Professional Documents
Culture Documents
www.beyondmassageschool.com
3-Hours Continuing Education
Lecture Notes
Table of Contents
Instructions.. 3
Educational Objectives.. 3
Chapter 1: Introduction to infectious agent control and modes of transmission....4
Chapter 2: Massage therapy in a health care setting (Universal Precautions Standards)....13
Chapter 3: Bacteria...27
Chapter 4: Viruses ....64
Chapter 5: Fungi ...93
Chapter 6: Parasites ..128
Chapter 7: Massage Environment Hygiene.141
Summary of Controlling Infectious Agents in the Massage Room .....155
Course Completion: Certificate of Completion and Transcript.156
Course Evaluation and Errata...157
Help and Technical Support Line..157
Bibliography (Sources)...158
Definition of Terms
Cleaning is the removal of soil through manual or mechanical means, often
in preparation for disinfection or sterilization.
Disinfection is the destruction of pathogenic microorganisms or their toxins
by direct exposure to chemical or physical agents. Disinfectants are
described as low-, intermediate-, and high-level. These interventions can
kill most pathogens, but bacterial spores may be spared.
Sterilization is destruction of all microorganisms in a given field. It is
accomplished through baking, chemicals under pressure, or steam under
pressure.
Sanitation is use of measures designed to promote health and prevent
disease; it usually refers to creating a clean environment, but does not
specify the level of cleanliness.
Plain soap is any detergent that contains no antimicrobial products or only
small amounts of antimicrobial products that act as preservatives.
Antimicrobial soap is a detergent that contains antimicrobial substances.
Rationale for this course (why its relevant to you)
According to Occupational Safety Health Administration (OSHA) massage
therapists and bodyworkers are not at great risk for occupational exposure
to bloodborne pathogens, but due to the fact that our work is on the human
body it is important that the basics of the Bloodborne Pathogen standard
and Universal precautions as set forth by the Center for Disease Control
and the Occupational and Safety Health Administration are reviewed and
understood.
So we study Universal precautions in massage school (and we will be
reviewing it in this course also) but we do not spend nearly enough time on
the other infectious dangers that we are exposed to, in some cases with
alarming frequency.
Bloodborne pathogens are only part of the story; there are also airborn
pathogens (respiratory diseases and infections) and contagious skin
conditions that people can be bringing into your massage room every day.
Theres a very real reason why many states require massage therapists to
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Wear a gown for direct patient contact if the patient has uncontained
secretions or excretions.
Remove gown and perform hand hygiene before leaving the patients
environment.
Do not reuse gowns, even for repeated contacts with the same patient.
Routine donning of gowns upon entrance into a high-risk unit.
Mouth, nose, eye protection
Use PPE to protect the mucous membranes of the eyes, noseand mouth
during procedures and patient-care activities that are likely to generate
splashes or sprays of blood, body fluids, secretions and excretions. Select
masks, goggles, face shields, and combinations of each according to the
need anticipated by the task performed
During aerosol-generating procedures (e.g., bronchoscopy, suctioning of
the respiratory tract [if not using in-line suction catheters], endotracheal
intubation) in patients who are not suspected of being infected with an
agent for which respiratory protection is otherwise recommended (e.g., M.
tuberculosis, SARS or hemorrhagic fever viruses), wear one of the
following: a face shield that fully covers the front and sides of the face, a
mask with attached shield, or a mask and goggles (in addition to gloves
and gown)
Respiratory Hygiene/Cough Etiquette
Educate healthcare personnel on the importance of source control
measures to contain respiratory secretions to prevent droplet and
fomite transmission of respiratory pathogens, especially during seasonal
outbreaks of viral respiratory tract infections (e.g., influenza, RSV,
adenovirus, parainfluenza virus) in communities
Implement the following measures to contain respiratory secretions in
patients and accompanying individuals who have signs and symptoms of a
respiratory infection, beginning at the point of initial encounter in a
healthcare setting (e.g., triage, reception and waiting areas in emergency
departments, outpatient clinics and physician offices)
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Chapter 3: Bacteria
Bacteria are ubiquitous, present in the soil, air and water all around you.
Some bacteria can be beneficial, while other bacteria causes illness and
even death. Pathogenic bacteria, those organisms that cause disease,
relentlessly bombard your body daily. Your bodys immune system fights off
most of these invaders. Some types of bacteria cause more harm to
humans than others, overwhelming your bodys defenses and frequently
causing death in terrifying ways and at alarming speeds.
Bacteria are a large domain of prokaryotic microorganisms. Unlike the cells
of animals and other eukaryotes, prokaryotic cells do not contain a nucleus
and rarely harbour membrane-bound organelles.
Bacterium are usually only a few micrometres in length and have a wide
range of shapes, ranging from spheres to rods and spirals. They are
present in most habitats on Earth and can be found in the soil, in the Earths
crust, in acidic hot springs, in radioactive waste dumps, deep in the ocean
and of course, in the intestinal tracks of all animals, including us humans.
There are usually 40 million bacterial cells in just one gram of soil and a
million bacterial cells in a millilitre of fresh water; in all, there are
approximately five nonillion (yeah, thats a real number-google it) bacteria
on Earth.
Bacteria are needed to recycle nutrients, with many steps in nutrient cycles
depending on these organisms, such as the fixation of nitrogen from the
atmosphere and putrefaction.
The scientific study of bacteria is known as bacteriology, it is a branch of
microbiology, and since most bacteria on the planet have not been
characterized, and only about half of the phyla of bacteria have species
that can be grown in the laboratory I think they better get cracking.
The vast majority of the bacteria in the human body are rendered harmless
by the awesome protective power of the immune system. Some of the
bacteria in our body is even beneficial, but since this course is about
pathology we are going to skip those.
There are a few species of bacteria that are pathogenic and cause
infectious diseases, including but not limited to cholera, syphilis, anthrax,
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leprosy, and bubonic plague. By far the most common fatal bacterial
diseases are respiratory infections, with tuberculosis in the lead with an
astounding 2 million people each year, mostly in sub-Saharan Africa.
In more developed countries antibiotics are used to treat bacterial
infections so antibiotic resistance is becoming common. We use bacteria
in sewage treatment facilities and for the breakdown of oil spills, the
production of yummy cheese and yogurt products, and the recovery of
gold, palladium, copper and other commercial metals in the mining sector.
Etymology
The word bacteria is the plural of the New Latin bacterium, which is the
latinisation of the Greek baktrion, the diminutive of baktria, meaning
"staff, cane",because the first ones to be discovered were rod-shaped.
Morphology
Bacteria can be found in a wide variety of shapes and sizes, called
morphologies. Bacterial cells are about one tenth the size of eukaryotic
cells and are typically 0.55.0 micrometres in length.
Most bacterial species are either spherical, called cocci (sing. coccus, from
Greek -kkkos, grain, seed), or rod-shaped, called bacilli (sing. bacillus,
from Latin baculus, stick). Elongation is associated with swimming. Some
rod-shaped bacteria, called vibrio, are slightly curved or comma-shaped;
others, can be spiral-shaped, called spirilla, or tightly coiled, called
spirochaetes.
The most common household bacteria are described on the following
pages:
1. Staphylococcus
Staphylococcus is a genus of Gram-positive bacteria. Under the
microscope, they appear round (cocci), and form in grape-like clusters. The
Staphylococcus genus includes at least 40 species. Most are harmless and
reside normally on the skin and mucous membranes of humans and other
organisms. Found worldwide, they are a small component of soil microbial
flora.
Staphylococcus can cause a wide variety of diseases in humans and other
animals through either toxin production or penetration. Staphylococcal
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The time between ingesting the STEC bacteria and feeling sick is called the
incubation period. The incubation period is usually 3-4 days after the
exposure, but may be as short as 1 day or as long as 10 days. The
symptoms often begin slowly with mild belly pain or non-bloody diarrhea
that worsens over several days. HUS, if it occurs, develops an average 7
days after the first symptoms, when the diarrhea is improving.
STEC live in the guts of ruminant animals, including cattle, goats, sheep,
deer, and elk. The major source for human illnesses is cattle. STEC that
cause human illness generally do not make animals sick. Other kinds of
animals, including pigs and birds, sometimes pick up STEC from the
environment and may spread it.
Transmission of STEC
Infections start when you swallow STECin other words, when you get tiny
(usually invisible) amounts of human or animal feces in your mouth.
Unfortunately, this happens more often than we would like to think about.
Exposures that result in illness include consumption of contaminated food,
consumption of unpasteurized (raw) milk, consumption of water that has
not been disinfected, contact with cattle, or contact with the feces of
infected people. Some foods are considered to carry such a high risk of
infection with E. coli O157 or another germ that health officials recommend
that people avoid them completely. These foods include unpasteurized
(raw) milk, unpasteurized apple cider, and soft cheeses made from raw
milk. Sometimes the contact is pretty obvious (working with cows at a dairy
or changing diapers, for example), but sometimes it is not (like eating an
undercooked hamburger or a contaminated piece of lettuce). People have
gotten infected by swallowing lake water while swimming, touching the
environment in petting zoos and other animal exhibits, and by eating food
prepared by people who did not wash their hands well after using the toilet.
Almost everyone has some risk of infection.
STEC infections statistics
An estimated 265,000 STEC infections occur each year in the United
States. STEC O157 causes about 36% of these infections, and non-O157
STEC cause the rest. Public health experts rely on estimates rather than
actual numbers of infections because not all STEC infections are
diagnosed, for several reasons. Many infected people do not seek medical
care; many of those who do seek care do not provide a stool specimen for
testing, and many labs do not test for non-O157 STEC. However, this
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situation is changing as more labs have begun using newer, simpler tests
that can help detect non-O157 STEC.
STEC infections are usually diagnosed through laboratory testing of stool
specimens (feces). Identifying the specific strain of STEC is essential for
public health purposes, such as finding outbreaks. Many labs can
determine if STEC are present, and most can identify E. coli O157. Labs
that test for the presence of Shiga toxins in stool can detect non-O157
STEC infections. However, for the O group (serogroup) and other
characteristics of non-O157 STEC to be identified, Shiga toxin-positive
specimens must be sent to a state public health laboratory.
Contact your healthcare provider if you have diarrhea that lasts for more
than 3 days, or is accompanied by high fever, blood in the stool, or so
much vomiting that you cannot keep liquids down and you pass very little
urine.
STEC typically disappear from the feces by the time the illiness is resolved,
but may be shed for several weeks, even after symptoms go away. Young
children tend to carry STEC longer than adults. A few people keep
shedding these bacteria for several months. Good hand-washing is always
a smart idea to protect yourself, your family, and other persons.
Treatment for STEC infection
Non-specific supportive therapy, including hydration, is important.
Antibiotics should not be used to treat this infection. There is no evidence
that treatment with antibiotics is helpful, and taking antibiotics may increase
the risk of HUS. Antidiarrheal agents like Imodium may also increase that
risk.
Should an infected person be excluded from school or work?
School and work exclusion policies differ by local jurisdiction. Check with
your local or state health department to learn more about the laws where
you live. In any case, good hand-washing after changing diapers, after
using the toilet, and before preparing food is essential to prevent the
spread of these and many other infections.
Prevention of STEC infections
WASH YOUR HANDS thoroughly after using the bathroom or changing
diapers and before preparing or eating food.
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WASH YOUR HANDS after contact with animals or their environments (at
farms, petting zoos, fairs, even your own backyard).
COOK meats thoroughly. Ground beef and meat that has been needletenderized should be cooked to a temperature of at least 160F/70C. Its
best to use a thermometer, as color is not a very reliable indicator of
doneness.
AVOID raw milk, unpasteurized dairy products, and unpasteurized juices
(like fresh apple cider).
AVOID swallowing water when swimming or playing in lakes, ponds,
streams, swimming pools, and backyard kiddie pools.
PREVENT cross contamination in food preparation areas by thoroughly
washing hands, counters, cutting boards, and utensils after they touch raw
meat. To learn more about how to protect yourself from E. coli, see CDCs
feature, E. coli Infection.
5. Corynaebacterium
Corynebacterium is a genus of Gram-positive rod-shaped bacteria. They
are widely distributed in nature and are mostly innocuous. Some are useful
in industrial settings such as C. glutamicum.
The most notable human infection is diphtheria, caused by
Corynebacterium diphtheriae. It is an acute and contagious infection
characterized by pseudomembranes of dead epithelial cells, white blood
cells, red blood cells, and fibrin that form around the tonsils and back of the
throat.
It is an uncommon illness that tends to occur in unvaccinated individuals,
especially school-aged children, those in developing countries, elderly,
neutropenic or immunocompromised patients, and those with prosthetic
devices such as prosthetic heart valves, shunts, or catheters. It can
occasionally infect wounds, the vulva, the conjunctiva, and the middle ear.
It can be spread within a hospital.
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6. Salmonella
Salmonella is found worldwide in cold- and warm-blooded animals
(including humans), and in the environment. They cause illnesses like
typhoid fever, paratyphoid fever, and foodborne illness.
Salmonella infections are zoonotic and can be transferred between humans
and non-human animals. Many infections are due to ingestion of
contaminated food.
A distinction is made between enteritis Salmonella and Salmonella
typhoid/paratyphoid Salmonella, where the latter because of a special
virulence factor and a capsule protein (virulence antigen) can cause
serious illness, such as Salmonella enterica subsp. enterica serovar Typhi.
Salmonella typhi. is adapted to humans and does not occur in other
animals.
Bacillus Anthracis
The bacteria Bacillus anthracis, or anthrax, can enter the body via three
avenues: through the skin, into the lungs or down the digestive tract. Of
these three methods, inhalation anthrax is the most deadly, with symptoms
resembling those of the flu or a cold. The Centers for Disease Control and
Prevention (CDC) classify anthrax as a Category A agent, the most
dangerous group of pathogens, or disease-causing organisms.
Animals may spread the anthrax bacteria to humans through contact with
infected animal products, inhalation of spores originating from infected
animals or consumption of infected meat not thoroughly cooked. So far,
human-to-human infections have not occurred. Treatment currently
includes antibiotics. A vaccine does exist, but it is not yet available to the
public.
Anthrax is a serious infectious disease caused by gram-positive, rodshaped bacteria known as Bacillus anthracis. Anthrax can be found
naturally in soil and commonly affects domestic and wild animals around
the world. Although it is rare, people can get sick with anthrax if they come
in contact with infected animals or contaminated animal products.
Contact with anthrax can cause severe illness in both humans and animals.
Anthrax is not contagious, which means you cant catch it like the cold or
flu.
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Domestic and wild animals such as cattle, sheep, goats, antelope, and deer
can become infected when they breathe in or ingest spores in
contaminated soil, plants, or water. In areas where domestic animals have
had anthrax in the past, routine vaccination can help prevent outbreaks.
People get infected with anthrax when spores get into the body. When
anthrax spores get inside the body, they can be activated. When they
become active, the bacteria can multiply, spread out in the body, produce
toxins (poisons), and cause severe illness.
This can happen when people breathe in spores, eat food or drink water
that is contaminated with spores, or get spores in a cut or scrape in the
skin. It is very uncommon for people in the United States to get infected
with anthrax.
How People Are Infected
People get infected with anthrax when spores get into the body. When this
happens, the spores can be activated and become anthrax bacteria. Then
the bacteria can multiply, spread out in the body, produce toxins (poisons),
and cause severe illness. This can happen when people breathe in spores,
eat food or drink water that is contaminated with spores, or get spores in a
cut or scrape in the skin.
Certain activities (described below) can increase a persons chances of
getting infected.
Working with infected animals or animal products
Most people who get sick from anthrax are exposed while working with
infected animals or animal products such as wool, hides, or hair.
Inhalation anthrax can occur when a person inhales spores that are in the
air (aerosolized) during the industrial processing of contaminated materials,
such as wool, hides, or hair.
Cutaneous anthrax can occur when workers who handle contaminated
animal products get spores in a cut or scrape on their skin.
Eating raw or undercooked meat from infected animals. People who eat
raw or undercooked meat from infected animals may get sick with
gastrointestinal anthrax. This usually occurs in countries where livestock
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are not routinely vaccinated against anthrax and food animals are not
inspected prior to slaughter.
In the United States, gastrointestinal anthrax has rarely been reported. This
is because yearly vaccination of livestock is recommended in areas of the
United States where animals have had anthrax in the past, and because of
the examination of all food animals, which ensures that they are healthy at
the time of slaughter.
Injecting heroin
A newly discovered type of anthrax is injection anthrax. This type of anthrax
has been seen in northern Europe in people injecting heroin. So far, no
cases of injection anthrax have been reported in the United States.
Is Anthrax Contagious?
Normally no. You cannot catch anthrax from another person the way you
might catch a cold or the flu, but person-to-person transmission has been
reported with cutaneous anthrax, where discharges from skin lesions might
be infectious.
Anthrax is most common in agricultural regions of Central and South
America, sub-Saharan Africa, central and southwestern Asia, southern and
eastern Europe, and the Caribbean.
Anthrax is rare in the United States, but sporadic outbreaks do occur in wild
and domestic grazing animals such as cattle or deer. Anthrax is more
common in developing countries and countries that do not have veterinary
public health programs that routinely vaccinate animals against anthrax. In
the United States, yearly vaccination of livestock is recommended in areas
where animals have had anthrax in the past.
Types of Anthrax
The type of illness a person develops depends on how anthrax enters the
body. Typically, anthrax gets into the body through the skin, lungs, or
gastrointestinal system. All types of anthrax can eventually spread
throughout the body and cause death if they are not treated with antibiotics.
Cutaneous Anthrax
When anthrax spores get into the skin, usually through a cut or scrape, a
person can develop cutaneous anthrax. This can happen when a person
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blown around by the wind or carried on peoples clothes, shoes, and other
objects.
It only takes a small amount of anthrax to infect a large number of people.
If anthrax spores were released into the air, people could breathe them in
and get sick with anthrax. Inhalation anthrax is the most serious form and
can kill quickly if not treated immediately. If the attack were not detected by
one of the monitoring systems in place in the United States, it might go
unnoticed until doctors begin to see unusual patterns of illness among sick
people showing up at emergency rooms.
Clostridium Botulinum
Clostridium botulinum causes a severe form of food poisoning, with most
cases arising from improper canning methods. The U.S. Food and Drug
Administration (FDA) notes that acidity or high heat will kill the bacteria.
Once inside the human body, the bacteria start producing toxins, or
poisons. Just a minute amount of toxin can make you ill with botulism.
Botulinum toxin acts on the nervous system, causing trouble with
respiration, swallowing, speaking, vision and overall physical weakness.
Death results from the inability to breathe when the toxin paralyzes
breathing muscles. Early introduction of an antitoxin and respiratory aid can
save a patient.
Clostridium botulinum is the name of a group of bacteria. They can be
found in soil. These rod-shaped organisms grow best in low oxygen
conditions. The bacteria form spores which allow them to survive in a
dormant state until exposed to conditions that can support their growth.
There are seven types of botulism toxin designated by the letters A through
G; only types A, B, E and F cause illness in humans.
Botulism in the United States
In the United States, an average of 145 cases are reported each year. Of
these, approximately 15% are foodborne, 65% are infant botulism, and
20% are wound. Adult intestinal colonization and iatrogenic botulism also
occur, but rarely. Outbreaks of foodborne botulism involving two or more
persons occur most years and are usually caused by home-canned foods.
Most wound botulism cases are associated with black-tar heroin injection,
especially in California.
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Symptoms of botulism
The classic symptoms of botulism include double vision, blurred vision,
drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and
muscle weakness. Infants with botulism appear lethargic, feed poorly, are
constipated, and have a weak cry and poor muscle tone. These are all
symptoms of the muscle paralysis caused by the bacterial toxin. If
untreated, these symptoms may progress to cause paralysis of the
respiratory muscles, arms, legs, and trunk. In foodborne botulism,
symptoms generally begin 18 to 36 hours after eating a contaminated food,
but they can occur as early as 6 hours or as late as 10 days.
Physicians may consider the diagnosis if the patient's history and physical
examination suggest botulism. However, these clues are usually not
enough to allow a diagnosis of botulism. Other diseases such as GuillainBarr syndrome, stroke, and myasthenia gravis can appear similar to
botulism, and special tests may be needed to exclude these other
conditions. These tests may include a brain scan, spinal fluid examination,
nerve conduction test (electromyography, or EMG), and a tensilon test for
myasthenia gravis. Tests for botulinum toxin and for bacteria that cause
botulism can be performed at some state health department laboratories
and at CDC.
Treatment
The respiratory failure and paralysis that occur with severe botulism may
require a patient to be on a breathing machine (ventilator) for weeks or
months, plus intensive medical and nursing care. The paralysis slowly
improves. Botulism can be treated with an antitoxin which blocks the action
of toxin circulating in the blood. Antitoxin for infants is available from the
California Department of Public Health, and antitoxin for older children and
adults is available through CDC.If given before paralysis is complete,
antitoxin can prevent worsening and shorten recovery time. Physicians may
try to remove contaminated food still in the gut by inducing vomiting or by
using enemas. Wounds should be treated, usually surgically, to remove the
source of the toxin-producing bacteria followed by administration of
appropriate antibiotics. Good supportive care in a hospital is the mainstay
of therapy for all forms of botulism.
Complications from botulism
Botulism can result in death due to respiratory failure. However, in the past
50 years the proportion of patients with botulism who die has fallen from
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about 50% to 3-5%. A patient with severe botulism may require a breathing
machine as well as intensive medical and nursing care for several months,
and some patients die from infections or other problems related to
remaining paralyzed for weeks or months. Patients who survive an episode
of botulism poisoning may have fatigue and shortness of breath for years
and long-term therapy may be needed to aid recovery.
Preventing botulism
Many cases of botulism are preventable. Foodborne botulism has often
been from home-canned foods with low acid content, such as asparagus,
green beans, beets and corn and is caused by failure to follow proper
canning methods. However, seemingly unlikely or unusual sources are
found every decade, with the common problem of improper handling during
manufacture, at retail, or by consumers; some examples are chopped garlic
in oil, canned cheese sauce, chile peppers, tomatoes, carrot juice, and
baked potatoes wrapped in foil.
In Alaska, foodborne botulism is caused by fermented fish and other
aquatic game foods. Persons who do home canning should follow strict
hygienic procedures to reduce contamination of foods, and carefully follow
instructions on safe home canning including the use of pressure
canners/cookers as recommended through county extension services or
from the US Department of Agriculture. Oils infused with garlic or herbs
should be refrigerated. Potatoes which have been baked while wrapped in
aluminum foil should be kept hot until served or refrigerated.
Because the botulinum toxin is destroyed by high temperatures, persons
who eat home-canned foods should consider boiling the food for 10
minutes before eating it to ensure safety. Wound botulism can be
prevented by promptly seeking medical care for infected wounds and by
not using injectable street drugs. Most infant botulism cases cannot be
prevented because the bacteria that causes this disease is in soil and dust.
The bacteria can be found inside homes on floors, carpet, and countertops
even after cleaning. Honey can contain the bacteria that causes infant
botulism so, children less than 12 months old should not be fed honey.
Honey is safe for persons 1 year of age and older.
Public education about botulism prevention is an ongoing activity.
Information about safe canning is widely available for consumers. Persons
in state health departments and at CDC are knowledgeable about botulism
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Between 1995 and 2005 over 32,000 cases of Legionnaires' disease and
more than 600 outbreaks were reported to the European Working Group for
Legionella Infections There is a shortage of data on Legionella in
developing countries and it is likely that Legionella-related illness is
underdiagnosed worldwide. Improvements in diagnosis and surveillance in
developing countries would be expected to reveal far higher levels of
morbidity and mortality than are currently recognised. Similarly, improved
diagnosis of human illness related to legionella species and serogroups
other than Legionella pneumophila would improve knowledge about their
incidence and spread.
A 2011 study successfully used modeling to predict the likely number of
cases during Legionnaires outbreaks based on symptom on-set dates from
past outbreaks. In this way, the eventual likely size of an outbreak can be
predicted, enabling efficient and effective use of public health resources in
managing an outbreak.
Legionella pneumophila thrives in aquatic systems where it is established
within amoeba in a symbiotic relationship. In the built environment, central
air conditioning systems in office buildings, hotels, and hospitals are
sources of contaminated water. Other places it can dwell include cooling
towers used in industrial cooling systems as well as evaporative coolers,
nebulizers, humidifiers, whirlpool spas, hot water systems, showers,
windshield washers, fountains, room-air humidifiers, ice making machines,
and misting systems typically found in grocery store produce sections.
Potential sources of contaminated water include cooling towers (some 40%
to 60% of ones tested) used in industrial cooling water systems as well as
in large central air conditioning systems, evaporative coolers, nebulizers,
humidifiers, whirlpool spas, hot water systems, showers, windshield
washers, architectural fountains, room-air humidifiers, ice making
machines, misting equipment, and similar disseminators that draw upon a
public water supply.
The disease may also be transmitted from contaminated aerosols
generated in hot tubs if the disinfection and maintenance program is not
done rigorously. Freshwater ponds, creeks, and ornamental fountains are
potential sources of Legionella. The disease is particularly associated with
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hotels, fountains, cruise ships and hospitals with complex potable water
systems and cooling systems.
Respiratory care devices such as humidifiers and nebulizers used with
contaminated tap water may contain Legionella. Using sterile water is very
important, especially when using respiratory care devices. Other sources
include exposure to potting mix and compost and misting systems in
produce sections of grocery stores.
Signs and symptoms
Patients with Legionnaires' disease usually have fever, chills, and a cough,
which may be dry or may produce sputum. Some patients also have
muscle aches, headache, tiredness, loss of appetite, loss of coordination
(ataxia), and occasionally diarrhea and vomiting. Confusion and impaired
cognition may also occur, as can a so-called 'relative bradycardia', i.e. low
or low normal heart rate despite the presence of a fever. Laboratory tests
may show that patients' renal functions, liver functions and electrolytes are
deranged, including hyponatremia. Chest X-rays often show pneumonia
with bi-basal consolidation. It is difficult to distinguish Legionnaires' disease
from other types of pneumonia by symptoms or radiologic findings alone;
other tests are required for diagnosis.
Persons with Pontiac fever experience fever and muscle aches without
pneumonia. They generally recover in 2 to 5 days without treatment. The
time between the patient's exposure to the bacterium and the onset of
illness for Legionnaires' disease is 2 to 10 days; for Pontiac fever, it is
shorter, generally a few hours to 2 days.
People of any age may suffer from Legionnaires' disease, but the illness
most often affects middle-age and older persons, particularly those who
smoke cigarettes or have chronic lung disease. Immunocompromised
patients are also at elevated risk. Pontiac fever most commonly occurs in
persons who are otherwise healthy.
The most useful diagnostic tests detect the bacteria in sputum, find
Legionella antigens in urine samples (due to renal fibrosis), or the
comparison of Legionella antibody levels in two blood samples taken 3 to 6
weeks apart. A urine antigen test which is simple, quick, and very reliable
will only detect Legionella pneumophila serogroup 1, which accounts for
70% of disease cause by L. pneumophila. This test was developed by
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attack any part of the body such as the kidney, spine, and brain. If not
treated properly, TB disease can be fatal.
TB is spread through the air from one person to another. The TB bacteria
are put into the air when a person with TB disease of the lungs or throat
coughs, sneezes, speaks, or sings. People nearby may breathe in these
bacteria and become infected.
TB is NOT spread by
Shaking someones hand
Sharing food or drink
Touching bed linens or toilet seats
Sharing toothbrushes
Kissing
Latent TB Infection and TB Disease
Not everyone infected with TB bacteria becomes sick. As a result, two TBrelated conditions exist: latent TB infection and TB disease.
Latent TB Infection
TB bacteria can live in the body without making you sick. This is called
latent TB infection. In most people who breathe in TB bacteria and become
infected, the body is able to fight the bacteria to stop them from growing.
People with latent TB infection do not feel sick and do not have any
symptoms. People with latent TB infection are not infectious and cannot
spread TB bacteria to others. However, if TB bacteria become active in the
body and multiply, the person will go from having latent TB infection to
being sick with TB disease.
TB Disease
TB bacteria become active if the immune system can't stop them from
growing. When TB bacteria are active (multiplying in your body), this is
called TB disease. People with TB disease are sick. They may also be able
to spread the bacteria to people they spend time with every day.
Many people who have latent TB infection never develop TB disease.
Some people develop TB disease soon after becoming infected (within
weeks) before their immune system can fight the TB bacteria. Other people
may get sick years later when their immune system becomes weak for
another reason.
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For people whose immune systems are weak, especially those with HIV
infection, the risk of developing TB disease is much higher than for people
with normal immune systems.
TB Symptoms
Symptoms of TB disease include:
A bad cough that lasts 3 weeks or longer
Pain in the chest
Coughing up blood or sputum
Weakness or fatigue
Weight loss
No appetite
Chills
Fever
Sweating at night
TB Risk Factors
Once a person is infected with TB bacteria, the chance of developing TB
disease is higher if the person:
Has HIV infection;
Has been recently infected with TB bacteria (in the last 2 years);
Has other health problems, like diabetes, that make it hard for the
body to fight bacteria;
Abuses alcohol or uses illegal drugs; or
Was not treated correctly for TB infection in the past
Testing for TB Infection
There are two kinds of tests that are used to detect TB bacteria in the body:
the TB skin test (TST) and TB blood tests. These tests can be given by a
health care provider or local health department. If you have a positive
reaction to either of the tests, you will be given other tests to see if you
have latent TB infection or TB disease.
Exposure to TB
If you think you have been exposed to someone with TB disease, contact
your health care provider or local health department to see if you should be
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tested for TB infection. Be sure to tell the doctor or nurse when you spent
time with the person who has TB disease.
Treatment for Latent TB Infection and TB Disease
If you have latent TB infection but not TB disease, your health care provider
may want you be treated to keep you from developing TB disease.
Treatment of latent TB infection reduces the risk that TB infection will
progress to TB disease. Treatment of latent TB infection is essential to
controlling and eliminating TB in the United States. The decision about
taking treatment for latent TB infection will be based on your chances of
developing TB disease.
Treatment for TB Disease
TB disease can be treated by taking several drugs, usually for 6 to 9
months. It is very important to finish the medicine, and take the drugs
exactly as prescribed. If you stop taking the drugs too soon, you can
become sick again. If you do not take the drugs correctly, the germs that
are still alive may become resistant to those drugs. TB that is resistant to
drugs is harder and more expensive to treat.
TB in Specific Populations
Tuberculosis (TB) is a challenging disease to diagnose, treat, and control. It
is critical to target prevention and control efforts to certain populations so
as to reduce disparities related to TB, and further reduce TB rates both in
the United States and worldwide.
High Risk Groups
AfricanAmerican Community
Blacks in the United States continue to have a disproportionate share of
TB. The percentage of TB cases that occur in blacks or African Americans
is higher than expected based on the percentage of blacks in the US
population.
If looking at only people born in the US, the proportion of TB in African
Americans is even greater.
Rates of TB in both blacks and whites have gone down over the past
decade, but the disparity remains.
We must better target our efforts to prevent and control TB in this group.
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Combined, these four states accounted for 4,917 TB cases, 51.3% of all TB
cases reported in 2013.
Among U.S.-born persons, the number and rate of TB cases decreased in
2013. The 3,377 TB cases reported among U.S.-born persons (35.4% of all
cases with known national origin) were 7.6% fewer than the number
reported in 2012 and 61.0% fewer than the number reported in 2000
(Figure 2). The rate of 1.2 per 100,000 population among U.S.-born
persons is an 8.4% decrease since 2012 and a 64.7% decrease since
2000.
Among foreign-born persons in the United States, the number and rate of
TB cases also decreased in 2013. A total of 6,172 TB cases were reported
among foreign-born persons (64.6% of all cases in persons with known
national origin), a 1.6% decrease since 2012 and a 19.0% decrease since
2000. The 15.6 cases per 100,000 population TB rate among foreign-born
persons is a 2.1% decrease since 2012 and a 41.1% decrease since 2000.
In 2013, 54.2% of foreign-born persons with TB and known country of birth
originated from five countries: 1,233 (20.0%) from Mexico, 776 (12.6%)
from the Philippines, 495 (8.0%) from India, 454 (7.4%) from Vietnam, and
377 (6.1%) from China.
The TB incidence rate among Asians was the highest among all
racial/ethnic groups and was 25.9 times higher than the incidence rate
among whites (Table). Although incidence rates among all racial/ethnic
groups declined in 2013, the decrease was greater among whites (9.2%)
and blacks (7.5%) than among Hispanics (5.3%) and Asians (0.3%).
Among persons with TB, 95% of Asians, 75% of Hispanics, 40% of blacks,
and 23% of whites were foreign-born. Among U.S.-born persons, the
incidence rate among blacks was 6.2 times higher than among whites.
HIV status was known for 85% of TB cases reported in 2013, as in 2012.
Among TB patients with known HIV status, 6.8% had a positive test result
for HIV infection in 2013, compared with 7.4% in 2012.
Among persons aged 15 years with TB, 98.5% had known housing status,
5.7% of whom reported being homeless within the past year. Among
persons aged 15 years with TB, 99.1% had a known incarceration status,
3.9% of whom were confined to a detention or correctional facility at the
time of TB diagnosis.
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Chapter 4: Viruses
Well known to the student of the human body, a virus is a microscopic
infectious agent that can only reproduce itself in the living cell of another
host organism. They have been known to infect all types of organisms,
animals, plants, and even bacteria.
About 5,000 different viruses have been described in detail, but there are
literally millions of different kinds. Viruses can be found in almost every
ecosystem on the planet and are the most abundant type of biological
entity.
The study of viruses is a sub-specialty of microbiology called virology.
The basics of Viruses
A virus is made up of particles (known as virions) consisting of the genetic
material made from either DNA or RNA, some long molecules that carry
genetic information; a protein coat that protects the genes; and in some
cases an envelope of lipids that surrounds the protein coat when they are
outside a cell.
The average virus is only about one one-hundredth the size of the average
bacterium, and the average bacterium is not very big at all, so we are
talking tiny here. Most viruses are way too small to be seen directly with a
light microscope. The shapes of a virus can range from a simple helical and
icosahedral forms to more complex structures.
Viral infections in animals are met with an innate immune system response
that generally wipes out the virus. This innate response can also be used
to make a vaccine, which can convey an artificially acquired immunity to
the specific viral infection.
Unfortunately some viruses evade or even overwhelm immune responses
and result in chronic infections. Antibiotics have no effect on viruses, but
several antiviral drugs have been developed.
Viruses spread in different ways. In plants, for example, viruses are often
transmitted from plant to plant by insects that feed on them. In animals
viruses can be carried by blood sucking insects (Fleas, Ticks, Mosquitoes,
etc). We call these disease carrying organism vectors.
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Symptoms
Norovirus causes inflammation of the stomach or intestines or both. This is
called acute gastroenteritis, other common symptoms
Diarrhea
Throwing up
Nausea
Stomach pain
Fever
Headache
Body aches
If you have norovirus illness, you can feel extremely ill and throw up or
have diarrhea many times a day. This can lead to dehydration, especially in
young children, older adults, and people with other illnesses. Prevent
dehydration by drinking plenty of liquids to replace fluids that are lost from
throwing up and diarrhea.
Sports drinks and other drinks without caffeine or alcohol can help with mild
dehydration. But, these drinks may not replace important nutrients and
minerals. Oral rehydration fluids that you can get over the counter are most
helpful for mild dehydration.
If you think you or someone you are caring for is severely dehydrated, call
a doctor.
Most people with norovirus illness get better within 1 to 3 days.
Symptoms of dehydration
Decrease in urination
Dry mouth and throat
Feeling dizzy when standing up
Children who are dehydrated may cry with few or no tears and be
unusually sleepy or fussy.
Transmission
Norovirus is a highly contagious virus. Anyone can get infected with
norovirus and get sick. Also, you can get norovirus illness many times in
your life. One reason for this is that there are many different types of
noroviruses. Being infected with one type of norovirus may not protect you
against other types.
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Norovirus can be found in your stool (feces) even before you start feeling
sick. The virus can stay in your stool for 2 weeks or more after you feel
better.
You are most contagious when you are sick with norovirus illness, and
during the first few days after you recover from norovirus illness.
You can become infected with norovirus by accidentally getting stool or
vomit from infected people in your mouth. This usually happens by
Norovirus and food
Norovirus is the leading cause of illness and outbreaks from contaminated
food in the United States. Most of these outbreaks occur in the food service
settings like restaurants. Infected food workers are frequently the source of
the outbreaks, often by touching ready-to-eat foods, such as raw fruits and
vegetables, with their bare hands before serving them. However, any food
served raw or handled after being cooked can get contaminated with
norovirus.
Norovirus outbreaks can also occur from foods, such as oysters, fruits, and
vegetables, that are contaminated at their source.
Eating food or drinking liquids that are contaminated with norovirus,
touching surfaces or objects contaminated with norovirus then putting your
fingers in your mouth, or having contact with someone who is infected with
norovirus (for example, caring for or sharing food or eating utensils with
someone with norovirus illness).
Norovirus can spread quickly in closed places like daycare centers, nursing
homes, schools, and cruise ships. Most norovirus outbreaks happen from
November to April in the United States.
Practice proper hand hygiene
Wash your hands carefully with soap and water especially after using the
toilet and changing diapers, and always before eating, preparing, or
handling food.
Noroviruses can be found in your vomit or stool even before you start
feeling sick. The virus can stay in your stool for 2 weeks or more after you
feel better. So, it is important to continue washing your hands often during
this time.
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virus most when they are sick and during the first 3 days after they recover
from rotavirus disease.
The virus spreads by the fecal-oral route; this means that the virus must be
shed by an infected person and then enter a susceptible persons mouth to
cause infection. Rotavirus can be spread by contaminated
Hands
Objects (toys, surfaces)
Food
Water
Rotavirus can spread easily. Good hygiene (handwashing) and cleanliness
are important but are not enough to control the spread of the disease.
Rotavirus vaccines are very effective in preventing rotavirus gastroenteritis
and the accompanying diarrhea and other symptoms.
CDC recommends routine vaccination of infants with either of the two
available vaccines: RotaTeq (RV5), which is given in 3 doses at ages 2
months, 4 months, and 6 months; or Rotarix (RV1), which is given in 2
doses at ages 2 months and 4 months.
Both rotavirus vaccines are given orally. The vaccines are very effective
(85% to 98%) in preventing severe rotavirus disease in infants and young
children, including rotavirus infection that requires hospitalization.
Rotavirus vaccines will not prevent diarrhea or vomiting caused by other
viruses or pathogens.
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Viral Hepatitis
"Hepatitis" means inflammation of the liver and also refers to a group of
viral infections that affect the liver . The most common types are Hepatitis
A, Hepatitis B, and Hepatitis C.
Viral hepatitis is the leading cause of liver cancer and the most common
reason for liver transplantation. An estimated 4.4 million Americans are
living with chronic hepatitis; most do not know they are infected.
Hepatitis A
Hepatitis A, caused by infection with the Hepatitis A virus (HAV), has an
incubation period of approximately 28 days (range: 1550 days). HAV
replicates in the liver and is shed in high concentrations in feces from 2
weeks before to 1 week after the onset of clinical illness. HAV infection
produces a self-limited disease that does not result in chronic infection or
chronic liver disease.
However, 10%15% of patients might experience a relapse of symptoms
during the 6 months after acute illness. Acute liver failure from Hepatitis A
is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection
is directly related to age, with >80% of adults having symptoms compatible
with acute viral hepatitis and the majority of children having either
asymptomatic or unrecognized infection. Antibody produced in response to
HAV infection persists for life and confers protection against reinfection.
HAV infection is primarily transmitted by the fecal-oral route, by either
person-to-person contact or consumption of contaminated food or water.
Although viremia occurs early in infection and can persist for several weeks
after onset of symptoms, bloodborne transmission of HAV is uncommon.
HAV occasionally might be detected in saliva in experimentally infected
animals, but transmission by saliva has not been demonstrated.
In the United States, nearly half of all reported Hepatitis A cases have no
specific risk factor identified. Among adults with identified risk factors, the
majority of cases are among men who have sex with other men, persons
who use illegal drugs, and international travelers.
Because transmission of HAV during sexual activity probably occurs
because of fecal-oral contact, measures typically used to prevent the
transmission of other STDs (e.g., use of condoms) do not prevent HAV
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Vomiting
Abdominal pain
Dark urine
Clay-colored bowel movements
Joint pain
Jaundice
In children aged <6 years, 70% of infections are asymptomatic; if illness
does occur, it is typically not accompanied by jaundice. Among older
children and adults, infection is typically symptomatic, with jaundice
occurring in >70% of patients.
When symptoms occur, how long do they usually last?
Symptoms usually last less than 2 months, although 10%15% of
symptomatic persons have prolonged or relapsing disease for up to 6
months.
Incubation period for Hepatitis A
The average incubation period for Hepatitis A is 28 days (range: 1550
days).
The Hepatitis A Virus outside the body
HAV can live outside the body for months, depending on the environmental
conditions. The virus is killed by heating to >185 degrees F (>85 degrees
C) for one minute. However, the virus can still be spread from cooked food
if it is contaminated after cooking. Adequate chlorination of water, as
recommended in the United States, kills HAV that enters the water supply.
Preventing Hepatitis A Infection
Vaccination with the full, two-dose series of Hepatitis A vaccine is the best
way to prevent HAV infection. Hepatitis A vaccine has been licensed in the
United States for use in persons 12 months of age and older. The vaccine
is recommended for persons who are more likely to get HAV infection or
are more likely to get seriously ill if they get Hepatitis A, and for any person
wishing to obtain immunity (see Who should be vaccinated against
Hepatitis A?).
Immune globulin is available for short-term protection (approximately 3
months) against Hepatitis A, both pre- and post-exposure. Immune globulin
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Men who have sex with men. Sexually active men (both adolescents and
adults) who have sex with men should be vaccinated. Hepatitis A outbreaks
among men who have sex with men have been reported frequently. Recent
outbreaks have occurred in urban areas in the United States, Canada, and
Australia.
Users of illegal injection and noninjection drugs. During the past two
decades, outbreaks of Hepatitis A have been reported with increasing
frequency among users of both injection and noninjection drugs (e.g.,
methamphetamine) in North America, Europe, and Australia.
Persons who have occupational risk for infection. Persons who work with
HAV-infected primates or with HAV in a research laboratory setting should
be vaccinated. No other groups have been shown to be at increased risk
for HAV infection because of occupational exposure.
Persons who have chronic liver disease. Persons with chronic liver disease
who have never had Hepatitis A should be vaccinated, as they have a
higher rate of fulminant Hepatitis A (i.e., rapid onset of liver failure, often
leading to death). Persons who are either awaiting or have received liver
transplants also should be vaccinated.
Persons who have clotting-factor disorders. Persons who have never had
Hepatitis A and who are administered clotting-factor concentrates,
especially solvent detergent-treated preparations, should be vaccinated.
Household members and other close personal contacts of adopted children
newly arriving from countries with high or intermediate hepatitis A
endemicity.
Hepatitis A does not become chronic and IgG antibodies to HAV, which
appear early in the course of infection, provide lifelong protection against
the disease.
Hepatitis B
Hepatitis B is caused by infection with the Hepatitis B virus (HBV). The
incubation period from the time of exposure to onset of symptoms is 6
weeks to 6 months. HBV is found in highest concentrations in blood and in
lower concentrations in other body fluids (e.g., semen, vaginal secretions,
and wound exudates). HBV infection can be self-limited or chronic.
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Approximately 3.2 million persons in the United States have chronic HCV
infection. Infection is most prevalent among those born during 19451965,
the majority of whom were likely infected during the 1970s and 1980s when
rates were highest.
Who is at risk for HCV infection?
The following persons are at known to be at increased risk for HCV
infection:
Current or former injection drug users, including those who injected
only once many years ago
Recipients of clotting factor concentrates made before 1987, when
more advanced methods for manufacturing those products were
developed
Recipients of blood transfusions or solid organ transplants before July
1992, when better testing of blood donors became available
Chronic hemodialysis patients
Persons with known exposures to HCV, such as health care workers
after needlesticks involving HCV-positive blood recipients of blood or
organs from a donor who tested HCV-positive
Persons with HIV infection
Children born to HCV-positive mothers
HCV infection becomes chronic in approximately 75%85% of cases.
A person infected with HCV mounts an immune response to the virus, but
replication of the virus during infection can result in changes that evade the
immune response. This may explain how the virus establishes and
maintains chronic infection.
Hepatitis C Severity
Of every 100 persons infected with HCV, approximately
7585 will go on to develop chronic infection
6070 will go on to develop chronic liver disease
520 will go on to develop cirrhosis over a period of 2030 years
15 will die from the consequences of chronic infection (liver cancer or
cirrhosis)
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Prior infection with HCV does not protect against later infection with the
same or different genotypes of the virus. This is because persons infected
with HCV typically have an ineffective immune response due to changes in
the virus during infection. For the same reason, no effective pre- or
postexposure prophylaxis (i.e., immune globulin) is available.
Chronic HCV infection is the leading indication for liver transplants in the
United States.
How many deaths can be attributed to chronic HCV infection?
A recent CDC analysis of death certificate data found that HCV-attributable
deaths increased significantly between 1999 and 2007. CDC estimates that
there were 15,106 deaths caused by HCV in 2007. The citation can be
found at "The increasing burden of mortality from viral hepatitis in the
United States between 1999 and 2007." Ly, K., et al. Annals Of Internal
Medicine, 2012. 156(4): p. 271-278External Web Site Icon
No vaccine for Hepatitis C is available. Research into the development of a
vaccine is under way.
Transmission and Symptoms
HCV is transmitted primarily through large or repeated percutaneous (i.e.,
passage through the skin) exposures to infectious blood, such as
Injection drug use (currently the most common means of HCV transmission
in the United States).
Receipt of donated blood, blood products, and organs (once a common
means of transmission but now rare in the United States since blood
screening became available in 1992)
Needlestick injuries in health care settings.
Birth to an HCV-infected mother
HCV can also be spread infrequently through
Sex with an HCV-infected person (an inefficient means of transmission)
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Abdominal pain
Loss of appetite
Nausea
Vomiting
Joint pain
Jaundice
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sex at a young age. Still, in most cases, genital herpes is caused by the
second type of herpes virus (HSV-2).
HSV-2 lives in the nerves. When it's active, it travels to the surface of the
infected area (skin or mucous membrane) and makes copies of itself. This
is called "shedding" because these new viruses can, at this time, rub off on
another person. Then the virus travels back down the nerve to a ganglion
(mass of nerve tissue), usually at the base of the spine, where it lies
dormant for a while.
About one-fifth of all people aged 12 and up in the U.S. are infected with
the HSV-2 virus that causes genital herpes, but as many as 90% don't
know it. (By comparison, experts estimate 50% to 80% of adults have oral
herpes.)
More women than men are infected -- one in four women compared with
one in five men. One reason may be that the virus can infect a woman's
genitals more easily than it can a man's. Genital herpes is more common
among blacks than it is among whites, and it becomes more common as
people age. The more sex partners people have, the more common it is,
too.
Herpes (Oral or Genital) Transmission
HSV-1 is usually passed from person to person by kissing. HSV-1 can also
spread from the mouth to the genitals during oral sex (fellatio, cunnilingus,
analingus). If this happens, it becomes a case of genital herpes.
HSV-2 is most often passed by vaginal sex and anal sex. But just as HSV-1
can infect the genitals and cause genital herpes, HSV-2 can pass from one
person's genitals to another person's mouth, resulting in oral herpes.
Why this matters to massage therapists:
HSV-1 and HSV-2 can survive outside the body, although for how long is a
matter of debate.
This means that the cloth on the face rest of your massage table or even
the linen on the table itself can harbor the virus and pass it on to the next
client, in theory1.
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Herpes Simplex Demystified By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
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The CDC suggests that the virus can only last outside the body for a few
hours and that is only in the right conditions (warm and moist-like the
unchanged sheets of a massage table). It is possible (again, theoretically)
that if a massage therapist failed to change the linens on their table after
working on a client with an active Herpes infection and then had another
client use the same linens within a few minutes (as with back to back
appointments). While experts agree that it is possible, its highly unlikely.
Influenza
Influenza (flu) is a contagious respiratory illness caused by influenza
viruses. It can cause mild to severe illness. Serious outcomes of flu
infection can result in hospitalization or death.
The flu is a contagious respiratory illness caused by influenza viruses that
infect the nose, throat, and lungs. It can cause mild to severe illness, and at
times can lead to death. The best way to prevent the flu is by getting a flu
vaccine each year.
Signs and symptoms of flu
People who have the flu often feel some or all of these signs and
symptoms:
Fever or feeling feverish/chills
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (very tired)
Some people may have vomiting and diarrhea, though this is more
common in children than adults.
How flu spreads
Most experts believe that flu viruses spread mainly by droplets made when
people with flu cough, sneeze or talk. These droplets can land in the
mouths or noses of people who are nearby. Less often, a person might also
get flu by touching a surface or object that has flu virus on it and then
touching their own mouth, eyes or possibly their nose.
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Person to Person
People with flu can spread it to others up to about 6 feet away. Most
experts think that flu viruses are spread mainly by droplets made when
people with flu cough, sneeze or talk. These droplets can land in the
mouths or noses of people who are nearby or possibly be inhaled into the
lungs. Less often, a person might also get flu by touching a surface or
object that has flu virus on it and then touching their own mouth or nose.
To avoid this, people should stay away from sick people and stay home if
sick. It also is important to wash hands often with soap and water. If soap
and water are not available, use an alcohol-based hand rub. Linens, eating
utensils, and dishes belonging to those who are sick should not be shared
without washing thoroughly first. Eating utensils can be washed either in a
dishwasher or by hand with water and soap and do not need to be cleaned
separately. Further, frequently touched surfaces should be cleaned and
disinfected at home, work and school, especially if someone is ill.
The Flu Is Contagious
Most healthy adults may be able to infect other people beginning 1 day
before symptoms develop and up to 5 to 7 days after becoming sick.
Children may pass the virus for longer than 7 days. Symptoms start 1 to 4
days after the virus enters the body. That means that you may be able to
pass on the flu to someone else before you know you are sick, as well as
while you are sick. Some people can be infected with the flu virus but have
no symptoms. During this time, those persons may still spread the virus to
others.
Period of contagiousness
You may be able to pass on the flu to someone else before you know you
are sick, as well as while you are sick. Most healthy adults may be able to
infect others beginning 1 day before symptoms develop and up to 5 to 7
days after becoming sick. Some people, especially young children and
people with weakened immune systems, might be able to infect others for
an even longer time.
Flu is unpredictable and how severe it is can vary widely from one season
to the next depending on many things, including:
What flu viruses are spreading,
How much flu vaccine is available
When vaccine is available
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heart disease or diabetes. Any flu infection can carry a risk of serious
complications, hospitalization or death, even among otherwise healthy
children and adults. Therefore, getting vaccinated is a safer choice than
risking illness to obtain immune protection. Flu vaccines are readily
available and are a good idea for people that routine have close contact
with the multiple strangers in a confined space (like massage therapists).
CDC recommends a yearly flu vaccine for just about everyone 6 months
and older, even when the viruses the vaccine protects against have not
changed from the previous season. The reason for this is that a person's
immune protection from vaccination declines over time, so an annual
vaccination is needed to get the optimal or best protection against the flu.
Some people report having mild reactions to flu vaccination. Common
reactions to the flu shot and the nasal spray flu vaccine are described
below.
Reactions to the flu shot:
The most common reaction to the flu shot in adults has been soreness,
redness or swelling at the spot where the shot was given. This usually lasts
less than two days. This initial soreness is most likely the result of the
body's early immune response reacting to a foreign substance entering the
body. Other reactions following the flu shot are usually mild and can include
a low grade fever and aches. If these reactions occur, they usually begin
soon after the shot and last 1-2 days. The most common reactions people
have to flu vaccine are considerably less severe than the symptoms
caused by actual flu illness.
Reactions to nasal spray flu vaccine:
People also may have mild reactions to the nasal spray vaccine. Some
children and young adults 2-17 years of age have reported experiencing
mild reactions after receiving nasal spray flu vaccine, including runny nose,
nasal congestion or cough, chills, tiredness/weakness, sore throat and
headache. Some adults 18-49 years of age have reported runny nose or
nasal congestion, cough, chills, tiredness/weakness, sore throat and
headache. These side effects are mild and short-lasting, especially when
compared to symptoms of seasonal flu infection.
What about serious reactions to flu vaccine?
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Serious allergic reactions to flu vaccines are very rare. If they do occur, it is
usually within a few minutes to a few hours after the vaccination. While
these reactions can be life-threatening, effective treatments are available.
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Chapter 5: Fungi
General Fungus infection information
Anyone can get a fungal infection, even people who are otherwise healthy.
Fungi are common in the environment, and people breathe in or come in
contact with fungal spores every day without getting sick. However, in
people with weak immune systems, these fungi are more likely to cause an
infection in people with weak immune systems
Infections that happen because a persons immune system is weak are
called opportunistic infections. These illnesses can be caused by bacteria,
viruses, or fungi. Many fungal infections are opportunistic infections.
Some people are born with a weak immune system. Others may have an
illness that attacks the immune system such as HIV/AIDS. Some
medications, like corticosteroids or cancer chemotherapy, can also lower
the bodys ability to fight infections.
If you have a weakened immune system, you should be aware that fungal
infections can happen. Learning about fungal infections can help you and
your doctor recognize them early. This may help prevent serious
complications.
Medications that Weaken Your Immune System and Fungal Infections
Overall, most serious fungal infections are rare, but they do happen. They
are most common among people with weak immune systems. People with
certain health conditions may need to take medications with side effects
that can weaken your immune system and put you at risk for fungal
infections.
Specifically, corticosteroids and TNF (tumor necrosis factor) inhibitors are
two types of medications that can increase your chances of getting a fungal
infection.
Corticosteroids are medications that treat conditions including arthritis,
asthma, allergic reactions, and autoimmune diseases such as lupus,
sarcoidosis, or inflammatory bowel disease.
TNF inhibitors are medications that treat autoimmune diseases such as
rheumatoid arthritis, psoriasis, and inflammatory bowel disease.
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for these types of events, CDC and partners can continue to track, test for,
respond to, and better understand emerging fungal health threats.
Some fungal diseases may be more common than previously realized, and
rare but newly-emerging fungi are becoming increasingly problematic.
Some types of fungal infections can be deadly if they are not identified and
treated quickly, so early recognition is essential in order to reduce the risk
of serious complications and save lives.
Aspergillosis
Aspergillus is a common fungus that can be found in indoor and outdoor
environments. Most people breathe in Aspergillus spores every day without
being affected. Aspergillosis is a disease caused by this fungus and usually
occurs in people with lung diseases or weakened immune systems. The
spectrum of illness includes allergic reactions, lung infections, and
infections in other organs.
What is Aspergillosis?
Aspergillosis is an infection caused by a fungus called Aspergillus. There
are several different kinds of aspergillosis. One kind is allergic
bronchopulmonary aspergillosis (also called ABPA), a condition where the
fungus causes allergic respiratory symptoms, such as wheezing and
coughing, but does not actually invade and destroy tissue in the body.
Another kind of aspergillosis is invasive aspergillosis, a disease that usually
affects people with weakened immune systems. In this condition, the
fungus invades and damages tissues in the body. Invasive aspergillosis
most commonly affects the lungs, but Aspergillus can spread throughout
the body and also cause infection in other organs.
What is Aspergillus?
Aspergillus is a fungus that is common in the environment. It is found in
soil, on plants, and in decaying organic matter. It is also found in household
dust and building materials. There are many different species of
Aspergillus, but the most common species are Aspergillus fumigatus and
Aspergillus flavus. Other species are Aspergillus terreus, Aspergillus
nidulans, and Aspergillus niger.
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Symptoms of Aspergillosis
What are the Symptoms of Aspergillosis?
The different kinds of aspergillosis can cause different symptoms.
Symptoms of allergic bronchopulmonary aspergillosis (ABPA) may
include:
Wheezing
Coughing
Fever (in rare cases)
Symptoms of invasive aspergillosis may include:
Fever
Chest pain
Coughing
Shortness of breath
Other symptoms may develop if the infection spreads beyond the lungs.
When invasive aspergillosis spreads outside of the lungs, it can cause
symptoms in almost any organ. If you have symptoms that you think are
related to aspergillosis, contact your doctor.
Allergic bronchopulmonary aspergillosis (ABPA) can affect people who are
otherwise healthy, but it is most common in people with asthma or cystic
fibrosis. Invasive aspergillosis generally affects people who have weakened
immune systems, such as people who have had a bone marrow transplant
or solid organ transplant, people who are taking high doses of
corticosteroids, and people who are getting chemotherapy for cancer.
Rarely, people with advanced HIV infection can also get invasive
aspergillosis.
Preventing Aspergillosis
It is difficult to avoid breathing in normal levels of Aspergillus spores. For
people with weakened immune systems or severe lung diseases, there are
steps that can be taken to help reduce exposure, including:
Wear an N95 mask when near or in a dusty environment such as
construction sites
Avoid activities that involve close contact to soil or dust, such as yard work
or gardening
Use air quality improvement measures such as HEPA filters
Take prophylactic antifungal medication if deemed necessary by your
healthcare provider
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Clean skin injuries well with soap and water, especially if the injury has
been exposed to soil or dust
Aspergillosis Transmission
Aspergillus is common in the environment, so most people breathe in the
fungal spores every day. It is probably impossible to completely avoid
breathing in some Aspergillus spores. For people with healthy immune
systems, this does not cause harm, and the immune system is able to get
rid of the spores. But for people with weakened immune systems, breathing
in Aspergillus spores can lead to infection. Studies have shown that
invasive aspergillosis can occur during building renovation or construction.
Outbreaks of Aspergillus skin infections have been traced to contaminated
biomedical devices. Aspergillosis cannot be spread from person to person
or between people and animals.
Aspergillosis Treatment
Aspergillosis requires treatment with antifungal medication prescribed by a
doctor. Voriconazole is currently the first-line treatment for invasive
aspergillosis. There are other medications that can be used to treat
invasive aspergillosis in patients who cannot take voriconazole or who have
not responded to voriconazole. These include itraconazole, lipid
amphotericin formulations, caspofungin, micafungin, and posaconazole.
Whenever possible, immunosuppressive medications should be
discontinued or decreased.
Blastomycosis
Blastomycosis is a disease caused by the fungus Blastomyces dermatitidis.
The fungus lives in moist soil and in association with decomposing organic
matter such as wood and leaves. Lung infection can occur after a person
inhales airborne, microscopic fungal spores from the environment;
however, many people who inhale the spores do not get sick. The
symptoms of blastomycosis are similar to flu symptoms, and the infection
can sometimes become serious if it is not treated.
Definition of Blastomycosis
Blastomycosis is a disease caused by the fungus Blastomyces dermatitidis.
The fungus lives in moist soil and in association with decomposing organic
matter such as wood and leaves. Lung infection can occur after a person
inhales airborne, microscopic fungal spores from the environment;
however, many people who inhale the spores do not get sick. The
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In extremely rare cases, the fungal spores can enter the skin through a cut,
wound, or splinter and cause a skin infection.
Symptoms of valley fever may appear between 1 and 3 weeks after a
person breathes in the fungal spores.
Duration of Symptoms
The symptoms of valley fever usually last for a few weeks to a few
months.However, some patients have symptoms that last longer than this,
especially if the infection becomes severe.
Severe valley fever
Approximately 5 to 10% of people who get valley fever will develop serious
or long-term problems in their lungs.4 In an even smaller percent of people
(about 1%), the infection spreads from the lungs to other parts of the body,
such as the central nervous system (brain and spinal cord), skin, or bones
and joints.
Anyone who lives in or travels to the southwestern United States (Arizona,
California, Nevada, New Mexico, Texas, or Utah), or parts of Mexico or
Central or South America can get valley fever. Valley fever can affect
people of any age, but its most common in adults aged 60 and older.
Certain groups of people may be at higher risk for developing the severe
forms of valley fever, such as:
People who have weakened immune systems, for example, people
who:
Have HIV/AIDS
Have had an organ transplant
Are taking medications such as corticosteroids or TNF-inhibitors3
Pregnant women
People who have diabetes
People who are Black, or Filipino
Transmission
The fungus that causes valley fever, Coccidioides, cant spread from the
lungs between people or between people and animals. However, in
extremely rare instances, a wound infection with Coccidioides can spread
valley fever to someone else, or the infection can be spread through an
organ transplant with an infected organ.
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cells to infect other areas of the body, typically the central nervous
system (6).
Treatment and Outcomes for C. gattii cryptococcosis
Cryptococcosis requires treatment with prescription antifungal medication
for at least 6 months, usually longer. Treatment of severe cryptococcal
infections, including those with central nervous system involvement, usually
begins with amphotericin B, often in combination with flucytosine. For
patients with mild-to-moderate cryptococcosis, fluconazole or itraconazole
are the preferred forms of treatment. Fluconazole can also be used for
maintenance therapy in HIV-infected patients with cryptococcal
meningoencephalitis.
Dermatophytes (Ringworm)
Dermatophytes are fungi that cause skin, hair, and nail infections.
Infections caused by these fungi are also sometimes known as "ringworm"
or "tinea." Despite the name "ringworm," this infection is not caused by a
worm, but by a type of fungus. Dermatophytes can live on moist areas of
the skin, on environmental surfaces, and on household items such as
clothing, towels, and bedding.
Definition of Dermatophytes (Ringworm)
Dermatophytes are fungi that cause skin, hair, and nail infections.
Infections caused by these fungi are also sometimes known as "ringworm"
or "tinea." Despite the name "ringworm," this infection is not caused by a
worm, but by a type of fungus. There are many types of infections caused
by this fungus. The infections are generally identified by its location on the
body.
Some common ringworm infections:
Tinea barbae ringworm of the bearded parts of the face and neck
Tinea capitis ringworm of the scalp
Tinea corporis ringworm of the body
Tinea cruris ringworm of the groin, skin folds, inner thighs, or buttocks,
also known as jock itch
Tinea faciei ringworm of the face (other than bearded parts)
Tinea pedis - ringworm of the feet, also known as athletes foot
Tinea unguium / onychomycosis - ringworm of the toenail or fingernail
There are many different species of dermatophytes that can cause infection
in humans. Some species spread from person to person (Trichophyton
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very rare condition, but if left untreated, it can become serious and result in
vision loss or blindness.
Risk & Prevention
Fungal keratitis most commonly occurs in tropical and sub-tropical regions
of the world. In temperate areas of the world such as the United States, risk
factors for developing fungal keratitis include:
Recent eye trauma, particularly involving plant matter (for example, thorns
or sticks)
Underlying ocular (eye) disease
Weakened immune system
Contact lens use
Prevention of fungal keratitis
Protective eyewear is recommended for people who are at risk for eye
trauma involving organic matter, such as agricultural workers.
People who wear contact lenses should continue to follow proper lens care
practices:
Wash your hands with soap and water before handling contact lenses.
Wear and replace your contact lenses according to the schedule prescribed
by your doctor.
Follow the specific lens cleaning and storage guidelines from your doctor
and the solution manufacturer.
Keep your contact lens case clean and replace it every 3 to 6 months.
If you experience symptoms such as eye redness, pain, tearing, increased
light sensitivity, blurry vision, discharge, or swelling, remove your lenses
and consult your doctor immediately.
Sources of Fungal Keratitis
The most common way that someone gets fungal keratitis is after
experiencing trauma to the eye, especially if the trauma is caused by plant
matter such as a stick or a thorn. Fungal keratitis cannot be spread from
person to person.
In 2006, CDC investigated an outbreak of Fusarium keratitis that was
associated with a specific type of contact lens solution, which was later
withdrawn from the market.
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Your eye doctor will examine your eye and may possibly take a tiny
scraping of your cornea. The sample will be sent to a laboratory to be
examined under a microscope or cultured. Polymerase chain reaction
(PCR) and confocal microscopy are also being used as newer, faster forms
of diagnosis; however, culture from corneal scrapings is considered to be
the standard for definitive diagnosis of fungal keratitis.
Treatment and Outcomes for Fungal Keratitis
Fungal keratitis must be treated with prescription antifungal medicine for
several months. Natamycin is a topical ophthalmic antifungal medication
that works well on superficial corneal infections, particularly those caused
by filamentous fungi such as Aspergillus and Fusarium species. However,
corneal infections that are deeper and more severe usually require
treatment with systemic antifungal medication such as amphotericin B,
fluconazole, or voriconazole. Patients who do not get better after topical
and oral antifungal medications may require surgery, including corneal
transplantation.
Fungal Keratitis Statistics
The exact incidence in the general population is unknown, but fungal
keratitis is thought to be more common in warmer climates.
Fungal keratitis is not a notifiable condition. However, healthcare providers
who are concerned about an unusual number of new cases of fungal
keratitis should contact their state or local health departments.
Histoplasmosis
Histoplasmosis is a disease caused by the fungus Histoplasma
capsulatum. The fungus lives in the environment, usually in association
with large amounts of bird or bat droppings. Lung infection can occur after
a person inhales airborne, microscopic fungal spores from the environment;
however, many people who inhale the spores do not get sick. The
symptoms of histoplasmosis are similar to pneumonia, and the infection
can sometimes become serious if it is not treated.
Definition of Histoplasmosis
Histoplasmosis is a disease caused by the fungus Histoplasma
capsulatum. The fungus lives in the environment, usually in association
with large amounts of bird or bat droppings. Lung infection can occur after
a person inhales airborne, microscopic, fungal spores from the
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environment; however, many people who inhale the spores do not get sick.
The symptoms of histoplasmosis are similar to pneumonia, and the
infection can sometimes become serious if it is not treated, especially if the
infection spreads from the lungs to other organs.
Symptoms of Histoplasmosis
Many people who are infected with the fungus do not show any symptoms.
In areas of the world where the fungus is very common in the environment,
many people may have been infected with Histoplasma capsulatum without
having any symptoms. If symptoms occur, they usually start within 3 to 17
days after being exposed to the fungus.
In people who develop disease, the most common symptoms are similar to
those of pneumonia, and include: fever, chest pains, and a dry or
nonproductive cough. Some people may also experience joint pain. If the
disease is not treated, it can disseminate (spread) from the lungs to other
organs.
Risk & Prevention
Anyone can get histoplasmosis, even people who are otherwise healthy.
However, infants, young children, and older people, particularly those with
chronic lung disease, are at increased risk for developing severe disease.
Disseminated disease is most frequent in people who have weakened
immune systems, such as people with cancer or HIV/AIDS.
Histoplasma capsulatum, the fungus that causes histoplasmosis, can be
found throughout the world, but it is most common in North and Central
America. In the United States, the fungus is endemic (native and common)
in the Mississippi and Ohio River Valleys.
Prevention of Histoplasmosis
There is no vaccine to prevent histoplasmosis, and it is not always possible
to prevent exposure to the fungus in areas where the fungus is endemic.
However, you should avoid areas with accumulations of bird or bat
droppings, especially if you have a weakened immune system. Areas with
accumulations of bird or bat droppings should be cleaned up by
professional companies that specialize in the removal of hazardous waste.
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Sources of Histoplasmosis
H. capsulatum grows in soil and material contaminated with bat or bird
droppings. The microscopic fungal spores can become airborne when the
soil is disturbed, and breathing in the spores can cause infection in the
lungs. Histoplasmosis cannot be transmitted from person to person or from
animals to people.
There are multiple tests available to diagnose histoplasmosis. One way to
diagnose the infection is to perform a fungal culture. Doctors take small
samples from tissues or body fluids, such as blood, sputum, bone marrow,
liver, or skin and see if the fungus will grow from these samples in a
laboratory.
A urine test is available that can check for recent infection from
Histoplasma, by measuring the presence of antigen. Histoplasmosis can
also be diagnosed by looking at a small sample of infected tissue under a
microscope. A blood test can measure prior exposure to the fungus by
detecting Histoplasma antibodies.
Treatment & Outcomes of Histoplasmosis
The mild pulmonary (lung) form of histoplasmosis will generally resolve
within about a month without treatment.
Prescription antifungal medications are needed to treat severe cases of
acute histoplasmosis, and all cases of chronic or disseminated disease.
Itraconazole is one commonly used antifungal medication. Treatment may
continue for 3 to 12 months, depending on the severity of the disease and
the immune status of the person. Past infection can provide partial
protection against severe disease if a person becomes re-infected later in
life.
Histoplasmosis Statistics
Between 50% and 80% of people who live in areas where Histoplasma
capsulatum is common in the environment will show evidence of having
been exposed to the fungus at some point in their lifetime. In these areas,
10% to 25% of HIV-infected people will develop disseminated
histoplasmosis.
Histoplasmosis is reportable in some states, including Kentucky,
Minnesota, Illinois, Mississippi, Michigan, Indiana, and Pennsylvania. No
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Sources of Mucormycosis
There are two main types of infection that people can get, and these
depend on the route of exposure. In the pulmonary or sinus form, exposure
occurs by inhaling fungal spores from the environment. These spores can
cause an infection to develop in the lungs, sinuses, eyes, and face, and in
rare cases the infection can spread to the central nervous system. In the
cutaneous form, the fungus can enter the skin through cuts, scrapes,
puncture wounds, or other forms of trauma to the skin. Mucormycosis is not
contagious and does not spread from person to person.
Organism
Several different fungi can cause mucormycosis, but the most common is
Rhizopus arrhizus (oryzae). Less frequent causes of infection include
Lichtheimia
(Absidia)
corymbifera,
Apophysomyces
elegans,
Cunninghamella bertholletiae, Rhizomucor pusillus and Saksenaea
vasiformis. All cause similar diseases in humans, and the diagnostic and
treatment approaches are similar.
Reservoir
The fungi that cause mucormycosis are found in the soil and decomposing
organic matter, such as leaves or wood.
Transmission
Most human infections follow inhalation of fungal spores that have been
released into the air. Less frequently, infection occurs during traumatic
inoculation, when fungal organisms gain entrance to deep body tissues
following a traumatic event that damages the skin. Infection can also occur
following ingestion of contaminated food.
Treatment & Outcomes of Mucormycosis
Mucormycosis needs to be treated with antifungal medication prescribed by
a health care provider. These medications are given by mouth or through a
vein. Skin infections with the fungus may require surgery to cut away the
infected tissue.
In cutaneous mucormycosis, wounds should be thoroughly debrided and
resected in conjunction with antifungal-based therapy debrided and
resected, antifungal therapy (conventional or lipid formulations of
amphotericin B) should be administered, and control of the underlying
immunocompromising condition should be attempted when possible.
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TMP-SMX can cause negative side effects such as a rash and nausea, but
the benefits of treating the PCP usually outweigh the risks of these side
effects. Without treatment, PCP can be fatal.
Pneumocystis pneumonia Statistics
Before the beginning of the HIV/AIDS epidemic in the 1980s, PCP was very
uncommon. In fact, unusual clusters of PCP were one of the first signs that
the HIV/AIDS epidemic was beginning. PCP soon became one of the main
AIDS-defining illnesses in HIV-infected patients in the United States. Since
then, the incidence of PCP in HIV/AIDS patients has declined in the U.S.
due to the introduction of highly active antiretroviral therapy (HAART) and
TMP-SMX prophylaxis. However, PCP is still a serious health concern for
people with HIV/AIDS or other conditions that weaken the immune system.
In the U.S., the incidence of PCP is estimated to be 9% among hospitalized
HIV/AIDS patients and 1% among solid organ transplant recipients. In
immunocompromised patients, the mortality rate ranges from 5% to 40% in
those who receive treatment. The mortality rate approaches 100% without
therapy.
Sporotrichosis
Sporotrichosis is an infection caused by a fungus called Sporothrix
schenckii. The fungus lives throughout the world in soil, plants, and
decaying vegetation. Cutaneous (skin) infection is the most common form
of infection and usually occurs after handling contaminated plant material,
when the fungus enters the skin through a small cut or scrape.
Definition of Sporotrichosis
Sporotrichosis is an infection caused by a fungus called Sporothrix
schenckii. The fungus lives throughout the world in soil, plants, and
decaying vegetation. Cutaneous (skin) infection is the most common form
of infection, although pulmonary infection can occur if a person inhales the
microscopic, airborne fungal spores. Most cases of sporotrichosis are
sporadic and are associated with minor skin trauma like cuts and scrapes;
however, outbreaks have been linked to activities that involve handling
contaminated vegetation such as moss, hay, or wood.
Symptoms of Sporotrichosis
The first symptom is usually a small painless nodule (bump) resembling an
insect bite. The first nodule may appear any time from 1 to 12 weeks after
exposure to the fungus. The nodule can be red, pink, or purple in color, and
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it usually appears on the finger, hand, or arm where the fungus has entered
through a break in the skin. The nodule will eventually become larger in
size and may look like an open sore or ulcer that is very slow to heal.
Additional bumps or nodules may appear later near the original lesion.
Most Sporothrix infections only involve the skin. However, the infection can
spread to other parts of the body, including the bones, joints, and the
central nervous system. Usually, these types of disseminated infections
only occur in people with weakened immune systems. In rare cases, a
pneumonia-like illness can occur after inhaling Sporothrix spores, which
can cause symptoms such as shortness of breath, cough, and fever.
Risk & Prevention
People who handle thorny plants, sphagnum moss, or bales of hay are at
increased risk of getting sporotrichosis. The infection is more common
among people with weakened immune systems, but it can also occur in
otherwise healthy people. Outbreaks have occurred among florists, plant
nursery workers who have handled sphagnum moss, rose gardeners,
children who have played on bales of hay, and greenhouse workers who
have handled thorns contaminated by the fungus.
Prevention of sporotrichosis
There is no vaccine to prevent sporotrichosis. You can reduce your risk of
sporotrichosis by wearing protective clothing such as gloves and long
sleeves when handling wires, rose bushes, bales of hay, pine seedlings, or
other materials that may cause minor cuts or punctures in the skin. It is also
advisable to avoid skin contact with sphagnum moss.
Sources of Sporotrichosis
The fungus lives in sphagnum moss, hay, other plant materials, and soil.
The fungus can enter the skin through small cuts or punctures from thorns,
barbs, pine needles, or wires. In rare cases, inhalation of the fungus can
cause pulmonary infection. Sporotrichosis is not spread from person to
person; however, a small number of human cases have been caused by
scratches or bites from infected animals such as cats.
Sporotrichosis Diagnosis and Testing
Sporotrichosis is typically diagnosed when your doctor obtains a swab or a
biopsy of the infected site and sends the sample to a laboratory for a fungal
culture. Serological tests are not always useful in the diagnosis of
sporotrichosis due to limitations in sensitivity and specificity.
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Chapter 6: Parasites
A parasite is an organism that lives on or in a host organism and gets its
food from or at the expense of its host. There are three main classes of
parasites that can cause disease in humans: protozoa, helminths, and
ectoparasites.
Parasitism is the relation between two different kinds of organisms in which
one receives benefits from the other by causing damage to it. Usually a
parasite refers to organisms with lifestages that need more than one host
(e.g. Taenia solium). These are now called macroparasites (typically
protozoa and helminths). The word parasite also refers to microparasites,
which are typically smaller, such as viruses and bacteria, and can be
directly transmitted between hosts of the same species.
Parasites are generally much smaller than their host and show a high
degree of specialization, they reproduce at a faster rate than their hosts.
Classic examples of parasites include animals like tapeworms, flukes, ticks
and fleas.
Etymology
The word parasite comes from the Latin parasitus, the latinisation of the
Greek (parasitos, "one who eats at the table of another" and that from para,
"beside, by" + sitos, "wheat".
Pediculus humanus capitis
Pediculosis is an infestation of lice. These are blood-feeding insects of the
order Phthiraptera. The condition can occur in almost any species of warmblooded animal including humans. Although "pediculosis" in humans may
properly refer to lice infestation of any part of the body, the term is
sometimes used loosely to refer to pediculosis capitis, the infestation of the
human head with the specific head louse.
Head-lice infestation is most frequently found on children aged 310 and
their families. Approximately 3% of school children in the United States
contract head lice. Females are more frequently infested than males,
probably due to the fact that they generally have more hair. African
Americans generally suffer less infestations due to the difference in hair
texture.
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Head lice are spread through direct head-to-head contact with an infested
person or by sharing hats, combs and other hair products. From each egg
or "nit" may hatch one nymph that will grow and develop to the adult louse.
Lice feed on blood by piercing the skin with their tiny needle-like
mouthparts; their saliva irritates the skin and causes the characteristic
itching. They do not burrow into the skin.
Diagnosis
To diagnose a lice infestation the scalp is combed thoroughly with a louse
comb and the teeth of the comb are examined for the presence of living lice
after each time the comb passes through the hair.
The most obvious symptom of infestation is pruritus (itching) on the head
which normally intensifies 3 to 4 weeks after the initial infestation.
Excessive scratching of the infested areas can cause sores, which may
then become infected. In addition, body lice can be a vector for other
diseases, such as louse-borne typhus, louse-borne relapsing fever or
trench fever.
Epidemiology
Around 6-12 million people (mostly children) are treated for head lice in the
United States each year. Head lice infest a new host by close contact
between individuals, making social contacts among children and parent
child interactions the most likely routes of infestation. Shared hats, combs,
brushes, towels, clothing, and beds are also routes of lice transmission.
Body lice
This condition, is caused by body louse (Pediculus humanus humanus,
sometimes called Pediculus humanus corporis) is a louse which infests
humans and lays eggs in their clothing, rather than at the base of hairs.
Pubic lice
The pubic or crab louse (Pthirus pubis) is another offshoot of the original
louse and is adapted to body hair. Humans have the dubious honor of
being the only known host of this parasite. Arent we AWESOME?
Scabies
Scabies (from Latin: scabere, "to scratch") is a contagious skin infection
that occurs among humans and other animals. It has been classified by the
WHO as a water-related disease. It is caused by a tiny parasite that is not
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visible to the naked eye, which burrows under the host's skin and causes
an intense itching. The infection in animals (caused by different but related
mite species) is called sarcoptic mange.
Scabies are microscopic, but sometimes are visible as pinpoints of white.
The pregnant females tunnel into the outermost layer of a host's skin and
deposit eggs in shallow burrows. The eggs then hatch into larvae in around
310 days. These young mites move about on the skin and molt into a
"nymphal" stage, before maturing as adults, which live 34 weeks in the
host's skin. Males roam on top of the skin, occasionally burrowing into the
skin. This movement of mites on and inside the skin produces an intense
itch, which has the characteristics of a delayed cell-mediated inflammatory
response to allergens.
The disease is most often transmitted by direct skin-to-skin contact, with
the probability of transmission increasing with the duration of contact. Initial
infections require four to six weeks to become symptomatic. Reinfection,
however, may manifest symptoms within as little as 24 hours. Because the
symptoms are allergic, their delay in onset is often mirrored by a significant
delay in relief after the parasites have been eradicated.
Signs and symptoms
The primary symptom of a scabies infection is an intense itching and a
superficial burrowing. The burrow tracks often form a neat "line" of four or
more equally developed "bites". These are often found in crevices of the
body, such as on the webs of fingers and toes, around the genital area, and
under the breasts of women.
Itching
Generally the itch is made worse by the application of warmth and is worse
at night (although that is probably because the person experiencing it has
less distraction at night, so it just seems worse).
Rash
The burrows are created by the excavation (digging) of the adult mite in the
skin. It generally occurs in the areas of the hands, feet, wrists, elbows,
back, buttocks, and external genitals. The infection doesnt usually appear
on the face or scalp except in people with compromised immune systems
or very young children.
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can take anywhere from minutes to days for chlorine to kill them.
Swallowing just a little water that contains these germs can make you sick.
Recreational water illnesses (RWIs) are caused by germs spread by
swallowing, breathing in mists or aerosols of, or having contact with
contaminated water in swimming pools, hot tubs, water parks, water play
areas, interactive fountains, lakes, rivers, or oceans. RWIs can also be
caused by chemicals in the water or chemicals that evaporate from the
water and cause indoor air quality problems.
RWIs include a wide variety of infections, such as gastrointestinal, skin,
ear, respiratory, eye, neurologic, and wound infections. The most
commonly reported RWI is diarrhea. Diarrheal illnesses are caused by
germs such as Crypto (short for Cryptosporidium-see below), Giardia,
Shigella, norovirus and E. coli O157:H7.
With RWI outbreaks on the rise, swimmers need to take an active role in
helping to protect themselves and prevent the spread of germs. It is
important for swimmers to learn the basic facts about RWIs so they can
keep themselves and their family healthy every time they swim.
In the past two decades, there has been a substantial increase in the
number of RWI outbreaks associated with swimming. Crypto, which can
stay alive for days even in well-maintained pools, has become the leading
cause of swimming pool-related outbreaks of diarrheal illness. From 2004
to 2008, reported Crypto cases increased over 200% (from 3,411 cases in
2004 to 10,500 cases in 2008).
Although Crypto is tolerant to chlorine, most germs are not. Keeping
chlorine at recommended levels is essential to maintain a healthy pool.
However, a 2010 study found that 1 in 8 public pool inspections resulted in
pools being closed immediately due to serious code violations such as
improper chlorine levels.
Knowing the basic facts about recreational water illnesses (RWIs) can
make the difference between an enjoyable time at the pool, beach, or water
park, and getting a rash, having diarrhea, or developing other, potentially
serious illnesses.
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disinfectant levels in hot tubs even more regularly than in swimming pools.
The germs that cause "hot tub rash" can also be spread in pools that do not
have proper disinfectant levels and in natural bodies of water such as
oceans, lakes, or rivers.
Decorative Water Fountains
Not all decorative fountains are chlorinated or filtered. Therefore, when
people, especially diaper-aged children, play in the water, they can
contaminate the water with fecal matter. Swallowing this contaminated
water can then cause diarrheal illness.
Oceans, Lakes, and Rivers
Oceans, lakes, and rivers can be contaminated with germs from sewage
spills, animal waste, water runoff following rainfall, fecal incidents, and
germs rinsed off the bottoms of swimmers. It is important to avoid
swallowing the water because natural recreational water is not disinfected.
Avoid swimming after rainfalls or in areas identified as unsafe by health
departments.
Cryptosporidium
Cryptosporidium is a microscopic parasite that causes the diarrheal
disease cryptosporidiosis. Both the parasite and the disease are commonly
known as "Crypto."
There are many species of Cryptosporidium that infect humans and
animals. The parasite is protected by an outer shell that allows it to survive
outside the body for long periods of time and makes it very tolerant to
chlorine disinfection.
While this parasite can be spread in several different ways, water (drinking
water and recreational water) is the most common method of transmission.
Cryptosporidium is one of the most frequent causes of waterborne disease
among humans in the United States.
Cryptosporidiosis is a diarrheal disease caused by microscopic parasites,
Cryptosporidium, that can live in the intestine of humans and animals and
is passed in the stool of an infected person or animal. Both the disease and
the parasite are commonly known as "Crypto." The parasite is protected by
an outer shell that allows it to survive outside the body for long periods of
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Contaminated water may include water that has not been boiled or filtered,
as well as contaminated recreational water sources (e.g., swimming pools,
lakes, rivers, ponds, and streams). Several community-wide outbreaks of
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Failure to provide a clean and safe environment violates the key principle of
non-maleficence, the do no harm aspect of medical ethics.
In the massage industry, following strict procedures and sterilization
techniques is critically important not only for clients but for the protection of
professionals.
Massage therapists are in the 'paramedical' arena, are protected by the
Occupational Safety and Health Act of 1970 (the Act), 29 U.S.C. 655, which
minimizes occupational exposure to Hepatitis B Virus (HBV), Human
Immunodeficiency Virus (HIV) and other bloodborne pathogens.
OSHA has made a determination that employees face a significant health
risk as the result of occupational exposure to blood and other potentially
infectious materials because they may contain bloodborne pathogens. The
Agency further concludes that this exposure can be minimized or
eliminated using a combination of engineering and work practice controls,
personal protective clothing and equipment, training, medical surveillance,
Hepatitis B vaccination, signs and labels, and other provisions.
The environment in the massage setting is obviously different than in a
medical setting. The material published in connection with the Occupational
Safety and Health Administration (OSHA) standard, 'Occupational
Exposure to Bloodborne Pathogens' (29 CFR 1910.1030) does not include
any information on the risks of transmission of diseases in the massage
profession. Under the standard, it is the responsibility of the employer to
evaluate the potential for contact with blood, bacterial, fungi or other
potentially infectious material among his or her employees.
Laundering your massage linens
What both medical massage and luxury massage have in common is that
they often launder their own linens and towels in ordinary washers and
dryers that do not deliver hygienically clean linens, putting their clients at
risk for healthcare acquired infections (HAIs) and other easily transmitted
skin diseases and infections. In contrast, other healthcare facilities such as
hospitals and ambulatory surgery centers are under increased scrutiny and
regulation to develop superior infection prevention programs due to the
alarming rise in HAIs. Laundry tends to be the most outsourced department
and while commercial laundries certainly improve hospital efficiencies and
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are better for the environment, quality control, infection control, and other
safety issues are still a concern. Day spas should take note.
So, what are the recommended quality practices and processes for medical
spa and day spa laundry operations, and how can commercial healthcare
laundries deliver hygienically clean textiles that minimize any risk of
spreading infection?
Accreditationthe industry's highest rating on quality and safetyfrom the
Healthcare Laundry Accreditation Council (HLAC) provides assurance that
spa textiles, just like healthcare textiles, cleaned by a company that
adheres to the highest possible standards. The HLAC is a non-profit
organization formed for the purpose of inspecting and accrediting laundries
processing healthcare textiles for hospitals, ambulatory surgery centers,
nursing homes, and other healthcare facilities. Standards incorporate
stringent requirements for healthcare linen processing that addresses
proper techniques for washing and extraction, drying, finishing, quality
control, packaging, storage, and delivery to the healthcare facility. They
ensure that healthcare textiles processed at an HLAC-accredited laundry
plant carry negligible risk to healthcare workers and patients, providing the
clean products are not inadvertently contaminated before use.
Additionally, proper wash formulas in the laundering process are constantly
monitored to assure consistent delivery of hygienically clean linens,
adequately removing any bio-burden so they can be used without fear of
being a contamination source. Wash water quality and usage, temperature,
pH, oxidation, chemical sanitizers, drying, ironing and equipment
performance are all carefully controlled. The HLAC also incorporates the
Occupational Safety and Health Care Act (OSHA) Standard Precautions
that must be included as part of a healthcare laundrys daily operations in
order to protect its employees who handle and sort soiled healthcare
linens.
Using proper hygiene is necessary for massage therapists to protect them
and the public they serve from infectious diseases and to keep them from
spreading between their clients.
The goal of proper hygiene is to prevent the growth and spread of
pathogens and allergens.
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Wash any blankets and pillows the same way. If you cannot bleach them,
add 1 cup of a phenol or other disinfectant.
Wipe down the massage tables surface and the any bolster used with a
disinfectant.
Proper use of Disinfectants
Disinfectants are chemical substances that are applied to non-living objects
to kill microorganisms that are living on the surface of the objects. It is
important to know that disinfections does not necessarily kill all
microorganisms present, some species of bacterial spores are very hard to
destroy.
Disinfections are less effective than total sterilization, which is an extreme
physical and/or chemical process that kills all types of life. Disinfectants
work by destroying the cell wall of microbes or interfering with their
metabolic processes.
Disinfectants are not the same as antibiotics,
microorganisms within the body, or antiseptics,
microorganisms on the surface of living tissue.
which
which
destroy
destroy
Disinfectants are also different from biocides the latter are intended to
destroy all forms of life, not just microorganisms. This would include
humans, so obviously it is not used to clean your massage room.
Bacterial endospores are most resistant to disinfectants, but some viruses
and bacteria possess some tolerance as well, which is why simply using a
hand sanitizer is not the same as washing your hands properly.
Properties
A perfect disinfectant would offer complete microbiological sterilization,
without harming us humans, be cheap, and good for the environment.
They dont exist.
Most disinfectants are potentially harmful, even toxic to us humans (they
are poisons, after all). Most modern disinfectants contain Bitrex, an
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Air disinfectants
Air disinfectants are typically chemical substances capable of disinfecting
microorganisms suspended in the air. Disinfectants are generally assumed
to be limited to use on surfaces, but that is not the case. In 1928, a study
found that airborne microorganisms could be killed using mists of dilute
bleach. An air disinfectant must be dispersed either as an aerosol or
vapour at a sufficient concentration in the air to cause the number of viable
infectious microorganisms to be significantly reduced.
In the 1940s and early 1950s, further studies showed inactivation of diverse
bacteria, influenza virus, and Penicillium chrysogenum (previously P.
notatum) mold fungus using various glycols, principally propylene glycol
and triethylene glycol. In principle, these chemical substances are ideal air
disinfectants because they have both high lethality to microorganisms and
low mammalian toxicity.
Although glycols are effective air disinfectants in controlled laboratory
environments, it is more difficult to use them effectively in real-world
environments because the disinfection of air is sensitive to continuous
action. Continuous action in real-world environments with outside air
exchanges at door, HVAC, and window interfaces, and in the presence of
materials that adsorb and remove glycols from the air, poses engineering
challenges that are not critical for surface disinfection. The engineering
challenge associated with creating a sufficient concentration of the glycol
vapours in the air have not to date been sufficiently addressed.
A Review of the Principles of Universal Precautions include:
Assume that all individuals you have contact with as a result of job
responsibilities, are potential carriers for blood born pathogens.
Assume that all blood and other potentially infectious material (OPIM:
human blood, semen, vaginal secretions, wound drainage, fluids visibly
contaminated with blood, cerebrospinal fluid, synovial fluid, pleural fluid,
pericardial fluid, peritoneal fluid, amniotic fluid, unfixed tissue or organs,
and any body fluids in situations where it is difficult or impossible to
differentiate between body fluids are infectious for bbp and must be treated
as infectious.
Universal precautions do not apply to feces, nasal secretions, sputum,
sweat, tears, urine, and vomitus unless they contain visible blood.
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Good Housekeeping
Keeping a clean work environment is absolutely critical when it comes to
protecting the public and yourself.
Broken glass should never be handled by hand. Use a dustpan and broom
to clean up any hazardous materials.
Clean environmental work surfaces when they become contaminated with
blood or OPIM and immediately secure the area, disinfect the area, and
clean the area. (Bleach and water is considered the most universal
disinfectant, otherwise read labels, 1 part Bleach to 9 parts water, mixed as
needed, do not store overnight.)
Double bag and label any contaminated waste before proper disposal.
Clean and disinfect all equipment: massage table, mechanical massage
devices, face cradles, bolsters, oil/lotion bottles, etc. between clients.
Use germicidal cleaners, diluted beach, rubbing alcohol for routine
disinfecting of equipment.
Personal Protective Equipment (PPE)
(a) When there is anticipated potential of exposure to blood/OPIM PPE
must be used. The most common piece of PPE is gloves. Other types of
PPE may include gowns, goggles, face shield, masks, and CPR Micro
shields. (b) The rule of thumb for PPE is dress for the occasion. Use the
right equipment for the right potential situation.
Massage therapists and bodyworkers should always have gloves (vinyl or
latex) and CPR micro shields available in their work area for potential
emergencies.
Post Exposure
Anytime someone else's blood or OPIM gets into your body (puncture,
mucous membranes, open areas, etc.) in a work situation, report and follow
the procedure of the employer and seek medical follow up immediately.
Infection Control
Massage therapists, due to the physical connection with others can be at
risk of spreading infections. As well they can be susceptible to receiving
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Course Evaluation
Read the lecture notes. When you feel ready to take the quiz you can pay
to access the quiz by clicking the blue button on the website underneath
this embed on the website.
You can also download a copy of the quiz in advance to prepare.
If you are reading this on a mobile device (Kindle, Nook, cellphone or tablet) you may need to
download the FREE Scribd app. You can find a link to it on our webpage.
Errata
If you found a typo PLEASE LET US KNOW what page it is on and the
paragraph and we will fix it ASAP. This book has 45,000 words in the
course content alone. Some of those are going to be misspelled. Were not
perfect, but we strive to be- so help us out.
Help and Technical Support
We have worked hard to make this course as easy to use as possible, but it
does rely on technology and sometimes there are factors that are out of our
control (like your local internet provider, your computer, your browser
version, the device you are using etc).
If for some reason you are not able to access the quiz you can call us and
let us know, and we will problem solve it for you. We have office hours,
Monday-Friday 8:00 am-5:00 pm PST but you can call or email for help at
any time after hours, I monitor the system every hour until I go to sleep, so
call if you need to and I will do my best to help you. The number is (209)
777-6305.
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Bibliography
All information regarding bacteria, fungus and viruses in this course are
from the Center for Disease Control (CDC.GOV) as are the rules for
Universal Precautions in a health care setting.
Herpes Simplex Demystified By Ruth Werner, LMP, NCTMB, Massage
Therapy Foundation President Massage Today November, 2004, Vol. 04,
Issue 11
Mosby's Pathology for Massage Therapists Susan G. & Craig Salvo
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