Infectiousdiseases

nfectious Diseases nfectious Diseases
Lynn K. Wittwer, MD, MPD Lynn K. Wittwer, MD, MPD

Clark County EMS Clark County EMS
Microorganisms Microorganisms
Normal Flora
Pathogens
Bacterial
` Staphylococci
` Streptococci
` Enterobacteriaceae
Viral
` Rickettsiae
` Protozoans
Opportunistic
Pathogens
Normal Flora
Pathogens
Bacterial
` Staphylococci
` Streptococci
` Enterobacteriaceae
Viral
` Rickettsiae
` Protozoans
Opportunistic
Pathogens
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Bacteria Bacteria
Common Bacterial Diseases Common Bacterial Diseases
`` Sinusitis Sinusitis
`` Otitis media Otitis media
`` Bacterial pneumonia Bacterial pneumonia
`` Pharyngitis Pharyngitis
`` TB TB
`` UT's UT's
Bacterial growth Bacterial growth
E.coli E.coli
Bacterial Growth (cont.) Bacterial Growth (cont.)
LAG PHASE: Growth is slow at first, LAG PHASE: Growth is slow at first,
while the "bugs" acclimate to the food while the "bugs" acclimate to the food
and nutrients in their new habitat. and nutrients in their new habitat.
LOG PHASE: Once the metabolic LOG PHASE: Once the metabolic
machinery is running, they start machinery is running, they start
multiplying exponentially, doubling in multiplying exponentially, doubling in
number every few minutes. number every few minutes.
STATONARY PHASE: As more and STATONARY PHASE: As more and
more bugs are competing for dwindling more bugs are competing for dwindling
food and nutrients, booming growth food and nutrients, booming growth
stops and the number of bacteria stops and the number of bacteria
stabilizes. stabilizes.
DEATH PHASE: Toxic waste products DEATH PHASE: Toxic waste products
build up, food is depleted and the bugs build up, food is depleted and the bugs
begin to die. begin to die.
&;.7lococcus .ureus &;.7lococcus .ureus
www.cells.live.com www.cells.live.com
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Bacteria (cont.) Bacteria (cont.)
Gram Stains Gram Stains
``Gram positive Gram positive
``Gram negative Gram negative
Types of Bacteria Types of Bacteria
``Cocci (spheres) Cocci (spheres)
``Rods Rods
E. coli E. coli
``Spirals Spirals
Spirochetes Spirochetes
Endotoxins Endotoxins
Released from gram Released from gram
neg. bacteria neg. bacteria
Released during cell Released during cell
destruction destruction
Exotoxins Exotoxins
Toxic protein shed by Toxic protein shed by
living bacteria living bacteria
Viruses Viruses
Obligate ntracellular Obligate ntracellular
Parasites Parasites
Grow/reproduce w/in Grow/reproduce w/in
host cell host cell
Virus Replication Virus Replication
Viral llness Viral llness
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Other Microorganisms Other Microorganisms
Prions Prions
Fungi Fungi
Protozoa Protozoa
Parasites Parasites
Pinworms Pinworms
Hookworms Hookworms
Trichinosis Trichinosis
i.rdi. l.mbli. i.rdi. l.mbli.
En;.moeb. is;ol;ic. En;.moeb. is;ol;ic.
.;er .;erborne, free borne, freeliving living
7.r.si;e, c.uses .moebic 7.r.si;e, c.uses .moebic
dsen;er .nd inv.sive dsen;er .nd inv.sive
liver .bscesses. liver .bscesses.
Cellsalive.com
Contraction, Transmission, and Contraction, Transmission, and
Stages of Disease Stages of Disease
Transmission of nfectious Disease Transmission of nfectious Disease
nteraction of Host, nfectious Agent, and nteraction of Host, nfectious Agent, and
Environment Environment
Reservoirs Reservoirs
Direct vs. ndirect Transmission Direct vs. ndirect Transmission
Routes of Exposure Routes of Exposure
Bloodborne, airborne, sexual, fecal Bloodborne, airborne, sexual, fecal- -oral, and foodborne oral, and foodborne
Risk of nfection Risk of nfection
Theoretical vs. measurable Theoretical vs. measurable
Factors Affecting Disease Transmission Factors Affecting Disease Transmission
Mode of Entry Mode of Entry
Virulence Virulence
Number of Organisms Transmitted Number of Organisms Transmitted
Host Resistance Host Resistance
Other Host Factors Other Host Factors
Phases of the nfectious Process Phases of the nfectious Process
Latent Period Latent Period
Communicable Period Communicable Period
ncubation Period ncubation Period
Seroconversion and the window phase Seroconversion and the window phase
Disease Period Disease Period
The Body's Defenses against The Body's Defenses against
Disease Disease
Barriers to Entry Barriers to Entry
ntact Skin ntact Skin
Respiratory System Respiratory System
The mmune System The mmune System
The Reticuloendothelial System (RES) The Reticuloendothelial System (RES)
dentifies Foreign Material dentifies Foreign Material
ncludes antigens of most bacteria and viruses. ncludes antigens of most bacteria and viruses.
An inflammatory response triggers An inflammatory response triggers
mechanisms designed to remove foreign mechanisms designed to remove foreign
material. material.
ir.l .n;igens ir.l .n;igens
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Disease Disease
The mmune System (cont.) The mmune System (cont.)
Leukocytes Leukocytes
Neutrophils and macrophages Neutrophils and macrophages
Cell Cell- -Mediated mmunity Mediated mmunity
Humoral mmunity Humoral mmunity
Results in the formation of antibodies. Results in the formation of antibodies.
Memory and specificity. Memory and specificity.
Antibodies (mmunoglobulins) Antibodies (mmunoglobulins)
gG, gM, gA, gD, and gE gG, gM, gA, gD, and gE
Autoimmunity Autoimmunity
neu;ro7il, inges;ing neu;ro7il, inges;ing
&;re7;ococcus &;re7;ococcus
7ogenes 7ogenes
Disease Disease
The Complement System The Complement System
The Body's "Rapid Response System The Body's "Rapid Response System
Proteins that work with antibody formation and Proteins that work with antibody formation and
inflammatory reaction to fight infection. inflammatory reaction to fight infection.
Recognizes endotoxins of certain bacteria. Recognizes endotoxins of certain bacteria.
The Lymphatic System The Lymphatic System
Structures Structures
Spleen, thymus, lymph nodes, and ducts. Spleen, thymus, lymph nodes, and ducts.
Collects and filters lymph. Collects and filters lymph.
Facilitates Phagocytosis in Lymph Nodes. Facilitates Phagocytosis in Lymph Nodes.
Disease Disease
ndividual Host mmunity ndividual Host mmunity
Passive mmunity Passive mmunity
Maternal atibodies Maternal atibodies
Active mmunity Active mmunity
mmunization mmunization
Direct exposure Direct exposure
Seroconversion Seroconversion
Titer Titer
nfection Control in Prehospital nfection Control in Prehospital
Care Care
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Care Care
Phases of Prehospital nfection Control Phases of Prehospital nfection Control
Preparation for Response Preparation for Response
Provide written procedures for infection control. Provide written procedures for infection control.
Prepare an infection control plan. Prepare an infection control plan.
Provide adequate infection control training. Provide adequate infection control training.
Ensure easy access to appropriately fitted, Ensure easy access to appropriately fitted,
checked, and maintained personal protective checked, and maintained personal protective
equipment. equipment.
Ensure that all personal wounds are bandaged Ensure that all personal wounds are bandaged
and treated before responding to an emergency. and treated before responding to an emergency.
Use disposable supplies and equipment when Use disposable supplies and equipment when
possible. possible.
Care Care
Phases of Prehospital nfection Control (cont.) Phases of Prehospital nfection Control (cont.)
Preparation for response (cont.) Preparation for response (cont.)
Ensure personnel have access to facilities for personal Ensure personnel have access to facilities for personal
hygiene. hygiene.
Do not allow infected personnel to deliver patient care. Do not allow infected personnel to deliver patient care.
Monitor EMS personnel for compliance with vaccinations and Monitor EMS personnel for compliance with vaccinations and
diagnostic tests. diagnostic tests.
Appoint a designated infectious disease control officer. Appoint a designated infectious disease control officer.
dentify jobs and processes where the possibility of exposure dentify jobs and processes where the possibility of exposure
exists. exists.
Provide haz Provide haz- -mat education, including MSDS training mat education, including MSDS training
regarding chemicals or mixtures and health hazards. regarding chemicals or mixtures and health hazards.
Care Care
Response Response
Obtain as much information as possible from Obtain as much information as possible from
dispatch. dispatch.
Prepare for patient contact. Prepare for patient contact.
Prepare mentally for the call. Prepare mentally for the call.
Care Care
Patient Contact Patient Contact
solate all body substances. solate all body substances.
Wear appropriate PPE. Wear appropriate PPE.
Allow only necessary personnel to make Allow only necessary personnel to make
patient contact. patient contact.
Use airway adjuncts for assisted ventilation. Use airway adjuncts for assisted ventilation.
Use disposable items whenever possible. Use disposable items whenever possible.
solate all body substances. solate all body substances.
Wear appropriate PPE. Wear appropriate PPE.
Allow only necessary personnel to make Allow only necessary personnel to make
patient contact. patient contact.
Use airway adjuncts for assisted ventilation. Use airway adjuncts for assisted ventilation.
Use disposable items whenever possible. Use disposable items whenever possible.
Care Care
(cont.) (cont.)
Properly dispose of Properly dispose of
biohazardous waste. biohazardous waste.
Use extreme caution with Use extreme caution with
sharp instruments and sharp instruments and
dispose of sharps in proper dispose of sharps in proper
containers. containers.
Never smoke, eat, or drink in Never smoke, eat, or drink in
the patient compartment of the patient compartment of
the ambulance. the ambulance.
Do not apply cosmetics or lip Do not apply cosmetics or lip
balm or handle contacts balm or handle contacts
when a possibility of when a possibility of
exposure exists. exposure exists.
(cont.) (cont.)
Properly dispose of Properly dispose of
biohazardous waste. biohazardous waste.
Use extreme caution with Use extreme caution with
sharp instruments and sharp instruments and
dispose of sharps in proper dispose of sharps in proper
containers. containers.
Never smoke, eat, or drink in Never smoke, eat, or drink in
the patient compartment of the patient compartment of
the ambulance. the ambulance.
Do not apply cosmetics or lip Do not apply cosmetics or lip
balm or handle contacts balm or handle contacts
when a possibility of when a possibility of
exposure exists. exposure exists.
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Care Care
Recovery Recovery
Wash your hands immediately after patient Wash your hands immediately after patient
contact. contact.
f you sustain a wound and are exposed to f you sustain a wound and are exposed to
the body fluids of others, wash the wound the body fluids of others, wash the wound
with soap and water immediately. with soap and water immediately.
Dispose of biohazardous wastes in Dispose of biohazardous wastes in
accordance with local laws and regulations. accordance with local laws and regulations.
Recovery Recovery
Wash your hands immediately after patient Wash your hands immediately after patient
contact. contact.
f you sustain a wound and are exposed to f you sustain a wound and are exposed to
the body fluids of others, wash the wound the body fluids of others, wash the wound
with soap and water immediately. with soap and water immediately.
Dispose of biohazardous wastes in Dispose of biohazardous wastes in
accordance with local laws and regulations. accordance with local laws and regulations.
Care Care
Recovery (cont.) Recovery (cont.)
Place potentially infectious wastes in leak Place potentially infectious wastes in leak
proof biohazard bags. Bag and label soiled proof biohazard bags. Bag and label soiled
linen. linen.
Decontaminate contaminated clothing and Decontaminate contaminated clothing and
reusable equipment. reusable equipment.
Handle uniforms in accordance with agency Handle uniforms in accordance with agency
policy. policy.
Care Care
Decontamination Decontamination
Low Low- -Level Disinfection Level Disinfection
Routine cleaning does not destroy Routine cleaning does not destroy mycobacterium mycobacterium
tuberculosis tuberculosis
ntermediate ntermediate- -Level Disinfection Level Disinfection
Destroys Destroys TB TB and most viruses and fungi not bacterial and most viruses and fungi not bacterial
spores. (1:10 H spores. (1:10 H
2 2
O and bleach) O and bleach)
High High- -Level Disinfection Level Disinfection
Destroys all microorganisms and most bacteria Destroys all microorganisms and most bacteria
Sterilization Sterilization
Autoclave and some chemical immersion agents. Kills Autoclave and some chemical immersion agents. Kills
everything everything
nfectious nfectious Diseases of mmediate Diseases of mmediate
Concern to EMS Providers Concern to EMS Providers
Human mmunodeficiency Virus Human mmunodeficiency Virus
Pathogenesis Pathogenesis
Risk to the General Public Risk to the General Public
Found in blood, blood products, and body fluids. Found in blood, blood products, and body fluids.
Common methods of transmission include sexual contact Common methods of transmission include sexual contact
and shared needles. and shared needles.
Risk to Health Care Workers Risk to Health Care Workers
Transmission to health care workers is actually rare. Transmission to health care workers is actually rare.
Accidental needlesticks are the most common source. Accidental needlesticks are the most common source.
High High- -risk exposures are those involving a large volume of risk exposures are those involving a large volume of
blood, deep percutaneous injury, actual intramuscular blood, deep percutaneous injury, actual intramuscular
injection, or a high antibody injection, or a high antibody- -retrovirus titer in the source retrovirus titer in the source
Diseases of mmediate Concern to Diseases of mmediate Concern to
EMS Providers EMS Providers
HV (cont.) HV (cont.)
Clinical Presentation Clinical Presentation
Fatigue, fever, sore throat, lymphadenopathy, Fatigue, fever, sore throat, lymphadenopathy,
splenomegaly, rash, and diarrhea. splenomegaly, rash, and diarrhea.
Kaposi's sarcoma. Kaposi's sarcoma.
Secondary (opportunistic) infections and weight Secondary (opportunistic) infections and weight
loss. loss.
Dementia, psychosis, and peripheral neurological Dementia, psychosis, and peripheral neurological
disorders develop as ADS progresses. disorders develop as ADS progresses.
HV (cont.) HV (cont.)
Postexposure Prophylaxis Postexposure Prophylaxis
Medical evaluation Medical evaluation
"Triple Therapy "Triple Therapy
Postexposure counseling Postexposure counseling
Summary of HV Summary of HV
HV rarely presents life HV rarely presents life- -threatening challenges, but threatening challenges, but
often presents psychosocial challenges. often presents psychosocial challenges.
Take appropriate infection control precautions. Take appropriate infection control precautions.
Precautions should not be a barrier to professional care Precautions should not be a barrier to professional care
Hepatitis Hepatitis
General Signs & Symptoms General Signs & Symptoms
Symptoms are similar regardless of type of infection. Symptoms are similar regardless of type of infection.
Headache, fever, weakness, joint pain, anorexia, nausea, Headache, fever, weakness, joint pain, anorexia, nausea,
vomiting, and URQ abdominal pain. vomiting, and URQ abdominal pain.
Jaundice, clay Jaundice, clay- -colored stool, and dark urine develop as the colored stool, and dark urine develop as the
disease progresses. disease progresses.
Hepatitis A (nfectious or Viral Hepatitis) (HVA) Hepatitis A (nfectious or Viral Hepatitis) (HVA)
Transmitted by fecal Transmitted by fecal- -oral route. oral route.
Typically is mild; many patients are asymptomatic. Typically is mild; many patients are asymptomatic.
Rarely serious and lasts 2 Rarely serious and lasts 2 6 weeks. 6 weeks.
Hepatitis (cont.) Hepatitis (cont.)
Hepatitis B (Serum Hepatitis) (HBV) Hepatitis B (Serum Hepatitis) (HBV)
Virus is transmitted through direct contact with Virus is transmitted through direct contact with
infected blood, semen, vaginal fluids, or saliva. infected blood, semen, vaginal fluids, or saliva.
Risk is significantly higher for EMS providers. Risk is significantly higher for EMS providers.
5 5- -35% of all needlesticks result in infection. 35% of all needlesticks result in infection.
Vaccination is available and recommended for all Vaccination is available and recommended for all
EMS workers. EMS workers.
60 60 80% of infected individuals are asymptomatic. 80% of infected individuals are asymptomatic.
Hepatitis (cont.) Hepatitis (cont.)
Hepatitis C (HCV) Hepatitis C (HCV)
Primarily transmitted by V drug abuse and sexual contact. Primarily transmitted by V drug abuse and sexual contact.
Chronic infection that can cause active disease years later. Chronic infection that can cause active disease years later.
May cause cirrhosis and end May cause cirrhosis and end- -stage liver disease. stage liver disease.
Hepatitis D (HDV) Hepatitis D (HDV)
Exists only concurrently with HBV. Exists only concurrently with HBV.
Hepatitis E (HEV) Hepatitis E (HEV)
s similar to HAV but primarily associated with contaminated s similar to HAV but primarily associated with contaminated
drinking water. drinking water.
Tuberculosis Tuberculosis
General nfo General nfo
Most common preventable infectious disease Most common preventable infectious disease
Drug Drug- -resistant TB resistant TB
Skin Testing Skin Testing
Pathogenesis Pathogenesis
Chills, fever, fatigue, chronic cough, weight loss Chills, fever, fatigue, chronic cough, weight loss
Night sweats Night sweats
Hemoptysis Hemoptysis
Tuberculosis (cont.) Tuberculosis (cont.)
EMS Response EMS Response
ndex of suspicion ndex of suspicion
N95 and HEPA respirators N95 and HEPA respirators
Postexposure dentification and Management Postexposure dentification and Management
Pneumonia Pneumonia
General General
Differentiating pneumonia from CHF Differentiating pneumonia from CHF
Source pathogens Source pathogens
At At- -risk patient populations risk patient populations
History and Assessment History and Assessment
Community Community- -acquired pneumonia. acquired pneumonia.
Signs include acute onset of chills, fever, dyspnea, pleuritic Signs include acute onset of chills, fever, dyspnea, pleuritic
chest pain, cough, adventitious breath sounds. chest pain, cough, adventitious breath sounds.
n geriatric patients, the primary sign may be an altered n geriatric patients, the primary sign may be an altered
mental state. mental state.
Pneumonia Pneumonia
Patient Management and PPE Patient Management and PPE
Management should support oxygenation and Management should support oxygenation and
ventilation. ventilation.
Consider the possibility of TB. Consider the possibility of TB.
Consider placing a mask on yourself or the patient. Consider placing a mask on yourself or the patient.
mmunization and Postexposure Management mmunization and Postexposure Management
Routine vaccination is not necessary. Routine vaccination is not necessary.
Antimicrobial agents and multidrug Antimicrobial agents and multidrug- -resistant resistant
strains. strains.
Chickenpox Chickenpox
Varicella Zoster Virus (VCV) Varicella Zoster Virus (VCV)
Respiratory symptoms, malaise, and low Respiratory symptoms, malaise, and low- -grade grade
fever followed by a rash. fever followed by a rash.
Rash may be the first sign of illness and may be Rash may be the first sign of illness and may be
limited or widespread; often prolific on the trunk. limited or widespread; often prolific on the trunk.
Transmission is through airborne droplets and Transmission is through airborne droplets and
direct contact with lesions. direct contact with lesions.
Can be lethal in adult immunocompromised Can be lethal in adult immunocompromised
patients. patients.
Chickenpox (cont.) Chickenpox (cont.)
Assessing mmunity Assessing mmunity
Past history of chickenpox is sufficient. Past history of chickenpox is sufficient.
EMS Response and Postexposure EMS Response and Postexposure
Observe universal (standard) precautions. Observe universal (standard) precautions.
Get postexposure vaccination. Get postexposure vaccination.
Meningitis Meningitis
nflammation of the Meninges nflammation of the Meninges
Caused by a variety of pathogens. Caused by a variety of pathogens.
Transmission Factors Transmission Factors
Host resistance factors, weather Host resistance factors, weather
Contact with oral secretions Contact with oral secretions
Crowding, close contact, smoking Crowding, close contact, smoking
Meningitis (cont.) Meningitis (cont.)
ncubation period of 4 ncubation period of 4 10 days 10 days
Fever, chills, headache, nuchal rigidity, arthralgia, lethargy, Fever, chills, headache, nuchal rigidity, arthralgia, lethargy,
malaise, altered mental status, vomiting, and seizures malaise, altered mental status, vomiting, and seizures
Brudzinski's and Kernig's signs Brudzinski's and Kernig's signs
EMS Response and Postexposure EMS Response and Postexposure
Observe universal (standard) precautions. Observe universal (standard) precautions.
Perform postexposure prophylaxis within 24 hours. Perform postexposure prophylaxis within 24 hours.
Other Job Other Job- -Related Related
Airborne Diseases Airborne Diseases
nfluenza and the Common Cold nfluenza and the Common Cold
Viral nfection Viral nfection
Mutation and virulence Mutation and virulence
Epidemics Epidemics
Symptoms Symptoms
Fever, chills, malaise, muscle aches, nasal Fever, chills, malaise, muscle aches, nasal
discharge, mild cough discharge, mild cough
Secondary infections Secondary infections
Management Management
Measles Measles
Highly communicable, with lifelong immunity after disease. Highly communicable, with lifelong immunity after disease.
Transmitted by airborne droplets and direct contact. Transmitted by airborne droplets and direct contact.
Symptoms Symptoms
Presents similar to severe cold with fever, conjunctivitis, Presents similar to severe cold with fever, conjunctivitis,
photophobia, cough, and congestion. photophobia, cough, and congestion.
Rash. Rash.
Mumps Mumps
Transmitted by airborne droplets and direct contact with Transmitted by airborne droplets and direct contact with
saliva of infected patient. saliva of infected patient.
Occurs primarily in 5 Occurs primarily in 5- - to 15 to 15- -year year- -old patients. old patients.
Symptoms Symptoms
Painful enlargement of salivary glands Painful enlargement of salivary glands
Symptoms of cold with earache, difficulty chewing, and Symptoms of cold with earache, difficulty chewing, and
swallowing swallowing
Rubella Rubella
Systemic Viral nfection Systemic Viral nfection
Symptoms Symptoms
Sore throat, low Sore throat, low- -grade fever, and fine pink rash grade fever, and fine pink rash
Management and mmunization Management and mmunization
Respiratory Syncytial Virus (RSV) Respiratory Syncytial Virus (RSV)
Common cause of pneumonias and bronchiolitis Common cause of pneumonias and bronchiolitis
Commonly associated with lower respiratory Commonly associated with lower respiratory
infections during the winter infections during the winter
RSV (cont.) RSV (cont.)
Symptoms Symptoms
Runny nose and congestion, followed by wheezing, Runny nose and congestion, followed by wheezing,
tachypnea, and signs of respiratory distress tachypnea, and signs of respiratory distress
Pertussis (Whooping Cough) Pertussis (Whooping Cough)
Bacterial nfection Bacterial nfection
Symptoms Symptoms
Catarrhal, paroxysmal, and convalescent phases Catarrhal, paroxysmal, and convalescent phases
Management and mmunization Management and mmunization
Protocol for Prehospital Protocol for Prehospital
Exposure Exposure
Known or suspected exposure Known or suspected exposure
Notify appropriate agency personnel (agency SOP) Notify appropriate agency personnel (agency SOP)
Upon arrival notify team leader of exposure Upon arrival notify team leader of exposure
Prophylaxis/treatment as per infection control Prophylaxis/treatment as per infection control
May require admission to fas trac May require admission to fas trac
Unknown exposure Unknown exposure
Personnel contacted by SWMC upon confirmation Personnel contacted by SWMC upon confirmation
Prophylaxis/treatment as per infection control Prophylaxis/treatment as per infection control
May require admission to fas trac May require admission to fas trac

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nfectious Diseases nfectious Diseases

Lynn K. Wittwer, MD, MPD Lynn K. Wittwer, MD, MPD

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