Medical Education & Research challenges PhD MD FRCP DCN, DTM&H Professor of Inf. Diseases & Clinical Immunology Baghdad, Iraq

INTRODUCTION TO INFECTIOUS DISEASES Third Year Curriculum AL- Abbasi A.M.

Population growth rate = 3% More than 24% living in the capital Baghdad Iraqi Land area is 435,000 Km 2 Population = 32.1 million,75% urban Total fertility rate = 4.9 Pop. Below 15 years = 46.3%, 65 years & over =3%

Family Size 7.8 Mean age males 59.2 year Females 62.3 year ╬ year 2001 National income / Capita 865 American dollars Crude birth rate Crude fatality rate 39.4/ / 1000 ╬ year 1997

Preventable infections diseases caused sharp increase in the fatality rates for all ages after substantial regression before 1990.

Salmonellosis, Shigellosis, Compylobacteriosis,helmenths Parasitic diseases, viral Diarrhea, food poisoning, chemical poisoning … etc. noCFRDisease 1,804,374 (rate of infection =5- 8/child) 0.14ARI 750,000 Rate = 3-6/child0.08Diarrheal Dis.

More than 29,000 case Typhoid fever Viral Hepatitis (enterically transmitted) Pulmonary TB 3.218Kala- Azar

British style 1960

Perfect diagnosis. good training Prudent use of drugs Environmental Contamination & Radiation Chemical Contamination Emerging & Reemerging diseases

Hospital Contamination & Nosocomial infections Multiple antimicrobial resistant microbes

Definitions Infection - the pathological state resulting from the invasion of the body by pathogenic microorganisms. Infection is the invasion of a host bodily tissues by disease-causing organisms, their multiplication, and the reaction of host tissues to these organisms and the toxins they produce. Contagious disease

Infectious Agents &Some Definitions Prions Viroids Viruses Chlamydia Bacteria Fungi Parasites Helminthes Co infection Super infection Autoinfection Opportunistic infection Virulence Latent infection Incubation period Zoonosis

Koch's postulates The microorganism must be found in abundance in all hosts suffering from the disease, but should not be found in healthy host. The microorganism must be isolated from a diseased host and grown in pure culture. The cultured microorganism should cause disease when introduced into a healthy host. The microorganism must be re isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

However, Koch abandoned the universalist requirement of the first postulate altogether when he discovered asymptomatic carriers of cholera and, later, of typhoid fever. choleratyphoid fever AsymptomaticAsymptomatic or subclinical infection carriers are now a common feature of many infectious diseases, especially viruses as polio, herpes simplex, HIV, and hepatitis C.subclinical infectionpolioherpes simplexHIVhepatitis C As a specific example, all doctors and virologists agree that poliovirus causes paralysis in just a few infected subjects, and the success of the polio vaccine in preventing disease supports the conviction, poliovirus is the causative agent.polioviruspolio vaccine The second postulate may also be suspended for certain microorganisms or entities that cannot (at the present time) be grown in pure culture, such as prions responsible for Creutzfeldt– Jakob disease.prionsCreutzfeldt– Jakob disease

Scenarios Requiring Empiric Implementation of Precautions Airborne Precautions Vesicular rash Vesicular rash Maculopapular rash with coryza and fever Maculopapular rash with coryza and fever Cough, fever, upper lobe pulmonary infiltrate Cough, fever, upper lobe pulmonary infiltrate Cough, fever, any pulmonary infiltrate in an HIV-infected patient (or patient at risk for HIV infection) Cough, fever, any pulmonary infiltrate in an HIV-infected patient (or patient at risk for HIV infection) Fever, respiratory symptoms in a person with recent contact with SARS patient or recent travel to area with SARS transmission * Fever, respiratory symptoms in a person with recent contact with SARS patient or recent travel to area with SARS transmission *

Scenarios Requiring Empiric Implementation of Precautions Droplet Precautions -Meningitis -Petechial or ecchymotic rash with fever -Paroxysmal or severe persistent cough during periods of pertussis activity

Scenarios Requiring Empiric Implementation of Precautions Contact Precautions Acute diarrhea with likely infectious etiology in incontinent or diapered Patient Acute diarrhea with likely infectious etiology in incontinent or diapered Patient Diarrhea in adult with recent antibiotic use Diarrhea in adult with recent antibiotic use Vesicular rash * Vesicular rash * Respiratory infections in infants and young Children Respiratory infections in infants and young Children History of infection or colonization with MDR Organisms History of infection or colonization with MDR Organisms Abscess or draining wound that cannot be Covered Abscess or draining wound that cannot be Covered Fever, respiratory symptoms in a person with recent contact with SARS patient or recent travel to area with SARS transmission * Fever, respiratory symptoms in a person with recent contact with SARS patient or recent travel to area with SARS transmission *

Scenarios with Known or Suspected Diseases or Pathogens Airborne Precautions Measles Measles Monkey pox Monkey pox Tuberculosis, pulmonary or Tuberculosis, pulmonary or laryngeal laryngeal SARS SARS Smallpox Smallpox Varicella Varicella Zoster (disseminated or immune Zoster (disseminated or immune compromised patient) compromised patient)

Scenarios with Known or Suspected Diseases or Pathogens Droplet Precautions Adenovirus (infants, children)* Adenovirus (infants, children)* Diphtheria, pharyngeal Diphtheria, pharyngeal Haemophilus influenzae meningitis, epiglottitis Haemophilus influenzae meningitis, epiglottitis H. influenzae pneumonia (infants, children) H. influenzae pneumonia (infants, children) Influenza Influenza Meningococcal infections Meningococcal infections

Scenarios with Known or Suspected Diseases or Pathogens Droplet Precautions Mumps Mumps Mycoplasma pneumonia Mycoplasma pneumonia Parvovirus B19 Parvovirus B19 Pertussis Pertussis Plague, pneumonic Plague, pneumonic Rubella Rubella Streptococcal (group A) pharyngitis, Streptococcal (group A) pharyngitis, pneumonia, scarlet fever pneumonia, scarlet fever (infants or young children) (infants or young children)

Scenarios with Known or Suspected Diseases or Pathogens Contact Precautions Abscess, not covered or drainage Abscess, not covered or drainage not contained not contained Adenovirus (infants, children)* Adenovirus (infants, children)* Cellulitis (uncontrolled drainage) Cellulitis (uncontrolled drainage) Clostridium difficile diarrhea Clostridium difficile diarrhea Conjunctivitis, acute viral Conjunctivitis, acute viral Decubitus ulcer, infected and drainage not contained Decubitus ulcer, infected and drainage not contained Diphtheria, cutaneous Diphtheria, cutaneous

Scenarios with Known or Suspected Diseases or Pathogens Contact Precautions Escherichia coli O157:H7 colitis (diapered or Escherichia coli O157:H7 colitis (diapered or incontinent patient) incontinent patient) Enteroviral infections (infants, young children) Enteroviral infections (infants, young children) Furunculosis (infants, young children) Furunculosis (infants, young children) Hepatitis A (diapered or incontinent patient) A Hepatitis A (diapered or incontinent patient) A HSV (neonatal; disseminated; severe primary mucocutaneous) HSV (neonatal; disseminated; severe primary mucocutaneous) Impetigo Impetigo Lice Lice MDR bacteria (e.g., MRSA, VRE, VISA, VRSA) MDR bacteria (e.g., MRSA, VRE, VISA, VRSA) infection or colonization infection or colonization

Scenarios with Known or Suspected Diseases or Pathogens Contact Precautions Monkeypox Monkeypox Parainfluenza infection (infants, children) Parainfluenza infection (infants, children) Rotavirus (diapered or incontinent) Rotavirus (diapered or incontinent) RSV infection (infants, children, RSV infection (infants, children, immunocompromised) Rubella, immunocompromised) Rubella, congenital congenital SARS SARS Staphylococcus aureus major skin, Staphylococcus aureus major skin, wound or burn infection wound or burn infection Scabies Scabies

Scenarios with Known or Suspected Diseases or Pathogens Contact Precautions Shigella (diapered or incontinent) Shigella (diapered or incontinent) Smallpox Smallpox Streptococcal (group A) major skin, burn or wound infection Streptococcal (group A) major skin, burn or wound infection Varicella Varicella Viral hemorrhagic fevers Viral hemorrhagic fevers Yersinia enterocolitica enteritis Yersinia enterocolitica enteritis (diapered or incontinent) (diapered or incontinent) Zoster (disseminated or immunocompromised) Zoster (disseminated or immunocompromised)

Clinical Immunology Defense Mechanisms Non Immunological Skin Mucous membrane Saliva, tears Respiratory cilia Cough & expectoration Gastric acidity Peristalsis Flash of urine Vaginal acidity Immunological Complement system Phagocytosis Opsonization Antibody Compl. Fixation Neutralization Lyses Agglutination Cell Mediated Immunity