Infection

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Infection: Invasion of the body tissue by a microorganism and their proliferation there
Assymptomatic: Microorganism produces no clinical evidence of disease
Disease: A detectable alteration in normal tissue function
Chain of Infection: -Infectious agent: microorganism
-Reservoir: the normal location for the pathogen
-Portal of exit from the reservoir:
-Mode of transportation: Direct (physical) and indirect (ingestion) contact, air and dust, fomites, arthropod (bites) and accidental (needle sticks) inoculation.
-Portal of entry: GI tract, blood and blood derivatives, respiratory tract, wounds
-Susceptible host:
Natural Immunity: -Nonspecific response to a foreign invader
-Physical barriers: skin, mucus membranes, chemical
Acquired Immunity: -Specific response to a foreign invader
-Involves the immune system responding to a specific foreign antigen
-Includes humoral and cellular response
-Acitve or Passive
Acitve Acquired Immunity: -Antibodies produced in the body in response to an infection
-Long lasting
-Natural or artificial
Natural Active Acquired Immunity: -Formed in the presence of an active infection: chicken pox, hep A
-Lifelong
Artificial Active Acquired Immunity: -Immunized with vaccines or toxoids and stimulates antibody production
-Lifelong though may require a booster
Passive Acquired Immunity: -Antibodies are produced by another source
-Short acting
-Natural (breast milk) or artificial (hep A)
Natural Passive Acquired Immunity: -Antibodies transferred naturally from immune mother to infant at birth or through breast milk
Artificial Passive Acquired Immunity: -Immune serum from another source transferred by injection
-Exp: hep A
Immunizations: -Important to health promotion
-Many adults not adequately immunized
-Adult immunizations include:
*hep B
*Influenza
*Diptheria/Tetanus
*Measles, Mumps, Rubella (MMR)
Inflammmatory Response: -Chemical medications are released in response to tissue injurt or organisms to:
*Control blood loss
*Wall of organism
*Activate phagocytes
*Promote scar formation and tissue regeneration
Inflammatory Response: -Local: redness, swelling, pain, heat, and loss of function
-Systemic: increased body temp, fatigue, increased WBC, and swollen lymph nodes
Contact Transmission: -Prevent transmission of organism through direct or indirect contact
-Herpes, Diptheria, Staph, Hep A, and wound infection
-Private room
-Glove and gown worn
-Door can be open
-Direct: skin-to-skin
-Indierct: skin-to-object (MRSA, lice, scabbies)
Droplet Transmission: -Prevent transmission of large molecular organisms (>5microns)
-Diptheria, Pertussis, Strept throat, Scarlet fever, Meningitis, Rubella, Influenza, SARS
-Private room
-3ft distance or wear mask w/glasses
-Door allowed to be open
-Coughing, sneezing, talking droplets can travel up to 3 feet
Responsibilities of the CDC: -Prevent the transmission of communicable diseases
-Collect data
-Updating recommendations
-Publishes the Mortality and Morbidity Report
-Disease Surveillance
-Research
Cardinal signs of inflammation: -Redness
-Pain
-Swelling
-Heat
-Loss of function
Four stages of the infectious process: -Incubation: time between contact and onset of signs and symptoms
-Prodromal period: the period between the earliest symptoms and the onset of a rash or fever
-Illness period: the onset of the disease
-Convalescent period: recovery phas
Airborne Transmission: -To prevent transmission of small particles (<5 microns)
-Negative air pressure room
-Door closed
Particulate respiratory mask tight fit (orange)
Anti-Infective Agents: -Treatment and prophylaxis of variuos bacterial agents
-Mechanisms of action:
*inhibits cell wall synthesis
*alters plasma membranes
*inhibits protein synthesis
*inhibits synthesis of essential metabolites
-Mode of action:
*bactericidal or bacteristatic (inhibit new growth)
*not active against viruses and fungi
-Spectrum:
*broad or narrow
*divided into categories depending on the chemical similarities and anitmicrobial spectrum
Pharmacological Management: -Antibacterial:
*broadest group
-Antiviral:
*inhibits viral DNA replication
-Antifungal:
*inhibits mycotic (fungal) infections
Toxic Shock Syndrome: -Caused by a toxin of Staph A. when in the bloodstream in susceptible individuals
-55% of menstrating women
-Associated with tampon use
S/S and Tx of Toxic Shock Syndrom: -Sudden fever
-Decreased b/p
-Headache
-Diarrhea
-Red rash on palms of hands and soles of feet
-Fluids and antibiotics
Stapphylococcal: -Normal flora of skin and respiratory tract
-Usually nonpathogenic but can cause serious infections
-Cause of nosocomial UTI and endocardititis
-Pathogenic staph in 30% of health people
-Contact precautions
Streptococcal: -Virulent and contagious
-Causes of Scarlet fever, strept throat, and impetigo
-GAS
Coccidioidomycosis: -Fungal infection
-Indiginous to San Joaquin Valley
-Valley Fever
-Inhalation of spores into lungs after rainfall
-Rainfall increases growth
-Sunlight inhibits growth
-Dx is made by skin test
-Tx is Amphotercin B
-Very toxic
-Hypersensitivity reactions
-Phlebitis
-Renal changes
-Hypokalemia
-Standard precautions
Clostridium Difficele: -Anarobic Spore forming organism
-Common nosocomial causing diarrhea
-Easily spread
-Usually starts within 48 hours after antibiotic therapy started
-Vancomycin: drug of choice
-Contact precautions
MRSA: -Methicillin Resistant Staph
-Contagious form of staph not susceptible to penicillin
-Caused by misuse of antibiotics
-Requires isolation until 2 negative cultures
-Vancomycin drug of choice
-Contact isolation
VRE: -Vancomycin Resistant Enterococcus
-Gram positive
-Normal Flora of GI tract
-20 fold increase since 1989
-VRE may serve as a reservoir of genes coded for vanco resistance that can be transferred to staph
-Penicillin used but no cure
Lyme Disease: -Multi-system disorder caused by Borrelia Burgdorferi organism carried by the TICK
-Identified in the 1970s
-Progresses in stages
-Starts with skin lesion and progresses to cardiac and neurological abnormalities
Tuberculosis: -Droplet nuclei gains into upper lobes of lungs and multiples
-Spread by cough, sneeze, speaking
-4-5 weeks without treatment the germs are numerous and spreads to the blood stream
-Immune system is stimulated
-Droplet isolation
S/S Tuberculosis and Screening: -Fatigue
-Weight loss
-Anorexia
-Low grade temperature, night sweats, long lasting cough
-Screening:
*Intradermal Mantoux Test
*Purified Protein Derivative (PPD)
*Read in 48 hours
*Those exposed wil have a + reaction:
~>5mm + HIV + or recent close contact
~>10mm + if from high risk group
~>15mm + for all others
*+ skin test does not mean active TB
*Sputum is the only definitive Dx
*AFB sputum obtained in arm, need 3 consecutive specimens
*Chest X-Ray used for screening only
Tuberculosis Classification: -0 = no TB
-1 = TB exposure, no disease
-2 = TB exposure, and + PPD
-3 = TB disease, + sputum, + skin
-4 = History of TB disease
-5 = TB suspect (3 months)
Tuberculosis Treatment: -Medications: Rifampin, Isoniazid
-Chemotherapy (medications)
-6 months to 1 year
-2 months of of daily INH, RIF, ENH
-4 months twice daily
-up to 1 year of 2 drugs twice daily
-Reduces the risk of developing active TB
-Recent skin test converter
-Pediatric with know close contact
-High risk
-6 months of INH only
Tuberculosis Medications: -Isoniazid (INH):
*Side effects: peripheral neuritis, hepatoxicity, hypersensitivity, and optic neuritis
-Rifampin (RIF):
*Side effects: hepatitis, febrile reaction, GI disturbance, peripheral neuropathy, and hypersensitivity
-Ethambutol:
*Side effects: skin rash, GI disturbances, malaise, peripheral neuritis, optic neuritis
-Streptomycin:
*Side effects: audiotoxicity, nephrotoxicity, hypersensitivity
-2nd line drugs:
*Ethionamide
*Capreomycin
*Kanamycin
*Pyrazinamide
*Para-aminosalicylic acid (PAS)
Hepatitis: -Infects the liver
-Many people do not have and S/S but may have serious or fatal complications
like cirrhosis, liver CA, chronic liver disease
-5-10% become carriers
-5 types
Types of Hepatitis: -Hep A: fecal/oral
-Hep B: serum
-Hep C: non A non B
-Hep D: delta
-Hep E: enteric
Heptatis A: -Fecal/oral
-Ingestion of contaminated foods
-poor sanitation
-Day care centers
-Incubation: 15-19 days
-Vaccine available
Hepatitis B: -Blood and body fluids
-Sexually transmitted
-Needles
-Incubation: 28-165 days
-Vaccine available
-10% carrier status
Hepatitis C: -Non A, Non B
-Needle stick
-Blood transfusion
-Mother to baby
-Incubation: 15-120 days
-S/S can occur up to 30 years after exposure
-No Vaccine
Hepatitis D: -Delta
-Needle sticks
-Sexually transmitted
-Must have Hep B to get Hep D
-Incubation: 21-140 days
-High carrier rate
-Vaccine for Hep B
Hepatitis E: -Enteric
-Poor santitation
-Water
-Not seen in the US
-Incubation: 15-65
-Unknown immunity
Hepatitis Protection: -Blood borne pathogen
-Universal precautions
-Hep B vaccine
Causative Organism: The types of organism that cause infection are bacteria, rickettsiae, viruses, protozoa, fungi, helminths
Reservoir: Any person, plant, animal, substance, or location that provides nourishment for microorganisms and enables further dispersal of the organism
Mode of Exit: The organism must have a mode of exit from the reservoir. Organisms exit through the respiratory tract, the GI tract, the genitourinary tract and the blood
Route of Transmission: Is necessary to connect the infectious source with its new host. Organisms may be tramsmitted through sexual contact, skin-to-skin contact, percutaneous injection, or infectious particles carried through the air
Carrier: A person who carries, or transmits an organism and who does not have apparent signs and symptoms of infection
Susceptible Host: For infection to occur a host must be susceptible (not possessing immunity to a particlular pathogen)
Portal of Entry: Is needed for the microorganism to gain access to the host
Colonization: Microorganisms present in or on a host, without host interference or interaction and without eliciting symptoms in the host
Infectious Disease: The state in which the infected host displays a decline in wellness due to the infection
Microbiology Report: Usually shows:
*the smear and stain
*the culture and organism identification
*the antimicrobial susceptibility (sensitivity)
CDC and OSHA: -CDC goal: disease reduction
-OSHA goal: reduction of risk exposure
-CDC Regulations: optional
-OSHA Regulations: mandatory

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