested clothes or bedding Severe itching at night Secondary infection possible Treat as for lice Copyright © 2007. . Inc. 2006. an affiliate of Elsevier Inc. 2001. 1994 by Mosby..

.. Inc. an affiliate of Elsevier Inc. 2001.Pubic (Crab) Louse Copyright © 2007. 2006. 1994 by Mosby.

an affiliate of Elsevier Inc.. 2001. 2006.Male Human Head Louse Copyright © 2007. 1994 by Mosby. . Inc.

1994 by Mosby. blood products. parenteral contact with blood. Inc. 2006. nonintact skin. 2001. or other potentially infectious materials  Whom to report to Medical evaluation and follow-up   Steps involved  Written report and confidentiality Copyright © 2007. mucous membrane. bloody body fluids. mouth. ..Reporting an Exposure  Report suspected exposures to designated officer  Significant exposure is eye. an affiliate of Elsevier Inc.

wait until lesion is crusted and dry Are jaundiced    Have mononucleosis Copyright © 2007. 1994 by Mosby. . 2001. Inc. an affiliate of Elsevier Inc.Don’t Go to Work if You…  Have diarrhea Have a draining wound or any type of wet lesion.. 2006.

an affiliate of Elsevier Inc. . wear a surgical mask to protect your patients   Copyright © 2007. 2006. 2001.. 1994 by Mosby. Inc.Don’t Go to Work…  If you have not been treated for lice or scabies Until you have been taking antibiotics for 24 hrs for strep throat If you have a cold and you must go to work.

if appropriate to your occupational/recreational risk Copyright © 2007. 2006. 1994 by Mosby. 2001. Inc. an affiliate of Elsevier Inc..Preventing Disease Transmission  Current immunization status  MMR  Hepatitis B. A (if appropriate)  DPT  Polio  Chickenpox  Influenza (seasonally)  Rabies. .

1994 by Mosby. . Inc. 2006. an affiliate of Elsevier Inc..Preventing Disease Transmission  Approach with caution Control scene Observe BSI:        Wear gloves If chance of splash: • Protective eyewear or face shield If large volumes of blood possible: • Gown If possible TB patient: • Particulate mask Wash hands Copyright © 2007. 2001.

. . 2006. 1994 by Mosby. Inc. 2001. an affiliate of Elsevier Inc.Preventing Disease Transmission  Don’t treat patients differently because there is a possibility of an infectious process Don’t avoid doing things for your patients if you think they have a communicable disease  Copyright © 2007.

2001. . an affiliate of Elsevier Inc.Preventing Disease Transmission  After calls. 1994 by Mosby. tuberculosis    Also kill hepatitis viruses Any soap kills HIV High-level disinfection on laryngoscope blades Copyright © 2007.. 2006. Inc. disinfect equipment and patient compartment with a disinfectant that kills M.

Inc. 2001. 2006. .. wash separately Report exposure to designated officer Copyright © 2007. an affiliate of Elsevier Inc. scabies. ticks. 1994 by Mosby. or other insect vectors:     Spray stretcher and patient compartment with insecticide Wipe off/mop up insecticide residue Bag linen separately • Ensure it is not taken home.Preventing Disease Transmission  After call with lice.

an affiliate of Elsevier Inc. Inc. 1994 by Mosby. ..Conclusion Emergencies involving infectious and communicable diseases are common in the prehospital setting and can pose a significant health risk to EMS providers. Copyright © 2007. 2006. 2001.

2001.. . Inc. an affiliate of Elsevier Inc. 2006.Questions? Copyright © 2007. 1994 by Mosby.