aids – acquired immune deficiency syndrome
DESCRIPTION
AIDS – Acquired Immune Deficiency Syndrome. A syndrome of opportunistic infections that occur as the final stage of infection by the human immunodeficiency virus (HIV) Destruction & progressive loss of the immune function Can affect any organ First identified in 1981. AIDS Spectrum. - PowerPoint PPT PresentationTRANSCRIPT
AIDS – Acquired Immune Deficiency Syndrome
• A syndrome of opportunistic infections that occur as the final stage of infection by the human immunodeficiency virus (HIV)
• Destruction & progressive loss of the immune function
• Can affect any organ
• First identified in 1981
AIDS Spectrum
• Infected individuals that appear healthy• No signs of infection
• Chronic Illness
• Terminal Stage Disease
AIDS Spectrum
• From the time of infection until full blown AIDS can take 1 year to 15 years
• May take 6 weeks to a year from time of infection to when a person becomes HIV positive• May pass it on to others• False sense of security
Transmission of AIDS
• Transmitted through body fluids• Tears• Saliva• Blood• Sexual Intercourse• Mother’s Breast Milk
• Homosexuals, IV drug users/infected needles• Sex with multiple partners• Blood transfusions• Organ transplants
Protection Against AIDS
• UNIVERSAL/STANDARD PRECAUTIONS!!• Gown, Gloves, Goggles
• Protection from needle sticks• Never recap needles
Opportunistic Infections
• Skin lesions• Purplish blotches or bumps on the face &
extremities
• Pneumonias• Bacterial (H Influenza & Streptococcus)
• Viral Infections• Cytomegalovirus most common virus• Effects the lungs and eyes
Opportunistic Infections
• Kaposi’s Sarcoma • Cancer of skin spreading to other sites
(lungs & GI)
• Tuberculosis• Fungal Infections
• Mucosal & tongue Candidiasis• Fungal Pneumonias (Pneumocystis
Carinii)• Eye infections
• Cervical Cancers
Treatment
• Supportive Care • Oxygen• Psychological counseling• Anti-viral agents
• AZT• Retrovir• Videx
• Treat individual infections
Treatment
• Pneumocystis Carinii Pneumonia• IV or aerosolized pentamidine
• Trade Name: Nebupent
• Aerosolized pentamidine associated with less side effects.
• Administered is given with Respirgard II nebulizer
• Series of 3 one-way valves
• Expiratory filter to trap exhaled particles• Particle size needs to be 1-2 microns to
deposit in the alveoli
Dosage of pentamidine
• Comes in a dry powder
• 300 mg vial must be reconstituted with 6 mL of sterile water.
• The entire 6 mL is placed in the nebulizer.
• Give a bronchodilator before giving the pentamidine.
• Given on out-patient basis; 300 mg/once a month.
Environmental Exposure to Healthcare Worker
• Risk to Healthcare Workers (HCW)
• Exposure to the drug.
• Risk of infection with TB often associated with AIDS (airborne transmission).• HCW should be tested periodically for TB.
• Nursing and Pregnant women should avoid exposure to the drug.
Environmental Risk of HCW
• HCW have developed• Bronchospasm• Conjunctivitis
• Need to protect themselves during administration• Gloves, mask and goggles• Stop nebulization if the patient takes the
mouthpiece out of their mouth or if they stop to cough..
• Use an isolation booth or hood assembly with an exhaust fan and high efficiency filter.
Lung Abscess• Lung abscess is a necrotizing infection
characterized by localized pus • Aspiration of oral and GI fluids containing
anaerobic organisms.• Aspiration a result of impaired cough function
(unconscious or obtunded from alcohol)
• Mouth (between teeth and gums); poor oral hygiene:
• Peptostreptococcus sp.• Bacteroides sp.• Fusobacterium sp.• Clostridium sp.
Chest Assessment
• Increased tactile and vocal fremitus
• Dull percussion note
• Crackles/rhonchi
• Pleural friction rub
• Bronchial breath sounds
• Whispered Pectoriloquy
• Bronchophony or Egophony
Clinical Assessment
• Nonproductive, barking or hacking cough.• Later, cough becomes productive.
• Hemoptysis• Purulent
• Painful respirations.• Pleural is involved.
• Fever & sweats
• Weight loss
• Periodontal disease
Chest X-ray
• Consolidation with single cavity containing an air-fluid level.
• Air bronchograms
• Pleural effusions
• Silhouette sign
Aspiration Pneumonitis
• Aspiration of gastric juice with a pH of 2.5 or less causes serious and fatal pneumonia
• Acute inflammatory reaction does not usually occur until 12-24 hours after aspiration
• Can lead to the development of ARDS
• Mendelson’s Syndrome
Lipoid Pneumonitis
• Aspiration of oil • Mineral Oils• Oils from animal fat
Avian Flu
Influenza Pandemic
• Pandemic vs. Epidemic
• Three conditions must be met for an Influenza pandemic to start: • A new influenza virus subtype must emerge for
which there is little or no human immunity; • It must infect humans and causes illness; and• It must spread easily and sustainably (continue
without interruption) among humans.
Past Influenza Pandemics
• 1933: Influenza virus first isolated
• 1918-1920: Spanish Flu (H1N1)• Hundreds of millions infected; 50 million
deaths (600,000 in US)• Mortality highest in 20- to 40-year age group
• 1957: Asian Flu (H2N2)• Million deaths worldwide (80,000 in US)
• 1968: Hong Kong Flu (H2N2)• 700,000 deaths (34,000 in US)
Avian Flu
• H5N1 virus• Thought to have originated by reassortment
between multiple cocirculating avian influenza strains prevalent in Hong Kong in 1997.• Continued evolution since 1997.
• Human transmission appears to be associated with close contact with infected poultry.• Plucking• Playing• Cock fights• Drinking raw duck blood
Human-to-Human Transmission
• Rare• 15 family clusters involving more than two
family members documented between 1/04 & 7/05.
• 200 cases worldwide – none in US.• 2006: H5N1 found in Azerbaijan, Cambodia,
China, Djibouti, Egypt, Indonesia, Iraq, Thailand, Turkey
• http://www.cdc.gov/flu/avian/
Symptoms of Avian Flu• Non-specific complaints of fever.
• Cough
• Dyspnea
• Conjunctivitis
• CXR: Diffuse infiltrates; rare pleural effusions.
• Lab: Leukopenia
Treatment for Avian Flu
• Supportive
• Antiviral drugs• amantadine, rimantadine, oseltamivir, and
zanamivir
• Vaccine• Flu vaccine not effective
Swine Flu
http://www.cdc.gov/h1n1flu/key_facts.htm
Severe Acute Respiratory Syndrome (SARS)
SARS Outbreak
• Emerged from Southern China• First case reported 11/16/02• 1/31/03 patient presented to hospital in
Guangdong, China.• Transmission to 49 HCWs and 19 family members.
• Spread throughout local municipalities.• Carried to Hong Kong by nephrologist
attending a wedding.• Transmission to 15 hotel guests (including
international travelers)• Outbreaks in Vietnam, Canada, Singapore, & Phillipines
Coronovirus
• Novel human coronovirus (SARS-CoV)
• Coronaviruses are enveloped RNA viruses.• Some strains well-recognized as causing the
common cold.
• Transmission to human thought to be associated with the handling (and eating) of the palm civet, ferret badgers, and raccoon dogs.
Epidemiology & Clinical Presentation
• Transmission is by inhalation of infected respiratory droplets
• Incubation period is 2 to 10 days• Maximum infectivity does not occur at the
time of symptom onset (unlike most viruses)• Occurs in 2nd week and at the time of rapid
clinical deterioration.
• Initial symptoms resemble influenza, with fever, cough, chills, rigor, and myalgia.
Diagnostic Testing
• CXR: Usually normal initially• Pulmonary infiltrates as disease progresses
• Lab: WBC normal or low
Treatment
• Supportive• 70-80% have full recovery• Others develop ARDS-like picture and 50% die
• Mechanical Ventilation• Anti-Viral Agents
• oseltamivir• ribavirin
• ISOLATION!• Protection of healthcare workers.• N-95 masks