Viral Infections PFN: SOMCML1D - JSOMTC

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Slide 1JSOMTC, SWMG(A)

Viral InfectionsPFN: SOMCML1D

Hours: 3.0


Terminal Learning Objective

Action: Communicate knowledge of “Viral Infections”

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


References

Current Diagnosis & Treatment (51st

edition; 2012; Mcphee; Papadakis)

The Merck Manual (19th edition; 2011; Porter; Kaplan)

Special Operations Forces Medical Handbook, 2008

Pathophysiology for the Health Professions (4th edition; 2011; Gould; Dyer)

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Reason

The regions that SOF personnel deploy to are among the most disease‐ridden places on the planet. Preventative measures combined with maintaining a high index of suspicion will result in more combat ready forces on the battlefield accomplishing the mission.



Agenda

Communicate factors specific to viral infections

Communicate the etiology, signs and symptoms, diagnostic tests, and management of influenza

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Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of dengue and dengue hemorrhagic fever

Communicate the etiology, signs and symptoms, diagnostic tests, and management of Chikungunya disease


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of yellow fever


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of viral hemorrhagic fevers, to include: Lassa fever, Bolivian hemorrhagic fever, Crimean‐Congo hemorrhagic fever, Marburg, and Ebola viruses

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Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of hantavirus infections

Communicate the etiology, signs and symptoms, diagnostic tests, and management of arboviral encephalitis


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of rabies

Communicate the etiology, signs and symptoms, diagnostic tests, and management of poliomyelitis (polio)

Communicate the etiology, signs and symptoms, diagnostic tests, and management of infectious mononucleosis


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of viral hepatitis

Communicate the etiology, signs and symptoms, diagnostic tests, and management of HIV/AIDS

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Factors Specific to Viral Infections


Viral Infections

What are viruses?

Minute particles of genetic material ‐ outer protein coat

Obligate intracellular parasites

What diseases are caused by viruses?

How are viruses spread?

Zoonotic viruses


Viral Infections

Retrovirus (HIV)

Prion diseases (slow viral diseases)

Diagnosis

High index of suspicion

Travel history and pertinent exposures

Clinical evaluation of signs and symptoms

Prophylaxis and treatment

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Determine a Viral Infection

SUBJECTIVE

History ‐ Exposures Recent travel

Animals/Insects

Unusual dietary habits

High risk sexual behavior

Contact with ill persons

Inhalation of aerosolized dust

Contaminated water/mud (swimming, wading)

OBJECTIVE

Physical

Laboratory (CBC count and differential)

Neutropenia

Lymphocytosis


Differentiate:Is it Viral?

Viral diseases will not cause elevated WBC

Viral diseases will not cause eosinophilia

Viruses require specialized viral culture

Viruses are not visible under a light microscope; seen by electron microscope

Antibiotics will have no effect on viruses


The Etiology, Signs and Symptoms, Diagnostic Tests, and Management

of Influenza

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Influenza

Etiology

Type B – antigenic drift, seasonal epidemics

Type A – antigenic shift, sporadic pandemics

Epidemiology

Clinical findings: “flu‐like” symptoms

Transmission

Complications


Influenza

Pandemics

1918 Spanish flu (50 to 100 million deaths)

2009 H1N1 (Swine flu)

1997 H5N1 (Avian Influenza)

Treatment

Prevention


Influenza

Cold versus Flu

Both are respiratory illnesses with similar symptoms, caused by different viruses

The flu usually has symptoms that are more intense

The presence of fever, body aches, extreme tiredness and dry cough often means flu

Colds generally do not result in serious health problems or complications

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Influenza

Assessment

Treatment:

symptomatic: rest; fluids, acetaminophen…

antibiotics (only if at risk for secondary infection)

moderate to severe nasal congestion (Afrin)*; pseudoephedrine

non‐productive cough, dextromethorphan

antiviral medications – within 48h

Prevention: Hand washing, vaccination


The Etiology, Signs and Symptoms, Diagnostic Tests and Management

of Dengue Fever (Dengue Hemorrhagic Fever / Dengue Shock Syndrome)


Dengue Fever

Take‐home points

Mosquito‐borne illness

First infection can be a bad experience

Second infection can be deadly, if caused by a different serotype

No antiviral treatment

No vaccine (yet)

Dengue infection may range from asymptomatic to severe hemorrhagic fever

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Dengue Fever

A.K.A. “Breakbone fever”

A mosquito‐borne flaviviral infection

Etiology – infection with one of four types of dengue virus

Transmission

• Vector: Aedesmosquito

• No person‐to‐person transmission

Geographic association: tropics and subtropics

Risk factors


Dengue Fever


Dengue Fever

Signs and symptoms

Sudden onset of fever, headache and myalgias, sore throat, nausea, and abdominal pain

Chills

Malaise

Prostration (similar to severe flu)

Retro‐orbital pain*

Rash appears with a second fever spike

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Dengue Fever

Focused History

What symptom bothers you the most? (severe headache, muscle pain and retro‐orbital pain are typical)

When did you first feel sick? (Typically patient can recall exact time of onset)

Have you traveled overseas within the past 2 weeks? (Look for travel to endemic area)


Dengue Fever

Objective: Signs

Cyclical fevers up to 104oF (40oC) over 3‐7 days (“saddle‐back fever”)

Flushing with conjunctival injection; prominent maculopapular, blanching rash over trunk and extremities, sparing palms and soles

General lymphadenopathy, hepatosplenomegaly

Dengue fever is a self‐limiting disease


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Dengue Hemorrhagic Fever andDengue Shock Syndrome

More severe form of the disease with hypotension and bleeding

Occurs primarily in children < 10 living in an endemic area (previous exposure)

Acute onset of fever with GI symptoms

Any hemorrhagic manifestation

Evidence of increased vascular permeability


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Dengue Hemorrhagic Fever



Dengue Hemorrhagic Fever

Objective

Lab: marked leukopenia on WBC, serial Hct and platelet counts: ↑Hct; ↓Platelets ‐ DHF

Blood smears x 3 to rule out malaria

Monitor pulse pressure and ↓BP ‐ DSS

DHF: Perform a tourniquet test if DHF is suspected

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Tourniquet Test


Assessment

Clinical Diagnosis

Differentials

Malaria

Chikungunya

Yellow fever

Leptospirosis

Other viral hemorrhagic fevers


Dengue Fever

Plan

Treatment: There is no specific treatment

Treat symptoms including pain with acetaminophen and codeine ‐ (Avoid aspirin,NSAIDs)

Patient education:

• General: use body fluid precautions

• Prevention: use personal protection against insect bites

Evacuate all DHF/DSS cases early and urgently

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THE TAKE‐HOME MESSAGE:

Consider dengue in any patient with a febrile illness who has recently traveled to a tropical area, especially if symptoms include severe myalgias and arthralgias, retro‐orbital pain, and fatigue.



of Chikungunya Disease


Chikungunya Fever

Etiology – Arboviral infection (Alphavirus)

Transmitted by Aedesmosquito

Epidemiology‐ tropical Africa ,Asia & India

Clinical findings (arthritis is pronounced)

Diagnostic testing

Treatment and prevention

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of Yellow Fever


Yellow Fever

Etiology

Arboviral illness that causes hemorrhagic fever

The incubation period is 3‐6 days, and 80‐90% of cases recover completely

10‐20% develop jaundice and hemorrhagic disease (potential for epidemics)

Geographic association

Risk factors: Travel to YF endemic areas; occupational exposure (Sylvatic form)


Yellow Fever

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Focused History

Have you ever been vaccinated against yellow fever?

(Reduces chance of yellow fever infection < 1%)

When did you first feel sick?

(Typically patient recalls exact time of onset of fever)

Have you traveled overseas in the past 3 weeks?

If so, where? (look for travel to endemic areas)


Clinical Findings

Spectrum of clinical illness

Abortive, nonspecific febrile illness w/o jaundice

Life‐threatening disease with fever, jaundice, renal failure and hemorrhage


Clinical Findings

Infection Phase

Abrupt onset of fever, chills and headache

Muscle pains: neck, back, and legs

Severe prostration, restlessness, irritability

Vomiting

In mild cases, illness ends at this stage after 1‐3 days

Remission Phase 24‐48 hours

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Clinical Findings

Severe cases: fever returns “intoxication phase”

Jaundice, and disorientation

Some deteriorate with coffee‐ground hematemesis (“Black Vomit”)

Malignant cases: delirium, convulsions, and coma


“Black Vomit”


Laboratory Findings

Lab: Proteinuria on urinalysis (nephritis), CBC, Hct, and platelet count; type and cross match if bleeding

White blood cell count (WBC) drops

Neutropenia

Thrombocytopenia (decreasing platelet count)

↑Hct (rising to > 50%) hemo‐concentration

Blood smear to r/o malaria

Quick assay cards

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Diagnosis

Clinical diagnosis

Endemic area, and exposure to biting vector

No history of yellow fever immunization*

Classic triad

Jaundice

Hematemisis or other signs of bleeding

Albuminuria (protein in the urine)


Plan

General: Use body fluid precautions

Activity: Bed rest

Diet: NPO if hemorrhagic, until stable

Medications: Codeine for pain. Avoid acetaminophen (liver) and aspirin (bleeding)

Prevention: Immunize with yellow fever vaccine. Booster q 10 years

Consult infectious disease specialist for all cases of hemorrhagic yellow fever, and for any cases in team members (Evacuate severe cases)


The Etiology, Signs and Symptoms, Diagnostic Tests, and Management of Viral Hemorrhagic Fevers, to include: Lassa Fever, Bolivian

Hemorrhagic Fever, Crimean‐Congo Hemorrhagic Fever, Marburg, and

Ebola Viruses

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Definition

Viral hemorrhagic fever (VHF):

Acute, febrile, mutisystemic illness characterized by malaise, myalgia, prostration, and bleeding diathesis

Bleeding is the hallmark finding of the VHFs

Caused by lipid‐enveloped, single‐stranded, RNA viruses


Viral Hemorrhagic Fever

Overview

VHFs in general

Epidemiology: epidemics occur sporadically

Clinical aspects

Diagnosis

Preventive measures

Treatment



Lassa fever

Bolivian hemorrhagic fever

Crimean‐Congo hemorrhagic fever

Marburg fever

Ebola fever

*SOF Handbook (CBR: Biological Warfare –pp. 6‐52)

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Transmission

Person to person

Nosocomial/lab transmission

Inhaling or ingesting excretions / secretions from rodent hosts (urine, feces)

Bite from an infected arthropod (tick, mosquito)

Bushmeat

Other reservoir species, such as bats



Spectrum of Clinical Presentations

Early phase – symptoms are similar

• Flu‐like illness

• Gastroenteritis

• Hepatitis

Late phase‐ more specific

• Organ failure

• Persistent leukopenia

• Hemorrhage


Petechiae Purpura

Ecchymosis

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Lassa Virus

Sub‐Sahara

West Africa


Bolivian Hemorrhagic Fever


Crimean‐Congo Hemorrhagic Fever

Europe, Africa, Asia

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Marburg Virus

Uganda , Kenya, Zimbabwe


Ebola Virus


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Management

Supportive care while minimizing risk to others

Isolation of patient /quarantine

Barrier precautions

Contact Infectious Disease expert

Prevention includes proper handling of the dead



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Geographically restricted

Linked to ecology, reservoir/vector – get a detailed travel history!

VHF should be suspected in any patient presenting with severe febrile illness and evidence of vascular involvement who has traveled to an area where VHF is known to occur

Differential diagnosis should include malaria



of Hantavirus Infections


Hantavirus Infections

Hanta viruses infect rodents worldwide

Transmission to humans is through inhalation of infectious aerosols from rodent urine, droppings, and saliva (excreta)

Incubation is generally 1‐4 weeks

Divided into two groups

HFRS "old‐world"

HPS "new‐world

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Transmission



Presentation of HFRS:

Constitutional: high fever, chills, myalgias, headache, fatigue and lethargy

Specific: abdominal pain, flushed face

• Petechiae

• Lowered blood pressure, low urine output

• Back pain

• Diuresis, renal concentrating defect (>2wks)


Hantavirus Pulmonary Syndrome (HPS)

Presentation of HPS:

Constitutional: same as HFRS

Specific: dizziness, abdominal pain, diarrhea

• Dyspnea

• Non‐productive cough

• Shock

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Hantavirus Pulmonary Syndrome

Focused History

Have you recently seen evidence mice/rats near or in where you live or sleep? (typical exposure)

Have others in your family, village or unit had similar symptoms? (outbreaks occur in others similarly exposed)



Plan

Supportive care

Avoid excess fluids

HFRS: ribavirin IV, consider blood transfusion, give O2, and Trendelenburg position for shock


Hantavirus Pulmonary Syndrome

Plan

HPS: Infection has high mortality, most deaths occur with the first 48 hours

Prevention: minimize human‐rodent contact

Evacuate

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of Arboviral Encephalitis


Arboviral Encephalitides

Etiology – zoonotic diseases, flavivirus

Japanese encephalitis (JE)

West Nile (WN)

Transmission arthropod vector (mosquito)

Epidemiology – cause periodic epidemics

Sporadic fatal meningoencephalitis

Non‐specific flu‐like syndrome


Japanese Encephalitis

Most common and one of the most dangerous

Over 50,000 cases reported annually

25% die and 50% are left with permanent neurologic sequelae

Typically many hundreds of asymptomatic infections occur for each clinical case of encephalitis

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Mode of transmission

Occurrence

Risk for travelers

Clinical presentation



Diagnosis – Clinical

High index of suspicion

Recent travel to endemic area

Treatment

Intensive supportive therapy

Evacuate suspected cases of encephalitis

Prevention

Vaccination

Personal protective measures

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West Nile Virus

West Nile Virus is found throughout Asia, Africa, the Middle East and the U.S.

Spread to humans by infected mosquitoes

Clinical findings

Treatment is supportive


Arboviral Encephalitis

Geographic association:

Seasonal variation: mosquito vector…

Risk factors: exposure to infectious viruses in vectors or animal hosts


Focused History

Have you completed the full vaccination series for JE?

Was fever your first symptom? (Typically, there is sudden rise of fever after a period of apparent recovery from acute febrile illness, or without any prodromal symptoms)

Have you traveled outside the country or been bitten by mosquitoes?

Have there been recent outbreaks of animal diseases in the area?

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Assessment

Clinical diagnosis

DDX:

Malaria

Meningitis

Herpes simplex encephalitis

Rabies

Subdural hematoma, and other trauma

Drug use (esp. opioids)


Plan

There is no drug treatment for JE or other arboviral encephalitidies

Closely monitor obtunded patients (seizures, aspiration, etc.) pending evacuation

Analgesics for fever or pain

Consult infectious disease expert


Plan

Prevention: Vaccinate against JE, decrease exposure to vector

Evacuate suspected cases of arboviral encephalitis

Provide antibiotic therapy if unable to rule out bacterial meningitis

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of Rabies


Rabies

Rabies is a fatal, acute, viral encephalitis

Infection through bites, scratches, or licks from an infected animal

Worldwide ( 99% ‐ Asia, Africa, and South America)

Invariably fatal once CNS symptoms begin


Rabies

Incubation period varies

Typified by fever with ascending paralysis and abnormalities of consciousness and behavior

Hydrophobia

Prevention‐ rabies vaccine pre‐exposure

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Rabies

Prodromal Stage (4‐10 days)

Tingling or pain at inoculation site

Fever, malaise, headache, nausea, vomiting

CNS Stage (Encephalitis)

Apprehension, agitation, hyperactivity

Bizarre behavior, hallucinations

Hydrophobia

Nuchal rigidity, paralysis

Coma, death (100% mortality)



Rabies

Focused History

Have there been behavioral changes or increased aggressiveness in the patient?

How long has the patient been ill? (>5 days with progression)

Is there history of animal bite, exposure to bats, or travel to rabies endemic area within the past several months? (increase suspicion of rabies)

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Rabies

Assessment (Clinical)

Positive exposure history of animal bite

Pathognomonic: fluctuating consciousness and hydrophobia

Biting animals should be quarantined and observed for 10 days

Report of Animal Bite‐Rabies Exposure


Rabies

Post exposure management

Immediately scrub with soap and water

Debride or irrigate with water or sterile saline

• Flush individual punctures with ~ 200 cc of solution

• Do not suture wounds

Give tetanus prophylaxis, antibiotic tx for animal bites

Use narcotics and benzodiazepines judiciously


Rabies

Post exposure prophylaxis (PEP)

Infiltrate around wound with human rabies immune globulin (HRIG)

If patient is not immunized: start human diploid cell rabies vaccine (HDCV) x 5

Previously immunized, two doses HDCV, (HRIG not required)

HRIG and HDCV should never be given in the same syringe or at the same site

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Rabies

Post exposure

If possible, isolate suspected animal and observe 10 days for signs of rabies

Credible bite report (DD form 2341)

Prevention: pre‐exposure prophylactic rabies vaccination (HDCV) x 3

Evacuate personnel suspected of exposure



of Poliomyelitis (Polio)


Poliomyelitis (Polio)

Description‐ Polio is a highly infectious disease that invades the nervous system

Transmission‐ Polio is spread by person to person contact through fecal or pharyngeal secretions

Complications: Polio is associated with outbreaks of paralytic poliomyelitis.

Paralysis leads to disability

Death

Incubation is 7‐14 days

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Typically asymptomatic; < 1% develop neurologic disease

Polio is primarily a disease associated with poor sanitation and is found in developing countries of Asia and Africa

Symptomatic polio manifests in 3 ways

Abortive poliomyelitis (minor illness)

Nonparalytic poliomyelitis

Paralytic poliomyelitis



Patient presents with:

Malaise, headache, nausea, vomiting, and sore throat; uneventful recovery within several days (abortive poliomyelitis)

Some progress with severe muscle spasms, neck and back stiffness, and muscle tenderness lasting about 10 days (nonparalyticpoliomyelitis)

Few develop paralytic poliomyelitis:asymmetric weakness or paralysis



Focused history

Have you completed the full polio vaccination series?

Did fever precede the limb weakness?

Have you traveled or been exposed to poliovirus?

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Complications of Polio


Complications of Polio



Assessment

Asymmetric flaccid limb paralysis or bulbar palsies without sensory loss during and acute febrile illness in a child or young adult

Possible respiratory complications

Laboratory – consistent with viral cause

•Normal WBC

• Lymphocytosis

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Plan

Treatment‐ Supportive care is indicated:

• Analgesics for fever or pain

• No specific treatment exists for these viruses

Prevention:

• Do not expose others to infected body fluids

• Immunize with inactivated poliovirus vaccine (Salk)

• Live OPV (Sabin) limited to usage for outbreaks

Evacuate patients suspected of having polio



of Infectious Mononucleosis

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Infectious Mononucleosis

Caused by Epstein‐Barr virus (EBV)

“Mono” is common in young adults

Transmitted by infectious salivary secretions (“kissing disease”)

Incubation 4‐6 weeks

Risk factors: Transmission is facilitated by crowded conditions, close contact



Focused history

Do you have a cough? (IM rarely has pulmonary symptoms)

What were your first symptoms? (Malaise for several days, then fever and sore throat)

Has anyone you live with been sick with similar illness in the past few months?



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Patient presents with:

Fever, sore throat, malaise

swollen lymph nodes in neck

Chronic fatigue

Splenomegaly (in up to 50% of patients)



Objective: Signs

Vitals: Fever to 100.4‐104F

Nontoxic appearance, swollen neck, faint measles‐like rash, pharyngitis with edema or exudative tonsillitis, palatal petechiae (red spots on back of throat)

Splenic enlargement, +/‐ hepatomegaly; swollen cervical lymph nodes

Laboratory: Mono‐spot


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Assessment

Clinical diagnosis – classic triad:

• Fever

• Pharyngitis

• Lymphadenopathy

Laboratory

•Mono spot test

• Heterophile antibody test



Laboratory

Mono spot test



Plan

Treatment is supportive: fever and sore throat (acetaminophen), warm saline gargles

Caution: no heavy lifting or contact sports (or parachuting) for 1 month to prevent splenic rupture

Rest during acute phase

Return immediately for sudden onset of severe abdominal pain, or fainting or lightheadedness after abdominal trauma

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Infectious Mononucleosis at a Glance

Here are key facts about infectious mononucleosis:

Epstein‐Barr virus (EBV) is a contagious infection that causes infectious mononucleosis.

The illness is spread by casual contact, usually via saliva. Mono has an incubation period of 4 to 6 weeks.

The vast majority of adults have antibodies against EBV, meaning they have been infected with the virus and are immune to mono.

Fatigue, severe sore throat, swollen lymph nodes, and fever are common symptoms of mono.

Specialized blood tests are used to confirm the diagnosis of mono.

Mono can be associated with an enlarged spleen and liver inflammation (hepatitis).

One should avoid contact sports during active mono illness and during recovery because of the possibility that the spleen can rupture.



of Viral Hepatitis


Viral Hepatitis

Definition:

Inflammation of the liver

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Causes


Viral Hepatitis

Diagnosis

History

Differential diagnosis

Laboratory


Acute Viral Hepatitis

Inflammation of the liver caused by specific hepatotropic viruses:

Hepatitis A virus (HAV)

Hepatitis B virus (HBV)

Hepatitis C virus (HCV)

Hepatitis D virus (HDV)

Hepatitis E virus (HEV)

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Symptoms and signs

Varies from mild flu‐like illness to fulminant, fatal liver failure

Prodromal phase: anorexia, nausea, vomiting, fever, clay colored stools, headache, RUQ pain, and arthralgias, itchy red hives

Icteric phase: urine darkens, jaundice



Symptoms and Signs (cont’d)

Recovery phase: variable jaundice, hepatomegaly

Laboratory: Striking aminotransferaseelevations, AST and ALT are typically 500 to 2000 IU/L

Hepatitis virus panel

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Chronic Hepatitis

Hepatitis C, B

Carriers of the virus

Cirrhosis of the Liver

Primary Liver Cancers


Signs and Symptoms


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Diagnosis

Clinical signs and symptoms

Liver function tests (blood test)

Hepatitis Panel

Good history to identify possible cause


Viral Hepatitis

Treatment

Supportive care in acute phase

Prognosis

Refrain from use of all alcohol products

Avoid medications that are cleared by liver

Prevention

No improvement/deterioration

Follow‐up actions


Viral Hepatitis

Enterically transmitted hepatitis: A and E –primarily oral – fecal route

Parenterally transmitted hepatitis:

HBV, HDV primarily intimate personal contact

HCV primarily blood transfusion, IV drug use

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Hepatitis A“Infectious Hepatitis”


Hepatitis A“Infectious Hepatitis”

Occurrence:

Cause/ transmission

Long‐term effects

Persons at risk

Prevention

Vaccine recommendations

Treatment and medical management


Hepatitis E

Occurrence

Cause/ transmission

Long‐term effects

Persons at risk

Prevention

Medical management

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Parenterally Transmitted Hepatitis

B, C, and D


Hepatitis B

Occurrence

Cause / transmission

Long‐term effects (without vaccination)

Persons at risk

Prevention

Vaccine recommendations



Chronic Hepatitis B

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Hepatitis C


Hepatitis C

Occurrence

Cause/transmission

Long‐term effects

Recommendations for testing/risk groups

Prevention



Hepatocellular Carcinoma

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Hepatitis D

Occurrence

Cause/transmission

Long‐term effects

Persons at risks

Prevention

Medical management



of HIV/AIDS


Human Immunodeficiency Virus(HIV)

HIV is a retrovirus

Transmitted through:

• Sexual contact, needlestick/sharps, perinatally, infected blood or body fluid contact with non‐intact skin or mucous membranes, breastfeeding and blood transfusions

Incubation period is weeks to months

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Acquired Immune Deficiency Syndrome (AIDS)

Acquired Immune Deficiency Syndrome (AIDS)

HIV positive

Opportunistic infections and malignancies

CD4 lymphocyte count below 200 cells/mcL

Untreated infections are eventually fatal!



Subjective: symptoms

Should be viewed as a continuum of initial exposure, asymptomatic infection, symptomatic disease, and end‐stage AIDS

Acute HIV Infection

• Pharyngitis

• Rash

Patient History (ask about risk factors)



Objective ‐ a thorough physical examination:

Respiratory (Pneumocystis jiroveci pneumonia)

Skin (Kaposi’s sarcoma)

Oral mucosa (candidiasis, herpes, oral hairy leukoplakia, and Kaposi’s sarcoma)

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Oral Hairy Leukoplakia


Kaposi’s Sarcoma



Laboratory: In the “field,” Rapid Immunoassay – RIA (OraQuick)*

HIV Testing

Standard test is an enzyme‐linked immuno‐sorbent assay (ELISA) for antibodies to the virus

• Positive ELISA is repeated; if it is again positive, a confirmatory Western blot (immunoblot) test is performed

Skin testing for tuberculosis in HIV positive

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Assessment:

Plan:

There is no cure

Evacuate newly diagnosed team members

• If evacuation is not available in foreseeable future, then test with PPD and treat with INH prophylaxis if >5mm

•Also treat active opportunistic infections



Treatment of the HIV/AIDS infection –HAART *

Prevention

Sexual practices

HIV testing

Screen blood products

Precautions regarding injection drug use

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Questions?


Terminal Learning Objective

Action: Communicate knowledge of “Viral Infections”

Condition: Given a lecture in a classroom environment

Standard: Received a minimum score of 75% on the written exam IAW course standards


Agenda

Communicate factors specific to viral infections

Communicate the etiology, signs and symptoms, diagnostic tests, and management of influenza

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Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of dengue and dengue hemorrhagic fever

Communicate the etiology, signs and symptoms, diagnostic tests, and management of Chikungunya disease


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of yellow fever


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of viral hemorrhagic fevers, to include: Lassa fever, Bolivian hemorrhagic fever, Crimean‐Congo hemorrhagic fever, Marburg, and Ebola viruses

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Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of hantavirus infections

Communicate the etiology, signs and symptoms, diagnostic tests, and management of arboviral encephalitis


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of rabies

Communicate the etiology, signs and symptoms, diagnostic tests, and management of poliomyelitis (polio)

Communicate the etiology, signs and symptoms, diagnostic tests, and management of infectious mononucleosis


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of viral hepatitis

Communicate the etiology, signs and symptoms, diagnostic tests, and management of HIV/AIDS

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Reason

The regions that SOF personnel deploy to are among the most disease‐ridden places on the planet. Preventative measures combined with maintaining a high index of suspicion will result in more combat ready forces on the battlefield accomplishing the mission.


Break


Check on Learning

Which of the following does not aid in making a viral assessment in the field clinic setting?

A. High index of suspicion, based on history and presenting signs and symptoms

B. CBC with differential

C. Fever pattern

D. Antigen detection immunofluorescence

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Check on Learning

The SOF medic uses which “Classic Triad” to help make a clinical diagnosis of yellow fever?

A. Arthropod vector, fever, and rash

B. Jaundice, person‐to‐person contact, and myalgias

C. Travel to Asia, jaundice, and mosquito exposure

D. Jaundice, hematemisis, and protein in urine


Check on Learning

In a young adult with fever, malaise, sore throat and swollen cervical lymph nodes you should suspect?

A. Abortive polio

B. Influenza

C. Dengue

D. Infectious mononucleosis


Check on Learning

Your Afghan interpreter has just returned from a 30‐day visit home on leave. He tells you that while away he was bitten by a sick dog, but the wound has since healed. What is concerning?

A. Rabies is endemic to Afghanistan

B. Dogs are high risk for spreading rabies

C. Rabies incubation period in humans varies from 10 days to > one year and averages 1 ‐ 3 months

D. All of the above

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Check on Learning

What is the most likely form of transmission for hantavirus infections?

A. Arthropod vector

B. Person‐to‐person contact

C. Cough (airborne particles)

D. Inhalation, ingestion


Check on Learning

Which of the following is true about viral hepatitis?

A. HAV is a leading cause for liver transplants

B. HBV has no chronic carrier state

C. Hepatitis D can only exist as a co‐infection with HBV

D. Hepatitis C is spread by contaminated food/water

Viral Infections PFN: SOMCML1D - JSOMTC

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Transcript of Viral Infections PFN: SOMCML1D - JSOMTC