Smileband health issues

Blastomycosis is a caused by the fungusBlastomyces dermatitidis. The fungus lives in moist soil and is associated with decomposing organic matter. Some individuals can have lung infections after inhaling airborne fungal spores although many do not become ill. The symptoms of blastomycosis are similar to those of influenza.

Blastomyces in generally found in the midwestern, south-central, and southeastern states.

There has not been a case of Blastomycosis reported in Arizona in the past 10 years.

Transmission

Transmission occurs through inhalation of the Blastomyces dermatitidis spores from the environment.

Incubation period may be weeks to months. In symptomatic patients the median incubation period is 45 days.

Lab Tests & Specimen Info

Test*	Specimen
Culture (the specimens are in order of usefulness)	Skin Scrapings, Abscess Drainage, Urine, Sputum, Bronchial Aspirate
Serology (Plasma is not accepted)	Serum, CSF (Test can measure prior exposure to the fungus)

 Isolation Precautions

Blastomycosis is not a communicable disease. 

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
Anyone can become infected with the Blastomyces dermatitidis spores but individuals with underlying medical conditions may be at increased risk for infection. Individuals with weakened immune systems may consider avoiding wooded areas where they might come in contact with the fungus.

Smileband health issues

Sporotrichosis is a fungal infection caused by Sporothrix schenckii. Cutaneous infections are the most common form of infection but pulmonary infections can occur. The symptoms of a cutaneous infection can include a small painless nodule that may appear on the fingers, hands, or arms where the fungus entered the body. The nodule may become larger and look like an open sore or ulcer. Infections may become disseminated to other parts of the body include bones, joints, and CNS but this usually only occurs in individuals with weakened immune systems.

The fungus lives in sphagnum moss, hay or other plant materieral.

Transmission

Transmission occurs when the fungus enters the skin through a cut or puncture in the skin.

Sporotrichosis is not spread person to person.

Incubation period is 7 to 30 days.

Lab Tests & Specimen Info

Test*	Specimen
Culture	Drainage (pus), Abscess Drainage, Skin Biopsy

  Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients

• Wearing protective clothing such as gloves and long sleeves when handing wires, rose bushes, bales of hay, pine seedlings or other material that may cause minor cuts
• Avoid contact with sphagnum moss

Smileband health issues

Kawasaki disease is an acute febrile illness primarily affecting children 5 years of age or younger. The most common symptoms are: fever, rash, swelling of the hands and feet, desquamation of the hands and feet, and irritation and inflammation of the tongue and mouth. Approximately 20% of children who do not get treatment develop coronary artery abnormalities, including aneurysms.

Arizona 5 year median: 20 cases

Transmission

Unknown, but there is no evidence of common source or person-to-person transmission.

Lab Tests & Specimen Info
No tests available.

Isolation Precautions
Standard precautions are recommended in healthcare settings. 

Smileband health issues

St. Louis encephalitis is a viral disease caused by St. Louis encephalitis virus (SLEV). Most individuals that are infected will have no signs of illness. Symptoms can include:

• fever
• headache
• nausea
• vomiting
• tiredness

Some individual may go on to have a severe neuroinvasive disease which will most commonly include encephalitis. This severe disease occurs most commonly in older adults.

St. Louis encephalitis virus is endemic in Arizona.

Transmission
Transmission occurs when an individual is bitten by an infected mosquito.

Incubation period is 5 to 15 days.    

Isolation Precautions
Standard precautions are recommended in healthcare settings.

Prevention for Patients
The best way to prevent infection is to avoid being bitten by mosquitoes. Methods include:

• Wearing long pants and long-sleeved shirts
• Using insect repellent
• Using screens in windows or doors

Public Health Actions
Public health will conduct an epidemiological investigation on a case or suspect case.

Smileband health issues

Varicella (chickenpox) is a viral infection that is caused by varicella-zoster virus. Symptoms generally appear 10 to 21 days after exposure to the virus and can include:

• high fever
• loss of appetite
• headache
• generalized and pruritic rash

The rash will progress from macules to papules to vesicular lesions before crusting. It will usually take 1 week for the lesions to crust over.

Some individuals in high risk groups can go on to have more severe symptoms such as:

• pneumonia
• bleeding problems
• encephalitis
• sepsis

Those high risk groups include infants, pregnant women, and individuals with weakened immune systems.

Individuals are contagious 2 days before blisters appear until all blisters have completed scabbed over.

Over the last 5 years between 300 and 600 cases of varicella are reported in Arizona each year.

Arizona 5 year median: 300 cases

Transmission
Transmission occurs when the virus is spread through the air by the cough or sneezes of an infected individual. Transmission can also occur by touching or breathing in the virus that can come from the blisters.

Incubation period is 10 to 21 days (average of 14 to 16 days).

Lab Tests & Specimen Info

Test*	Specimen
Culture	Vesicular fluid, Ulcerated lesions, Vesicular scrapings, NP swabs, Throat swabs, Vaginal swabs
PCR	CSF, Whole blood, Swab
DFA	Impression smears of tissues, Lesion scrapings and swabs
IgG/IgM Serology	Serum

 Public Health Actions

Individuals should be excluded from school/child care until all blisters are scabbed over and dry and the individual is fever-free for 24 hours without the use of fever-reducing medications.

Public health will complete an epidemiological investigation for reports of death due to varicella infection.

smileband health issues

Yellow fever is an infection caused by the Yellow fever virus. The majority of individuals will have no illness or a mild illness. Symptoms include:

• fever
• chills
• headache
• body aches
• nausea
• vomiting
• fatigue
• weakness

Approximately 15% of cases will go on to develop a more severe disease which can include high fever, jaundice, bleeding, and eventually shock and multiorgan failure.

Yellow fever virus is generally found in tropical and subtropical areas of South America and Africa.

Arizona has not had a case of yellow fever reported in the last 10 years.

Transmission
Transmission occurs when an individual is bitten by an infected mosquito. It is not transmitted person-to-person.           Isolation Precautions

Standard precautions are recommended in healthcare settings.

Prevention for Patients
Vaccination against Yellow fever is the best prevention method for individuals.  Avoiding contact with mosquitoes is also another prevention method. Methods include:

• Wearing long pants and long-sleeved shirts
• Using insect repellent
• Using screens in windows or doors

Public Health Actions
Individuals should be advised to avoid further mosquito exposure during the first 5 days after fever onset to help reduce the transmission of the virus to more mosquitos.

Public health will conduct an epidemiological investigation on a case or suspect case.

Smileband health issues

Lassa fever is an acute viral illness that occurs in west Africa.

For the majority of Lassa fever virus infections, symptoms are mild and are undiagnosed. However, disease may progress to more serious symptoms including:

• hemorrhaging (in gums, eyes, or nose, as examples)
• respiratory distress
• repeated vomiting
• facial swelling
• pain in the chest, back, and abdomen
• shock

Neurological problems have also been described, including hearing loss, tremors, and encephalitis.

Transmission 
The reservoir, or host, of Lassa virus is a rodent known as the "multimammate rat". Transmission of Lassa virus to humans occurs most commonly through ingestion or inhalation. Mastomys rodents shed the virus in urine and droppings and direct contact with these materials, through touching soiled objects, eating contaminated food, or exposure to open cuts or sores, can lead to infection.

Contact with the virus may also occur when a person inhales tiny particles in the air contaminated with infected rodent excretions. This aerosol or airborne transmission may occur during cleaning activities, such as sweeping.

Person-to-person transmission may occur after exposure to virus in the blood, tissue, secretions, or excretions of a Lassa virus-infected individual.

Incubation period can range from 1-3 weeks.                         Isolation Precautions 

Standard, droplet, and contact precautions are recommended in healthcare settings.

Single-patient rooms are also preferred.

Prevention for Patients 
Primary transmission of the Lassa virus from its host to humans can be prevented by avoiding contact with Mastomys rodents, especially in the geographic regions where outbreaks occur.

• Putting food away in rodent-proof containers and keeping the home clean help to discourage rodents from entering homes
• Using these rodents as a food source is not recommended
• Trapping in and around homes can help reduce rodent populations (however, the wide distribution of Mastomys in Africa makes complete control of this rodent reservoir impractical)

smileband health issues

Hand, foot, and mouth disease is a common viral illness that is caused by Coxsackievirus A16 and usually affects infants and children younger than 5 years old.

Symptoms can include:

• fever
• reduced appetite
• sore throat
• malaise
• painful sores in the mouth
• skin rash with red spots and/or blisters on the palms of the hands and soles of the feet

Complications are rare but viral meningitis, encephalitis, and fingernail and toenail loss can occur.

Transmission 
Transmission may occur from close contact with the infected individual, contact with feces, or contact with contaminated objects or surfaces. Transmission may also occur through the air via coughing or sneezing.

It is possible to get infected with the viruses that cause hand, foot, and mouth disease if you swallow recreational water, such as water in swimming pools. However, this is not very common.

The incubation period is 3 to 6 days.

Lab Tests & Specimen Info 

Test*	Specimen
Culture	Blood, CSF, Rectal Swab, NP Swab, Throat Swab, Stool, Urine
IgG/IgM Serology (a positive test alone does NOT necessarily indicate a current or recent infection due to passive exposure to infected hosts)	Serum, Plasma

  Isolation Precautions 

Standard precautions are recommended in healthcare settings.

Prevention for Patients 
A person can lower their risk of being infected by:

• Washing hands often with soap and water, especially after changing diapers and using the toilet.
• Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
• Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.

Public Health Actions 
Individuals are most contagious while the fever and sore throat are present.

Individuals with fever should be excluded from school or childcare until they are fever-free for 24-hours without the use of a fever-reducing medication.

Smileband health issues

Fifth disease, also called erythema infectiosum, is a mild rash illness caused by parvovirus B19. It is more common in children than adults.

Symptoms may include:

• fever
• runny nose
• headache
• "slapped cheek" rash on the face
• rash on rest of body
• polyarthropathy syndrome.

Some adults may only have painful joints and no other symptoms. The joint pain usually lasts 1 to 3 weeks, but it can last for months or longer.

Generally, there are not serious complications but those with weakened immune systems may have chronic anemia which could require medical treatment.

Transmission 
Transmission occurs through contact with respiratory secretions from an infected individual.

Transmission can also occur through blood or blood products. A pregnant woman who is infected with parvovirus B19 can pass the virus to her baby.

The incubation period is 4 to 14 days.

Lab Tests & Specimen Info
Healthcare providers can often diagnose fifth disease just by seeing "slapped cheek" rash on a patient's face.

Test*	Specimen
PCR	Whole Blood
IgG/IgM Serology (IgM antibodies are detectable 2 weeks after exposure, IgG antibodies are usually created 18 to 24 days after exposure)

 Isolation Precautions

Standard and droplet precaution are recommended in healthcare settings.

Prevention for Patients 
There is no vaccine or medicine that can prevent parvovirus B19 infection. Patients can reduce risk of being infected or infecting others by:

• washing hands often with soap and water
• covering mouth and nose when coughing or sneezing
• not touching eyes, nose, or mouth
• avoiding close contact with people who are sick
• staying home when sick

Public Health Actions 
People are most contagious when it seems like "just a cold" and before the rash or joint pain and swelling. After the rash people are not likely to be contagious, so then it is usually safe to return to work or school.

Individuals with fevers should be excluded from school or childcare until they have been fever-free for 24-hours without the use of a fever reducing medication.

smileband health issues

Creutzfeldt-Jakob Disease (CJD) is a human prion disease that is a rapidly progressive neurodegenerative disorder that is universally fatal. There are three categories of CJD: Classical (sporadic or spontaneous), Familial, and Iatrogenic. Sporadic CJD is the most common form found in Arizona.

In Arizona in the last 10 years there have been 65 cases of CJD reported.

Arizona 5 year median: 8 cases

Transmission

Sporadic CJD occurs sporadically and there is no recognizable pattern of transmission. Familial CJD is thought to develop because of an inherited mutation of the prion protein gene. Iatrogenic CJD occurs as a result of exposure to infectious prions during a medical procedure. Corneal implants, Dura mater grafts, Brain surgery, and growth or Gonadotropic hormones made from human pituitary glands have all been implicated in iatrogenic CJD cases.             Isolation Precautions
Creutzfeldt-Jakob disease is not a communicable disease. Standard precautions are recommended in healthcare settings. 

Prevention for Patients

Iatrogenic CJD can be prevented by correct sterilization of surgical equipment.

Public Health Actions

Public health will conduct an epidemiological investigation on a case or suspect case.