Communicable Diseases, Meningococcal Septicemia, HIV, Influenza, Tuberculosis, SARS Flashcards
changes in Medical Thinking:
Development of public health strategies
• Quarantine
• sanitation
• urban clean ups
• magic bullets -quinine penicillin, antibiotics
•Concealment: China and SARS – Naples and cholera
Ethical issues of human experimentation
Methicillin – Resistant Staphylococcus Aureus Infections
MRSA is a term used to describe a number of strains of bacteria in
particular Staphylococcus aureus that are resistant to a number of
antibiotics including methicillin.
Symptoms most commonly localised to the skin signs of redness, swelling,
pain, pus and area is hot to touch. May progress to become boils,
abscesses , cellulitis.
Patient may also present with signs of sepsis – malaise, febrile, rigors,
SOB, dizziness secondary to hypotension or pneumon
Those at Risk of MRSA:
- People with weak immune systems (HIV/AIDS, cancer patients,
immunocompromised patients) - Young children
- Elderly people
- People staying or working in a health care for prolonged time
- People who spend time in enclosed high population density area
including occupants of homeless shelters, prison inmates, and any
common areas i.e.. Leisure centres/gyms et
Why is MRSA important to paramedics?
Numerous recent studies have been conducted worldwide in testing for the
presence of MRSA in Ambulances.
Outstandingly one study by Kurt B. Stevenson et al. in Southern Maine (USA)
reported 49% of the ambulances in the study had at least one positive area
for MRSA. Other studies report much lower percentages.
Another study by Merlin et al. highlighted the presence of MRSA on medical
practitioners Stethoscopes.
On placement how many times have you seen paramedics disinfect their
stethoscopes after each patient? Yet their partner has disinfected the entire stretcher with VIRKON and hard surfaces while their partner was completing
their VACIS.
Meningococcal Septicaemia;
Bacterial infection leading to sepsis Signs & Symptoms: Neck Stiffness/Joint Pain Altered Conscious State Headache Photophobia Febrile Nausea & Vomiting Tachypnoea Tachycardia (Bradycardia late sign) Hypotension
Which rash is which?
Meningococcal Septicaemia is recognised for its Blue/Purple Rash that is non blanching. Tumbler Test – If a glass (i.e.. Tumbler) is held against the rash the rash will not blanch or change colour.
VS
Urticaria
– Or hives are pale red, raised, itchy bumps resultant from allergic/anaphylaxis reaction\
Hand, foot & Mouth Disease
– body rash followed by sores with blisters on palms of hand, soles of
feet, and sometimes on the lips. The rash is rarely itchy for children, but can be extremely itchy
Severe sepsis/meningococcal septicaemia or meningitis paramedic management:
Is it severe sepsis or is it meningococcal septicaemia or meningitis? Does this
affect our treatment?
PPE! (particularly if advanced airway management is required as it is spread
via airway secretions & droplets. Close contact and breathing in this bacteria
may lead to bacteria penetrating your larynx and nasal passages)
Ceftriaxone
Adult – 1g Ceftriaxone
IM – diluted with 3.5ml lignocaine (1g in 4ml)
IV – diluted with 9.5 ml water for injection (1g in 10ml)
Children – 50mg/kg
IM ONLY! – diluted with 3.5ml lignocaine.
(if >20kg will receive adult dose)
NOTIFY receiving hospital!!
Notify DTM for follow up for possible staff exposure
HIV/AIDS:
Member of the retrovirus family that causes acquired immunodeficiency syndrome (AIDS)
• Essentially progressive deficiency of immune cells, activation, and immune response
Transfer of disease via:
• Blood and body fluids i.e.. Semen, vaginal or cervical secretions
Directly transmitted person to person by:
Anal or vaginal sex
Across the placenta/breast milk
Direct contact with infected body fluids or blood on mucous membranes or open wounds
Indirect Transmission via:
Blood transfusion with whole blood or blood products
Transplanted tissues and organs
Needle-stick injuries or contaminated needles/syringes
Can transmit as either:
• Free virus particles
• Infected immune cells
HIV risk factors:
- High Risk Sexual behaviour – sexual intercourse, particularly anal
sex without use of a condom - IV drug use – especially relating to sharing of needles (decreased
risk through Australian implementation of free needles policies) - Blood or Blood product transfusion recipients prior to routine
screening (1985) - Infants born of HIV positive mother – remains a significant issue
in African countries.
HIV to AIDS:
Most of the HIV infected population die of AIDS:
- Opportunistic infections
- Malignancies
- Cardiovascular disease
Most develop AIDS within 10 years depending on:
- Co-morbidities
- Environmental
- Health care access
Treatment with antiretroviral therapy significantly impacts on clinical
prediction
HIV signs and symptoms:
- Elevated viral load
- Acute infection
- Fever
- Rash
- Malaise+++
- Oesophageal abrasions and lesions
- Latency
- Very few symptoms approx. several years
- AIDS
- Various opportunistic infections
Acute HIV infection:
Introduction of virus
• Rapid viral replication stage
• Peripheral blood may display approx. 1-10 billion replicated viruses
• Extreme depletion of CD4 cells!!
• CD* T cells destroy the infected CD4 cells
• B cell produces antibodies
• Seroconversion
• Rebound CD4 cell re-population
• At this stage most develop an influenza infection!! &
• Constitutional symptoms
Chronic HIV infection:
• Powerful immune response
-Lasts anywhere from approx. 2 weeks -20 years if treated
• Activation of virus within lymph nodes
- Surrounding lymph tissues rich in CD4 population become infect
AIDS:
When CD4 cell numbers reach a critically low level and CMI is completely depleted: • Opportunistic infections ensue: • Respiratory compromise • Rashes • Ulcerations • Tuberculosis • Pneumonia
Super infections with no immunity!
clinical perspective
Opportunistic:
• Infections
• Malignancies
The virus itself supresses the activity of the bone marrow: • Low WBC • Low haemoglobins • Anaemia's • Constitutional symptoms • Weight loss • Anorexia • Night sweats
