Module 2: Community Acquired Infections

What type of virus is Norovirus?

RNA virus

RNA virus characteristics

spread faster

mutates more

smaller size

Norovirus transmission

VERY CONTAGIOUS

fecal-oral, vomitus-oral

contaminated food, water, surfaces

Precautions for norovirus

contact precautions

wash with soap and water y'all

bleach surfaces

norovirus symptoms

N/V/D

cramps

low grade fever

risk factors for norovirus

pediatrics

known exposure to virus

norovirus diagnosis

PCR (polymerase chain reaction) to detect viral particles - not often done in isolated clinical practice

treatment for norovirus

supportive

ensure hydration - gatorade

norovirus vaccines

none bruh

norovirus immunity duration

2-3 weeks so can get it multiple times

HIV virus type

RNA virus

HIV transmission

contact blood or body fluids

vertical transmission - mother to child in utero, during childbirth, or through breast milk

HIV precautions

standard precautions

HIV symptoms

initial transmission - fever, malaise

HIV risk factors

High risk sexual behavior

Illicit drugs

HIV diagnosis

ELISA

Western Blot

HIV treatment

HAART (highly active antiretroviral therapy) - cocktail of antiretroviral drugs to prevent HIV replication and spread within the system

HIV vaccines

none

PrEP

SARS-CoV-2 virus type

coronavirus (COVID-19)

SARS-CoV-2 transmisttion

droplets

particles in air

SARS-CoV-2 precautions

airborne precautions

SARS-CoV-2 symptoms

Fever, Cough, SOB, Headache, Fatigue, Loss of taste/smell, N/V/D

SARS-CoV-2 risk factors

Age, Chronic dx, Decreased immunity, PREGNANCY

SARS-CoV-2 diagnosis

Antigen test (nasal swab)

PCR

CXR

SARS-CoV-2 Treatment

Antivirals

Nirmatrelvir / ritonavir (Paxlovid)

Steroids (Dexamethasone)

Remdesivir - used in inpatient; paxlovid - used in outpatient

SARS-CoV-2 vaccine recs

every 6 months

influenza virus type

RNA virus

influenza transmission

Droplets

Particles in air

Fomites

influenza precautions

droplet precaution

influenza symptoms

Fever, Cough, SOB, Myalgias

influenza risk factors

Age, Chronic dx, Decreased immunity, PREGNANCY

same as COVID-19

influenza diagnosis

Rapid test

PCR

influenza treatment

Low risk: Supportive

High risk/severe: Antiviral, Olsetamivir (Tamiflu)

influenza vaccine rec

annual vaccine

legionella type

gram negative bacteria

legionella transmission

Droplets from contaminated water or soil

legionella precautions

standard precautions

legionella symptoms

Fever, cough, SOB, N/V/D

legionella risk factors

Age, Chronic dx, Decreased immunity

legionella diagnosis

Antigen test (urine)

PCR

Sputum culture

legionella treatment

Macrolide antibiotic (azithromycin)

legionella vaccine recs

none

parts of the body affected by COVID-19

heart, lungs, pancreas, kidney, GI tract, blood vessels, liver, spleen, brain

potential complications of COVID-19

acute respiratory distress syndrome (ARDS)

thromboembolic events (i.e. PE, CVA, DVT)

acute cardiac injury and shock

increased inflammatory response

increased inflammatory response identification

Persistent fevers, elevated inflammatory markers,

elevated proinflammatory cytokines

long COVID

continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation

most frequently reported symptoms of long COVID

fatigue, shortness of breath, difficulty sleeping, muscle aches, joint pain, brain fog, cardiac complications

PT Considerations - COVID-19

monitor vitals closely and use RPE

acute and post acute specific considerations

utilize outcome measure: 6MWT, 5xSTS

recommend referrals as needed: speech, OT

acute specific PT considerations - COVID-19

early interventions: VTE prevention, breathing and airway clearance techniques, functional mobility, delirium prevention, low intensity ther ex

post acute specific PT considerations - COVID-19

Address deconditioning with attention to patient specific symptoms/impairments

Screen for dysautonomia (POTS)

• Lie down for minimum of 10 min - assess HR

• Stand up and do not walk

• Take HR at 2, 5, and 10 min in standing

• Positive test: increase in HR 30 bpm (40bpm for children/adolescents) or HR elevated >120 bpm (130 bpm for 13-year-old or younger) within first 10

min of standing

pathogenesis of HIV

virus damages the immune system, especially CD4+ T cells

What happens to a cell when it is infected by HIV?

1. cell is killed directly --> HIV disrupts cell membrane during budding + disrupts normal metabolism needed for the survival of the cell

2. apoptosis (cell suicide) --> regulation of cell's machinery and functions become grossly distorted because of HIV replication so the infected cell may undergo apoptosis

HIV disease course

1. transmission

2. acute HIV infection - viral prodrome

- asymptomatic period -

3. chronic HIV infection

4. AIDS

viral prodrome

early non-specific signs and symptoms that often indicate the onset of a disease before more diagnostically specific signs and symptoms develop characterized by rapid viral replication and seroconversion of antibodies

what occurs during the asymptomatic phase of HIV?

Steady state viral load

Progressive decline in CD4 counts

Individual becomes more susceptible to certain infections (candidiasis, folliculitis)

signs HIV is progressing into Acquired immunodeficiency syndrome (AIDS)

CD4<200

AIDS defining conditions present

purpose of Pre-Exposure Prophylaxis (PrEP)

decrease transmission >90%

PrEP indications

High risk for exposure - includes high risk sexual behavior and illicit drug use

Medical clearance - negative HIV and no medical risk factors for complications from medication

Patient adherence - strict adherence required

example of PrEP

Truvada (disoproxil/emtricitabine)

2 types of post exposure prophylaxis (PEP)

nonoccupational (nPEP)

occupational (healthcare)

when would nPEP be administered?

Exposure to known HIV positive individual

Unknown HIV status indications

nPEP treatment length

Must start within 72 hours (with 24 hours best)

28 days of treatment

nPEP regimen

Truvada plus Raltegravir

occupational PEP

high risk exposures

if exposure involves a cut, immediate wound care should be provided

test patient for HIV if they approve to know their status

starting immediate therapy may or may not happen

HIV prevention methods

PMTCT

HIV testing/counseling

PrEP

blood supply screening

microbicides

clean syringes

STI treatment

medical male circumcision

treatment/prevention of drug/alcohol abuse

education/behavior modification

treatment as prevention

condoms