Smileband health topics

Pertussis or whooping cough is a highly contagious respiratory disease that is caused by the bacteria Bordetella pertussis.

 

The disease generally goes through three stages: catarrhal stage, paroxysmal stage, and convalescent stage. In the catarrhal stage, the individual has a runny nose, mild cough and low-grade fever which usually lasts 1-2 week. This is when the individual is the most contagious. The paroxysmal stage is when the paroxysms and posttussive vomiting can occur. This can last 1-6 weeks. The convalescent stage is when coughing lessens and the individual begins to recover gradually.

 

In Arizona, there has been a general increase in the number of pertussis cases reported each year.

 

Arizona 5 year median: 580 cases

 

Transmission
Pertussis is transmitted person to person by contact with aerosolized droplets from an infected person.

The incubation period is 7-10 days with a range of 5 to 21 days.

Lab Tests & Specimen Info

Test*	Specimen
Culture (Culture is not as likely to be positive if > 2 weeks since cough onset)	NP Swab (synthetic swabs only)
PCR (PCR is not as likely to be positive if > 4 weeks since cough onset)	NP Swab (synthetic swab on

  Isolation Precautions

Standard and droplet precautions are recommended for 5 days after initiation of therapy or until 3 weeks after cough onset.

Prevention for Patients
Vaccination is the best prevention method. Tdap vaccine is recommended for pregnant women during their third trimester to help protect the infant. Also, it is recommended for anyone who will be caring for the infant to also have a Tdap vaccine.

Public Health Actions
Untreated individuals should be excluded from school or childcare for 3 weeks following the onset of a cough and treated individuals should be excluded until 5 days of antibiotic treatment is completed. 

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

Smileband health topics

Methycillin-resistant Staphylococcus aureus(MRSA) is a type of staph bacteria resistant to beta-lactam antibiotics. Anyone can get MRSA and infections range from mild to life-threatening. Individuals may be carriers of MRSA and have it on their skin or in their nose but still be asymptomatic. These individual can still infected others with MRSA even though they are asymptomatic.

 

In the community, most MRSA infections are skin infections and are generally mild. Skin infections often look like a boil, pimple, or spider bite.

 

The more serious MRSA infections often occur in healthcare settings. In a healthcare setting, such as a hospital or nursing home, MRSA can cause severe problems such as bloodstream infections, pneumonia and surgical site infections.

 

In Arizona over the last 10 years there have been a range of 1,000 to 1,400 cases of invasive MRSA reported each year.

 

Arizona 5 year median: 1,155 cases

 

Transmission
Infections occur due to direct contact with contaminated surfaces or skin.

In the community, MRSA easily spreads in settings such as daycare, correctional facilities, or sport camps by frequent skin-to-skin contact, crowding, compromised skin, contaminated items and surfaces and lack of cleanliness.

In health care settings, poor adherence to standard infection control precautions (e.g. hand hygiene) can lead to transmission between patients and to clusters of infections.

Lab Tests & Specimen Info

Test*	Specimen
Culture	Specimen from a normally sterile site
Susceptibility testing	Isolate

  Isolation Precautions

Patients with MRSA should be put on standard and contact precautions.

Prevention for Patients
Maintaining good hand and body hygiene is the best prevention method.

• Washing hands often, and cleaning body regularly, especially after exercise.
• Keeping cuts, scrapes, and wounds clean and covered until healed.
• Avoid sharing personal items such as towels, washcloths, razors, clothing, and uniforms.

Individuals are infectious as long as the sores are draining.

Public Health Actions
Cases should be excluded from school or child care only if the sores cannot be covered.

Public health will conduct an epidemiological investigation on an outbreak.

Smileband Health issues

Diphtheria is an infection caused by toxigenic strains of the bacteria Corynebacterium diphtheriae.

Initial symptoms consist of:

• sore throat
• difficulty swallowing
• malaise
• low-grade fever

The pathogen produces a toxin that interferes with cellular processes causing tissue destruction, which in turn causes the most notable symptom of diphtheria, a grayish-white pseudomembrane over the tonsils, pharynx, or larynx. The membrane can cause the airway to become obstructed which can be fatal. The toxin can be absorbed into the bloodstream and can cause damage to tissue throughout the body.

Cases of diphtheria are still seen throughout the world and many of those cases are from southeast Asia.

There has not been a case of diphtheria reported in Arizona in the last 10 years.

Transmission

Diphtheria is spread by respiratory tract droplets and contact with skin lesions. Rarely, fomites and raw milk or milk products can act as a mode of transmission. Fully immunized individuals can act as carriers. 

Test*	Specimen
Culture	NP swab (synthetic only), Throat swab (synthetic only)

 Isolation Precautions

Isolate and institute droplet precautions for a pharyngeal diphtheria case or a suspect case.

Isolate and institute contact precautions for a cutaneous diphtheria case or suspect case. 

Prevention for Patients
Vaccination is the best prevention method. >95% of healthy adults and infants, children, and adolescents develop adequate antibody response after a 3-dose series. Tdap booster is recommended for adults in place of the Td booster

In untreated individuals, the pathogen can be present in discharges for 2 – 6 weeks after infection. In properly treated individuals they will no longer be contagious 48 hours after the treatment

Public Health Actions
Antitoxin is available through the CDC and should be given as soon as possible after diagnosis, even before culture results are determined. 

Cases of diphtheria should be excluded from working as a food handler, caring for patients in a healthcare institution, or caring for children in or attending a school or child care establishment until a set of cultures negative for C. diphtheriaeis obtained from the nose and throat specimen.

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

Smileband Health issues

A medieval child whose mummified body was thought to show the earliest known case of smallpox was really suffering from hepatitis, scientists say.  DNA analysis of the 16th century remains, found in the Basilica of Saint Domenico Maggiore in Naples, revealed the child was infected with an ancient strain of the hepatitis B virus (HBV). 

The team believe their findings could help shed new light on the ancient origins of the disease which, according to the World Health Organisation (WHO), kills 1.5 million people a year. Previous scientific analysis of the 16th century remains - which did not include DNA testing - suggested the child was infected with Variola virus, or smallpox. 

In fact, this was the oldest evidence for the presence of smallpox in Medieval remains and a critical time stamp for its origins.

Using advanced sequencing techniques, researchers led by McMaster University now believe child was actually infected by HBV. 

Children infected with HBV infections can develop a facial rash, known as Gianotti-Crosti syndrome.

This may have been misidentified as smallpox and illustrates the trickiness of identifying infectious disease in the past. 

Using small tissue samples of skin and bone, scientists were able to tease out tiny fragments of DNA and then stitch together pieces of genetic information to create a much more complete picture.

While viruses often evolve very rapidly - sometimes in just days - researchers suggest that this ancient strain of HBV has changed little over the last 450 years Researchers suggest this find underlines the importance of studying ancient viruses.  

'These data emphasise the importance of molecular approaches to help identify the presence of key pathogens in the past, enabling us to better constrain the time they may have infected humans,' said Hendrik Poinar, an evolutionary geneticist with the McMaster Ancient DNA Centre and a principal investigator with the Michael G. DeGroote Institute for Infectious Disease Research.

'The more we understand about the behaviour of past pandemics and outbreaks, the greater our understanding of how modern pathogens might work and spread, and this information will ultimately help in their control,' he said.

The findings are published online in the journal PLOS Pathogens. 

Smileband Health issues

What is a psychiatrist?

A psychiatrist is a medically-qualified practitioner who will have spent 5-6 years training to be a doctor. He or she will then have worked as a doctor in general medicine and surgery for at least a year. He or she will then have had at least 6 years of further training in helping people with psychological problems. psychiatrist’s special skills?All psychiatrists will learn how to:

• assess a person's state of mind
• use the “biopsychosocial” model of understanding. This emphasises the importance of a person's past experiences, family, culture, surroundings and work as well as any medical features.
• diagnose a mental illness
• use a range of psychological treatments
• use a range of medications
• help a person recover.

As well as these 'core' skills, a psychiatrist will specialise and develop skills in working with the particular problems that affect different groups of people.

For example:

• a general adult psychiatrist needs to develop skills in talking with people who have disordered thinking and hallucinations.
• a child psychiatrist will usually develop skills in working with families and with the special needs of children.

Where do psychiatryists work?

These days, NHS psychiatrists work across a whole range of places – from the street (literally) to specialist hospital units. However, most work in community mental health teams, out-patient departments and hospital wards. Some do sessions in general practices.

How do they work?

Psychiatrists sometimes see patients on their own in an out-patient clinic. More often, they work as part of a team with colleagues from other professions such as nursing, social work, psychology and occupational therapy.

The team will ask the psychiatrist to see patients, either on their own or with another member of the team present. The psychiatrist will also work as a consultant to the team, discussing people's individual mental health needs and working out how to best manage them.

The psychiatrist will also review patients with other team members in their regular team review meetings.

How would I get to see a psychiatrist?

Usually your GP will need to refer you. Quite often, the first person you will see is a nurse, a social worker or an occupational therapist from the community mental health team. They will usually decide with you whether you need to see the psychiatrist. Some specialist teams accept referrals directly from families, social workers or voluntary groups.

What might a psychiatrist ask me about?

A psychiatrist will ask you about the problem that has brought you to see them. They may also ask about anything that has happened in your life, your thoughts and feelings and your physical health. This is so that he or she can get a thorough understanding of your situation.

What might a psychiatrist recommend?

• Psychological treatments
• Medications
• Practical ways of dealing with an illness
• Practical ways to stay well
• Ways to get active, see other people and get back to things you like doing.

Smileband Health issues

Diphyllobothrium Infection is caused by Diphyllobothrium latum which is the largest tapeworm species that can infected humans. Most individuals infected will be asymptomatic but complications such as intestinal obstruction and gall bladder disease can occur. The parasite can be found in freshwater fish and generally is found in the Northern Hemisphere.

Transmission

Transmission occurs when an individual eats contaminated raw or undercooked fish.

Lab Tests & Specimen Info

Test*	Specimen
Microscopic examination	Stool

 Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
Do not eat raw or undercooked freshwater fish.

Smileband Helath issues

Chagas disease is caused by the parasite Trypanosoma cruzi, which is transmitted to animals and people by insect vectors found only in the Americas. Transmission commonly occurs in rural areas in Mexico, Central America and South America, and rarely in some southern US states.

The acute phase of the infection lasts 2-3 months and is followed by the chronic phase that without successful antiparasitic will be lifelong. Approximately 20-30% of individuals with chronic T. cruzi infections will develop clinical disease.

All cases that have been reported in Arizona were considered to be travel-associated.

Arizona 5 year median: 1 case

Transmission

Transmission of the parasite Typanosoma cruzi is generally from the feces of an infected triatomine bugs (kissing bugs). Transmission can also occur from mother to child, through blood transfusions or organ transplantation, consumption of uncooked food contaminated with feces from an infected bug or accidental laboratory exposure. Incubation period is 5-14 days after bite from infected triatomine bug.   Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
Reduce contact with the triatomine bugs by improving housing conditions and spraying insecticide.

Public Health Actions
Patients should be advised to not donate blood.

Information about symptoms, exposure to kissing bugs, and travel history are important to help find out how the individual might have been exposed.

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

Smileband Helath issues

Pneumocystis pneumonia is a fungal infection caused by Pneumocystis jirovecii which is one of the most common opportunistic fungal infections. Symptoms can include fever, dry cough, shortness of breath and fatigue. In individuals with HIV or weakened immune systems the infection presents sub-acutely and they will have a low-grade fever. In HIV-unifected patients the symptoms will include a high fever and the infection will develop more quickly.

Transmission

Transmission is unknown but there is some evidence to suggest that transmission in humans in airborne.

Incubation period is unknown.

Lab Tests & Specimen Info

Test*	Specimen
Microscopic examination	Sputum, Bronchoalveolar Lavage, Lung Biopsy, Transbronchial Biopsy
PCR	Sputum, Bronchial Washing, Bronchoalveolar Lavage, Body Fluids

 Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
Pneumocystis pneumonia is a very rare infection that usually only affects individuals who are immunocomprised. 

For those individuals at high risk, chemoprophylaxis may be recommended

Smileband Health ssues

A combination of immunotherapy and a virus could treat aggressive breast cancer, an 'absolutely amazing' study has revealed.   Breakthrough research showed the pairing cured up to 90 per cent of mice plagued by triple negative breast cancer - deemed the deadliest form.

Canadian scientists are hopeful the findings will lead to a potential cure, as survival depends on how early the disease is caught.

The trial, led by Ottawa University scientists, comes as a separate study found that an injection of a virus could also treat aggressive brain tumours. Dr Marie-Claude Bourgeois-Daigneault, lead author of the Canadian study, was full of praise for the findings, which may apply to humans.

She said: 'It was absolutely amazing to see that we could cure cancer in most of our mice, even in models that are normally very resistant to immunotherapy.

'We believe that the same mechanisms are at work in human cancers, but further research is needed to test this kind of therapy in humans.'

Every year 11,400 people die from breast cancer in the UK. In the US, the figure is around four times higher.

Charities estimate around 15 per cent of all cases of breast cancer are triple negative - but death rates are proportionally higher. 

The study, published in Science Translational Medicine, adds to the growing body of evidence that shows the vast benefits of immunotherapy. 

All of the mice in the study were resistant to the checkpoint inhibitor, which blocks proteins on cancer cells to stop them from growing, that was used. This type of drug - made famous by nivolumab, which Sunday Times food critic referred to as the weapon of choice for 'every oncologist in the first world' before he died, is already used to treat some forms of cancers, including lung and kidney. 

Separate trials showed an oncolytic virus called Maraba boosted the immune system of the mice, attacking the cancerous cells.

However, it had little effect on their survival of mice on its own. The rodents were engineered to be in a state of metastasis - when the cancer has spread from the original location.

When it was used alongside the checkpoint inhibitor it cured between 60 and 90 per cent of the mice.

This was compared to a 0 per cent cure rate for the immunotherapy alone and 20 to 30 per cent for just a dose of the virus.

The new treatment, which backs up older trials using the same technique, saw the virus given before surgery and the drug after.

Dr John Bell, co-author, added: 'Our immune system is constantly trying to recognize and kill cancer cells, but the cancer cells are always trying to hide from it.

'When you infect a cancer cell with a virus, it raises a big red flag, which helps the immune system recognize and attack the cancer.

'But in some kinds of cancer this still isn't enough.

'We found that when you add a checkpoint inhibitor after the virus, this releases all the alarms and the immune system sends in the full army against the cancer.'

Researchers recently confirmed oncolytic viruses and checkpoint inhibitors have potential for treating melanoma.

The new study was the first to test viruses and checkpoint inhibitors in a surgery and metastasis model, which is particularly relevant for patients.  

Smileband Health issues

Aspergillosis is a fungal infection caused by Aspergillus, a common mold that lives indoors and outdoors. Most people breathe in Aspergillus spores every day without getting sick. However, people with weakened immune systems or lung diseases are at a higher risk of developing health problems. The types of health problems caused by Aspergillus include allergic reactions, lung infections, and infections in other organs.

Transmission

People can get aspergillosis by breathing in microscopic Aspergillus spores from the environment. Aspergillosis can’t spread between people or between people and animals from the lungs.

Lab Tests & Specimen Info

Test*	Specimen
Microscopic  examination	Respiratory  Specimen
Culture	Sputum,  Bronchial Aspirate, Lung biopsy
Galactomannan  Antigen Test	Serum,  Bronchoalveolar Lavage
IgG Serology	Serum
PCR	Bronchoalveolar Lavage,  Tissue

 Isolation Precautions

Standard precautions are recommended in healthcare settings.

Prevention for Patients
It’s difficult to avoid breathing in Aspergillus spores because the fungus is common in the environment. For people who have weakened immune systems, there may be some ways to lower the chances of developing a severe Aspergillus infection. It’s important to note that although these actions are recommended, they have not been proven to prevent aspergillosis.

• Try to avoid areas with a lot of dust like construction or excavation sites. If you can't avoid these areas, wear an N95 respirator while you're there.
• Avoid activities that involve close contact to soil or dust, such as yard work or gardening.
• To reduce the chances of developing a skin infection, clean skin injuries well with soap and water, especially if they have been exposed to soil or dust.