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Lyme Disease Etiology?
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Lyme: Endemic ?
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MCPHS Inf Disease E2
MCPHS Infec Diseases Exam 2 P2s
| Question | Answer |
|---|---|
| Lyme Disease Etiology? | Lyme: Acute Inflamitory Bacterium Borrelia burgdorferi Spirochete |
| Lyme: Endemic ? | NE & Central Great Lakes (some in TX, FL, West Coast) 19.8K cases in 2004 in USA |
| Lyme: Symptoms? | Lyme: 75% Bulls Eye Rash in 2-30 days, Fatigue, Chills, Fever, HA, Joint Ache, Lymph (Diseminated/Untreated: Loss of Musscle Tone, Bell's Palsy, HA, Meningitis, Shooting Pains at night, Joint Pain, Heart Palpitations, Dizziness, Arthritis, Joints Swell |
| Lyme: Vectors? | Deer Tick (NE) Blacklegged Tick (West Coast) USA Live 2 yrs: Larvae, Nymph Adult |
| Lyme: Diagnosis? | Flu-like, arthritis, MS-like Neurological, History in Endemic areas, Abs to bacterium, ELISA, PCR (Western Blot), Immuno-Florecent (IFA) |
| Lyme: Treatment? | Antibiotics: oral/IV responds well if early tx. Doxy, Amox, Ceftriaxone (multi-drug for severe cases) |
| Lyme: Prevention? | Avoid tick-infested areas, repellent, deet, Landscaping zones, Discourage deer, Vaccine taken off market in 2002 |
| SARS: Etiology? | SARS: Coronavirus (Palm Civet animal virus 1:1255 AA change to bind to human ACE2 Receptor) |
| SARS: Nov 2002 - July 2003 (History)? | 2002 Nov. First Case: Guangdong, China, Jan: Seafood Worker Hospitalized (19 relatives/ 50 Healthcare MD to Metropole Hotel HK Feb 2003, March WHO global allert, by July 8098 cases, 29 Countries, 774 Deaths, 9.6% fatality rate, 29 in USA w/0 deaths in USA |
| SARS: Symptoms? | SARS: incubation 2-14d, fever >100.4, HA, Body Aches, Mild Resp Onset, Diarrhea 10-20%, 2-7d of onset Non-productive cough, then most develop Pneumonia, |
| SARS: Transmission? | SARS: Person-Person, Cough/Sneeze/Fomites (No trans from Asymptomatic case), Most Contagious Second Wk of Illness, Limit Human Contact 10 d after fever & Respiratory disappear |
| SARS: Epidemiology? | SARS: Nosocomial, most Adults, Children less often/less severe |
| SARS: Treatment? | SARS: Antivirals, Antibiotics (Bac. Complications), Steroids reduce lung inflammation, Recovered PT's Serum (Inconclusive Results), Supportive Oxygen, Mech. Ventilation |
| SARS: Tests? | SARS lab tests: RT-PCR of blood, stool, nasal secretions; Serology (ELISA or IFA) Abs after infection, or Viral Cultures |
| SARS: Prevention? | SARS: Min Travel, avoid contact 10d after s&s gone, Hygiene, Masks, goggles, gloves |
| SARS: Dynamics of Spread? | SARS: Ro = 3 (Small Pox 5.5, Flu 1.5) But, SARS 8-10 d Shed 2x's Flu (Quarantine Contacts before start shedding virus -that's why Public Health measures worked) |
| Avian Flu: Etiology? | Avian Flu: ss-RNA 8-Segment Virus, Mutates Freq. Drift Birds, Pigs = mix Antigenic Shift 1918 Spanish Flu, recent H5N1 Drift Bird-Human, Ducks Endemic Asia |
| Avian Flu: History? | 1918 Spanish Flu H1N1 (20-50M Deaths, 1/2M USA Death & 25% US Infected), 1957-58 Asian Flu H2N2 (1-4M Death, 70K Deaths USA), 68-69 HK Flu H3N2 (1-4M Death, 34K D US), 1997 Bird-Human H5N1 (18 Hos/6 deaths = 17M Poltry Killed to end), 1999 H9N2 2 child HK |
| Types of Influenza? | A=Humans, Birds, Swine, Severe for All, Shift & Drift causing Pandemics B=Humans Only, Severe in Risk Groups, Drift Only, C=Human, Dog, Swine, Drift Only |
| Type A Viruses? | No Proof Reading, H1-15 (attachment), N1-9 (exits), glycoprotien spikes ags body recogn., |
| Avian Flu: Recent H5N1? | 97' HK (18/6 Infec/deid), Feb. 2003-04' SAR family father, son, daughter HK traveled to S. China, 2 died, (vietnam 22/15, Thailand 12/8). World Totals 03-04': 251/148 |
| Avian Flu: How? | Avian: Density of infected poultry, Freq. of Human Exposure, Duck Fecal in yards, Viral Pathogen Contact/aerosol/fomite, bird-human, no Human-Human (no reassortment) |
| Bad News about Avian Flu? | Endemic Dom/Wild Birds SE Asia, Virus in Birds more Virulent, Asymptomatic Ducks, Expanding host range to Cats/tigers, 04' virus survives longer in environment, no H5 immunity in Humans |
| Good News about Avian Flu? | No H-H trans, Surveillance in place, vaccines faster, antivials better/buys time to help quarentine and make vaccine, ea day = 5 M vaccines produced (limited production and high cost) |
| Hantavirus: First Outbreak? | May 93', Four-Courners (AZ, NM, CO, UT), Merrill Bahe, fit, 19 yo male, died 5/14/93, Acute Resp Distress Syndrome (ARDS) Leakiness of vescles, fluid build up in lungs, Dr. Bruce Tempest, Reported to NM IHS 5 died all young healthy, lungs wt. 2x's normal |
| Huntavirus: Carrier? | June - Aug 93' trapped Deer Mice, 30% Infected, Population 10x's norm, excess snow, increase in food sup., Virus Named Muerto Canyon Virus (death valley), renamed: "Sin Nombre Virus" (SNV) |
| Hantavirus Pulmonary Syndrome (HPS)? | S&S HPS: flu-like, 1-2 d get better, then sudden onset respiratory failure, Mortality 50% w/ Aggressive Tx. (O2, ventalator, Rivavirin by IV) |
| Huntavirus stats? | Hantavirus stats: 416/146 died by Feb. 2006, cases mostly in mid-western pacific coast states, Man in Utah 1959 samples tested positive, prior IHS reports for years |
| Huntavirus: Transmission? | Huntavirus: Trans of Virus by Rodent Urine, Feces, Saliva, No H-H Trans, Bites Rare |
| Huntavirus: Etiology? | Huntavirus: Bunyaviridae Family, 5 Genera, 250 Species (Hemorrhagic Fever w/ Renal Failure is Close relative to Huntavirus Pulmonary Syndrome), RNA virus, Budding, Persist n Host, Lipid Membrane, Others are Transmitted Via Arthropods, but Hunta by rodents |
| Huntavirus is also found in? | LA, FL, NY, Argentina, Brazil, Chile, Paraguay, Uraguay (Dif. Strains Co-evolved in dif Rodents) Sin Nombre, Black River, NY strains... |
| Huntavirus: Pathogenesis? | Req's beta-3 Integrins w/virus glycoproteins to cause vascular integrity disruption making capilaries more permeable and disrupting arteriole vaso-constrictions/dilation problems, binds to platelet receptors affecting clotting factors |
| Huntavirus Patho Inflammatory Reaction? | Hantavirus Patho Immune response caused by Viral epitopes on host cells triggers cytotoxic T-Cell attack on host tissues |
| Huntavirus: Detected by? | ELISA, PCR of Viral RNA, Immuno-Chem of Virus |
| Huntavirus: Biowarfare? | Long Incubation, Dif to Dx, Highly Leathal, Low infectivity of HPS, Dif to Produce, Not Stable |
| Antibiotic History? | Ernest Duschesne Pen 1896, Alexander Fleming Pen Rediscovered 1928, WWII widely avail, 47' S.Aureus Resistant to Penicillin, 67' Pen-Resist. Streptococcus Pneumoniae & Gonorrhea (SE Asia Prostitutes), 76' GI's to USA, 83' Hos-aq'd Pen-Res Entro, 87' VREs |
| Todays Antibiotic Resistance? | VREs, MRSAs, nearly all Staph Aureus are Pen resistant, Vancomycin is drug of choice for Staph Aureus (some are now Vanco-Resistant) |
| CDC est. Scope of Antibiotic Problems? | 2 M Nosocomial Infections Yr. USA, 90K Deaths Yr USA, >70% bacteria causing these infections are Resistant to Commonly used Antibiotics |
| Contributing Factors to Antibiotic Resistance? | 85' 6M Rxs for Sinusitis, 15 M for Inner Ear: 92' 13 M Sinusitis & 23 M for Inner Ear Infections. Expanding Population of Immunocomp Hosts, Pts living longer, getting sicker, dieing more slowly, Incr Invasive Procedures, Inappro Use of Med (viral/animal) |
| Antibiotic Resistant Org/diseases? | Gonorrhea, Lice, Malaria, MRSA, Strep Pneumo, ViSA, VREs |
| Why does Resistance Occur? | Adapts or Dies off, Mutation Rates unchecked/uncorrected viral drift, fast growth rate, subtherapeutic dosing, poor adherence to Tx, too few drugs (Ehrlich 1913 Hit them hard/early, resistance w/single point mutation eg. TB) |
| 4 Mech. for Tx Failure? | Pass on Resistant Orgs to new hosts, Bal. Shift (suscept org killed off increase prob host is infected w/resist org), Mod.g' Tx'd Host's Resit to Colonization by wiping out norm flora, Increased Density of Resist Org in Host |
| 3 Mech of Resistance? | Restricted Uptake/Efflux (Pumping), Drug Inactivation (Enzymatic Alt of Drug, Drug Sequestering by pro bind, Enzymatic Degradation of Drug), Mutations in Targets (Mod targets, Over Prod. target, Metabolic Bypass of targeted Pathway) |
| 3 Mech of Resistance Occurs by ? | Bacterial DNA transfer (Plasmid vector = Conjugation, Bacterial Phage vector = Transduction, Naked DNA uptake) |
| Ways to combat Resistance? | Encourage MDs to Rx Appropriately (not for viral, 30% un-nesecessary), Prop drug/dose, Finish Rx, Don't skip/save/expect, Quick ID & Isolate Pts w/ resist Orgs, Not Prophylactic in Animal feed, Hygiene, Dev Vaccines/new drugs |
| Bioweapons: History | 400-190 BC Archers/Fecal, Persain/Greek Lit/Wells, Hannibal Vessel Snakes vs Pergamon, 1346 Siege Caffa Tartar hurl Plague, 1710 Russian plag vs sweeds n Estonia, 18th Frnch/Indn War Brits Smallpox Blankets |
| Bioweapons: Recent History | WWI Germans/Anthrax/Glanders/Cholera/Wheat Fungus, 25' Geneva Protocal 108 Nat'n Proh-Use, WWII Unit 731 Manchuria/Janpanese >3K Plag/Anthrx/Syphilis, 42' US War Resch Srvs Anthrax/Botulinum Tox (stockpile 44'), 72' Biological Weapons Conventn 144 Nat'ns |
| Bioweapons: Rogue Nations/groups? | 84' Rajneesh follower salad bars salmonella, 85' Iraq use Anthrx/botunlium tox/Aflatoxin, 94' Aum Shinrikyo Cult Anthrx Tokyo bldgs, 95' MN militia Pos conv Ricin, 96' mail Bubonic OH man, 01' Mail Anthrax media 5 dead, 02' Eng Ricin Lab, |
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