Module 11 MicroPara continuation

b. VIRAL i. Circulatory system 1. Cytomegalovirus - infections in healthy individuals are asymptomatic with the virus remaining - major cause of morbidity and mortality in HIV-infected patients CAUSATIVE AGENT: Cytomegalovirus (CMV) – member of the human herpesvirus family. MODE OF TRANSMISSION: Sexual contact, close personal contact, blood-to-blood contact, organ transplantation, perinatal transmission SIGNS & SYMPTOMS: The patient may present with symptoms involving various organ systems, including the CNS and GI tract. MANAGEMENT: ✔ Educate patients about the importance of medication therapy. ✔ Ganciclovir, Valganciclovir, Foscarnet and Cidofovir may be effective for treating CMV. PREVENTION AND CONTROL: Avoid personal contact with infected individuals. 2. Dengue - (break-bone fever) is a viral infection that spreads from mosquitoes to people. It is more common in tropical and subtropical climates. CAUSATIVE AGENT: Aedes aegypti mosquito (vector) MODE OF TRANSMISSION: The dengue virus is transmitted to humans through the bites of infected female mosquitoes, primarily the Aedes aegypti mosquito. Other species within the Aedes genus can also act as vectors, but their contribution is normally secondary to Aedes aegypti. SIGNS & SYMPTOMS: ● high fever (40°C/104°F) Page 10 of 12 ● severe headache ● pain behind the eyes ● muscle and joint pains ● nausea ● vomiting ● swollen glands ● rash. MANAGEMENT: ● There is no specific treatment for dengue. The focus is on treating pain symptoms. Most cases of dengue fever can be treated at home with pain medicine ● Acetaminophen (paracetamol) is often used to control pain. Non-steroidal anti-inflammatory drugs like ibuprofen and aspirin are avoided as they can increase the risk of bleeding. ● For people with severe dengue, hospitalization is often needed. PREVENTION AND CONTROL: The mosquitoes that spread dengue are active during the day. Lower the risk of getting dengue by protecting yourself from mosquito bites by using: ● clothes that cover as much of your body as possible; ● mosquito nets if sleeping during the day, ideally nets sprayed with insect repellent; ● window screens; ● mosquito repellents; and ● coils and vaporizers. Mosquito breeding can be prevented by: ● preventing mosquitoes from accessing egg-laying habitats by environmental management and modification; ● disposing of solid waste properly and removing artificial man-made habitats that can hold water; ● covering, emptying, and cleaning domestic water storage containers every week; ● applying appropriate insecticides to outdoor water storage containers. If you get dengue, it’s important to: ● rest; ● drink plenty of liquids; ● use acetaminophen (paracetamol) for pain; ● avoid non-steroidal anti-inflammatory drugs, like ibuprofen and aspirin; and ● watch for severe symptoms and contact your doctor as soon as possible if you notice any. 3. Malaria - (aka KING OF TROPICAL DISEASE, AGUE/MARSH FEVER) CAUSATIVE AGENT: Protozoa of genus plasmodia a. Plasmodium falciparum (Malignant tertian) ● most serious because of the development of high parasitic densities in blood; with a tendency to agglutinate and form microemboli ● most virulent form Page 11 of 12 ● no dormant stage b. Plasmodium vivax (Benign tertian) ● non-life threatening except to the young and old ● can remain dormant in the liver c. Plasmodium malariae (Quartan) ● non-life threatening ● no dormant phase but can persist as low-level infection for up to 30 years d. Plasmodium ovale ● rarely seen in the Philippines ● can remain dormant in the liver for 6-11 months MODE OF TRANSMISSION: Bite of female Anopheles Mosquito, parenterally through Blood Transfusion, occasionally through contaminated needles, and Transplacental transmission is a rare cases ● It breeds in clear, flowing, and shaded streams usually in the mountains. ● It is bigger than an ordinary mosquito. ● It is brown. ● It is a night-biting mosquito. ● It usually does not bite a person in motion. ● It assumes a 36° position when it alights on walls, trees, curtains, and the like. SIGNS & SYMPTOMS: a. Prodromal Phase ● headache, anorexia, nausea, fatigue, muscle pain, anemia b. Actual Attack ● Cold stage - chills, shaking of body, and chattering of chin ● Hot stage- fever of 41ºC, skin becomes red and warm ● Diaphoretic stage- excessive sweating, body weakness MANAGEMENT: ● Anti-malarial drugs ● Chloroquine– DOC for all except p. malariae ● Quinine – WOF neurotoxicity ● Watch for neurotoxicity (Quinine infusion): muscle twitching, delirium, confusion, convulsion, coma ● Sulfadoxine for the resistant P. falciparum ● Primaquine for relapses of P. vivax and ovale ● Antipyretic ● Erythrocyte exchange transfusion for rapid production of high levels of parasites in the blood PREVENTION AND CONTROL: ● Mosquito breeding places must be destroyed. ● On stream clearing: cutting of vegetation overhanging along stream banks to expose breeding stream to sunlight ● Homes should be sprayed with effective insecticides which have residual actions on the walls. Page 12 of 12 ● Mosquito nets should be used especially when in infected areas. ● Prophylactic treatment for those in endemic areas – Pyrimethamine/ Sulfadoxine (Fansidar) ● Chemoprophylaxis ● Chloroquine 2 weeks before departure to an endemic area and be continued for 4 weeks after return ● Other preventive measures (DOH/ Malaria Control Service) ● Wearing of clothing & other personal protective measures ● Avoiding outdoor night activities, particularly during the vector’s peak biting hours ● Using mosquito repellants (mosquito coils, soap/lotion) ● Planting of Neem Trees or other herbal plants ● Zooprophylaxis – raising of domestic animals like the carabao, cow etc. ● People living in malaria-infested areas should not donate blood for at least 3 yrs. ● Proper screening of blood donors ii. Nervous System 1. Rabies - a.k.a Hydrophobia, Lyssa - a deadly viral infection that is mainly spread by infected animals CAUSATIVE AGENT: Rhabdo Virus MODE OF TRANSMISSION: Through infected saliva that enters the body through a bite or broken skin SIGNS & SYMPTOMS: Anxiety, stress, drooling, convulsions, excitability, loss of feeling in an area of the body, loss of muscle function, muscle spasms, restlessness, swallowing difficulty MANAGEMENT: ● First aid in animal bites ○ Immediately wash the bite vigorously with soap and water for ten minutes to remove animal saliva ○ Flush the wound with a virucidal agent followed by a clear water rinse. ○ Apply sterile dressing ○ Don’t suture wounds. Don’t stop bleeding unless it’s massive. ○ Get the history of the bite. ○ Consult local health authorities for treatment information. PREVENTION AND CONTROL: Immunization and Patient isolation Iii. Gastrointestinal System A. HEPATITIS - characterized by the inflammation of the liver - symptoms vary significantly depending on the cause and the overall health of the infected individual Page 13 of 12 - six types (HEPA A, HEPA B, HEPA C, HEPA D, HEPA E & HEPA G) CAUSATIVE AGENT: Hepatitis Virus MODE OF TRANSMISSION: ⮚ Type A & E – fecal-oral route ⮚ Type B – parenteral route/sexual contact/ transplacental ⮚ Type C – needle-sharing/ blood transfusion/ sexual contact ⮚ Type D - parenteral route/ sexual contact/ person-person/ household contacts ⮚ Type G – parenteral route SIGNS AND SYMPTOMS: General weakness, fatigue, loss of appetite, nausea, fever, abdominal pain and tenderness, jaundice MANAGEMENT: ✔ Supportive and symptomatic care. ✔ Complete bed rest, or moderate activity as tolerated. ✔ Avoid alcohol and hepatotoxic drugs. PREVENTION AND CONTROL ✔ Safe and effective vaccines are available to prevent HEPA A & B. C. BACTERIAL i. Gastrointestinal System 1. Staphylococcal Food Poisoning - a.k.a. Staphylococcal Enterotoxicosis - is a leading cause of gastroenteritis caused by ingestion of enterotoxin produced by S. aureus. CAUSATIVE AGENT: Staphylococcus aureus MODE OF TRANSMISSION: food-borne transmission SIGNS & SYMPTOMS: nausea, vomiting, fever, abdominal cramps, diarrhea, dehydration MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Proper food handling and preparation. ✔ Keep kitchens and food-serving areas clean and sanitized. ✔ Store cooked food in a wide, shallow container and refrigerate as soon as possible. 2. Salmonellosis - a.k.a. Salmonella Gastroenteritis CAUSATIVE AGENT: Salmonella typhimurium and Salmonella enteritidis - rod-shaped, flagellated, gram-negative bacilli MODE OF TRANSMISSION: ingestion of contaminated foods; infected animal feces Page 14 of 12 SIGNS & SYMPTOMS: nausea, vomiting, fever, abdominal cramps, bloody diarrhea with mucus, dehydration MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Cook poultry, ground beef, and eggs thoroughly. ✔ Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry. ✔ Avoiding direct contact with animal carriers and washing hands contact with pet feces. 3. Typhoid Fever - a.k.a. Enteric Fever CAUSATIVE AGENT: Salmonella typhi – motile, gram-negative bacillus MODE OF TRANSMISSION: ingestion of contaminated food and water Vehicle of transmission: 5 Fs: feces, food, flies, fomites, fingers SIGNS & SYMPTOMS: ladder-like fever, malaise, diffuse abdominal pain, constipation, rose spots, coma vigil look, subsultus tendinum, carphologia MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Sanitary disposal of human feces. ✔ Careful food preparation and washing of hands. ✔ Avoid risky foods and drinks such as street foods. ✔ Vaccination against typhoid fever. 4. Cholera - a.k.a. “El Tor” CAUSATIVE AGENT: Vibrio cholerae – motile, gram-negative bacillus MODE OF TRANSMISSION: fecal-oral route SIGNS & SYMPTOMS: painless profuse rice watery stools, vomiting, acute colicky abdominal pain, tachycardia, weakness, fatigue, dry mucous membranes, loss of skin elasticity, hypotension MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Water purification. ✔ Sanitary disposal of feces. ✔ Cook food well, especially seafood. ✔ Vaccination. ii. Gastroenteritis - is a condition that causes irritation and inflammation of the stomach and intestines. Page 15 of 12 CAUSATIVE AGENTS: ● Escherichia coli – flagellated, gram-negative bacillus ● Campylobacter jejuni – spiral-shaped gram-negative bacillus ● Clostridium perfringes – a large, gram-positive, endospore-forming, obligatory anaerobic bacillus MODE OF TRANSMISSION: ingestion of raw or contaminated food, particularly meat, poultry, and unpasteurized milk SIGNS & SYMPTOMS: low-grade fever, nausea, vomiting, diarrhea, crampy abdominal pain MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Thorough washing of hands after handling raw foods of animal origin and before preparing food. ✔ Proper handling, storage, and preparation of food. ✔ Prevent cross-contamination in the kitchen. ✔ Do not drink unpasteurized milk. iii. Urinary System 1. Cystitis - a most common type of urinary tract infection that involves inflammation of the urinary bladder. CAUSATIVE AGENT: Escherichia coli usually bacteria enter the bladder via the urethra MODE OF TRANSMISSION: It's not always obvious how the bacteria get into the bladder, but it can be caused by: having sex. wiping your bottom after going to the toilet – particularly if you wipe from back to front. inserting a tampon or urinary catheter (a thin tube inserted into the urethra to drain the bladder) SIGNS & SYMPTOMS: dysuria, pyuria, pressure or cramping in the lower pelvis, urinary urgency MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Keep the genital area clean and wipe from front to back. ✔ Drink plenty of fluids to allow for frequent urination. ✔ Take showers instead of baths. Avoid bath oils. ✔ Urinate before and after sexual activity. iv. Circulatory System 1. Septicemia Page 16 of 12 - a.k.a. Blood poisoning; Bacteremia with sepsis; Systemic Inflammatory Response Syndrome (SIRS) - is the presence of bacteria in the blood and is often associated with severe infections. CAUSATIVE AGENT: Almost any type of germ can cause septicemia. The ones most often responsible are bacteria, including Staphylococcus aureus. Streptococcus pneumoniae. MODE OF TRANSMISSION: Spread of any infection to the bloodstream SIGNS & SYMPTOMS: Spiking fevers, chills, rapid breathing, rapid heart rate, fever MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Call the health care provider if child's vaccinations are not up-to-date. ✔ Appropriate treatment of localized infections. 2. Rheumatic Fever - is a non-infectious inflammatory disease that may develop after an infection with Group A beta-hemolytic streptococcal (GAS) infection. CAUSATIVE AGENT: Streptococcus pyogenes- a spherical, Gram-positive bacterium that is the cause of Group A streptococcal infections MODE OF TRANSMISSION: Inadequately treated Group A beta-hemolytic streptococcal (GAS) infection of the upper respiratory tract SIGNS & SYMPTOMS: Carditis, chorea, arthritis, erythema marginatum, subcutaneous nodules, fever, arthralgia MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ Bed rest. ✔ Increase oral fluid intake. ✔ Get quick treatment for strep throat and scarlet fever. 3. Anthrax - a.k.a. Woolsorter's disease; Ragpicker's disease; Cutaneous anthrax; Gastrointestinal anthrax CAUSATIVE AGENT: Bacillus anthracis - a microbe that lives in soil. MODE OF TRANSMISSION: There are three main routes of anthrax infection: direct contact, inhalation, and ingestion of anthrax-tainted meat. Anthrax does not spread from person to person. SIGNS & SYMPTOMS: Cutaneous anthrax: itchy painless sore develops that is similar to an insect bite; Inhalation anthrax: fever, malaise, headache, cough, shortness of Page 17 of 12 breath, and chest pain; Gastrointestinal anthrax: abdominal pain, diarrhea, fever, mouth sores, nausea and vomiting MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: ✔ For people who have been exposed to anthrax (but have no symptoms of the disease), doctors may prescribe preventive antibiotics, depending on the strain of anthrax. ✔ Vaccination of people at a high risk. 4. Lyme Disease - a.k.a. Borreliosis; Bannwarth syndrome CAUSATIVE AGENT: Borrelia burgdorferi MODE OF TRANSMISSION: Bite of an infected Ixodes tick. SIGNS & SYMPTOMS: Body-wide itching, "bulls eye" rash, chills, fever, general ill-feeling, headache, light-headedness or fainting, muscle pain, weakness, stiff neck, abnormal muscle movement, joint swelling in the knees and other areas MANAGEMENT: ✔ Antibiotic therapy ✔ Swollen joints can be reduced by Arthrocentesis. ✔ Spray all exposed skin and clothing with insect-repellant PREVENTION AND CONTROL: ✔ Wear light-colored clothing to make it easier to spot ticks ✔ Wear long-sleeved shirts and long pants with the cuffs tucked into shoes or socks ✔ To remove a tick: use tweezers to grasp the tick firmly at its head or mouth, next to the skin; pull firmly and steadily on the tick until it lets go of the skin; and lastly, swab the bite site with alcohol. v. Nervous System 1. Botulism - a.k.a. Botulinus intoxication - Botulism is a rare but serious illness that may be acquired from improperly canned or preserved foods. CAUSATIVE AGENT: Clostridium botulinum is a Gram-positive, rod-shaped bacterium that produces neurotoxins. MODE OF TRANSMISSION: Ingestion of the neurotoxin SIGNS & SYMPTOMS: Absent or decreased deep tendon reflexes, absent or decreased gag reflex, eyelid drooping, speech impairment, abdominal cramps, breathing difficulty, difficulty swallowing and speaking, bilateral weakness or paralysis MANAGEMENT: Antibiotic therapy PREVENTION AND CONTROL: Page 18 of 12 ✔ Removal of contaminated food in the gut through induced vomiting or enemas ✔ NEVER give honey or corn syrup to infants younger than 1 year old -- not even just a little taste on a pacifier. ✔ Prevent infant botulism by exclusively breastfeeding, if possible. ✔ Always throw away bulging cans or foul-smelling preserved foods. D. FUNGAL i. Gastrointestinal System 1. Ergot Poisoning - a.k.a. Ergotism; Ergotoxicosis; St. Anthony’s Fire - proposed explanation of bewitchment CAUSATIVE AGENT: Claviceps pupurea - fungus which infects rye & other cereals MODE OF TRANSMISSION: ingestion of products containing the fungus; consumption of grains or seeds contaminated by the fungus SIGNS & SYMPTOMS: ● convulsive stage – painful seizures & spasms, hallucinations, diarrhea, paresthesias, itching, headaches, nausea & vomiting ● gangrenous stage – weak peripheral pulses, loss of peripheral sensation, edema, death & loss of affected tissues, desquamation or peeling, dry gangrene in the fingers & toes PREVENTION AND CONTROL: ✔ Avoid eating rye & other cereal grains. ✔ Promote blood circulation by exercising regularly. ✔ Drink plenty of water at least eight glasses a day for proper hydration. ✔ Eat green leafy vegetables, whole grains, legumes, fish & poultry in small portions. 2. Aflatoxin Poisoning - a.k.a. Aflatoxicosis - a disease condition brought about by exposure to Aflatoxin - Aflatoxin is likely to be found in peanuts - produced by molds that can damage the liver & cause liver cancer - they were used as “cancer bombs” in Iraq CAUSATIVE AGENT: Aspergillus flavus - common mold which produces Aflatoxin (mycotoxin) - found in harvest during warm temperatures & high humidity - proliferates before & after harvest - affects seeds, and grains, including peanuts, corn & several nuts MODE OF TRANSMISSION: Ingestion of products containing the fungus such as peanuts SIGNS & SYMPTOMS: vomiting, abdominal pain, hemorrhage, pulmonary edema, acute liver damage, acute loss of function of the digestive tract, convulsions, cerebral edema & death PREVENTION AND CONTROL: Page 19 of 12 ✔ Buy only major brands of nuts & nut butter. ✔ Discard any nuts that are cold, moldy, discolored, or shriveled. ✔ Rapidly dry the harvest which could help in minimizing fungal growth. ✔ Careful sorting of the harvest to remove damaged kernels or nuts. ✔ Adsorbent: Activated charcoal 3. Candidiasis - a.k.a. Yeast infection; Candida, Thrush, Candidosis, Moniliasis - it can infect the mouth, vagina, skin, stomach & urinary tract - occurs in warm & moist body areas - common in baby’s mouth & nappy areas CAUSATIVE AGENT: Candida albicans - forms large, round, white, or cream-like colonies with a yeasty odor - ubiquitous fungi - yeast that normally lives in the vagina & other places in the body - limited by the lymphatic system & other bacteria in the body MODE OF TRANSMISSION: Overgrowth of candida from a pregnant woman to her child during pregnancy or breastfeeding SIGNS & SYMPTOMS: creamy white patches in the mouth or on the throat (oral thrush), painful cracks at the corner of the mouth (oral thrush), skin rashes, patches & blisters, vaginal itching & irritation with white discharge *commonly seen in infants but is abnormal if it is longer than 2 weeks PREVENTION AND CONTROL: ✔ Studies suggest that reducing sugar in the diet may help prevent the yeast infection. ✔ Reduce intake of milk, dairy products & foods with high concentrations of yeast. ✔ Increase intake of vitamin C. ✔ Avoid overuse of antibiotics which kill off the friendly bacteria. ✔ Wear cotton underwear, maintain good hygiene & stay at the proper weight. ✔ Women should avoid douches & vaginal deodorant.