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Question

infectious of rubella

Answer 1

clinical of rubella 50% of ppl are subclinical incubation 12-23days/ (2-3wks) prodrome: usually none rare: conjunctivitis, runny nose rash: 1st sx spreads for 1 day, lasts about 3 days, maculopapular: DISCRETE (not confluent like measles) hemorrhagic exanthema 20% •Lymphadenopathy- appears a week before the rash, last several weeks after it loc: postauricular, posterior cervical, suboccipital(theodor sign) dg difficult to dg rubella because: 1)clinical diagnosis unreliable 2)LAB -unremarkable, leukopenia and atypical lymphocytes. CRS indicates- viral culture, (PCR) serology (ELISA) - IgM in single sample is often (false (+)! - IgG seroconvertion: acute and convalescent ``` ddx: PETS 5 roses Enteroviruses, Parvovirus B19 (erythema infectiosum), Toxoplasmosis, Scarlet fever, Modified measles, Roseola, Fifth disease ``` ``` CONGENITAL RUBELLA SYNDROME transient birth sx A: Autism, B: Bony abnormalities, Behavioral disorders, C: Cloudy cornea, Congenital heart disease (pulmonic stenosis), Cryptorchidism, CP D: degenerative brain diusease G:Glaucoma, H:Hepatitis, Hepatosplenomegaly, I: ITP J: JAUNDICE L: Lymphadenopathy, Low birth weight, ``` dg maternal blood sample ASAP and test for rubella antibodies if: 1)rubella specfic ab IgG =maternal immunity CRS-ve 2)no anit rubella igG in blood: serum test in 2 wks -negative test result in both specimens indicates that infection has not occurred. Advice for vaccination -seroconversion: positive test result (IgM) in the second and not the first indicates recent infection – counseling for termination of pregnancy rx •Isolation: 7 days after onset of rash, congenital: till 1 y/o Treatment: supportive Prevention: immunization MMR vaccine

Answer 2

Definition:Q fever History Etiology - Coxiella burnetii - Obligate intracellular parasite. Stable and resistant. Killed by pasteurisation Serology -Two antigenic phases: Phase 1- virulent. Phase 2: less pathogenic ``` epidemiology Loc Worldwide, except New Zealand Age: vets, meat processing plant workers, dairy workers, livestock farmers season Cycle: -sheep, goats and cattle-can grow in large numbers in the female’s uterus and udder. dust humans Mortality ``` ``` Source & transmission A/Z: zoonotic contaminated milk / contact with foetus, placenta or fluids from when an animal gives birth. ihnalation of dust ``` ``` Characteristics of the disease Incubation: 2-6 weeks Entry Exit ``` Mech of disease -C. burnetii infects the respiratory tract. burnetti can survive and grow within acidic phagosome because of its sodium ion/proton exchangers. makes curing chronic Q fever with antibiotics difficult. --------------Pulmonary infection causes infiltration by mononuclear cells--> focal necrosis and haemorrhage. spreads to the liver, causing GRANULOMA . -chronic endocarditis occurs in susceptible pts Immunity and receptivity Anti epidemiological prophylaxis - Good hygiene practices in premises dealing with animals - pasteurisation of milk and milk products Immuno prophylaxis - Q-Vax, a whole-cell, inactivated vaccine. - single dose intradermal vaccination is composed of killed C. burnetti - life long protection blood test for existing immunity to avoid severe local reaction.

Answer 3

sx abrupt flu-like illness w/ dry cough. (10% of cases), a maculopapular rash appears. complications - ARDS - hepatitis with elevated transaminases, but minimal elevations in bilirubin; - myocarditis - pericarditis; - chronic endocarditis (negative echo early in the disease, high mortality) - meningitis; DG =cultures are not performed because of the danger to lab personnel. =PCR -Elevated IgG and IgM antibody indicate acute disease. -Elevated IgG and IgA antibody titres against phase I antigens are diagnostic of chronic Q fever. ``` RX Abiotics less effective self-limiting, lasting 2 weeks. !!Oral or intravenous doxycycline is the treatment of choice, and fluoroquinolones are considered a reasonable alternative.!! ``` longer therapy needed in chronic endocarditis

Answer 4

Definition: History Etiology Rickettsia. Conorii through the bite of the brown dog tick Rhipicephalus. Sanguineus. ``` Epidemiology Loc; Mediterranean area (Greece, Turkey, Romania and Bulgaria,) and southern Europe (italy, spain) Age/ risk group dog owners season Cycle Mortality ``` Source & transmission A/Z Characteristics of the disease Incubation Entry: skin, conjunctiva. w. charac tache noire Exit Mech of disease tick borne Immunity and receptivity Anti epidemiological prophylaxis - avoid close contact w/ animal vectors in endemic areas - Protective clothing w/ permethrin - freq Topical repellents on exposed skin; - daily self checks immuno prophylaxis -no vacc

Answer 5

``` clinical triad of MSF Fever: Rash (exanthema) lower legs, 2-6 days after fever Tache noire ``` DG - clinical feature - history: tick bite, which is typically tick bite is painless and can go unnoticed - contact with a dog; - recent travel to an endemic area. serologic test classic Weil-Felix test using biopsy of primary lesion ``` rx self limiting (2weeks) abiotics speed up recovery and reduce fever -Tetracyclines, ```

Answer 6

Etiology: Nairovirus – tick borne virus (Bunyaviridae fam) Ixodid (hard) ticks, especially those of the genus, Hyalomma, are both a reservoir and a vector for the CCHF virus. cattle, goats, sheep and hares, serve as amplifying hosts Serology Epidemiology Loc: endemic in Africa, the Balkans, the Middle East and Asia, countries south of the 50th parallel north.( south of a a line thats 50 degrees north of the equator) Age/ risk group slaughterhouse workers & animal herders in endemic areas season Cycle Mortality Source & transmission A/Z: zoo contact with infected ticks or animal blood. anthro: contact w/ infected blood Characteristics of the disease Incubation: 5-6 although 13 max has been seen Mech of disease Immunity and receptivity ``` Anti epidemiological prophylaxis risk groups should -use Insect repellants containing DEET ( diethyl-m-toluamide) -avoid blood contact -raise awareness ``` Immuno prophylaxis -NO VACC health care prophylaxis -basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.

Answer 7

clinical features sudden onset of consitutional sx typical sx for CCHF -Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common. 4th day-2wks progressive hemorrhagic sx -severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites dg: LAB RT-PCR ELISA culture: viral isolation rx: supportive - correct fluid electrolytes - correct metabolic abnormalities - rx of any 2ndary infec curative a.viral RIBAVIRIN oral/I.V

Answer 8

``` Etiology Borrelia burgdorferi, anaerobic, facultative intracellular spirochete bac Serology ``` ``` Epidemiology Loc Age season Cycle Mortality ``` Source & transmission A/Z: zoonotic through a bite from an infected tick, mainly a nymph or an adult. longer blood meal= increased risk of infection Characteristics of the disease Incubation: 3-30 days. Mech of disease skin Inoculation after meal--> ERYTHEMA MARGINATUM d/2 replication -->invade vessels & spread haematogenously to other organs (skin, CNS and joints)--->stim immune response==>specific IgM ab’s peak at 3rd -6th week after onset immunity and receptivity Anti epidemiological prophylaxis - early removal of attached ticks w/ tweezers as closely as possible to the skin, pulling gently upwards and trying not to break off the mouth parts. -wearing protective clothing, like long trousers and long-sleeved shirts, and using tick repellents. -regular skin checks of skin-folds e.g. groins, armpits, under breasts, waistband area, backs of knees—as ticks seek out more humid areas for attachment. Immuno prophylaxis NO VACCINE for lyme disease --Permethrin-impregnated clothing can be used by people who have frequent heavy exposure to ticks, such as forestry workers or military personnel on exercise.

Answer 9

early sx of lyme diseaseare flu like 3 stages of lyme disease sx Early LOC Lyme: Flu-like symptoms and typical 5 centimeters rash w/ Erythema migrans BULLS'EYE or uniform round red appearance Early DISS Lyme: Flu-like symptoms & CNS sx: pain, weakness or numbness in the arms and legs, vision changes & Bell's palsy & CVS sx: palpitations and chest pain LATE DISS Lyme: weeks, months, or years after the tick bite: arthritis, severe fatigue neck stiffness and headaches, vertigo, sleep disturbances, and mental confusion. dg of lyme - history of tick exposure - clinical sx - serolgy only in pts w/ specific signs and sx of lyme rx of lyme early: doxycylcine 10 days disseminated early and late: ceftriaxone 21 days

Answer 10

Definition: presence of one of 25 conditions indicative of severe immunosuppression in HIV + person OR HIV infection in an individual with a CD4+ cell count of less than 200 cells per cubic mm of blood. History Etiology Lymphotrophic lentivirus retroviridae fam Consists of the two species HIV-1 and HIV-2 serology Epidemiology Loc:  HIV-1: most common species worldwide  HIV-2: restricted almost completely to West Africa ``` Age/ RF -unprotected sex (oral,vaginal,anal) -other STI syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis; -I.V drug use -unsafe bloodtransfusion/ tissue transplant -needlestick injury ``` season Cycle Mortality Source & transmission A/Z: anthro Sexual: 80% of infections worldwide -semen/ vag secretions Parenteral: Needle sharing, needlestick injuries, blood transfusions. Vertical: During childbirth or through breastfeeding after birth CANNOT ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water Characteristics of the disease Incubation: approx 10 years Mech of disease 1. Acute HIV Infection: HIV multiplies rapidly and spreads throughout the body. virus destroys fighting CD4 T cells of the immune system. HIV in the blood is very high, which greatly increases the risk of HIV transmission. 2. Chronic HIV Infection HIV continues to multiply but at very low levels. pts are asxx still spread HIV to others. AIDS in 10 years or so w/o rx 3. AIDS HIV has severely damaged the immune system Opportunistic infections & infection-related cancers increase in severity/freq-death in 3years w/o rx Immunity and receptivity increased adhesion of HIV to anal epithelium Anti epidemiological prophylaxis practice safe sex -condoms, reduced promiscuity avoid needle sharing PROPHYLAXIS AFTER HIV EXPOSURE indicated in 1)Injury with HIV-contam needles 2)Contamination of open wounds or mucous membranes with HIV- contaminated fluid 3)Unprotected sexual activity with a known or potentially HIV-infected person procedure initate ASAP(1-2hrs) Drugs: A three-drug regimen 1)nucleoside reverse transcriptor inhibitor(Tenofovir) 2)nucleotide reverse transcriptase inhibitor (emtricitabine) 3)integrase inhibitor: (dolutegravir/raltegravir) VACCINATIONS IN HIV PTS -reduced efficacy (d/2 impaired immune function) general immunization precautions in HIV - Inactivated vaccines are safe - Live vaccines CI exceptions to immunization schedule -inactivated polio isntead of attentuated -live-attenuated influenza, varicella zoster, and MMR vaccines should not be given in AIDS determined by (CD4 count below 200 cells/μl or CD4 is only 15% in patients ≤ 5 years or if AIDS-defining conditions are present. T NEEDLE STICK INJURY RX  Let the wound bleed  Rinse/flush with water and soap and/or antiseptic agent  Immediately seek medical attention

Answer 11

3 stages ``` acute sx -Fever over 38°C, for 2 months -diarrhoea over 1 months -Wasting syndrome -Decreased body weight (over 10%) -Persistent Generalised Lymphadenopathy over 2 months at ≥2 extra inguinal sites ``` chronic asx AIDS Opportunistic infections -Pneumocystis pneumonia, -Tuberculosis, -Toxoplasmosis, -Candidiasis Neoplasms -----------Kaposi, - Hodgkin’s Lymphoma - Non-Hodgkin’s Lymphoma Neurological disorders dg 2 positive ELISA tests • CD4 number(below 200) or percentage(below 15%) • Virological markers: PCR (positive, at 400 copy/ml), Viral Load, HIV resistance tests ``` Lab pancytopenia pleiocytosis low albumin elevated acute phase proteins & liver ez ``` rx There is currently no cure or effective HIV vaccine. triple drug Highly Active Anti Retroviral Therapy 2NRTI plus 1 proteiase/integrase inhibitor

Answer 12

Caused by varicella zoster. Ins human herpes virus 3 Rna virus and instable In environmental Contagious in last 2-3 days of the incubation period. Once scabs form no more ciruses are released MOT - airborne. Carried by longer diseases than airborne biruses - person 2 person contact from rash - vertical from preg women to embryo Measures against disease - isolation at home till scabs form - hospitalised when: Meausred afainst contexted person -children in under 7contact monitured fot 21 years -kindergarten pol obvs for 21 years. Disinfection not necc

Answer 13

Etionis influenza viris from 3 types. ABC 2 antigens(H) hemagluttinin and M High mutabiloty causing epidemic strains Unsrable in environment Soread by secretions bt diseased and assyx pol Airborne aMot Contagious index is 90-100% Affects children and old sdults Immunity is tyoe soecific for one year Vaccines for risk grouos Measures afainst disease - isolation for 3 days - hospital for epidemiology indications - symptomatic drugs and immunomodulators Cleanin of the environment Under the control if WHO PREGENTION IS 2 stage Stage 1: preparetoty -anti influenza vacc to risk groups till end of october for 70% of population Specialisrs in hispitals for epidemics Stage 2: epidemic -isolation if pts to oregenr transmission Registering of pt Maskes for ots and workers changed EVERT 2 HRS Severe forms and complications are hospitals Isolation- close schools, stop planes, stop hospital visits Disinfection

Answer 14

``` Dissemination -globally, Etio -belong to the enterovirus familiy of picornoviridae -rna viruses -32 serotypes 1-9’11-27, Grouos A 27 seroyrypes B 6 serotypes ``` Very stable to chloroform and bile due to lack of lipid Stable in environment 170 days and 160 days in lakes 7 days at room temp Sensitive to chlorone disinfection ``` Incubation 1-2 weeks Source Of infection Diseased and healthy carriers for 1-6 months ``` Polytropic viruses that affect many organs Echo Meningitis, rash, conjunctivitis ``` Cocksie A Aseotic me i gitis Heroes angina B Aseotic men Myocarditis and pericarditits ``` Exho and cocksakie can cause scute apathetic paralysis MOT - fecal oral route. Cont friits and veg. Canak water. - airborne is secondary like polio Susceptibility -mainly kids but new age frouos affect all ages Lethaliry - most are favourable unless CNS or heart is involvedwoth high lethaliry Seasons- summer to autum Prevention - no specific vaccine due to many serotypes - wash hands and avoid sick Epidemiological measures -dispensary surveillance Contacts -40 day observation Environment -disinfection and disinsection

Answer 15

Acute himan disease bt rubria cholera Fecal oral mechanisms History - bulgaria firsr time in 1883 - eradicated since 20’s 3 serotypes Classic has low stablity. Lasts a year Later type has hih srability but is sensitive to disinfection and high temp. Loc in lakes. Lasts 6 mo Source Diseased- end of incubarion oeriod and during sx. 30 litres released in feces Carriers Convalescence Iceberg phenomena Convalescence careiage is 7 days Healthy carriers excrete bac for 2 weeks max MOT -fecal oral Susceptibility is common. -immunocomp, poor nutrition. Active age ppl but longer period in kids No lifelong immunity Seasonlitt is summer b Prophylaxis - prevent movement from endemic regions - endemics more common caused by latter tyoes - many atypical forms so no vaccine Measures against disease -hospitalisarion in infectios ward. 3-ve samples taken 24 hrs after end of abiotic rx Contacts -isolated for 5 days w/ abiotic Environment -disnindectioin w/ chlorine

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