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Flashcards in Infectious DIsease Deck (37)
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disease surveillance

  • "ongoing systematic collection, analysis, interpretation, and dissemination of specific health data for use in public health"
  • provides a means for nurses to monitor dz trends in order to reduce morbidity and mortality and to improve health



  • intentional or threatened use of viruses, bacteria, fungi, or toxins from living organism to produce death or dz in humans, animals, or plansts


biological agents of highest concern

  • Variola major (small pox)
    • no longer vaccinate
    • live vaccine
  • Bacillus anthracis (anthrax)
  • Yersinia pesis (plague)
  • Francisella tularensis (Tularemia)
  • Botulinum toxin (botulism)
  • filoviruses and arenaviruses (viral hemorrhagic fevers)
    • all suspected or confirmed cases should be reported to authorities immediately


advantageous of biologics as weapons

  • infectious via aerosol
  • organisms fairly stable in environment
  • susceptible civilian populations
  • high morbidity and mortality
  • person to person transmission (smallpox, plague)
  • difficult to dx and tx
  • easy to obtain
  • inexpensive to produce
  • potential for dissemination over large geographic area
  • creates panic
  • can overwhelm medical services
  • perpetrators escape easily



  • successful worldwide vaccination program
    • used a 2 pronged/bifurcated needle
  • last case in US was in 1949
    • last naturally occurring case in world was Somalia in 1977
  • in 1972, the routine childhood vaccination was discontinues, meaning that approx half of the US population was never vaccinated
  • small pox is caused by the variola virus
    • except for lab stockpiles, the variola virus has been eliminated
    • however, since the events of Sept and Oct 2001, there is heightened concern that the virus might be used as an agent of bioterrorism
    • it is a serious, contagious and sometimes fatal, infectious dz
    • no specific tx for dz, and only prevention is vaccination


2 clinical forms of small pox

  • Variola major: severe, most common form w/ more extensive rash and higher fever
  • Variola minor:
    • less common presentation of small pox
    • much less levere dz
    • death rates <1%


transmission of small pox

  • generally, direct and fairly prolonged face to face contact is required to spread smallpox from one person to another
  • can also be spread through direct contact with infected bodily fluids or contaminated beddings or clothing
  • rarely, has been spread in the air in enclosed settings such as buildings, buses, and trains


incubation period of small pox

  • duration 7-17 days: time of exposure to time of first symptoms
  • not contagious
  • no symptoms and may feel fine


initial symptoms of small pox

  • prodromal
  • duration 2-4 days
  • sometimes contagious
  • first symptoms: fever, malaise, HA, body aches, vomiting
    • fever usually high in range of 101-104
  • usually too sick to carry on normal activities


early rash in small pox

  • lasts about 4 days
  • most contagious
  • a rash first emerges first as small red spots on the tongue and in the mouth
  • spots develop into sores that break open and spread large amounts of virus into the mouth and throat
    • at this time, the person is the most contagious!


pustule rash with small pox

  • lasts about 5 days
  • bumps become pustules sharply raised usually round and firm to the touch as if there's a small round object under the skin
    • ppl often say the bumps feel like BB pellets embedded in skin


resolving scabs with small pox

  • lasts about 6 days
  • contagious
  • scabs begin to fall off, leaving marks on skin that eventually become pitted scars
    • most scabs will have fallen off 3 weeks after rash appears
  • once the scabs have resolved and fallen off completely, you are no longer contagious


post exposure prophylaxis of small pox

  • vaccination may be effective in preventing mobidity/mortality if given w/in 2-3 days of exposure
  • Cidofovir--an antiviral drug with substantial renal toxicity may improve outcomes if given w/in 1-2 days after exposure
    • however, there is no definitive to suggest that it is better than vaccine along


vaccination contraindications for small pox

  • apply to both potential vaccinees and their household contacts
  • eczema or atopic dermatitis and other acute, chronic, or exfoliative skin conditions
  • burns
  • impetigo
  • chicken pox
  • contact dermatitis
  • shingles
  • herpes
  • severe acne
  • severe diaper dermatitis
  • psoriasis
  • HIV/AIDs
  • solid organ/stem cell transplant
  • generalized malignancy
  • leukemia/lymphoma
  • pregnancy/breastfeeding
    • have to ask if they or any of household contacts are pregnant or intend to become pregnant w/in 4 weeks--if yes, then don't vaccinate
  • infants/children


small pox emergency

  • all contraindications to vaccinate would be reconsidered in the light of the risk of small pox exposure



  • caused by spore forming bacterium bacillus anthracis
    • aerosolized spore form
  • zoonotic dz in herbivores (sheep, goats, cattle) follows ingestion of spores in soil
  • human infection typically acquired through contact w/ anthrax, infected animals, or animal products
    • one deep breath at site of release
    • give antimicrobial prophylaxis for those who are potentially exposed
      • but often don't know you are infected
      • abx you are given is usually doxycycline
  • 3 clinical forms:
    • cutaneous
    • inhalational
      • dx by: CXR widened mediastinum, pleural effusions, infiltrates, pulmonary congestion
    • gastrointestinal


Tularemia (Francisella tularensis)

  • plague like dz in rodents (California)
  • deer fly fever (Utah)
  • rabbit fever (centralized US)


  • not contageious
  • dangers, highly virulent organism


streptococcus progenies

  • flesh eating bacteria
  • 1994
  • improperly cooked hamburgers
  • unpasteurized apple juice


mad cow dz

  • bovine spongiform encephalopathy BSE
  • transferred to humans through beef consumption


worldwide and infectious dz

  • infectious dz are the leading killer of children and young adults accounting for more than 13 million deaths a year and for half of all deaths in developing countries


epidemiologic triangle

  • agent
  • host: has to be a vulnerable host
  • environment: has to be an env that it can grow in


data sources for surveillance of infectious dz

  • health care supplies (CDC)
    • have to report STIs, TB, ebola, etc
  • mortality data--vital stats report (death certificants)
  • morbidity data


approx half of all deaths are caused by which 3 diseases?

  • TB
  • malaria
  • HIV/AIDs


what are 3 problems having to do with infectious dz?

  • new pathogenic orgs have emerged
  • new strains are more virulent
  • organisms have become resistant to many abx


foodborne diseases

  • can involve biological and non-biological agents
  • can be caused by microorganisms, marine orgs, fungi and toxins, and chemical contaminants
  • raw and undercooked foods of animal origin are most likely to be contaminated


top 5 pathogens contributing to foodborne illness

  • norovirus
  • salmonella
  • clostridium perfringens
  • campylobacter
  • staphylococcus aureus



  • responsible for most cases of GE
  • spread by fecal oral route
  • aerosolized vomitus has been implicated in some cases
  • 12-48 hours incubation period
  • usually resolves in 48 hours
  • elderly, children, and those with severe conditions are at inc risk for volume depletion
  • most cases occur in long term care facilities
  • prevention: good handwashing, thorough and immediate disinfection, isolation of sick indivs until 72 hours after they are symptom free
  • tx: oral hydration solns, IVF and electrolyte replacement


campylobacter enteritis

  • most common cause of bacterial illness
  • important cause of diarrhea illness thru world regardless of ppl's age
  • often implicated in traveler's diarrhea
  • consumption of contaminated poultry is common source
    • other sources: undercooked meats, ground beef, cheese, eggs, shellfish
  • incubation period 2-5 days
  • diarrhea illness last no more than a week
  • S/S: n/v, abdominal pain, fever, HA, muscle pain
  • dx: stool culture
  • tx: antidiarrheal drugs, abx


Listeria monocytogenes

  • primarily affects older ppl and pregnant women
    • can result in miscarriage, still birth, or severe illness/death in newborn
  • risk reduced by recommendations for safe food prep, consumption, storage


nontyphoid salmonella

  • bacterial dz transmitted by contaminated food/water, or contact w/ infected animals or reptiles
  • infants, elderly, and immunocompromised at highest risk
  • S/S: diarrhea, fever, abdominal cramps 12-72 hrs
  • lasts 4-7 days
  • tx: not always needed, but dehydration and electrolyte imbalance replacement is essential