Chapter 37: Infectious Disease

Infectious Disease- illness caused by infestation of the body by biological organisms. Index case- the individual who 1st introduced an infectious agent to a population. Local agencies are the first line of defense in disease surveillance and outbreak. Microorganisms Normal flora- organisms that live inside our bodies without ordinarily causing disease. Are part of the host defenses that help us keep disease-free by creating environmental conditions that are not conducive to disease-producing microorganisms. Pathogen- organism capable of causing disease. Opportunistic pathogen- ordinarily nonharmful bacterium that causes disease only under unusual circumstances. o Bacteria- microscopic single celled organisms that range in length from 1-20 micrometers. Gram stain- method of differentiating types of bacteria according to their reaction to a chemical stain process. Types of Bacteria Spheres (cocci)- Staphylococci, Streptococci Rods- Enterobacteriaceae Spirals- Spirochetes, Vibrio Bacterial Toxins- toxins that are produced by bacteria Exotoxin- toxic waste products released by living bacteria. Endotoxin- toxic products released when bacteria die and decompose. Antibiotics- substances that destroy or inhibit microorganisms Bactericidal- capable of killing bacteria. Bacteriostatic- capable of inhibiting bacterial growth or reproduction. o Viruses- disease-causing organism that can be seen only w/an electron microscope. Viruses are Obligate Intracellular Parasites- organism that can grow and reproduce only within a host cell. o Other Microorganisms Fungus- plant-like microorganism Protozoan- single-celled parasitic organism w/flexible membranes and the ability to move. Parasite- organism that lives in or on another organism. Pinworm- parasite that is 3-10mm long and lives in the distal colon. Hookworm- parasite that attaches to the hosts intestinal lining. Trichinosis- disease resulting from an infestation of Trichinella spriralis (contracted by eating raw or inadequately cooked pork products, most commonly sausage.

o Transmission Routes of Disease Reservoir- any living creature or environment that can harbor an infectious agent. Bloodborne- transmitted by contact w/blood or body fluids. Airborne- transmitted through the air by droplets or particles. Fecal-Oral route- transmission of organisms picked up from gastrointestinal tract into the mouth. o Risk factors of Transmission Communicable- capable of being transmitted o another host. Contamination- presence of an agent only on the surface of the host without penetrating it. Infection- presence of an agent within the host, without necessarily causing disease. o Factors Affecting Disease Transmission Mode of entry- mucous membrane is an effective point of entry Virulence- an organisms strength or ability to infect or overcome the bodys defenses. # of organisms transmitted Host Resistance- a hosts ability to fight off infection. o Phases of Infection Latent Period- time when a host cannot transmit an infectious agent to someone else. Communicable Period- time when a host can transmit an infectious agent to someone else. Incubation Period- time between a hosts exposure to infectious agent and the appearance of symptoms. Window Phase- time between exposure to a disease and Seroconversion. Seroconversion- creation of antibodies after exposure to a disease. Antigen- surface protein on most viruses and bacteria. Antibody- protein that attacks a disease antigen Disease Period- the duration from the onset of signs and symptoms of disease until the resolution of symptoms or death. Infection Control Phases of Prehospital Infection Control Preparation for response- SOPs, training, gather supplies, OSHA guidelines, etc. Response- gather dispatch info, don PPE, mentally prepare Patient Contact- wear additional PPE, isolate and dispose of all body substances, limit # of rescue personnel w/patent, carefully dispose of all sharps properly. Recovery- Wash hands, DECON, dispose of any Bio-HazMat

Decontamination- to destroy or remove pathogens. Disinfect- to destroy certain forms of microorganisms, buy not all. Sterilize- to destroy all microorganisms. Decontamination Levels o Low-level disinfection- use of household disinfectant o Intermediate-level disinfection- use of 1:10-1:100 dilute of water and chlorine bleach o High-level disinfection- use of chemical sterilizing agent for 10-45sec. o Sterilization- use of pressurized steam or chemical sterilizing agent for 6-10hrs. Ryan White Act- federal law that outlines the rights and responsibilities of agencies and health care workers when an infectious disease exposure occurs. Diseases of Immediate concern to EMS Providers HIV- organism responsible for AIDS. HIV specifically targets T-lymphocytes w/the CD4 marker. Hepatitis- inflammation of the liver characterized by diffuse or patchy tissue necrosis. o Hepatitis-A - is transmitted by the fecal oral route. o Hepatitis-B - transmitted through direct contact w/contaminated body fluids. o Hepatitis-C - transmitted primarily by IV-drug abuse and sexual contact. o Hepatitis-D - seems to only coexist w/ hepatitis B infection. o Hepatitis-E - transmitted like Hepatitis-A, but is associated w/contaminated drinking water. Tuberculosis (TB)- disease caused by a bacterium known as Mycobacterium tuberculosis that primarily affects the respiratory system. o PPE is N95 mask Pneumonia- acute infection of the lung, including alveolar spaces and interstitial tissue. Chickenpox/Varicella- viral disease characterized by a rash of fluid filled vesicles that rupture, forming small ulcers that eventually scab Meningitis- inflammation of the meninges, usually caused by an infection. o Brudzinkis sign- (Buckles) physical exam finding in which flexion of the neck causes flexion of the hips and knees. o Kernigs sign- (Kicks) inability to fully extend the knees w/hips flexed. Other Job-Related Airborne Diseases- Hand washing is the most important personal precaution against disease transmission. Influenza- disease caused by a group of viruses (types A, B, & C). o Leading cause of respiratory disease world wide. o Characteristics: sudden onset of fever, chills, malaise, muscle aches, nasal discharge, and cough. Common cold/viral rhinitis- mild, often w/out fever and can be difficult to differentiate from Influenza.

 Measles- highly contagious, acute viral disease characterized by a reddish rash that appears on the fourth or fifth day of illness. Mumps- acute viral disease characterized by painful enlargement of the salivary glands. Rubella/German measles- systemic viral disease characterized by a fine pink rash that appears on the face, trunk, and extremities and fades quickly. Respiratory Syncytial Virus (RSV)- common cause of Pneumonia and Brochiolitis in children. Pertussis/Whooping cough- disease characterized by severe, violent coughing. Viral diseases Transmitted By Contact Mononucleosis- acute disease caused by the Epstein-Barr virus Herpes Simplex Virus Type 1- organism that causes infections characterized by fluid-filled vesicles, usually in the oral cavity or on the genitals. Other Infectious Respiratory Conditions Epiglottitis- infection and inflammation of the epiglottis. Croup- viral illness characterized by inspiratory and expiratory Stridor and a seal-bark-like cough. Pharyngitis- infection of the pharynx and tonsils. Sinusitis- inflammation of the paranasal sinuses. Hantavirus- family of viruses that are carried by the deer mouse and transmitted by ticks and other arthropods. GI System Infections Gastroenteritis- generalized disorder involving nausea, vomiting, gastrointestinal cramping or discomfort, and diarrhea. Food poisoning- nonspecific term often applied to gastroenteritis that occurs suddenly and that is caused by the ingestion of food containing preformed toxins. Nervous System Infections Encephalitis- acute infection of the brain, usually caused by a virus. Rabies- viral disorder that affects the nervous system. Tetanus/Lock Jaw- acute bacterial infection of the central nervous system. Lyme disease- recurrent inflammatory disorder caused by a tick-borne spirochete. Sexually Transmitted Diseases (STDs)- illness most commonly transmitted through sexual contact. Gonorrhea- sexually transmitted disease caused by a gram-negative bacterium. Characterized by painful urination and urethral discharge. Syphilis- Bloodborne sexually transmitted disease, characterized by lesions that may involve virtually any organ or tissue. Genital warts- has been implicated as a causative factor of cervical cancer in females. Herpes Simplex Type 2- also called genital herpes Chlamydia- group of intracellular parasites that cause sexually transmitted diseases. It is the most clinically significant species of STDs, it affects the genital area, eyes, and respiratory system. Symptoms similar to Gonorrhea, but less severe. Chlamydia is the leading cause of preventable blindness.

 Trichomoniasis- STD caused by the protozoan Trichomonas vaginalis. It is frequently present w/gonorrhea and has symptoms of greenish-yellow vaginal discharge, irritation of the perineum and thighs, and Dysuria. Chancroid- highly contagious sexually transmitted ulcer. Diseases of the Skin Impetigo- infection of the skin caused by staphylococci or streptococci. Lice- parasitic infestation of the skin of the scalp, trunk, or pubic area. o Infestation- presence of parasites that do not break the hosts skin. Scabies- skin disease caused by mite infestation and characterized by intense itching. Nosocomial- acquired while in the hospital -All body fluids are possibly infectious. Universal precautions should be followed at all times.