Infectious Disease Flashcards
T/f: infectious disease is the number one cause of death worldwide
False, it used to be, but now it is chronic diseases
What are some reasons infectious disease is no longer the leading cause of death worldwide?
Vaccinations
Antibiotics
What are the current challenges in the world of infectious disease?
Parents not vaccinating their children decreases herd immunity
Antibody resistant organisms
New infectious agents
More rapid worldwide transmission
Aging population
What are the s/s of infectious diseases?
Systemic s/s
System specific signs
Rash
Red streaks
Inflammation lymph nodes
Jt effusion
Fever
What are the systemic s/s of infectious diseases?
Fever
Chills
Sweating
Nausea
Vomiting
Malaise
What are the s/s of infectious diseases in older adults?
Confusion
Memory loss
Difficulty concentrating
Hypothermia
Bradycardia/tachycardia
What do red streaks indicate?
Acute lymphangitis from an infected wound along the lymph channels that can lead to bacteremia and acute deterioration
T/f: with acute infection, lymph nodes can become tender, enlarged, and asymmetric
True
What does jt effusion signal may be going on?
Infectious arthritis
Body temperature is controlled by the ______
Hypothalamus
What does it mean that leukocytes and endotoxins from bacteria are pyrogenic?
It means that they act on the hypothalamus to increase temperature
When a fever is over 40deg C/104 deg F, what symptoms may we see?
Delirium
Seizures
Irreversible cell damage
What are some infectious causes of fever?
UTI, respiratory tract infection, catheter, surgical wound, pressure injury, colitis, peritonitis, meningitis
What are some non infectious causes of fever?
Drug reactions
PE
neoplasm
Tissue necrosis (stroke/MI)
Autoimmune disease
What factors make older adults more susceptible to infectious diseases?
Decreased # of naive T cells (slower to respond to new infections)
Decreased bone marrow (decreased # of B cells)
Increased reliance on memory cells (if activated too much, they become unable to respond)
T/f: older adults have reduced cell mediated immunity from T cells
True
Do older adults have a better or reduced reaction to vaccines?
Reduced reaction
What extrinsic factors increase susceptibility in older adults?
Atrophic skin makes it easier for infections to enter the skin
Decreased gag and cough reflexes
Decreased mucociliary activity
Denture associated infections
More often being in places where exposure can occur (hospitals and doctors offices)
Why are more severe infection less easily recognized in older adults?
Impaired thermoregulatory system
Vague/atypical symptoms
Implanted devices
What is the definition of an infection?
When an organism establishes a parasitic relationship w/a host an immune response is triggered and produces s/s
What is the definition of colonization?
When there is the presence of microorganisms without a/s of infection bc the host is a carrier
Host can transmit the infection
Those with immune system compromised may develop s/s
What is the definition of the incubation period?
The time bw the pathogen entering the host and the s/s appearing that can be days to months
What is the definition of latent infection?
When the pathogen has invaded and replicated but remains dormant and inactive for months to years
What are some examples of infections that have a latency period?
Tuberculosis, herpes zoster
What is the definition of the period of communicability?
The period that occurs during the latency period when the pathogen is present in height enough #s to shed but hasn’t yet produced s/s
The period of asymptomatic infection when the host can spread the infection from one person to another
What are the three possible results of disease transmission?
Destroyed by the first line defenses and never enters the host
Sub clinical infection with no s/s but a clinically identifiable immune response (increased WBCs)
Infectious disease where there is a clinically identifiable immune response and one or more clinical symptoms
What is the chain of transmission in infections?
There must be a pathogen present and capable of causing disease
There must be a reservoir for the pathogen to live and multiply (can be internal or external)
There must be a port of exit for the pathogen to leave the reservoir
There must be a way to get transmitted from host to another person
There must be a mode of entry for the pathogen to enter a new host
There must be a susceptible host with personal factors that decrease resistance to infection
What are the various modes of transmission of infections?
Contact
Airborne
Droplet
Vehicle
Vector borne
What is contact transmission?
Direct host to host transmission
Indirect host to surface to host transmission
What is airborne transmission of infections?
When an organism is less than 5um it can travel on air currents and stay suspended for hours
What is droplet transmission of infection?
When an organism is greater than 5um it can travel only up to 3 feet in the air then falls to surfaces
What is vehicle transmission of infection?
When one common source spread an organisms to many hosts often through infected food or water
What is vector-borne transmission of infection?
When infection travels through insect/animal
What are some examples of vector borne transmission infections?
Lyme disease
West Nile disease
Rabies
What is the goal of infection prevention and control?
To break as many chains in the chain of transmission as possible
T/f: where the chain of transmission is most effectively broken depends on the organism
True
What are some strategies for infection prevention and control?
Isolation/barriers
Immunizations
Drug prophylactics
Improved nutrition
Improved living conditions
Avoidance of risk behaviors like IV drug use and risky sex practices
Correction of environmental factors
What are the indications to use soap and water hand hygiene?
Hands are visibly soiled
Before eating
After using the restroom
With exposure to c diff
What are the indications for using an alcohol based rub for hand hygiene?
Exposure to bodily fluids
Direct client contact
Before and after donning gloves
After attending to a contaminated body area before moving onto a second area
Contact with objects in a client area
What are standard precautions?
Clean pt care areas and equipment
Hand hygiene
Handle laundry carefully
Proper handling of sharps
What are airborne precautions?
Private room
Door closed
N95 respirator mask
Limited pt transport
Restricted entry of susceptible persons
Who are standard precautions used for?
Everyone
Who are airborne precautions used for?
Varicella, zoster, COVID-19
What are droplet precautions?
Private room/shared with others with the same infection
Surgical mask
Limit pt transport
Who are droplet precautions used for?
Influenza
RSV
Adenovirus
What are contact precautions?
Private room/with others with the same infection
Gloves and gown (removed before leaving the room)
Limit transportation
Single use equipment where possible
Who are contact precautions used for?
MRSA
CRE
C diff
What are the healthcare associated infections (HAIs)?
Central line associated bloodstream infections (CLABSIs)
Catheter associated UTIs (CAUTIs)
Ventilator associated pneumonia (VAP)
Surgical site infections (SSIs)
What is involved in prevention of central line associated bloodstream infection (CLABSI)?
Dressing integrity
Hand hygiene
What is involved in prevention of catheter associated UTIs?
Hand hygiene before and after handling
Avoid kinks in the tubing
Avoid lifting above the level of the bladder
When does ventilator associated pneumonia occur?
Within 48-78 hours after intubation
How can we prevent ventilator associated pneumonia?
Raise the HOB 30%
Early mobility
What can we do to prevent surgical site infections?
Education about modifiable risk factors like smoking, obesity, and glucose control
Education about incisional care
What is enterobacteriaceae?
An infection typically found in the human GI tract that causes a range infections elsewhere
Why is enterobacteriaceae such a threat?
Bc we used to treat it with carbapenems, but now carbapenem resistant enterobacteriaceae (CRE) exists and doesn’t respond to this last resort treatment making it extremely hard to treat with only supportive care available
_____ is now recognized as one of the most urgent antimicrobial threats and can cause severe infection with few treatment options
CRE
What is the most common cause of healthcare associated diarrhea worldwide?
C diff
T/f: c diff infections can range from mild diarrhea to severe colonic inflammation that can lead to death
True
C diff is associated with _____ use and any factors that reduces normal GI tract flora/mucosa
Antibiotics
What is the route of transmission of c diff?
Fecal oral
What is a spore forming infection that can survive on surfaces for weeks to months and is resistance to alcohol to kill it?
C diff
When would we suspect a c diff infection?
With 3 or more loose stools in 24 hours with risk factors present
How can we prevent the spread of c diff?
Soap and water hand hygiene
Bleach contact precautions
Private room/grouping (not used much anymore)
Single use equipment
Antibiotic stewardship (not overusing antibiotics)
Is staphylococcus infection an issue if colonizing the skin?
No, only when there is a break in the skin and it can enter the body does it become an issue
Staphylococcus infections are common in _____ ______ areas
High contact
How is staphylococcus transmitted?
Via contact transmission
T/f: Staphylococcus infections are more common in people who are colonized
True
Which type of staphylococcus infection can be treated with methicillin?
MSSA
Which type of staphylococcus infection can’t be treated with methicillin?
MRSA
How does staphylococcus usually enter the body?
Through damaged skin
What is the wide range of clinical diseases that can be caused by staphylococcus infection?
Wound infection
Skin infection/abscess
Food poisoning
Bacteremia
Endocarditis
Infection of cardiac prostheses
Surgical incision infection
Osteomyelitis
Prosthetic joint infection
Septic arthritis
Pneumonia
What are the group A streptococcus infections?
Strep throat
Scarlet fever
Impetigo
Necrotizing fasciitis
Cellulitis
Myositis
Puerperal sepsis
Toxic shock syndrome
Rheumatic fever
Who is most at risk with group B streptococci?
Neonates
Peripartem women
Elderly
Immunocompromised
What does streptococcus pneumoniae lead to?
Meningitis
Bacteremia
Pneumonia
Otitis media
Sinusitis
What is the most common cause of meningitis?
Streptococcus pneumoniae
Are vaccines available for streptococcus pneumoniae?
Yup for infants, young children, adults with risk factors, and adults over 65
What is crostridial myonecrosis?
Gas gangrene
A sever life threatening Ms infection caused by anaerobic bacteria
How does anaerobic bacteria lead to necrosis in crostridial myonecrosis?
The toxins produced by the bacteria cause tissue necrosis and aggregation of platelets and neutrophils, occluding the blood vessels and leading to further ischemia and the immune response can access the site
What is the presentation of someone with crostridial myonecrosis?
Sudden onset severe pain, edema, skin darkening, gas bubbles, and foul odor
T/f: pseudomonas is usually hospital acquired
True
What does it mean that pseudomonas is an opportunistic infection?
It occurs in severely immunocompromised pts
What infections result from pseudomonas?
Pneumonia, UTI, wound infection, bacteremia
What are the risk factors for pseudomonas?
Burns, catheterization, CF, chronic lung disease, ventilation, neutropenia, diabetes
T/f: pseudomonas thrives in dry environments
False, it grows in moist environments
What is the #1 cause of death for people with CF?
Pseudomonas that leads to respiratory failure
T/f: once someone with CF has pseudomonas, it is very hard to get rid of
True
T/f: all herpes viruses have a primary sub clinical infection then persist in a latent phase
True
How is varicella zoster virus acquired?
From airborne droplets
What two inflections are caused by varicella zoster virus?
Chicken pox and shingles
What is ALWAYS the result of first infection with varicella zoster virus?
Chicken pox
T/f: you can only catch chickenpox from someone with chickenpox
False, you can get chicken pox from someone with chickpox or shingles
Where does varicella zoster remain dormant after the initial infection?
In the DRG
What is reactivation of varicella zoster virus called?
Shingles
T/f: varicella zoster is highly contagious in both active states
True
How long is varicella zoster contagious for?
From 1-2 days before the rash until all lesions have crusted
Chicken pox occurs when varicella zoster virus enters via where?
Mucus membranes
Chicken pox down regulates ____ cells
T
How does chickenpox spread throughout the body?
Through the bloodstream
What kind of rash forms from chickenpox.
A disseminated rash that is all over the body
Where does the chickenpox rash usually begin and where does it usually move to from there?
Scalp—>trunk—>extremities
What are common complications for chickenpox in young infants, adults, and the immunocompromised?
Pneumonitis
Cerebellar ataxia
Encephalitis
What is shingles?
Reactivating of the dormant varicella zoster virus that causes a painful blister like lesion along a dermatome
What are the risk factors for shingles?
Over 50 yo, immunocompromised, college students living in dorms
What are the most common dermatomes affected by shingles?
T3-L3
When does shingles become a medical emergency?
If it affects the trigeminal nerve and comes near the eye bc it can cause serious vision issues
When do influenza epidemics occur?
During late fall, early spring
T/f: new subtypes of influenza can cause more morbidity and mortality than normal types A and B
True
How is influenza spread?
Through droplets
What are the symptoms of influenza?
High fever, chills, malaise, HA, sore throat, nasal congestion, non productive cough
What are high risk groups for influenza?
Young children
People with chronic disease
The immunocompromised
Frail elderly
T/f: COVID-19 still has higher mortality rates than SARS-CoV-1 and influenza
False
How is COVID-19 spread?
Via inhaled droplets, but can also be aerosolized, or spread via contact
What is the incubation period of COVID-19?
2-12 days
When is viral load the highest with COVID-19?
1 days before symptom development
Who is at the highest risk for COVID-19?
Those over 65
Those with HTN
Those with cardiac disease
The immunocompromised Frail
Those with COPD
Those with asthma
Those with diabetes
What are the symptoms of COVID-19?
Fatigue, aches, SOB, dry cough
T/f: susceptible people can develop severe disease from COVID-19 5-10 days after initial symptoms
True
What severe diseases can result from COVID-19?
cytokine release syndrome, high fever, hypoxemia, pneumonia, ARDS
What are common non respiratory complications of COVID-19?
CVA
DVT
PE
cardiomyopathy
Long Covid has similar presentation and treatment to what with the addition of respiratory symptoms?
Chronic fatigue syndrome
T/f: COVID-19 causes increased clotting and risk for DVT/PE
True
What causes Lyme disease?
Spirochete species from ticks
How long do ticks have to feed before spirochete is injected to cause Lyme disease?
36-72 hours
How long does Lyme disease incubate before onset of symptoms?
3-32 days
What is the only tick in PA that can spread Lyme disease?
Black legged/deer ticks
How can we prevent Lyme disease?
Use bug spray, wears long sleeve and pants where deer have been, and do self tick checks
What is a key sign of Lyme disease?
Bullseye rash
When does stage 1 Lyme disease occur?
5-15 days post bite
What is the presentation of stage 1 Lyme disease?
Skin rxns
Possible flu like symptoms
When does stage 2 Lyme disease occur?
Days to weeks after infection
What is the presentation of stage 2 Lyme disease?
Skin rash (more diffuse)
Neuro symptoms
Cardiac complications
MSK pain
When does stage 3 Lyme disease occur?
Months to years later
What is the presentation of stage 3 Lyme disease?
Jt and nerve symptoms
STDs can be caused by what three things?
Bacteria
Viruses
Parasites
T/f: some STDs are easily cured and others are chronic
True
What are the risk factors for STDs?
Women
Teens
Men who have sex with men
Minorities
Multiple sex partners
Early adolescent initiation of sex
Partner with known risk factors
Residing in a detention center
Obstacles to obtaining healthcare
Blood transfusion between 1977-1984
Failure to use a condom or improper use of
Sharing drug needles
T/f: drug users are more at risk for bacterial infections
True
What about drug users determines the likelihood and types of infection?
What the drug is
Drug administration route
Drug administration site
Drug preparation
What are the most common sites for infection with drug users?
Skin
Endovascular (endocarditis)
Respiratory (pneumonia or direct lung damage)
MSK (osteomyelitis)
What is the first place that drugs go to?
The tricuspid valve in the R side of the heart
What is the most common bacterial infection in drug users?
S aureus
