1. Infectious Diseases

2. Outline Who are we? Common infectious diseases
How to prevent the spread of disease

3. A Few Questions… True or False:
Hepatitis B is preventable with a vaccine, but there is no cure
If you have Hepatitis C, you will look very sick
Tricky questions:
True and False: Hep B is preventable with a vaccine, and some people clear the virus on their own (they are cured), but there is no cure for people in whom the virus becomes chronic.
False: If you have Hep C, you may not necessarily look sick. In fact, you may be asymptomatic.

4. A Few Questions True or False: Oral Herpes has a cure
Chlamydia and gonorrhea are the most common sexually transmitted infections caused by bacteria
False: Oral herpes has no cure, but there are medications you can take to lessen the severity and length of outbreaks
True: Chlamydia and gonorrhea are the most common sexually transmitted infections caused by bacteria

5. A Few Questions… True or False:
Head lice cannot be spread by sharing a hairbrush
Tuberculosis only affects the lungs
HIV and AIDS mean the same thing
False: head lice can be spread by sharing a hairbrush
False: Tuberculosis can affect many different organs, including the lungs, kidneys, bones, and brain
False: HIV and AIDS are different…we’ll talk about that later.

6. Hepatitis Inflammation of the liver Bacteria Alcohol and toxins
Your own immune system
Viruses
Multiple different ones!
Today – Focus on Hep B and C
The liver has many functions, such as:
protein synthesis
metabolism (processing) of key nutrients (fat, sugar, protein)
hormone production
filtering of harmful substances in blood
energy storage
vitamin and mineral storage
Imagine what can go wrong if the liver isn’t working well!
Viral Hepatitis Screening:
Explain inflammation (scraped knee or skin from as a kid analogy)
Inflammation of the liver (inflammation is the body’s response to harmful things)
caused by bacteria, toxins (drugs or alcohol), the body’s own immune system
most often caused by a virus (a tiny infectious agent that can only replicate inside the cells of living organisms)
five types of viral hepatitis: Hepatitis A, B, C, D, and E
most common are Hep A, B, and C
Today we’ll talk about Hep B and C (Hep A rarely leads to permanent liver damage, fecal oral route and has a vaccine)

7. Hepatitis B Virus How do you get it? Blood Unprotected sexual contact
Sharing needles
During birth if mother infected
Blood transfusion (rare)
Some Symptoms
Nausea and vomiting
Jaundice
Pale feces/dark urine
Pain in upper right part of abdomen
Itching all over the body
How do you get it?
Transmitted by the blood, including fluids contaminated with blood (unprotected sexual contact with infected person, blood transfusion, sharing needles, birth to infected mother)
Not transmitted through food or water, sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, sneezing.
HBV can survive outside the body for at least 7 days and still be capable of causing infection.
What are the symptoms?
Fatigue
Nausea and vomiting
Loss of appetite
Jaundice
Pale feces/dark urine
Pain in upper right part of abdomen
Itching all over the body

8. Hepatitis B Virus Half of people show no symptoms
Chronic Hep B – long-term infection
5-10% of adults with Hep B develop this
Can lead to
Liver scarring
Liver cancer
Acute infection ranges from asymptomatic to mild disease to very rarely fulminant hepatitis.
Half of people infected with the virus will show no symptoms
Acute Hep B: in most cases symptoms only last a few weeks to months, and then the virus is cleared (95%)
Chronic Hep B: infection lasts over 6 months, and may never go away
Only 5-10% of adults develop chronic infection, much higher in children
Can cause scarring of the liver as well as liver cancer. Both can be fatal (15-25% of people with chronic infection will die of liver disease)
Risky behaviour = Consider seeing a doctor about it?

9. Hepatitis B Virus Diagnosis: blood tests No cure for chronic Hep B
Preventable with a vaccine
Treatment: anti-retroviral drugs
No cure for chronic Hep B, but preventable with a vaccine (3 injections at 1mo, 2mo, and 6mo) – good for at least 20 years; also given after exposure to HBV to prevent infection
Persons who have already been infected will receive no benefit from the vaccination
Treatment (to reduce damage caused by the virus): anti-retroviral drugs
Acute Hep B: no meds needed
Chronic Hep B: several antiviral drugs available; persons with chronic hep B infection require medical evaluation and regular monitoring to determine whether disease is progressing and to identify liver damage or hepatocellular carcinoma

10. Hepatitis C How do you get it? Blood Unprotected sex Sharing needles
During birth if mother infected
Blood transfusions (rare)
What are the symptoms?
80% of people have no symptoms
Symptoms may not show up for over years
Similar symptoms to Hep B
How do you get it?
Blood borne and mother to child during birth
Sharing needles, blood transfusions, unprotected sex
Before 1992, when blood screening for HCV became available, blood transfusion was a leading means of HCV transmission.
The most recent surveys of active IDUs indicate that approximately one third of young (aged 18–30 years) IDUs are HCV-infected. Older and former IDUs typically have a much higher prevalence (approximately 70%–90%) of HCV infection
What are the symptoms?
80% of people no symptoms
Symptoms may not show up for over years
Similar symptoms to Hepatitis B
Risky behaviour = Consider seeing a doctor about it?

11. Hepatitis C Diagnosis: blood test
75% of adults with Hep C develop chronic infection
Chronic Hep C can lead to
Liver scarring
Liver cancer
The cure rate with medication is ~50%
At least 75% of people infected with Hep C develop Chronic Hep C (15-25% clear it without treatment)
Most people with chronic HCV infection are asymptomatic.
Prior infection with HCV does not protect against later infection (for the same reason why there is no vaccine)
Chronic Hep C, like chronic Hep B, can lead to cirrhosis and liver cancer
Diagnosis: anti-HCV (can be detected 4-10 weeks after infection) or HCV RNA (can be detected 2-3 weeks after infection)
There’s no vaccine, but there are drugs to reduce the damage to the liver. Approximately 50% of chronically infected people respond to therapy.

12. Oral Herpes How do you get it? Touching infected saliva or skin
Examples - lips, mouth, nostrils, ears, eyelids, genital area, anus
Symptoms?
Painful sores
Fever and muscle aches
Commonly no symptoms
No cure
What is it and what are the symptoms?
an infection of the mouth and lips caused by the herpes simplex virus 1
causes painful sores on the lips, gums, tongue, inside cheeks, the roof of mouth and sometimes on the face and neck (commonly called “cold sores”)
can also cause fever and muscle aches
up to 65% of the population will have been exposed to the virus by age 40
commonly asymptomatic
How do you get it”
touching infected saliva, skin or mucous membranes (lips, mouth, nostrils, ears, eyelids, genital area, anus)
Progression: 3 Stages
primary infection: virus enters skin through small breaks or cracks, replicates, and sores develop and last for 2 to 3 weeks
Latency (dormant or quiet stage): virus moves to nerve tissue where it remains inactive, and there are no symptoms
Recurrence: the virus may reactivate and cause symptoms again after certain events (such as stress, fatigue, sunshine) 
There is no cure but medication (antiviral drugs like Denavir or Valtrex) does exist to shorten outbreaks and lessen symptoms

13. Genital Herpes How do you get it? Skin-to-skin contact
Sexual intercourse and oral sex
Symptoms
Lesions and ulcers
No cure
Medications to prevent and treat recurrences
How do you get it?
sexual intercourse and oral sex
Skin-to-skin contact
Many people are asymptomatic
Progression and recurrence:
Lesions typically last 2-3 weeks, then progress to ulcers,
There is no cure but medications do exist to shorten outbreaks and lessen symptoms

14. Chlamydia and Gonorrhea
How do you get it?
Spread through vaginal, anal or oral sex
Symptoms
Often no symptoms
Discharge, painful urination, fever
Treatment is with antibiotics
Prevention
Limiting sexual partners
safe sex practices
Chlamydia and gonorrhea are most common sexually transmitted infections caused by bacteria
Spread is through vaginal, anal or oral sex, and from mother to baby during birth
Symptoms:
up to 50% of men and up to 75% of women do not experience symptoms
women: yellow or greenish cervical discharge that comes out of the vagina; painful urination; fever; abdominal pain
men: painful or burning urination; yellow, white or green discharge from penis; tender testicals; fever
Diagnosis:
women: cervical secretions collected during pelvic examination are sent to the lab for testing
men: tiny cotton swab inserted into penis and sent to the lab for testing
Treatment is with antibiotics
Limiting sexual partners and safe sex practices are most effective prevention

15. Head Lice Live on the head and lay eggs How do you get it?
Direct contact
Sharing hairbrushes
Hats, towels, clothing and bedding
Insects that live on the scalp and lay eggs; may also be found in eyebrows and eyelashes
Adult lice live ~30 days
Easily spread
Direct contact or sharing hairbrushes, hats, towels, clothing, bedding, etc
Check Family Members

16. Head Lice Symptoms Itchy scalp See nits in hair Live lice near scalp
Treatment
Shampoos
Proper cleaning of brushes, clothes and sheets
Symptoms (intense itching, but does not lead to serious medical problems)
Itchy scalp
See nits in hair (whitish-grey, tan, yellow) that are size of sand. Often look similar to dandruff
Confirm with identifying live lice near scalp
Treatment (is recommended if even one egg is found)
Insecticides (Found in special shampoo)
No prescription needed
Noninsecticide
Breaks down exoskeleton of lice
Wash bedsheets in hot water

17. Scabies How do you get it?
Direct contact such as sexual relations and handshaking
Towels, clothing, bedding
Symptoms
Small, raised bites
Very itchy
Worse at night
Burrows under skin and lay eggs
Very itchy lesions, worse at night (the itchy rash is an allergic response to the mites)
Small papules with burrows
Common in skin folds
Spread
pets and animals cannot spread human mites
Highly contagious with personal contact, infected bedding, sexual relations, handshaking
Can be asymptomatic 2-4 weeks

18. Scabies Treatment Topical cream Wash bedding and clothing Diagnosis
See burrows
Microscopic visualization of mites, egg for accurate diagnosis
Treatment
Topical Permethrin, a scabicide to kill mites
Usually only one application
Treat all close contacts, even if not symptomatic
Wash bedsheets and clothing with hot water
Prevention
Do not share clothes, towels, bedsheets

19. Syphilis How do you get it? Sexually transmitted Direct contact
Symptoms
6 weeks – ulcer
6 months – rash, fever, aches
6 years and longer – affects heart, brain, etc.
Treatment
Antibiotics
Abstain from sex during treatment
Treponema pallidum infection
Symptoms
Primary syphilis: Ulcer at area of infection, resolves on its own 3-6 weeks
Secondary syphilis (weeks to months after 1°): Systemic rash, mucocutaneous lesions, adenopathy
Tertiary syphilis: Neurologic (asymptomatic, visual or hearing problems), cardiovascular (aortitis and aneurysm formation), gummatous (Granulomatous lesions in skeletal, skin, and mucocutaneous tissue)
Latent syphilis: Asymptomatic positive treponemal antibody test
Congenital syphilis: to fetus in utero

20. Tuberculosis How do I get it? Coughing Sneezing Talking
Contributing Factors
Immunosuppressed
Diabetes
Alcohol
Injection drug use
Spread airborne from droplets from coughs, sneezes, talking
Enter the lungs and enter macrophages and spread to lymph nodes
Seed distant organs
Kidney
Skeleton
Joints
Central nervous system
Pleural and pericardial infection
Contributing Factors
Immunosuppressed individuals
Diabetes
Alcohol use
Injection drug use
Higher among homeless, malnourished, and poorer populations

21. Tuberculosis Diagnosis Treatment Lungs infected most often Symptoms
May have no symptoms
Coughing and chest pain
Fever and chills
Night sweats and weight loss
Diagnosis
Skin test, chest x-ray, labs
Treatment
Multiple antibiotics
Asymptomatic Primary Infection
Body protects itself and walls the bacteria in caseous granulomas that become fibrous and calcified
Symptomatic Primary TB
Immunocompromised (ex: AIDS)
Secondary TB
Reactivation of infection in any organs that had primary infection due to a weakening of immune system (such as AIDS)

22. HIV Human immunodeficiency virus How do you get it? Sexual activity
Blood transfusions
Needle sharing
Mother to fetus
Human immunodeficiency virus (HIV)
Retrovirus that is reverse transcribed into DNA and joins cell DNA (can hide from body defenses and be latent)
Spread
Sexual activity: present in seminal fluid and vaginal secretions
Blood transfusions
Needle sharing
Mother to fetus (during pregnancy or at birth)
Enter T-helper cells, which are cells that help protect the body from getting sick
T-helper cells die and the body cannot protect itself from other illness

23. HIV Stages Acute viral illness Clinical latency (average 8 years)
No symptoms
Later symptoms
Fever and chills
Night sweats and weight loss
Herpes infection
Oral thrush – fungal infection
AIDS
Pneumonia
Meningitis
Brain infections
Severe mono infections
Acute viral illness
usually 2-4 weeks post exposure – flu or mono like symptoms
Clinical latency (average 8 years)
Constitutional Symptoms
weight loss
Oral thrush
Herpes zoster TB
AIDS (CD4 Count<200)
opportunistic infections and malignancies

24. HIV Diagnosis Blood testing Treatment
Antiretroviral therapy with multiple medications
Prevention! Avoid:
Needle sharing
Unprotected sex
Get educated!
Diagnosis
Antibodies (initial screening)
Viral RNA
Antigens p24 found in blood with Western Blot Test
Antibodies detected with Enzyme-linked immunosorbent assay (ELISA) test
AIDS
CD4 T-lymphocyte count less than 200
Treatment
Lower viral load
Treat opportunistic infections
Highly Active Antiretrovial Therapy (HAART) – combination of at least 3 drugs
Prevention
Avoid needle sharing, unprotected sex, become educated!
A course of antiretroviral treatment administered immediately after exposure, referred to aspost exposure prophylaxis, reduces the risk of infection If begun as quickly as possible.

25. A Few Questions… True or False:
Hepatitis B is preventable with a vaccine, but there is no cure
If you have Hepatitis C, you will look very sick
Tricky questions:
True and False: Hep B is preventable with a vaccine, and some people clear the virus on their own (they are cured), but there is no cure for people in whom the virus becomes chronic.
False: If you have Hep C, you may not necessarily look sick. In fact, you may be asymptomatic. 25

26. A Few Questions True or False: Oral Herpes has a cure
Chlamydia and gonorrhea are the most common sexually transmitted infections caused by bacteria
False: Oral herpes has no cure, but there are medications you can take to lessen the severity and length of outbreaks
True: Chlamydia and gonorrhea are the most common sexually transmitted infections caused by bacteria

27. A Few Questions… True or False:
Head lice cannot be spread by sharing a hairbrush
Tuberculosis only affects the lungs
HIV and AIDS mean the same thing
False: head lice can be spread by sharing a hairbrush
False: Tuberculosis can affect many different organs, including the lungs, kidneys, bones, and brain
False: HIV and AIDS are different…we’ll talk about that later. 27

28. Questions? THANK YOU!