EMERGING INFECTIOUS DISEASE IN THE ED SD ACEP CONFERENCE 2015 MARCH 6-7 …and I don’t mean Ebola

OBJECTIVES Become familiar with a selection of new emerging diseases and old re-emerging diseases Review the typical symptoms and presentations of these diseases Review the epidemiology and geography of new and re-emerging diseases

OH HOW TIMES HAVE CHANGED….

OR HAVE THEY? Dr. Scott Vankeulen Talks About The Recent Cases Of Measles Progress and Challenges Fighting Polio in Pakistan and Afghanistan

MEASLES

Airborne transmission remains infectious on surface and in air up to 2 hours Infectious for 4 days prior to rash outbreak and 4 days after rash resolves Symptoms fever malaise cough, coryza, conjunctivitis, koplik spots Rash starting on head and spreading down and out, involves palms and soles absent if immunocompromised

1/4 will be hospitalized 1/1000 will get encephalitis 1-2/1000 will die

INFLUENZA

Droplet transmission Infectious 1 day before symptoms develop and up to 5-7 days after. symptoms fever, cough, pharyngitis, rhinorrhea, myalgias, headache, fatigue, diarrhea High risk groups over 65, under 5 (especially under 2) pregnancy NH residents alaskan natives and american indians medical conditions (asthma, CF, COPD, long term ASA, DM, BMI>40…)

MERS

MERS(MIDDLE EAST RESPIRATORY SYNDROME), AN ATYPICAL CORONAVIRUS Arabian Peninsula, France, Germany, UK, Italy, Tunsinia Indiana, Florida Droplet transmission? Zoonotic? fever, cough, sob, pneumonia, ARDS, nausea, vomiting, diarrhea, kidney failure, death ( 50% in UAE 2013) MERS-CoV

DENGUE FLORIDA6 PUERTO RICO461 US VIRGIN ISLANDS 10 Cumulative 2014 Data as of 3 am, Jan 14, 2015 These data are provisional and may be revised or adjusted in the future. Cumulative Total Entire Country: 477

DENGUE FEVER “break bone fever,” dengue hemorrhagic fever Aedes mosquito transmission, onset 3-15 days after bite Symptoms fever, headache, joint and muscle pain, rash legs/feet 3-4 days after fever starts hemorrhagic form has anorexia, hematemesis, bleeding gums, headache, abdominal pain, rash, shock and circulatory failure - untreated has 50% mortality rate

OK A LITTLE BIT ABOUT EBOLA…

Droplet transmission - direct contact with bodily fluids and objects contaminated with bodily fluids Incubation period is 2-21 days ( usually 8-10 days), not contagious until symptoms appear Symptoms are headache, fatigue, myalgias, nausea, vomiting, diarrhea, bleeding intially non specific fever, fatigue and muscle aches then after 5 days abdominal symptoms followed by chest pain, sob, headache and rash (maculopapular on neck, trunk, arms that may desquamate). late stage bleeding, usually in stools Current mortality rate 61-70%

ARE YOU UP TO DATE ON YOUR PPE TRAINING????

CHIKUNGUNYA 8 locally transmitted cases in FL

CHIKUNGUNYA Aedes mosquito transmission Symptoms onset 3-7 days after bite fever, arthralgias, myalgias, headache, rash, joint swelling

look familiar? anti-CHIKV IgM anti-DENV IgM

MALARIA

Anopheles mosquito bite transmission beware of plasmodium falciparum symptoms are fever, chills, myalgias, headache, fatigue, nausea, vomiting, diarrhea, anemia, jaundice, organ failure, seizures, coma, death onset days after bite (can be days later) relapsing malaria (P. ovale, P. vivax)

HUMAN MONKEYPOX Central and West Africa Illinois, Wisconsin, Indiana 2003 Zoonotic Transmission Symptoms fever, headache, myalgias, chills, drenching sweats, dry cough 1-10 days later rash will develop starting on extremities, palms and soles 1-10% mortality rate in Africa, no deaths in the midwest outbreak

CORYNEBACTERIUM DIPTHERIAE Greek - leather hide

DIPTHERIA Droplet transmission Symptoms of membranous pharyngitis, fever, chills, enlarged anterior lymph nodes, edema soft tissue, skin lesions, death (1/5 under the age of 5) Mortality rate 5-10% ( worse if under 5 or over 40).

CHOLERA

VIBRIO CHOLERAE Fecal - Oral route of transmission ( food especially raw shellfish and fish, water, humans) Incubation period is 2 hours - 5 days, in feces for 7-14 days Symptoms are profuse watery diarrhea leading to dehydration Mortality rate <1% with treatment

POLIO

Fecal-Oral or Oral-Oral transmission Incubation period is 3-35 days, can transmit 7-10 days prior to symptoms and continue to pass in stool for up to 6 weeks after resolution of symptoms Symptoms 95% asymptomatic 4-8% mild viral illness ( sore throat, fever, nausea and vomiting) 1-2% non paralytic aseptic meningitis ( stiffness of neck, back, legs) <2% flaccid paralysis that is permanent Of the <2% with flaccid paralysis 2-5% of children die and 15-30% of adults die There is NO treatment

TYPHOID

TYPHOID MARY - MARY MALLON Cook in Oyster Bay, NY in the early 1900 responsible for infecting 1300 people died of pneumonia after 26 years in quarantine

BACTERIUM SALMONELLA TYPHI Fecal-Oral Transmission Incubation 3-21 days Symptoms are fever, headache, fatigue, weakness, anorexia and abdominal pain, diarrhea, bradycardia. Severe cases can get confusion, delirium, intestinal perforation, death Can get a rash - “rose spots” 5,700 cases in US annually Lasts 4-6 weeks and mortality rate is 12-30% without treatment (fluoroquinolones, azithromycin, ceftriaxone)

MDR-TB

MDR-TB AND XDR-TB Airborne transmission Resistant to isoniazide and rifampin, to fluoroquinolones and at least one injectible second line drug Incubation weeks to years Symptoms are cough, chest pain, hemoptysis, fever, sweats, “wasting” 1/3 of the world’s population is infected with latent TB, 10% lifelong risk of becoming ill 66% mortality rate without treatment

MEET ISAAC….

REFERENCES WHO website CDC website dipnet Thank you to all the patients who have taught me so much.