hello everybody and welcome to infection and here are the objectives outcomes and the outline for where we're going today in this presentation and when we talk about basic definition of infection diseases it's identified as a disorder in which tissue damage or dysfunction is produced by a microorganism now there's lots of terms as it relates to infectious diseases and so we're just going to get through all of these definitions when we talk about endemic this is the term that is used to describe that a disease that exists in all time so malaria is endemic to certain parts of africa i believe that we could say that coven 19 is endemic to just about most of the parts of the world and that's different than an epidemic that's an outbreak of a disease that spreads within a certain time frame to people in one or several communities so this is essentially a smaller group or setting in which there is an infectious disease versus a pandemic this is a disease that spreads from being epidemic to a few communities to being worldwide and so there are several examples of that as well now when we talk about disease concepts in general and we say infection we know that an infection is not only the present and multiplication of a living organism on or in the host but that microbe has to cause harm so we live in harmony with a lot of microbes they are there to almost protect us from worse microbes they're like somewhat of a guard because they are protecting us and it's only when this pathogen that is present in or on the host that causes harm that now we determine an infection now there are different types of pathogens uh we are the categories are viruses bacteria fungi protozoan nematides and microsportier and i list this not because you need to know these different types but you need to know that the terminology for treatment of these types may change in other words if your patient is on an antibiotic an antibiotic is truly used to describe a medication that kills bacteria and so your patient wouldn't be on an antibiotic if there's a virus that is causing the harm so it would be an antiviral so that's the only reason why we list these different types of pathogens not because you're going to be tested on these types that comes with microbiology course now let's talk about the different factors that determine whether a host will be infected and how it can be affected we know that there's microbes that are constantly out there and why is it that some individuals are infected and affected by them that they get very sick versus some that don't and it really and truly relates to the immunocompetence of the hosts is the host able to protect against the microbe or is the microbe just so vicious that even immunocompetent individuals at risk now note that immunocompetence means the immune system is on the go and ready to work as opposed to the opposite opposite which is immunocompromised or immunodeficient or immunosuppressed and these are individuals who really for whatever reason with comorbidity from other illnesses is at a much higher risk from suffering more harm from these infections now the other factor to consider whether a host is going to suffer greatly from an organism entry is the virulence because there are several different infecting organisms that are less virulent than others again just be aware of this you're not going to have to know about adhesion factors and invasive factors and evasive factors that's again microbiology but you do need to be aware of the term toxin because we're going to use it quite a bit as we move through this presentation and i like to think of toxin as poison so in other words microbes some microbes have the ability to make a toxin and so it's not so much the microbe that's the problem it's the toxin or poison that they produce and we don't call it poison it's called a toxin but in my mind i think of it as the same thing and it is the toxin that is produced by the infecting organism that is what causes the harm to the individual now we talk about the portal of entry so how does the microbe enter the host and this is super important for nurses or any health care provider to understand because we know that portal of entry is important because we have or deploy tactics to stop certain portals of entries with certain microbes now the cdc center for disease control helps us by dividing the infection risk into four transmission-based precautions and this is what is supposed to guide every healthcare worker and also as a method that healthcare workers are then going to teach their patients so that patients can also prevent or protect themselves from possible infection when we talk about one type of cdc precaution for infection prevention we talk about standard precautions and this is what everybody has to use it's a basic infection prevention measure that we the health care provider will use on every patient and what every patient or family member should deploy to prevent infection among groups of people in family zones when we talk about standard precaution look what's at the top and that's hand hygiene that's our best and most important defense in the spread of disease we're supposed to wash our hands before and after every meal after every patient contact and after using the toilet now the use of personal protective equipment is of course in the forefront of today because we know that ppe or personal protective equipment includes face masks uh gowns and gloves and so health care providers as well as the lay population can use these personal protective equipment to again prevent against disease transmission and spread respiratory hygiene includes cough etiquette we know that as a nurse you walk into your patient's room and you just sneeze out that you're going to spray your patient and potentially infect your immunocompromised patient with microbes as nurses we will use safe injection practices and dispose of needles very carefully and of course disinfecting surfaces and items that are used especially those items that move from patient to patient to patient we've got to clean those very very specific measures so that we don't infect our patients from another patients after another patient's use now again that's standard precautions but now we have some very specific items or methods that we use to prevent cross-contamination and that's contact precautions what does that entail well it entails hand washing and the use of gallon and gloves when any patient has diarrhea or stool incontinence especially because there's no control and so therefore the nurse can get these items on their clothing or on them when patients spray with certain substances draining wounds and swords uncontrolled vomiting and skin rashes and so i've given you some examples of where we use contact precautions um but again it's all about draining things and therefore you want to cover yourself with blood with a gown use of gloves and hand washing now i would like to mention that gloves are overused when you go into your favorite fast food restaurant they'll have gloves on and then they use that gloves to then touch the cash register which is just i'm sure lots and lots of microbes on there so i don't want you to think that well i put a glove on and i can wear it all day long and unprotected because they are somewhat porous and so again that's why glove changeout has to be very uh used quite frequently among healthcare providers but you know with covid problems and the coveted pandemic it was taught by hospital providers that you know what these gloves are at a premium we can't seem to get them because of the supply chain issues and so you can wash your hands over the gloves and that was an acceptable solution to preserve or reserve the use of lots and lots of different gloves all right moving on to droplet precautions droplets are defined as larger uh substances where microorganisms will travel no more than three feet this was the reason for all of those little circles on the ground maintain six to ten feet distance and again these droplets can be spread by coughing sneezing and talking it's not so much that saliva was the problem it's remember that the back of the throat will contain this coughing and seizing which will kind of mix in with saliva and that's how the microorganism is distributed we know that again the personal protective equipment is always hand washing and then face mask and so if your patient has any of the example listed then you know the nurse will put that face mask on before you enter the room and then um you can take it off after you're in the room and away from the patient airborne precautions this is used when the medical individual has a suspected or known infection with the specific knife microbes such as tb or measles chickenpox and smallpox because these particles are very small which means they will travel much much further and so that's why the nurse has to enter the room or put the face mask on a very specific face mask the n95 prior to entering the room i i may have said it wrong that the face mask with droplets is once you enter the room again because you've got that six feet of distance whereas airborne it's all over the place and so you have to put that mask on prior to entering the room and there's usually a special type of room um so that again these these airborne particles don't leave now when we talk about the course of the disease i you know zoom through these terms i'm not going to read them to you you know how to read i'm not going to ask you questions or your patho instructor is not going to ask you questions about all these terms as far as what do they mean just realize that these are some other stages that the pathogen specific can occur and this is more about micro you'll have to know this in microbiology but you won't be asked about these different terms now you will this is back again to items that you have to know and you have to know well because every exam two will have this topic on them and that's the topic of antibiotic antibiotic resistance a very important topic in healthcare because since the discovery of certain anti-infectives or antibiotics infectious disease has been controlled or lessened death has been lessened from these items but once these research has been done on these infective anti-infective medications or antibiotic medications the microorganisms have then developed their own adaptation and have mutated and so these antibiotics or anti-infectives they once used to take care of or get rid of these microbes are now not working and so there is lots and lots of different antibiotic resistance and you'll learn more about these as you enter the hospital setting as a registered nurse um but we're only going to talk about two examples of antibiotic resistance and that's antibiotic resistance to beta la tam antibiotics and antibiotic resistance to vancomyodas vancomycin so let's talk first about beta lactam resistance what does it mean well penicillin the drug penicillin and its derivatives derivatives are useful in counteracting certain microbes because of their electrical molecular structure that is the betalectim ring and if you're in pharmacy school then you'd have to know this chemical structure it's not important in nursing but it is important that you understand that this chemical ring this beta-lactam ring is what is effective against a wide spectrum of microbes and these certain microbes over time have now mutated and these certain microbes have developed an enzyme that called beta-lactamase which destroys that beta-lactam ring which then renders these antibiotics useless to kill these specific microbes and so we're talking about very specific beta lactamase producing microbes such as mrsa and resistant streptococcus streptococcus pneumoniae all right let's talk first about mrsa what does it stand for that's methicillin-resistant staphylococcus we know this is a microbe that we live with it's in harmony with us but it can cause an infection it can cause harm to us if there is the ability or of this microbe to get away or through the skin that barrier first line of defense barrier and then in certain immunocompetent immunocompromised excuse me people it can cause more of a problem now mrsa would developed in the 1960s because hospitalized patients were on antibiotics for a long period of time and the microbe became very smart to being to prevent itself from being harmed and eradicated and so it mutated and then created bad beta lactamase that then allowed it to become resistant now it's fairly rampant in some hospital settings or nursing home so it is generally considered to be a nosocomial disease it can be spread in these settings in hospitals and nursing homes direct patient to patient direct patient to hands to patient contact or from fomites so fomites are inanimate objects that can carry the microbe in other words back in the day when physicians used to wear ties they would bend over the patient to do their examination or assessment and if there was a draining room wound that microbe would then jump onto the tie and then it could move to the next patient room and that's how it was spread and we know that again it can be on the clothing and hands of a healthcare worker again think think think what kind of ppe would you be required to wear if your patient had mrsa because of its transmission pathway and we know that mrsa is also colonized in the nose of healthcare workers i've been a bedside nurse for 40 in a hospital setting for 40 years i don't have any doubt that mrsa lives with me doesn't cause me any harm until that time frame when i become immunocompromised now again once that mrsa is present on the fomite or on other substances or found in wounds then again it can invade and enter into the body space or blood space or in the urinary tract system through certain catheters because we know that we in break or puncture uh or insert certain items into the many different places in our patients into the meatus the urethral meatus or into their iv catheter in their veins and so this is a great pathway for mrsa to travel into the body and then set up shop and cause a great deal of harm now notice that there is a community acquired mrsa that has been found this has been found in certain wounds of people and most of the stories or times that i hear about community acquired mrsa it's been from an athlete such as a football player in a high school setting is where i've heard heard of it most often and of course they rough and tumble and they get this skin break and then perhaps they lived with a healthcare provider and so they were they were colonized with mrsa and therefore once that skin break occurred then now it's drained onto a fomite um such as a t-shirt or sock that they used and what do most athletes do when they're in high school they throw that into a nice warm locker that then will cause this to multiply and then it spreads through other by contact through other students in that they come in contact with so again community acquired mrsa is out there and unfortunately vancomycin is now one of the few drugs that will destroy mrsa vancomycin is given in the iv in for venus it is a little bit higher powered antibiotic which means that it costs more than our cheaper penicillin products and also carries more risk of complications from its administration we also talk about another beta lactamate of microbe that has caused beta-lactamase that is created beta-lactamase and that's resistant streptococcus pneumonia where do we find this well it's a common microbe that causes otitis meteor inner ear infection and it used to be that inner ear infection or otatus media was easily treated with penicillin drugs but now that's not the case because of over treatment or treated inappropriate and what i mean by that is you know if you're a parent that has a child in daycare and you need that child in daycare they develop a fever especially when they're in the younger ages toddlers and infants you can't take that child to the daycare with a fever and so the mother or parent would go to their health care provider and demand an antibiotic because they need to be on that antibiotic for a certain time frame before they're allowed back in day care and of course inner ear infection be caught by a virus and they didn't need antibiotics because we know that virus infections are not treated with antibiotics and so there was over treatment with antibiotics and then of course antibiotic therapy usually lasts for a period of seven to ten days parents are busy and maybe perhaps they gave the antibiotics to their child two or three days therefore the microbe was not adequately killed and then it decided to mutate and create that beta lactamase so this is the biggest problem and again part of the nursing education to ensure that all antibiotics were taken till they're gone for the full course of therapy all right our other type of uh infection or microbe that has mutated is the vre that's vancomycin resistant enterococcus this is a hospital-associated infectious enterococcus callus is a normal bowel flora but in hospitalized patients or in nursing home patients who have certain catheters in them then this microbe from the bowel can then migrate inside the body vancomycin used to be able to be treated with this microbe but now by because of its mutation vancomycin will bind to the microbe cell and destroy it and therefore we have to use other antibiotics to treat it and again when you see heavy duty alternatives think lots of money because they're newer researched antibiotics and also think more risk for your patient all right that concludes the general topic about infection and now we're going to get into specific infection diseases there's quite a few of them it's a laundry list 22 or more of these infectious agents and we have to know these because the board of nursing wants you to have some background knowledge on these what are considered fairly common infectious agents some of them we thought were eradicated or controlled by vaccines but that's not the case anymore because under certain circumstances some of these have come back to haunt us and that's due to inadequate vaccination um or the choice of not vaccinating you know some of our immigrants don't have access to vaccination and again because there's so much travel and so much um global spread of things that there is certain vaccines that are no longer controlling these issues and then there's the threat of bioterrorism if you can't bomb the heck out of this country well let's just throw out some microbes because some of these agents are very very harmful and so this is another way to produce a winning war so we got to know the basics and i know on exam two you're going to have to just simply memorize these i will zoom through them because they're fairly straightforward but be aware that on exam five which is a comprehensive exam there might be one question at most two about the specifics so you decide whether it's really worth your while to re-memorize them for exam five but for exam two you gotta know the specifics all right let's talk about these organisms or illnesses as we go through essentially our precautions so we're gonna talk about that contact problem so this is breach of skin or mucous membranes so some of these are about contact to contact and therefore again always think about what would you the nurse what precaution would you the nurse use what ppe would you use when we talk about cellulitis just like it sounds itis is inflammation of the dermis or subcutaneous tissue it is most commonly caused by that staphylococcus aureus that can once there is a breach then that can take can layer in and take hold of the underlying layer underlying dermis and subcutaneous tissue and cause inflammation and infection or harm there's a milder former a milder form of a staph infection and that is known as impentigo it is identified by this eruption of blisters it's usually around the nose and mouth and these eruptions are itchy and crusty and very contagious this is usually found in toddlers and younger children and it spreads like wildfire in especially in the daycare centers because kids especially in their toddler days they put things to their mouth and because this is contact contact then they're it's shared by others and that's how it's spread now we're going to talk about botulism this is caused by the toxin of clostridium botulinum this is a bacteria a bacillus that can invade the body via the food or soil and then that toxin in the spores of the vasilla can of clostridium of botulism sorry the toxin is botulism is what causes harm so this toxin heads for the neuromuscular nerve synapses and blocks acetylcholine muscle receptors so let's look at the path of how muscles work because i know you've slept since amp and when we talk about nervous innervation of our muscles we know that there are acetylcholine receptors and once the nerve releases the substance acetylcholine then that acetylcholine heads to the receptors and that's what then stimulates the muscle to work and the toxin is what interferes or interrupts with these uh lands on these receptors or interferes or blocks these receptors from connecting with the acetylcholine and then therefore your patient is going to have signs and symptoms of descending symmetric paralysis and of course when we talk about descending it will start from the neck down and we know that the respiratory muscles are a big target for this which can then cause paralysis and an individual inability to breathe which is why this is a top candidate of bioterrorism now you know i've kind of throw in this tester recall and we know that there are other problems that we've discussed in the mechanism of defense where we talked about a similar patho kind of a it's not caused by microbe but we know that there was some signs and symptoms of muscle weakness and this was the myosin of gravis so the signs and symptoms might be familiar we're going to really talk to our patient and identify hey what was leading up to this what did you do last two did you play in dirt or if it's seen in an infant especially in an infant's that's less than 12 months then what happened with that was your child exposed to honey and if you are a honey person and you know well is that raw honey or cooked honey it doesn't matter it's any honey because again that's an outside thing the honey can have the clostridium botulinum spores but once ingested in the gut then that's when that toxin is produced uh it's not known why infants less than a year are so susceptible this once they hit that greater than 12 month marker then give them all the honey they want but this is the recommendation again considered top candidate of bioterrorism and there is treatment for it treatment as well as mechanical biomechanical ventilation antibiotics moving on to our next disease or illness and that's tetanus we most of us are likely vaccinated as part of the dpt immunity weakens so your older aged individuals are less likely to get that booster every 10 years and so again we know that there are some immigrants or those homeschooled where it's not required may also be at risk for getting tetanus what is the pathogenesis of the tetanus disease again the patho part is caused by the bacterium a bacillus claustronium tetani which can live in the soil and again it's those spores when it germinate it will release that toxin tetanospasm what does that tetanospasm toxin do well it blocks the inhibitory neural transmitter and so therefore the individual can have the depolarization of that nerve impulse and muscle cell depolarization which means it'll go to work but it won't stop so again we're going to have to take that side trip because i know you've slept since anatomy and we see that that acetylcholine is released it goes down to that receptor and that's what tells the muscle hey go to work and contract well the problem with that titanospasm is that it will block the inhibitory neurotransmitter in other words the acetylcholinesterase that will put on the breaks of contraction and so without that there will only be constant contraction which is why your patient will have this jaw muscle tightening cause trismus which is why the common term for tetanus is lockjaw because they will not relax and so more severe tetany because of that constant contraction of the muscle spasm occurs and this will be seen as evidenced by muscle twitching cramps and it can cause convulsions the treatment is antibiotics and tetanus immunoglobulin which will help counteract the microbe and stop that toxin production now we're going to talk about vector-borne diseases and this is something where there is a transmission of the microbe by a bite-stained puncture of a host creature that then transmits microspotic disease-causing organisms so an example of a vector is known as mosquitoes or ticks or rats bats or dogs now when we talk about vector-borne disease probably the most common or most well-known is that of rabies note that rabies is a virus that is transmitted in the saliva of the infected host and often a bat and i have seen several patients who live out on a farm or live in austin where there are a lot of bats on that bridge and so it's not an uncommon problem so what happens well whenever the vector bites the host then the virus is then in um introduced into the individual and that virus then travels through the peripheral nervous system to the brain and spinal cord it takes about 14 days for that travel to go from pns to cns and then once in the brain it will cause brain inflammation the fancy term for brain inflammations encephalitis and that can lead to problems inside the brain it can cause problems with anxiety agitation confusion and ultimately cause convulsions now other signs and symptoms can include production of a large amount of saliva plus dysphagia so let's identify our terms dysphagia spelled with the g notice that there's a g in there that means that it's trouble swallowing so relate g dysphagia to gut versus dysphagia same pronunciation with an s related to s speaking so dysphagia problems with swallowing and therefore we'll see foaming at the mouth a lot of saliva is produced and the patient because they can't swallow will then have this foaming at the mouth because they can't swallow their saliva all that saliva and just kind of froths out of the mouth treatment with rabies needs to begin within 14 days because that's the amount of time it takes for it to travel from the pns to the central nervous system and treatment consists of one dose of rabies immunoglobulin and four doses of the rabies vaccines but again it's got to be very quickly initiated because if it's not if the rabies virus has already traveled to the central nervous system then we can't cure it we can't eradicate it or treat it again it's a virus antibiotics are not going to cure it and if or once it reaches the cns it is almost always fatal harm a horrible horrible way to go with the encephalitis moving on to our next illness and that is another vector-borne illness and that's malaria it is responsible for 2 million deaths in the world yearly it is caused by a protozoa that is transmitted by a mosquito vector what the patho of it is that the protozoa reproduces in the liver cells and then it's released into the blood where it infects the red blood cell and causes them to rupture causes hemolysis as the red blood cells rupture remember that will release or trigger the release of acute phase reactants and when your patient has this release of acute phase reactants that's what causes the signs and symptoms of the high fever and chills arthralgia is joint pain the patient again because of the hemolysis can have anemia because of the rapid hemolysis they can have a splenomegaly they can have cerebral ischemia because of the anemia it can also cause heart failure treatment with um again we've already linked the patho as far as the rupture of those red blood cells causing the acute phase reactants so i want you to think back acute phase reactants these are systemic anti or excuse me systemic inflammatory mediators can you name them think about the name of these systemic inflammatory mediators what would be circulating around that would cause or linked to the signs and symptoms all right let's talk about treatment treatment is prevention with malaria vaccination we see this in children that's vaccination is actually under research but it has very good results and so that the research continues but it's widely used in sub-saharan africa there is adults get quinine-based drugs for prevention measures again there's a lot of about mosquito nets in some of these countries the bill and melinda gates foundation has done a lot of work with mosquito nets use of insect repellent that contains deet and then once the illness is diagnosed there are anti-parasitic oral drugs as well as iv anti-malarial drugs for severe cases moving on to another vector-borne illness and that's zika zika is caused by the zika virus and it's spread primarily through the bite of an infected mosquito so when i talk about all of these vectors and when you think mosquito the prevention is going to be the same that mosquito net and d signs and symptoms are very mild it's like getting a case of the flu and so people don't usually die from this illness but a zika infection during pregnancy can cause birth defects and a very specific dirt birth defects known as microcephaly and that is a baby that will be born with a head smaller than normal transmission can occur from a mosquito that bites a person and then person to mosquito and then another mosquito can then bite another person so it's it's very easily spread from mosquito to person to person to mosquito again the pregnant woman to her fetus or by sexual transmission prevent the zika again with the deet uh here's some other maneuvers again these are things we either teach our patients or use ourself light color clothing when outdoors the mosquito nets and screens removal of standing water where mosquitoes reproduce sexual abstinence because once the illness has been there it's eight to eight weeks to six months which is a long long time um which is why condom use would be so important so again this is to prevent the pregnant woman for the transmission to the infant or growing fetus rather diagnose this blood or urine test and then treatment is just supportive it's a virus we've got to give fluids and treat the fever um again it's really all about that fetal protection invasion of the respiratory tracts and now we're moving to a different vector so again this picture here is what happens when you sneeze or any of us sneeze you can see all the microbes that move about and therefore can have the potential to infect others we're going to talk about our first respiratory illness and that's strep throat this is caused by streptococcus pyogeny or pyogenes however you say it which invades with on the vector of coughing and sneezing signs and symptoms include a red sore throat often white patches on the tonsil now here is the issue with the streptococcus bacteria is that there are certain strains of strep that are very virulent and they can redu produce that toxin that then will cause what's known as scarlet fever or it's also known as scarlet tina and so in addition to the red sore throat and the white patches the individual will have this very high fever and rash that can cover the whole body so that's what's known as scar latina and so we know that that is why the strep test rapid strep test was invented because it's very important if it is strep throat for the person to not only get antibiotics or to make sure that they complete their course of antibiotics so that they are less likely to have or suffer from any auto autoimmune disease from that step strep micron such as rheumatic fever and rheumatic heart disease diphtheria is a very contagious upper respiratory infection it is caused by a bacteria transmitted by again that cough and sneeze think about what ppe you would need to use the signs and symptoms are a sore throat fever and this is that pseudomembranous pseudomembrane that can develop across the throat um thankfully we do have a vaccine for this dpt but this was again a horrible horrible death for individuals who aren't vaccinated who get this and don't get access to health care because you can see how this can totally occlude someone's airway pertussis a very highly contagious bacterial disease again also prevented with the dpt that t is for the tetanus but the d is diphtheria p is for tested also known as whooping cough because it produces this horrible violent cough that can be so bad the person cannot eat and become malnourished it is also one of those where individuals as they age will need to get vaccinated against there's been a campaign where we see the little wolf that can of a grandparent that can infect an infant so again we need that vaccination booster every 10 years let me keep going mumps it's a virus that invades the parotic glands swelling and fever it's not too much of a problem for individuals but the complication is infertility in males it's rarely seen in developed countries again because of the mmr measles part of the mmr again rubiola is the two weeks measles we don't usually say two-week measles we just call it the measles this is a virus that's passed by coughing and sneezing look at the signs and symptoms that dense macropapillar rash it almost feels like a emery board or a nail file that kind of rough slightly raised red patches that's how i have been able to feel it and identify that this is the measles again because it is a respiratory transmission it usually starts off with the fever cough runny nose and conjunctivitis now what is the big deal with this not usually a problem but it can cause encephalitis which can lead to the demise of a patient if encephalitis occurs again rarely seen in those that are in developed countries with vaccination but again with the anti-vaccination movement it may have a resurgent and we've seen it periodically in regions rubella nicknamed three-day measles or german measles this is a milder virus mild signs and symptoms fever rash swollen why do you need to learn about what's the concern well the concern is when a woman who is pregnant contracts the disease because the virus can cause several problems in a developing fetus mental redortation eye problems hearing problems maybe you've heard of helen keller she's been gone for quite a while but look it up so she was a woman who was born deaf dumb and blind or i think proper terms that pardon me are she was born hearing impaired completely deaf she was blind and was unable to speak and so therefore couldn't voice for quite some time until she had an interaction with an individual so again any child bearing woman before they get pregnant is the best time should have a titer that's done so this would ensure that there is immunity now you know or you should know what a titer is because as a nursing student that applies for the program at uta you have to get titers done and so this is a way to measure the protection the level of antibodies to a specific illness and if titers are low then another booster or vaccination will be needed box diseases this refers to a family of herpetic diseases that all have one thing in common that it is some kind of herpetic virus now the herpes virus kind of its mo or its process is that once in the body it never really leaves its hides out in the nerves now for most of the time especially in certain illnesses like smallpox it never comes back it never comes out but there's always there is exception to the rule and that's with genital and oral herpes and shingles they that does come back out patients can suffer from repeated herpetic illnesses from shingles and gentlemen oral herpes now when we talk about one type of herpetic disease that's varicella it's common name it's known as chickenpox this is very contagious it is usually before the symptoms are heard the individual is going to be very contagious from a respiratory standpoint so that is the particle spread through inhalation of these particles again from coughing sneezing talking manifests once it takes hold it manifests as vesicles these are these uh raised and fluid filled blisters they begin on the trunk so that's the core and then they move outward and these pox lesions uh via chickenpox lesions are in various stages of development and healing but the individual is contagious until they're all crested over again not usually a problem it's very very uncomfortable because they itch like no other and because the chickenpox vaccine has been developed most children don't normally even get the varicero zoster again this is known as herpes zoster or nickname is shingle once the individual has had varicella then the varicella virus remains in one system it becomes dormant but when it comes back out especially as we age or in an individual who's immunocompromised it will pop out as painful lesions along the nerve dermatome so that's why it's kind of in a pattern so you can see with the gray shading here that individuals may get more than one dermatome affected but it's usually in a pattern most people have a single episode but not all and so again we have vaccines for this and antiviral meds and creams variola this is uh the nickname for smallpox this is a highly contagious inhaled virus that also has these vesicles so that's that fluid filled uh pustule and but the pattern is a little bit different than chickenpox their smallpox lesions are very dense they're at the same stage they start in the face and extremities and then move towards the trunk they again they can be very very virulent strain of smallpox i think it's called variola major and this is a high high high mortality rate individuals will have a very high fever they'll have painful pustules in their mouth and esophagus that can hemorrhage and so the mortality rate as i mentioned is very high it's been mostly eradicated through the vaccination process but again because of our bioterrorism threat that's always the concern influenza you all know about the influenza there's a lot of information here that i'm not going to read you can pause the recording and read all you want we know that this is a virus that it is a virus of the upper and lower respiratory system with signs and symptoms of fever chills myalgia which is muscle aches malaise dry coughing headache now we know that the pathogenesis of the flu is that the viral envelope contains a neuraminidase which is abbreviated as an n and a hemoglobin which is abbreviated as an h and so each viral envelope then can be identified as or designated as a different number so in other words h stands for hemoglobin five neuraminidase one what do i mean or what can the flu or the virus do well it can it can do what's known as an antigen antigenic drift and so what that means is there can be a shifting in what the neuraminidase and the hemoglobin look like or their configuration now why is it that the h and n designation is any big deal well i always think if we go back to that previous slide what's the purpose of the h and the n well i think of it like velcro if you've ever played a dark game that instead of with the pointy pointy sharp things you've given it to your five-year-old and it has the velcro it's this is like the velcro that once inhaled will stick to the respiratory tract and then cause inflammation and can cause harm to our patient again the treatment is really a lot of [Music] supportive measures but there are have been deaths from the flu because it puts patients at risk for the development of or at risk for a bacterial pneumonia that would catch hold and then cause harm and death to our patients so that's why you are supposed to get a yearly flu vaccine because of the antigenic drift of the virus and the alteration in the h1n1 or the h and n designation usually each yearly vaccine is produced sometime in the spring and they make a guesstimate over what the drift is going to be and therefore some years they get it wrong and it will at least provide some protection but not necessarily as much as is wanted all right moving on i know you're sick and tired of this but hang in there with me now we've got invasion of the gi tract that's infectious diarrhea and when we talk about infectious diseases of the gi tract this can be called enter colitis or infectious diarrhea because the microbe causes varying degrees of diarrhea and inflammation and ulcerations of the intestine again most of these invasion of the gi tract are usually mild and self-limiting but again you get into the very young children or you get into the very elderly or in general any age that's immunocompromised and this can cause again a secondary problem and place them at risk most or all of the gi tract excuse me all of the gi tract is transmitted by the oral fecal route so the pathogens are excreted from the gut and then they can enter the gi tract of another person through his or her mouth so again this is why what's our major way to prevent illness and transmission of microbes is that whole hand washing thing treatment of infectious diarrhea is going to vary depending on what the what the cause is but it can be antibiotics and then always always fluid replacement when we talk about viral diarrhea we're talking about mild signs or a viral illness we're talking about mild signs and symptoms with vomiting and watery diarrhea again usually self-limited um and patients can can just have to again supportive treatment bacterial the regular bacterial diarrhea or a bacterial infectious diarrhea is also known as non-bloody diarrhea again the spectrum from mild to severe life-threatening watery diarrhea especially if there's vomiting with it and your patient cannot intake in enough fluids examples of causing bacterial enteritis is e coli again not all strains are the same we know that e coli can be in the stool but not or in the bowel but not all forms of e coli are found in our intestines so this is a specific strain that is transmitted or ingested in undercooked meat and other foods salmonella which is again non-bloody diarrhea cows and chickens are the reservoirs so we know that it can be transmitted through fecal contamination from such as if you have a cow pasture and then you have a farm with lettuce and tomatoes that are growing and and the fecal matter gets downstream onto that lettuce and tomato we've seen some e coli contaminated substances such as the lettuce that was in chipotle had problems and then again some meat too eggs if you love to eat cookie dough you're not supposed to because this is when you can get this salmonella dysentery this is what infections diarrhea is called when it is bloody and severe there's your visual reminder of some nastiness of diarrhea that's bloody types of dysentery basiliary dysentery of course the etiology as a besella this is most common with the specific priscilla of shigella and then there's amoebic dysentery that's from a protozoa this is found in water again unlike regular non-bloody these microbes cause damage to the mucosal surface of the gut and so it is characterized by blood and mucus as well as pain with the bowel movements and of course that's relates to the damage infection and infil inflammation of the intestinal wall fever and dehydration geodarus geodiasis is a transmission caused by a protozoa called giardia which is usually contracted by drinking contaminated drinking water such as well water river water and then it can be transmitted again through that oral fecal route from person to person so what happens with giardia is this protozoa will adhere to the intestinal wall it interferes with fat absorption another beautiful visual reminder of for you where then fat can't be absorbed and it just goes out with the diarrhea so the diarrhea is greasy frothy and foul smelling but not bloody so small mercy there gr diocese can last months to years once identified easily fixable with antibiotics so again it's all about access to health care now we're going to go to antibiotic associated diarrhea yes if we get an infection and we take antibiotics for a long time then infectious diarrhea can occur which is also called pseudomembranous colitis why well colitis means inflammation of the colon and so it causes a problem to the lining in the intestines and you can see it will cause the development of this yellowish membrane like debris and of course it's caused by long-term antibiotic why because those antibiotics will wipe out that happy happy little bowel flora that the yogurt companies work so hard to promote and again this bacterium once our bowel flora which are like the guard dogs of our colon are gone then another opportunistic bacteria called clostridium difficile shortens c diff moves in and then sets up this inflammatory state it is the most common cause of iatrogenic or nosocomial diarrhea again iatrogenic would mean if you have a patient that's at home that's taking a lot of antibiotics for a long period of time they can get c diff or if your patient's immunocompromised in the hospital on antibiotics boy that's a recipe for c diff problem we want to stop the antibiotics they're given iv fluids input on another specific c diff antibiotics and boy there are times when it does take a long time for this to be eradicated there's some really aggressive methods for c diff treatment in those poor immunocompromised patients that suffer on the long term from it because infection can refer reoccur and there's just no way to prevent it i hope this recording has been helpful i really know that it's very stressful to have to memorize all of these hang in there get her done use the resources that are posted after the lecture notes to help you with the matching exercise of the infections to kind of help you remember the test is a multiple choice so you know hopefully your eyeballs will recognize it