hi everyone welcome to the third module of infectious disease where we will be discussing viral infections bloodborne pathogens that we will discuss such as he b c and also HIV it's important to note that OSHA sets the standards for safety and health administration exposure to bloodborne pathogens and the CDC provides guidelines for those infected uh those meaning healthcare workers infected and how they are to go about treating patients and vice versa again we want to make sure as mentioned before that with standard precautions that we're assuming that everyone is at risk of a transmission and that everyone possibly has a disease whether you know it or not diagnosed or undiagnosed and to avoid um any procedures that are unnecessary or that you're not trained to do and making sure that we're notifying The Physician of infection status uh before performing any sort of invasive procedure so an example of that would be maybe nursing having to do a blood draw making sure that they're taking all the steps and measures to draw blood and that they're dispensing of the needles in the sharps container um to prevent contamination of anything else or anyone else here's a nice little pamphlet from the CDC if it's tough for you to see let me know I can provide this for you in a PDF format but it's a nice way to kind of quickly look at ways to protect yourself and what you should do if you're exposed um there are recommendations for vaccination for HB um they discuss you know proper PPE and using Sharps Containers making sure that the surfaces are all clean and sanitized and then what to do particularly if you're exposed to a bloodb pathogen um and to irrigate the area washing the area and then reporting your exposure promply to ensure that you receive the proper follow-up care let's first talk about HB virus or excuse me hepb virus this is usually transmitted through percutaneous injury or some sort of contact with infected blood or bodly fluids it can survive up to one week on environmental surfaces so again highlighting the importance of cleaning the surfaces making sure we have a sanitary environment and the incubation period is anywhere from 45 to 180 days that's a long time of incubation period vaccination is available and strongly recommended especially for those who are more at risk or who don't have antigens to fight the virus if they're exposed or anyone is exposed um HBS AGS which are surface antigen levels for hepb um they can be taken at post exposure and prophylactic treatment can be given if indicated and then OSHA also emphasizes the importance of maintaining standard precautions looking at vaccinations and use of proper PPE to protect yourself and the patient pepc is uh usually contracted through C continuous injury for those working in the hospital so healthcare workers incubation period is 6 to 7 weeks and those who are infected with hcv usually it's chronic you'll see persistent Viria which is a medical condition where viruses enter the bloodstream and then now it has access to the rest of the body can be transmittable to others over extended time and patients with heepsy will develop curosis hypocellular carcinoma or some sort of liver failure so a lot of damage to the liver unfortunately there is no vaccine available and the best way to prevent heepsy obviously those standard precautions hand washing the PPE and protective barriers and making sure those sharp containers are used so we don't have a percutaneous injury HIV is uh in the hospital can be transmitted from patient to healthcare worker through percon continuous injury or mucus exposure to blood and bodily fluids the most common is percutaneous injury so that again poking of the needle U maybe they're giving or doing a procedure that involves a needle with a patient and then somehow the healthcare worker gets poked with a needle um that is the most common a higher risk of HIV contraction um so again you want to make sure that the needles are closed nowadays A lot of times the needles or shots that are given the needle automatically retracts and so that really helps limit um the possibility of getting poked when not wanting to and then disposing of all Sharps um needles and things in the sharps container uh seral conversion after precous exposure to infection kind of depends on uh the amount of Blood on the device or area prior to the injury um the needle placement whether it's in a vein or artery and how deep the injury is from the contaminated person so um seral conversion means um basically the body's way of producing antibodies in the blood serum after exposure to a virus so we won't start to develop antibodies or we will start to develop antibodies but the amount of antibodies that we start doing in the rate of that um will depend on again the amount of blood involved um if it's an artery or vein or the Deep of deepness of the injury versus like a superficial scratch will play a role in our bodies to start fighting off that virus the CDC recommends if you're exposed to HIV that you seek counseling they offer Baseline testing and follow-up testing is recommended as soon as possible and then starting antiviral therapy post exposure you need to wash the contaminated area immediately with antiseptic soap and rinse and then again starting antivirals for four weeks so if you think you may have been exposed for any reason or another you need to make sure that that you follow the procedures and protocols within the hospital and notify the right Personnel so that you can get the treatment that you need again prevention is handwashing your standard precaution those barriers and use of those Sharps Containers herpes virus there are eight different types of herpes viruses usually they go subclinically and the primary infection versus symptomatic presentation so oftentimes we don't even know that we have it or we're carrying it there's um a latent state for life of a host and things can kind of be reactivated when the host is compromised the host is the person that's carrying the herpes right so um and that will lead to lesions affecting organs or central nervous system it can trigger uh severe illnesses in infants or and often lead to death depending upon the rate and location and chronicity of the condition type one approximately 70% of those are older than 12 have type one it usually manifested these little sores you'll see in the mouth or oral cavity sometimes you'll see in the genit to unary system systemic symptoms that can develop with type one is fever malce or myalgia or like muscle sesses uh usually symptoms resolve within three days to 14 days so 3 days to two weeks and this uh type of virus has also been associated with Bel py and it's a culprit for the Whit low finger in which I have a picture for you below where you can see some of those open sores um on the finger type two is accountable for approximately 20% of those that are older than 12 years old so um what I mean by that is uh 20% of the population if you're over 12 um will be harboring this type too usually the cause of this is genital herpes uh via sexual contact Ur may start to affect the cervix SP rectum urethra and bladder so the genital urinary system symptoms of this would be painful small lesions um they often cause itching uh the sores that develop usually heal with anywhere from one to three weeks and women with genital herpes may pass the virus to an infant during birth so if a patient or excuse me female is known to have this type two herpes um they'll likely end up doing a C-section to prevent um exposure to the baby so type one and two can affect any visceral organ out there or within us rather um usually there's asymmet asymptomatic shedding immediately prior to the sores appearing so you might be um contagious and then once you develop sores like oh my gosh I'm having an outbreak of the herpes virus and I've just been around all these people and touching everything and whatnot so you're not really aware you have it until you start having the outbreak because it's kind of asymptomatic again it's transmitted through contact UM break in the mucosal membrane particularly if someone's immunal compromised and then initial infection you may be asymptomatic again right there is a latent period and periodic reactivation so if it's kind of Brewing right so we talked about the latent period how things can kind of be there but there's no actual symptomology um until things are activated um there's primary infections where the virus travels along the axon of the pereral sensory nerves and then physical or psychological stress may be related to um the lon virus and also reoccurrences are usually milder so if they have a reoccurrence of their herpes or reactivation the symptoms usually aren't as severe as the first time um hsv1 and Tu can also lead to menitis and sephtis and keratitis so we want to make sure that patients are treated when they start presenting with symptoms diagnosis is usually again confirmed with cultures there is no available vaccine it's usually treated with antivirals and education on prevention of spreading and managing your symptoms noal transmission is rare so it's usually Community Based there is an incubation period for both 1 and two anywhere from 2 to 14 days days and again looking at those standard precautions for prevention is huge so if you pretty much just maintain standard precautions you can avoid and help prevent many of the bacterial and viral infections that are out there berell zoster virus um also known as Herpes Type 3 this is responsible for the chicken box or later on the shingles right so usually um this is transmitted Airborne droplets or direct contact with a vascular flu fluid into the respiratory tract so that oozing um when those little blisters kind of open up somehow it um as it opens up if it gets into your respiratory tract then you can contract um chickenpox um initially vmia is four to six days after the infection um so it's now entering more systemic responses there's an incubation period from 14 to 16 days from exposure and viruses present with white blood cells up to 5 days before a rash and it can be contagious for one to two days prior to the rash and all lesions are kind of crusted so you're basically contagious before you develop a rash until all of these little bumps are done growing and they've all kind of crusted over um airborne and contact transmission as I mentioned earlier and then second episodes are uncommon uh unless initially initial infection is less than one year years old so um usually if you had the chickenpox before you don't get it again but it is possible um we do see that out there occasionally um and chicken pox has gotten more and more rare these days because of vaccination symptoms of the chickenpox you might already be aware right so you get fever malce and these pain and itchy little vesicles that are kind of like a do drop shape all over um so first the macule starts to develop then it grows into papules vesicules pules and then it starts to crust over and it isn't until they're crusted over um that we're looking at no longer shedding uh this infection and usually the pattern of distribution it might start on the scalp and then move towards the trunk and then further out to the extremities usually it's diagnosed based on symptoms and or they can do culture so they can culture one of the vesicles that have opened up they can culture that fluid treatment again antivirals for adults and children with high risk for complications prophylactics um would be vaccination up to 3 days post exposure um or just going in and getting your chickenpox or vericella amuno globulin vaccination as a kid herpy zosters also known as shingles usually this presents as a unilateral lesion and a dermatomal pattern so you can see um in the picture here it's kind of following a dermatomal pattern within the trunk and the trunk is usually one of the most common places um I think T3 to L3 is usually the most common areas for Zer uh zoster her zusters to occur I have seen it in cases on the face which is very um painful for folks complications can be post therapeutic neuralgia so after treatment and the shingles is done an over patients may still have some nerve pain within that area in which they were affected and vaccines are recommended and approved for adults older than 60 moving on to mononucleosis also known as mono this is considered type four herpes virus also known as Epstein bar virus 90% excuse me 95% of those 35 to 40 have been infected with mono at some point it usually affects young adults and children transmission is through oral secretions or through the blood there's been some talk about mononucleosis being a kissing disease but you don't have to necessarily kiss somebody with mono to contract mono maybe if you're sharing snacks or sharing a glass of water that can be contracted that way if it's um sharing with someone who has actual virus usually you're contagious before your symptoms appear you won't have a fever or lesions in the mouth there's an incubation period for about four to six weeks and then as symptoms start to develop there's a Mirad of symptoms um they're usually very vague and can mean a lot of other things so other things might be ruled out as they're trying to diagnose mono but you get fever sore throat s lift nodes you might have upper abdominal pain um spleen or um enlargement and things of that nature might occur serious complications you can develop gomber syndrome you will learn more about that in your rehab or spleen rupture that obviously would be a severe case if things are going untreated then main treatment for mono is rest these folks are usually very tired and a lot of supportive care helping them kind of manage their day-to-day and then medications to help suppress some of their symptoms um that they're feeling and then to note that later on reactivation of this virus may occur in folks who have had Mono before moving on to influenza we have a or b this can cause serious illness or even death if left untreated transmission is usually personto person via inhalation or direct contact and there's an incubation period from 1 to four days usually as we all know we've all had viruses before right or influenza usually it results in a high fever myalgia headache sore throat can have congestion or nonproductive cough meaning there's no spum coming out it's a dry cough there's no fleem coming out with your cough nausea omiting or even otitis media which is um inflammation in the ear um you could have secondary bacterial pneumonia that can develop when you have the flu um and then vaccination is recommended for those who are greater than six months old so influenza is a vaccination available for kiddos as soon as they hit six months and it's also recommended for those who are at higher risk so as we mentioned before The Young and the old pregnant population those who are living in close quarters and are older like those living in nursing homes if you have chronic metal conditions or if you're caring for others that are in a very high risk group uh vaccination for influenza is recommended antivirals can be given within 48 Hours of onset but it's not always prescribed so some of us fight them off just fine and others who are struggling or maybe they're more at risk population U might be getting antivirus help them combat the virus supportive therapy so we're feeling better droplet precautions are taken and then obviously prevention using those standard precautions RSV this is something that is a serious issue for infants and elderly especially those with lunger heart conditions or immuno compromised reoccurrence of RSV is very common and usually as a mild upper respiratory tract infection there's an incubation period for RSV for 3 to8 days and you would follow the droplet precautions for anyone with RSV and just know that um those who have RSV Can Shed the virus up to three to four weeks and so you're making sure you're taking those precautions to prevent spreading RSV to others you can get a whole mirror out of symptoms with RSV so you know like stuffy runny nose and a cough you're going to get a fever wheezing having with difficulty breathing and often with kiddos don't really want to eat because they're not feeling very well and so you want to make sure that your kiddo gets enough hydration sometimes a humidifier is helpful to kind of combat some of the difficulty of breathing and other supportive treatment with medication um to manage the symptoms involved there is no vaccination available the best route is to prevent so looking at standard precautions handwashing barriers uh and so forth to make sure that you're not Contracting diseases or spreading them and then we have SARS Co so this is a newer one well maybe it's not new to us now but it's newer compared to the ones that we just discussed this is transmitted from person to person either direct or indirect contact we should all know by now that covid virus we learned is a droplet precaution so follow those types of precautions when seeing these patients whether it's in home or in the hospital there's a six 7-Day incubation period and patients can be contagious 10 days after onset of their symptoms treatment uh can be with antimalarial drugs I give you an example of one of them there and then other treatments would be based on symptoms and the severity of the symptoms so if they're having respiratory issues they might be on inhaler more severe would be a respirator or ventilator if they're hospitalized and having difficulty if it's Advanced that far rest uh with which I would say is great because everybody wants to rest when they don't feel good but often times we need to make sure these patients are still moving especially if there's respiratory involvement because if the infection and virus is progressing and we are not moving enough we can have secondary tertiary complications so little ashk next to that rest and then prevention same thing looking at the precautions that you would take for droplets and maintaining good hand hygiene and sanitary environment symptoms of covid can be cough short of breath difficulty breathing fever is common muscle aches so kind of sounds like you're getting the flu you may or may not have di uh diarrhea or vomiting and then one of the key things that they have found with that's interesting with Co is the change or loss of taste or smell you have completed this module on viral infections please come to class with any questions you may have have thank you for your time