Highly Infectious Respiratory Diseases

Kenneth Miller MEd, MSRT, RRT-ACCS, AC-E, FAARC

Educational Coordinator

Respiratory Care Services

Lehigh Valley Health Network Allentown, Penna.

Learning Objectives

• Describe the epidemiology and prevalence of highly infectious respiratory diseases

• Define the clinical manifestation of highly infectious respiratory diseases

• Describe the clinical management of highly infectious respiratory diseases

Highly Infectious Respiratory Diseases

• Influenza• Seasonal

• Avian

• Pneumonia

• Severe Acute Respiratory Syndrome (SARS)

• Pertussis

• Respiratory Syncytial Virus (RSV)

• Tuberculosis

Influenza

• Often referred to as the “seasonal flu”

• Caused by a the influenza virus

• Highly contagious-spread by cough/sneeze of infectious individual

• Can cause pandemics

• Three types:

• A• Can infect birds, pigs, horses, and humans

• Can mutate to H1N1-H3N2 viruses

• B• Only found in humans and is less contagious

• C• Very mild and rare

Prevalence

• 200,000 hospitalization per year

• 36,000 deaths per year

• Trends to be more prevalent in urban areas

• Cost of care : 10 billion dollars!

• At risk population:• Elderly, individuals with chronic diseases, and

individuals with a comprised immune system.

• Secondary complications include:

• Pneumonia, sepsis, or endocarditis

Symptoms

• Acute onset of high fever (>102F)

• Headache, muscular, joint aches

• Non-productive cough

• Chills

• Pharyngitis

• Nasal congestion

• Rhinorrhea

Treatment

• Prevention !!!!• Vaccination

• Antiviral drugs• Tamiflu-tablet

• Relenza-spray inhaler

• Caution in use with asthmatics

• Rest, fluids, anti-inflammatory drugs

Flu Misconceptions

Antiviral Treatment

Tamiflu (Oseltamivir)

• Suppresses and decreased the spread of type A and B virus by blocking the action of neuramindaise.

• By blocking this enzyme it prevents the virus to spread from infected cells to healthy cells.

• Most effective if started within 48 hours of onset of symptoms and by can reduce the duration of the flu by 1-2 days.

• Adult dosage 75mg twice a day for five days.

Tamiflu

Flu Mutations

• A flu virus can mutate 413 times in a given season

• Avian flu—humans

• Usually highly pathological• Often is responsible for death rates>50%

Drift and Shift

• Virus are changing all the time.

• This why a person can get the flu repeated times in a lifetime.

• When a new virus strain develops-antibodies to an earlier virus does not recognize the new strain.

• An Antigentic shift refers an abrupt change to produce a novel subtype virus that is not usually seen in humans—Avian Flu.

Spanish Flu Endemic

Future Flu Fears

New Virus

Middle East Respiratory

Syndrome, or MERS,

MERS

• Saudi Arabia has been at the center of a Middle East outbreak of MERS that began two years ago.

• The virus has spread among health care workers, most notably at four facilities in that county last spring.

• At least 400 people have had the respiratory illness, and more than 100 people have died. All had ties to the Middle East region or to people who traveled there.

• The MERS virus has been found in camels, but officials don't know how it is spreading to humans. It can spread from person to person, but officials believe that happens only after close contact. Not all those exposed to the virus become ill.

• It has killed nearly a third of the people it sickened. That's a far higher percentage than seasonal flu or other routine infections. But it is not as contagious as flu, measles or other diseases. There is no vaccine or cure and there's specific treatment except to relieve symptoms.

Pneumonia

• Inflammation of the lungs

• Can be caused by:• Viruses, bacteria, mycoplasma

• Can be caused by aspiration, inhalation of toxic/caustic debris, and HIV—pneumocyctis carinii

• Bacteria-Streptococcus or Pneumococcal pneumoniae

Prevalence

• 8th leading cause of death

• 56, 000 deaths from pneumonia

• Cost $40.2 billions

• High rate seen in individuals >65 years old 189 per 10,000

• Age extremes and any patient with a

co-existing disease is at risk (5-7% mortality rate)

Rates higher in cigarette smokers

Symptoms

• Gradual to sudden onset

• Shaking chills

• Dyspnea

• Hypoxemia

• Lobar infiltrates on X-ray

• Fever can vary between 100-106F

• Elevated WBCs

• Secretions—• Minimal in viruses/mycoplasmatic

• Thick and purulent in bacteria

Treatment

• Vaccination for adults >65 yrs.

• Aspirin, NSAIDS, acetaminophen

• Fluids, enhance muco-kinesis

• Oral/IV antibiotics• Azithromycin, clarithromycin, erythromycin

• Oxygen/mechanical ventilation

• Bronchodilators

Severe Respiratory Syndrome (SARS)

• Viral breakout first identified in 2003

• Effected over 8,000 people world wide, mostly Asia

• Disease can lead to severe respiratory distress and is transmitted by cough, sneeze, or hand contact.

• Has the potential to cause a world-wide pandemic!!!

is a viral respiratory disease of zoonotic origin

caused by the SARS coronavirus .

Between November 2002 and July 2003, an outbreak of SARS in

southern China caused an eventual 8,273 cases and 775 deaths

reported in multiple countries with the majority of cases in Hong

Kong.(9.6% death rate) according to the World Health Organization

in weeks, SARS spread from Hong Kong to infect individuals

in 37 countries in early 2003.

SARS

In Hong Kong, the first cohort of

affected people were discharged from

the hospital on 29 March 2003. The

disease spread in Hong Kong from a

mainland doctor who arrived in

February and stayed at the ninth floor

of the Metropole Hotel in Kowloon

infecting 16 of the hotel visitors.

Those visitors traveled to Canada,

Singapore, Taiwan, and Vietnam,

spreading SARS to those locations.

Liver like appearance

Diffusive White Out

Diffuse basilar infiltrates

Prevention

Pertussis

• Usually starts with symptoms similar to a common cold:

-running nose, mild fever

• Several weeks later more severe symptoms appear:

-dyspnea, syncope, vomiting, whopping cough, diarrhea, cyanosis

-cough supplements will not stop the spasmodically coughing

Prevalence

10% develop pneumonia

Bordello Pertussis

Treatment

•Antibiotics

•Airway support

•Muco-kinesis

RSV

• Very contagious and the most common cause of Bronchiolitis and Pneumonia in children<1 yr. old

• Common among premature babies and infants with chronic diseases

• Spread by droplets and can enter the body through the eyes or nose

• Outbreaks mainly during the winter months

• Diagnosed by swab testing

Symptoms

• Coughing, sneezing, congestion and running nose, mild sore throat, wheezing

• Fever can be low or high grade

• In very young babies only symptoms can be irritability and labored breathing

Treatment

• Symptom management

• NO Antibiotics, since virus

• High Flow Oxygenation if Sat<90%

• Bronchodilator

• Utilize Bronchiolitis pathway

Tuberculosis

• Spread through the air

• Spread mostly easily in confined spaces over a long period of time

• If not treated TB can be fatal>50% of cases

• Is caused by Mycobacterium tuberculosis, a small, nonmotile bacillus

• It is theorized that 1/3 of the world’s population has been infected with TB!!!

• 8 million new cases yearly!!!

• 2nd most common infectious disease

New Cases 2010

Symptoms

• Chronic cough with blood tingled sputum

• Fever

• Night sweats

• Weight loss, inability to thrive

Diagnosis

• Chest X-ray

• Sputum cultures

• Tuberculin skin test (TST)

• Blood tests

Non-Pulmonary TB

Accounts for 15-20% of TB cases

Risk Factors

• HIV 33%

• Poor living conditions

• Over crowding• Prisons

• Homeless shelters

• Poor nutritional habits

• Patients on chronic steroid medications

• Disease of “poverty”

• Chronic lung disease• Smokers

• Silicosis

Prevention

• Vaccines• Calmette-Guerin

• Good health hygiene

• Good nutritional habits

• World Health Organization declared TB as a “global health emergency”

Clinical Management

• Management difficult secondary to the unusual structure and chemical composition of Bacillus cell wall

• Antibiotic therapy• Latent TB: Isoniazid and Rifampicin

• New onset: Pyrazinamide and Ethambutol added for several additional months

• Supportive care

• Life style change

Conclusion

• Infectious diseases are prevalent and scary!

• Many are very contagious and virulent

• Clinical management is often supportive

• Heath hygiene may be the best prevention

The End!!!