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TM: Emerging Infectious Diseases (Intro (recurred pathogens (ecological…
TM: Emerging Infectious Diseases
Intro
novel pathogens
recurred pathogens
usually due to animal contain (zoonoses)
ecological factors
climate change (e.g. mosquitoes move north as it gets hotter)
deforestation (changes interaction pattern)
or antimicrobial resistance
or breakdowns in public health measures
problems: long incubation periods, air travel
= infectious diseases whose incidence in humans has increased in past 2 decades or threatens to increase in near future
new infections resulting from changes / evolution of existing organisms
known infections spreading to new areas / pops
previously unrecognised infections appearing in areas undergoing ecologic transformation
cryptococcal meningitis Canada outbreak (Vancouver island) in early 2000s
leptospirosis in rats
hard to control outbreaks when there's no effective government + political instability in a country (e.g. DRC)
NB management steps (Public health priorities)
isolation
bloods (excl malaria)
notify senior staff
HPSC (health protection surveillance centre) website - management of VHF in Ire
reporting system
alert systems - outbreak potential
info gathering to better understand epidemiology
outbreak/epidemic = occurrence of more cases of disease than expected in a given area or among a pop over a particular time period
VHFs
filoviridae
Ebola
1st recognised in 1976 in Ebola river in DRC
reservoir = fruit bat
human-human spread via blood, secretions, bodily fluids
mortality = 50-90% - much lower (10%) if ICU available
experimental txs + vaccine working
4 stains
filovirus
Marburg
flavivirdae
dengue
yellow fever
kyasanur forest disease
bunyaviridae
CCHF (Crimean-Congo haemorrhagic fever)
Hantavirus HFRS
haemorrhagic fever with renal syndrome
newly discovered - early 2000s
also resp failure
carried asymptomatically by mice - shed in their urine, faeces, saliva
secretions dry on dust particles - in air (survive ext for up to 48 hrs)
esp in confined places
rift valley fever virus
SFTS virus (severe fever with thrombocytopenia syndrome)
arenaviridae
lassa virus
lujo virus
junin virus
machupo virus
guaranito virus
saris virus
Physician roles
high level of suspicion in appropriate setting
early recognition + tx
prevention of spread
working with public health teams for better understanding
Patient evaluation
signs + symptoms
think epidemiology - where have they been + what did they do?
incubation period - does it fit?
reporting
Chikungunya
arthropod-borne (arbovirus)
"to walk bent over" (severe bone pain)
similar to dengue - same mosquito (aedes)
persistent/recurring polyarthralgias
no specific tx
no vaccine available
usually full recovery, rarely death (1 in 1000)
Zika virus
frequently asymptomatic
mild ILI fever, rash, headache, arthralgia, conjunctivitis
implications for women of child-bearing age travelling to affected areas
risk of microcephaly if infected in 1st trimester
Guillan-Barre syndrome (body attacks PNS)
MERS-CoV
Middle East Resp Syndrome Coronavirus
similar to SARS (severe acute resp syndrome - has lower mortality of 10%)
high mortality = 30% - ICU
no vaccine or specific tx - supportive management only
transmission linked to camels
Air travel: S Korea outbreak
diffuse bilat pul infiltrates
small household contact risk (5%)
Super-resistant bugs
relying on old toxic agents
colistin
polymyxin B
few therapeutic options - last resorts
few new antibiotics in pipeline
UN antibiotic fund giving pharma financial incentives to make more last resort antibiotics
easily spread among institutions
MSRA, VRSA, CRE, super gonorrhoea etc
major global concern
common in E Europe + Mediterranean (antibiotics available OTC in S Europe - encourages selective pressures + drives mutations)
Angiostrongylus cantonensis
rat lung worm
nematode (roundworm)
SE Asia / Pacific Basin
accidental ingestion of larva, undercooked snails, food contaminated by rats
eosinophilic meningitis
geographic spread due to global transport of food (recently in Africa + USA)