Populations Exam 4

Foodborne Illnesses

Any illness resulting from the consumption of contaminated food, bacteria, viruses, parasites, chemical or natural toxins, poisonous mushrooms.

PulseNet

National program - Conducts molecular surveillance using DNA fingerprinting to serotype and subtype pathogens

Steps to diagnosis foodborne illness

risk factors for foodborne illness

Crowding

Eating chicken!

Poor hygiene

Childcare centers

Healthcare facilities, especially long-term care facilities

Eating raw/undercooked meats or fish

Ingesting raw/unpasteurized mild or dairy products

Working with animals or animal products

Traveling to developing countries

Abusing drugs

Having children in daycare or school

Investigation must go through a 72 hour meal history

s/sx foodborne illness

depends on causative agent, GI bugs cause - nausea, vomiting, abd cramps, diarrhea -> must be 2 or more persons not in same household

foodborne illness criteria

must be 2 or more persons not in same household

foodborne illness danger s/sx

Bloody diarrhea

Stiff neck with HA and fever

Excessive diarrhea/vomiting

When do I go back to work? vomiting and diarrhea

gone for 24 hours

Norovius return to work

72 hours

When do I go back to work? sore throat

restricted 24 hours antibiotics, neg throat culture or free from Strep infection

reportable food borne illnesses (big 5)

salmonella, shigella, E coli, hep A, norovirus

Norovirus

most common - 93% of viral gastroenteritis (causing severe puking and pooping AKA SHUKING)

cruise ships, undercooked veggies

Hepatitis A

2-6 weeks post exposure with fecal matter

Liver issues, pale/yellow skin, itchiness

Rotavirus

Foodborne transmission only 1% of cases

By the age of five, nearly every child in the world has been infected with rotavirus at least once. However, with each infection, immunity develops, and subsequent infections are less severe; adults are rarely affected

Shigellosis – “Bacterial Dysentery”

Often from stool on hands, swimming pools; incubation 1-3 days, lasts 5-7 days

Abdominal cramps, fever, often bloody diarrhea 10-30x/day

Salmonella

bacteria attach to GI lining produce toxins and attack the intestinal cells, can survive weeks in frozen water

diarrhea, fever, abdominal cramps within 2 hours to 4 days of ingesting bacteria

Cipro treatment

E. Coli

Produce SHIGA toxin STEC. Healthy organism and unhealthy ones in intestine; 24 hours incubation

low fever, nausea, vomiting, stomach cramps, bloody diarrhea, hemolytic urea syndrome (HUS), thrombotic thrombocytopenia purpura (TTP); “Traveler’s diarrhea” but worse

tx: abx ONLY if septic

Clostridium perfringens

Gram-positive bacterium; normal component of decaying vegetation, marine sediment

Sudden onset (6-24 hr) of colic and diarrhea, maybe nausea; vomiting and fever unusual; rarely fatal; duration 1 day or less

Campylobacter

undercooked poultry or raw milk

vomiting, diarrhea, fever 2-5 days after exposure: rare case leads to Guillain-Barr Syndrome

Increasingly resistant to fluoroquinolones

Staphylococcus Aureas

Food handlers main source of food contamination-especially with foods requiring a bit of handling

sudden onset, 30min-7hr, diarrhea

listeria

Fever, pains, miscarriage, deadly for babies

Especially bad if pregnant

Soft cheeses, Ice creams - contaminated machinery, unpasterized milk, contaminated fruits and vegetables

Toxoplasma gondii

from cats

infection in healthy persons is asymptomatic or mild 'flu-like' sx: headache, muscle aches-can last several weeks; moms can pass on to unborn child leading to death or teratogenic effects

Mushroom toxins

Found in several species of wild mushrooms

Number of cases low

Cases are sporadic

Large outbreaks are rare

Remember SLUDGE from Pharm?

›Muscarinic poisoning: salivation, tearing, bronchospasm, diarrhea, bradycardia, hypotension, CV collapse

atropine treatment

Typical course of foodborne illness

most are self-limiting, supportive care -> rest, rehydration, education

5 Keys to safer food

keep food clean, seperate raw and cooked foods, cook thoroughly, keep food at safe temp, use safe water and materials, wait 24 hours of no s/sx before going to work

keeping water safe

run water for 60 seconds, replace corrosive water systems, clean aerator, replace filters, test wells yearly

Waterborne Disease

›Cholera

›Typhoid.

›Bacterial dysentery

›Giardia lamblia

›Crytosporidiosis

Giardia – Beaver Fever

Diarrhea

Greasy stools that tend to float

Stomach or abdominal cramps

Upset stomach or nausea/vomiting

Dehydration (loss of fluids)

Giardia loves sugar and alcohol

Treated with Flagyl - no alcohol with Flagyl

Stool culture

›Should be requested if diarrhea lasts more than 1 day or if

- Bloody diarrhea

- Weight loss

- Diarrhea leading to dehydration

- Fever

- Prolonged diarrhea (3 or more unformed stools per day for several days)

- Neurologic involvement (parathesias, motor weakness, cranial nerve palsies)

- Sudden onset of nausea, vomiting and/or diarrhea

- Severe abdominal pain

three most common STDs

chlamydia, HPV, trichomoniasis

high risk group for STIs

Have multiple sexual partners

Do not use a condom during sex

Have other STDs

Have a sexual partner who has had an STD

Burden of disease for STIs

chlamydia, gonorrhea and syphilis all curable but if wait then causes longerm problems

Reportable STDs

Chlamydia, HIV, gonorrhea, syphilis

Expedited Partner Therapy

co treatment for chlamydia or gonorrhoeae (treat both pt and partner)

Gonorrhea

bacterial infection, genitals and anus, most people have no s/sx, discharge or burning in urination

Gonococcal pharyngitis

feels like strep throat, purulent discharge

Neonatal gonorrhea of the eye

TX: Oral antibiotics can cure the infection; tx both partners; abstain from sex until gone; test for other STDs; can cause pelvic inflammatory disease in women and infertility. Cephalosporins (Rocephin) + azyrthomicin (macrolide)

Antibiotic resistant gonorrhea

One of the top Seven deadliest superbugs!!!!

Trichomoniasis - trich

smells like fish, copius discharge, bleeding or spotting, tx flagyl

Chlamydia

hand in hand with gonorrhea, silent disease, 5 times more likely to get HIV

Reiter's Syndrome- "Reactive Arthritis"

Systemic Chlamydia and other

bacteria can cause this reactive

arthritis following the bacterial

infection; conjunctivitis, arthritis

(ankles and knees), urination issues

Primary Syphilis

chancre is painless, single, firm; non itchy ulceration/clean base, TX pcn

Secondary syphillis

rash

Tertiary Syphilis

Gumma, found in brain, heart, skin, bone, testis "balls of inflammation; grow and damage tissue; when contacting bone very painful leave major scars

Congenital Syphillis

ÒNearly half of all children infected with syphilis while they are in the womb die shortly before or after birth.

ÒNo bridge to nose (saddle nose)

Herpes

Type 1 Cold sores/fever blisters

Type 2 genital

no cure

Acyclovir may reduce symptoms

Can self-inoculate

Genital warts

Warts form around cervix, vulva, urethra, glans penis, and anus and anal canal

ÒMajority caused by Viruses HPV-6 and HPV-11

crotherapy

granuloma inguinale

new overseas sti

North Korea is pretty dark

We need to nuke it so that it glows toxic green at night

Pan American Health Organization

Quasi-independent branch of WHO

25 member countries in Western Hemisphere

United Nations Children's Fund (UNICEF)

Concentrates its efforts in maternal and child health

Agency of the UN

Focus:

•Communicable diseases

•Primary prevention

•Fresh water

•Safe food supplies

•Health education for mothers of children

•Education for girls

•Immunization programs

World Bank

35-40 year repayment period on loans

Major resource for developing countries to provide safe environment for people

•Safe water

•Adequate housing

•Proper agricultural techniques

•Improved sanitation

Agency for International Development (USAID)

Arm of the US State Department

“USAID's work advances U.S. national security and economic prosperity, demonstrates American generosity, and promotes a path to recipient self-reliance and resilience.”

Provides expertise and funding to countries needing economic development

Doctors Without Borders (MSF)

Non govermental

•Founded in France in 1971

•Provides medical care to people in more than 80 countries

•Provides both health personnel & supplies to people caught in wars, refugees, displaced persons, & victims of natural disasters

•Provides long-term assistance in countries with little or no health care delivery systems such as Sudan and Ethiopia

•Staff is composed primarily of volunteers: doctors, nurses, and other medical professionals

The Carter Center

established by President Jimmy Carter

neglected diseases

Committed to

promoting human rights

and

improving health

–Improving food production

–Promotes peace

Carter center diseases

•Elimination of guinea worm disease,

lymphatic filariasis,

river blindness,

schistosomiasis

The Bill and Melinda Gates Foundation

•Endowed initially by $220 million donated by Bill & Melinda Gates

•In 2006 Warren Buffett donated $34.7 billion worth of shares

•Annual budget for global health alone is $800 million – same as WHO

WHO ungraded

an event that is being assessed, tracked or monitored by WHO but that requires no WHO response at the time

WHO grade 1

a single or multiple country event with minimal public health consequences that requires a minimal WCO response or a minimal international WHO response.

WHO Grade 2

a single or multiple country event with moderate public health consequences that requires a moderate WCO response and/ or moderate international WHO response.

WHO Grade 3

a single or multiple country event with substantial public health consequences that requires a substantial WHO response and/ or substantial international WHO response.

lobal goals (for essay)

Poor nutrition leads lifetime issues with

•Stunting

• Susceptibility to disease

• Susceptibility to intestinal parasites

•Anemia

•Lethargy and apathy

Globesity

1 billion overweight or obese worldwide

Costs us $147 billion a year in the U.S.

A crisis of "epidemic" proportions (WHO)

Major threats in war

Fatal injuries

Antibiotic resistance

Infectious diseases (Ebola in Congo)

Disruptions in food supply

Lack of sanitation and water supply

Rebuilding health care services

Health issues in war regions

Mass immunization needs

Long-term malnutrition and dehydration

Uranium exposure

Landmines

Child soldiers

Displaced persons

Mental health issues

Rape

Mental illness and disability

Accounts for 30% of disability worldwide

Replacing Millennium Goals: Global Goals (for essay)

https://sdgs.un.org/goals pick a few headlines and say youre working towards it

Neglected Tropical Diseases

diverse group of communicable diseases in tropical and subtropical conditions in 149 countries

Rabies, Chagas Disease, Dengue, Hanson's, Guinea

Guinea Worm success

Being wiped out through filtering water, and changing people's behavior

Hanson's Disease- Mycobacterium Leprae (leprosy)

95% of humans immune, common with people who work/eat armadillos, wil take millennia to get rid of, reprograms liver of armadillo and causes liver to regrow

is a treatment

Polio

goal to eradicate it, for every 200 wpv1 only results in 1 symptomatic polio, aka hard to get rid of

Malaria

4 different types, 1 million annual deaths, vaccine pilot, spread by mosquitos,

mosquitos

carry 35 diseases

Quinine

used in tx of malaria, can be used to cut heroine

Symptoms of malaria

3 stages

10-16 days after bite, Symptoms coincide with RBC cell rupture at known time pattern - fever

With P. vivax malaria, the person may feel fine between attacks. Even without treatment, the paroxysms subside in a few weeks

with P. falciparum malaria, however, is likely to feel miserable even between attacks and, without treatment, may die

Malaria stages

First stage: chills, HA, fatigue, N and V, diarrhea - all lasts 1-2 hours

Second stage: fever, skin feels hot and dry.

Third stage: fever breaks with drenching sweat, weakness and may actually sleep.

Severe cases: anemia, jaundice, seizures, confusion,

kidney failure, ARDS, coma, death

Dengue Fever Virus

breakbone fever, spread by mosquitos, type of flavovirus, dengue likes urban environments,

Dengue Fever Virus s/sx

breakbone fever, high fever, rash, fatigue, headache, muscle aches, nausea, swollen lymph nodes

Hermans sign

no ibuprofen or asprin

Hermans sign

dengue fever, hand print stays on rash

treatment for dengue

tylenol, prevent dehydration, watch for hemorrhagic form akak blood in paces it shouldn't

Chikungunya Virus

hard to distinguish from dengue, tylenol only

Zika virus

also found in semen, spread by mosquitos, problems with pregnant people

Cholera

fecal-oral route, shit out your own intestines villi, disease of the poor

>1L poop a hour

vaccine available

Typhoid fever

can be deadly, highest risk in southern asia, fecal oral route

treat with abx

typhoid fever s/sx

fever, diarrhea, rose spots, spontaneously resolves 2-5 days, blanching rash

non blanching rash - remember for life not on exam

meningitis

Advice for Travelers to stay Healthy

Boil it, cook it, peel it, or forget it

TB and abx

not easily treated with simple antibiotic

2/3 of all TB case countries

India (highest rate), china, indonesia, russia, philippines, pakistan, nigeria, bangladesh, south africa

Rnot TB

3.5

s/sx of active TB

Fever, night sweats, weight loss

Who should get tested for TB?

Slides 7-9 of TB/HIV slides will be on exam

yup

Who really needs to get tested? High Risk for Exposure

•Close contacts of a person who has active TB

•Employees of correctional facilities and nursing homes

•Health care workers working with certain populations

•Medically Underserved & Low Income

–Native Americans, African Americans, Migrant workers, Homeless

•Immigrants

– From countries with high incidence rates

India (lead), China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh, South Africa, Russia

Latent TB

no s/sx, does not feel sick, cannot spread, can tst positive, normal chest xray and negative smear, needs treatment to prevent active TB

Active TB

has s/sx, feels sick, may spread TB to others, tsts positive, positive xray and smear, needs treatment

Who is at risk of developing Active Disease once Infected?

•Immunosuppressed

-HIV infection

-Prolonged steroid

tx or other

immunosuppressive drug

•Chronic Disease

-Diabetes

-Cancer

-COPD

•Poor Nutrition

-alcoholics

What is the risk of developing TB disease over a lifetime

no risk factors have 5% risk in first 2 years and 10% risk over lifetime

30% with diabetes

TB treatment

use multiple drugs:

Isoniazid

rifampin - (causes orange pee)

pyrazinamide

ethambutol