Survey - Chap 4 - Bacterial Diseases Acquired Through the Respiratory Route

Bacterial Diseases Acquired Through the Respiratory Route
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upper respiratory infections - characteristics
1. Pharyngitis, Laryngitis, Tonsillitis, and Sinusitis, Otitis Media (auditory canal)
2. Most common disease agents - Streptococci, S.aureus
3. Predisposing factors - colds, environmental pollutants, excessive dryness, pollen or other allergies
upper respiratory infections - transmission
airborne droplets, direct or indirect contact with secretions--autoinfection
upper respiratory infections - symptoms
sore throat, hoarseness, loss of voice, sinus pain, earache
upper respiratory infections - prevention/control
frequent hand washing
sinusitis
a. Most frequently reported chronic disease in the U.S.
b. Caused by several different disease agents
sinusitis - transmission
a. Natural inhabitants of the human body - autoinfection
b. Airborne droplets or secretions of nose and throat
sinusitis - symptoms
a. Temperature of 101-104 degrees, severe sore throat, swollen glands and tonsils, malaise, weakness, anorexia and occasional abdominal discomfort
b. Symptoms in small children may be inapparent
sinusitis - treatment
a. Penicillin or Erythromycin for 10 days
b. Early treatment—milder illness and less chance of complications
c. Bed rest
sinusitis - prevention/control
a. Any child with a constant sore throat and fever should be seen by a doctor
b. Avoid close contact with infected people
c. Proper food handling
d. Investigation to determine source
e. Antibiotics may be given prophylactically
streptococcal sore throat - pharyngitis
a. 95% caused by Streptococcal pyogenes
b. Up to 20% of school children carriers
c. Otitis Media or acute Sinusitis most common complication
d. Rheumatic Fever, Glomerulonephritis, rheumatic heart disease may occur later

needs to be diagnosed + treated properly

culture + (CNS) sensitivity of bacteria + rapid strep (if positive go home w/ treatment of penicillin) - if culture positive get treatment - re-culture to make sure its gone

untreated: can also cause scarlet fever

rheumatic fever - strep antibodies circulate and form antigen-antibody complexes w/ strep antigens that are circulating - kidney ends up w/ complexes in its membrane - complement activated - inflammation response in membranes in kidney - glomerulonephritis; can also involve joints and brain

strep antibodies can also bind to cardiac antigens on heart valves - inflammation - valves don't function properly
pharyngitis - transmission
a. Direct or intimate contact with individual who has active pharyngitis or a carrier
b. Ingestion of contaminated food
pharyngitis - symptoms
a. Temperature of 101-104 degrees, severe sore throat, swollen glands and tonsils, malaise, weakness, anorexia and occasional abdominal discomfort
b. Symptoms in small children may be inapparent
pharyngitis - treatment
a. Penicillin or Erythromycin for 10 days
b. Early treatment—milder illness and less chance of complications
c. Bed rest
pharyngitis - prevention/control
a. Any child with a constant sore throat and fever should be seen by a doctor
b. Avoid close contact with infected people
c. Proper food handling
d. Investigation to determine source
e. Antibiotics may be given prophylactically
rheumatic fever
1. Always preceded by another strep infection
2. Potentially dangerous although symptoms appear mild
3. Cause of rheumatic heart disease
4. Causative factors include low resistance and hypersensitivity
5. More prevalent in lower income groups
6. Disease of childhood which may recur
rheumatic fever - transmission
no person to person transmission possible
rheumatic fever - symptoms
1. Fever and migratory joint pain most common early
2. Abdominal pain, rash nodules under skin, cardiac involvement
3. Chorea may occur up to 6 months later
rheumatic fever - treatment
1. Penicillin
2. Erythromycin
rheumatic fever - prevention/control
1. Education of public - connection between Strep infection and Rheumatic Fever
2. Immediate treatment for strep infections
3. Contact investigation to find/treat carriers
4. Check for possible contaminated goods
Acute Poststreptococcal Glomerulonephritis (APSGN)
1. Follows strep infection - sore throat or impetigo
2. Most in children 6-10
3. 95% children and 70% adults recover completely
4. May be caused by deposition of antigen-antibody complexes on glomeruli
APSGN - transmission
no person to person
APSGN - symptoms
1. Fever
2. cocoa-colored urine, diminished urine output
3. hypertension, edema
4. fatigue
APSGN - treatment
1. Bed rest
2. Fluid and dietary sodium restrictions
3. Correction of electrolyte imbalance
4. Diuretics and antihypertensives
APSGN - prevention
healthy lifestyle for strong resistance, identification and control of original infection
pneumonia
A. Classified by disease agent, location, and type
B. With influenza, one of top 10 causes of death in United States
C. Caused by every infectious agent except metazoa
pneumonia types
1. Pneumococcal Pneumonia
2. Mycoplasmal Pneumonia
3. Legionnaires' Disease
Pneumococcal Pneumonia
(1) Most common type
(2) High frequency among very young and very old
(3) Common cause of death among alcoholics
(4) Incubation period 1-3 days
(5) Antibiotic therapy - noninfectious within 24-48 hours
Pneumococcal Pneumonia - transmission
direct or indirect contact with respiratory discharges
Pneumococcal Pneumonia - symptoms
(1) Sudden onset of chills, fever, chest pain, difficult breathing and cough
(2) Bright red or rusty sputum
(3) May also be pleurisy (pleuritis)—sharp pain with breathing
(4) Older people may be asymptomatic
Pneumococcal Pneumonia - prevention/control
(1) Vaccine for those at high risk
(2) In an outbreak, avoid crowds
Mycoplasmal Pneumonia
(1) Causes 20% of all pneumonias
(2) "Walking pneumonia" b/c can still function
(3) May last a month or more
(4) Light or asymptomatic in children under 5
Mycoplasmal Pneumonia - transmission
direct and indirect contact with respiratory secretions
Mycoplasmal Pneumonia - symptoms
(1) Sudden or insidious onset
(2) Headache, malaise, cough (paroxysmal often), sub-sternal pain
(3) Often not recognized as pneumonia
(4) Generally no complications, fatalities rare
Mycoplasmal Pneumonia - prevention/control
(1) No vaccine
(2) Avoid crowding in sleeping and living quarters
(3) Contact investigation
(4) Proper sanitary methods
Legionnaires' Disease
(1) Outbreaks traced to faulty cooling systems or excavation sites
(2) Unrecognized cause of pneumonia for many years (described in 1947)
(3) Has been diagnosed in most states and foreign countries
(4) Mortality rates as high as 15% of hospitalized patients
Legionnaires' Disease - transmission
(1) Organism lives in soil or water
(2) Infection by inhalation of air borne particles
(3) No evidence of person-to-person transmission
Legionnaires' Disease - symptoms
(1) Sudden or gradual onset
(2) Diarrhea, anorexia, malaise, myalgia, weakness, headache, high fever, chills
(3) Nonproductive cough
(4) May have grayish, blood-streaked sputum
(5) May have nausea, vomiting, disorientation, pleurisy, and bradycardia (half of patients)
(6) complications include congestive heart failure, acute respiratory failure, renal failure and shock
Legionnaires' Disease - prevention/control
(1) No vaccine available
(2) Implicated cooling systems and water supplies disinfected
(3) Dust control at excavation sites
Whooping Cough (Pertussis)
1. Decrease since vaccinations (DPT) began—1940
2. Increase in recent years - media
3. Bordetella pertussis
4. Mortality likely of secondary pneumonia in children under one and elderly
5. Highly communicable during late incubation and catarrhal stage
6. Low danger of transmission 3 weeks after cough begins
7. Antibiotics, communicable only 5-7 days
8. Up to 31% of adults with a chronic cough may be carriers
Whooping Cough (Pertussis)
1. Direct by droplets (most common)
2. Indirect by contact with contaminated objects
Whooping Cough (Pertussis)
1. Catarrhal - insidious onset, may include irritating cough; anorexia, sneezing, listlessness, infected conjunctiva, low-grade fever
2. Paroxysmal - spasmodic/recurrent coughing - expel tenacious mucus; cough - high pitched inspiratory whoop; vomiting - choking on mucus; nose bleed, detached retina, hernia (coughing); secondary infections - otitis media, encephalopathy, pneumonia; 3 weeks
3. Convalescent - cough may last 1-2 months and be triggered again by upper respiratory infection
Whooping Cough (Pertussis)
1. Infants hospitalized, fluid and electrolytes
2. Nutritional supplements, mild sedation (codeine) for cough; oxygen therapy
3. Antibiotics not very effective relieving symptoms; shorten period of communicability
Whooping Cough (Pertussis)
1. Vaccination at 2-3 months
2. Isolation of suspected cases
3. Vaccination for unvaccinated
4. Gamma globulin prophylactically
5. Contact investigation
diphtheria
1. Now uncommon in developed countries
2. Likely cause of death in underdeveloped countries
3. Corynebacterium diphtheriae - stays in upper respiratory region; produces deadly exotoxin, producing a pseudomembrane; toxin spreads
4. Reservoir of infection is humans
5. Attack does not always confer immunity
6. Epidemic proportions in Soviet Union since 1990
diphtheria - transmission
direct by droplets or indirect by contact with contaminated articles or milk
diphtheria - symptoms
1. Thick, patchy, grayish-green membrane over mucous membranes of pharynx, larynx, tonsils, soft palate, nose
2. Fever, sore throat, rasping cough, hoarseness
3. Difficulty in breathing - false membrane causes airway obstruction
4. Complications - myocarditis, neurologic involvement, kidney involvement
diphtheria - treatment
diphtheria antitoxin, antibiotics
diphtheria - prevention/control
active vaccination with diphtheria toxoid
tuberculosis
1. Mycobacterium tuberculosis (tubercle bacillus)
2. In 1900, 2 of every 1,000 Americans died of TB; 20 of every 1,000 ill with it
3. Present - 30,000 cases/year; 10 million infected; increasing (AIDS)
4. Primarily a disease of lungs; can invade blood stream and infect liver, brain, urogenital tract, bone
5. Illness and death rates increase with age
6. Rates higher among poor, non-white; cities higher than suburban areas
7. Primary reservoir humans - also cattle
8. Declared a Global Emergency in 1993
a. HIV/AIDS - low resistance
b. Increase in immigrants
c. Increase in poverty, alcoholism, drug abuse and homelessness
d. antibiotic resistant strains - 50%-60% fatality rate even when treated
e. difficulty in getting patients to take drugs
tuberculosis - transmission
1. direct or indirect; usually by inhalation of airborne droplets
2. prolonged exposure to an active case necessary
3. more likely in family situation, army barracks, college dormitory, or other institutional living arrangements
tuberculosis - symptoms
1. Usually none at first; might be fatigue, weakness, anorexia, weight loss, night sweats, and low grade fever
2. Organisms are encapsulated in lungs
3. Reactivation TB usually occurs late in life or at a time when the immune system is compromised; cough producing sputum containing mucus and pus, chest pains, and occasionally, bloody sputum
tuberculosis - treatment
isoniazid combined with rifampin or other drugs—9 months of therapy usually resolves the case
tuberculosis - prevention/control
1. Vaccination with BCG is available but not used routinely in the United States since it prevents diagnosis by skin test
2. Improved social conditions, education of public
3. Source and contact investigation; appropriate chemotherapeutic methods; frequent community surveys by testing and x-rays