communicable diseases Ravindra markad.pptx

II year g.n.m. in syllabus communicable diseses important study

1. Communicable Disease MARKAD RAVINDRA A. BROTHER TUTOR, SCHOOL OF NURSING, K.E.M. HOSPITAL PAREL MUMBAI -12

2. Diagnostic test AIM objective :- purpose of screening Please to sort out large group of apparently healthy person, those likely to have disease or increase risk of diseases under study to have bring those who are apparently abnormal under medical supervision and treatment.

3. Diagnostic test Explanation terms 1 Screening 2. case findings 3. Diagnostic test Uses of screening case detections Control of disease Research purposes Educational opportunities

4. Types of Screening Mass screening High risk screening or selective screening Multi phasic screenings Screening test Acceptability Repeatability observation Variant Biological variant Error relating technical methods Validity Combination test Evaluation of screening programme

5. Diagnostic test A staining and examination Gram stain Acid fast and moderate modified acid fast stains Fluorescent stains India ink stain Warthin-starry and dieterle stain Trichrome stain gomori Wheatly stain and iron haematoxylin stain

6. Gram stain

7. Gram stain The Gram stain is a fundamental laboratory technique in microbiology, named after Hans Christian Gram, who developed it in 1884. It's a differential staining method used to classify bacteria into two broad categories: Gram-positive and Gram-negative.Purpose:The Gram stain helps identify the type of bacteria, which informs treatment decisions, such as antibiotic selection.Procedure:1. Sample preparation: A sample is taken from a patient (e.g., blood, urine, or tissue).2. Smear preparation: A small amount of the sample is placed on a slide and spread thinly.3. Fixation: The smear is heat-fixed to adhere bacteria to the slide.4. Staining: - Primary stain (Crystal Violet): stains all bacteria purple. - Decolorizer (Ethanol or Acetone): removes excess stain from Gram-negative bacteria. - Secondary stain (Safranin): stains Gram-negative bacteria pink.Interpretation:Gram-positive bacteria:- Retain the primary stain (purple)- Thick peptidoglycan layer in cell wall- Examples: Staphylococcus aureus, Bacillus subtilis, Clostridium difficileGram -negative bacteria:- Lose primary stain, stained pink by secondary stain- Thin peptidoglycan layer in cell wall- Outer lipid bilayer containing lipopolysaccharides- Examples: Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniaeGram -variable bacteria:- Stain irregularly (mix of purple and pink)- Examples: Mycobacterium tuberculosis, Legionella pneumophilaLimitations :- Doesn't distinguish between all types of bacteria- Requires experience for accurate interpretation- Some bacteria, like Mycoplasma, don't stain wellClinical significance:The Gram stain guides:1. Antibiotic selection2. Identification of bacterial infections3. Differentiation between bacterial and viral infections4. Detection of antibiotic-resistant bacteriaWould you like more information on Gram staining or bacterial identification?

8. Acid fast and moderate modified acid fast stains

9. Acid fast and moderate modified acid fast stains Acid-fast and modified acid-fast stains are crucial in microbiology for identifying bacteria with unique cell wall properties.Acid -Fast Stain:Also known as the Ziehl- Neelsen stain, it's used to detect bacteria with a waxy cell wall, particularly Mycobacterium species (e.g., M. tuberculosis, M. leprae).Procedure:1. Carbol fuchsin (primary stain): stains all bacteria2. Acid-alcohol decolorizer : removes stain from non-acid-fast bacteria3. Methylene blue (counterstain): stains non-acid-fast bacteria blueInterpretation :- Acid-fast bacteria (AFB): retain carbol fuchsin, appear red- Non-acid-fast bacteria: stained blue by methylene blueModified Acid-Fast Stain:Used for bacteria with weaker acid-fast properties, such as:1. Nocardia species2. Rhodococcus species3. Cryptosporidium oocystsProcedure variations:1. Kinyoun acid-fast stain: uses a weaker acid-alcohol decolorizer2. Troutman acid-fast stain: uses a longer decolorization time3. Auramine-rhodamine stain: fluorescent dye-based methodModerate Modified Acid-Fast Stain:Used for bacteria with moderate acid-fast properties, such as:1. Mycobacterium marinum2. Mycobacterium kansasiiKey differences:- Concentration of acid-alcohol decolorizer - Decolorization time- Type of counterstainClinical significance:Acid-fast and modified acid-fast stains aid in:1. Diagnosing tuberculosis and other mycobacterial infections2. Identifying nocardiosis and rhodococcosis3. Detecting cryptosporidiosis in stool samples4. Guiding treatment decisions for acid-fast bacteriaComparison of Acid-Fast and Modified Acid-Fast Bacteria:| Bacteria | Acid-Fast | Modified Acid-Fast ||-----------------------|-----------|--------------------|| Mycobacterium spp. | + | - || Nocardia spp. | - | + || Rhodococcus spp. | - | + || Cryptosporidium spp. | - | + (modified) |Would you like more information on acid-fast staining or bacterial identification?

10. Fluorescent stains

11. Fluorescent stains Fluorescent stains are a vital tool in microbiology, using fluorescent dyes to illuminate specific microorganisms or cellular structures.Types of Fluorescent Stains:1. Acridine Orange (AO) stain: intercalates into DNA, staining bacteria orange2. Auramine-Rhodamine stain: targets mycobacterial cell walls, emitting yellow-orange fluorescence3. Fluorescein isothiocyanate (FITC) stain: conjugates to antibodies, detecting specific antigens4. DAPI (4',6-diamidino-2-phenylindole) stain: binds to DNA, staining bacteria blue5. SYTOX Green stain: targets bacterial DNA, emitting green fluorescenceApplications:1. Bacterial identification2. Detection of microbial infections3. Antibody-based diagnostics4. Cell viability assays5. Microbial community analysisFluorescent Microscopy Techniques:1. Epifluorescence microscopy2. Confocal laser scanning microscopy (CLSM)3. Total internal reflection fluorescence (TIRF) microscopy4. Fluorescence in situ hybridization (FISH)Advantages:1. High sensitivity and specificity2. Rapid results3. Ability to detect multiple targets simultaneously4. Non-destructive, allowing for further analysisLimitations:1. Requires specialized equipment and training2. Photobleaching (fading of fluorescence)3. Autofluorescence (background fluorescence)4. Interference from fluorescent contaminantsClinical Significance:Fluorescent stains aid in:1. Diagnosing tuberculosis (Auramine-Rhodamine)2. Detecting bacterial pathogens (Acridine Orange)3. Identifying fungal infections (Calcofluor White)4. Monitoring antibiotic resistance (SYTOX Green)5. Studying microbial communities (DAPI)Examples of Fluorescent Stains in Clinical Microbiology:1. Tuberculosis diagnosis: Auramine-Rhodamine2. Urinary tract infections: Fluorescein isothiocyanate (FITC)3. Sepsis diagnosis: SYTOX Green4. Fungal infections: Calcofluor White5. Microbial identification: DAPIWould you like more information on fluorescent staining or its applications?

12. India ink stain

13. The India ink stain, The India ink stain, also known as the Niger stain or Lacmoid stain, is a negative staining technique used to visualize microorganisms, particularly fungi and protozoa.Principle:The stain works by staining the background dark blue-black, while the microorganisms remain unstained, creating a contrast.Procedure:1. Prepare a sample (e.g., cerebrospinal fluid, blood, or tissue)2. Mix sample with India ink (or Niger stain)3. Allow to sit for 5-10 minutes4. Add a drop of glycerin to preserve5. Observe under a microscopeInterpretation :- Microorganisms appear as light, refractive, or translucent structures against the dark background.- Size, shape, and morphology help identify microorganisms.Applications:1. Cryptococcal meningitis diagnosis: India ink stain is sensitive for detecting Cryptococcus neoformans.2. Fungal identification: helps identify fungal elements (e.g., Candida, Aspergillus).3. Protozoan detection: useful for detecting protozoa like Toxoplasma gondii.4. Microbial morphology: aids in studying microbial shape and size.Advantages:1. Simple and rapid procedure2. Low cost3. High sensitivity for Cryptococcus neoformans4. Complements other staining techniquesLimitations:1. Limited specificity2. Background debris can interfere3. Requires experience for accurate interpretation4. Not suitable for all microorganisms (e.g., bacteria)Clinical Significance:India ink stain is crucial in:1. Diagnosing cryptococcal meningitis2. Identifying fungal infections3. Detecting protozoan infections4. Guiding treatment decisionsVariations:1. Niger stain: similar to India ink, but uses a different dye.2. Lacmoid stain: uses a combination of lac and iodine.3. Modified India ink stain: uses additives to enhance contrast.Would you like more information on India ink staining or its applications?

14. Warthin-starry and dieterle stain

15. he Warthin-Starry (WS) and Dieterle stains are silver impregnation techniques used to visualize microorganisms, particularly spirochetes, bacteria, and fungi.Warthin -Starry (WS) Stain:Developed by: Alden K. Warthin and William H. Starry (1920) Principle:WS stain uses silver nitrate to impregnate and stain microorganisms, making them visible under a microscope.Procedure:1. Tissue section or smear preparation2. Oxidation with potassium permanganate3. Reduction with hydroquinone4. Silver impregnation with silver nitrate5. Toning with gold chloride6. Counterstaining with nuclear fast redInterpretation :- Microorganisms appear black or dark brown against a pale background.- Useful for detecting spirochetes (e.g., Treponema pallidum), bacteria (e.g., Helicobacter pylori), and fungi.Dieterle Stain:Developed by: Robert R. Dieterle (1927) Principle:Dieterle stain is a modified silver impregnation technique, using a different silver solution and reduction method.Procedure:1. Tissue section or smear preparation2. Oxidation with potassium permanganate3. Reduction with borax4. Silver impregnation with Dieterle's silver solution5. Toning with gold chloride6. Counterstaining with nuclear fast redInterpretation :- Similar to WS stain, microorganisms appear black or dark brown.- Optimal for detecting spirochetes, particularly in tissue sections.Comparison :| | Warthin-Starry | Dieterle || --- | --- | --- || Silver solution | Silver nitrate | Dieterle's silver solution || Reduction method | Hydroquinone | Borax || Sensitivity | General purpose | Spirochete-specific || Background | Pale | Light brown |Applications:1. Spirochetal infections (e.g., syphilis, Lyme disease)2. Helicobacter pylori detection3. Fungal infections (e.g., histoplasmosis)4. Bacterial detection (e.g., Bartonella)Advantages:1. High sensitivity for spirochetes2. Useful for detecting microorganisms in tissue sections3. Complements other staining techniquesLimitations:1. Requires experience for accurate interpretation2. Background staining can interfere3. Not suitable for all microorganismsClinical Significance:WS and Dieterle stains aid in:1. Diagnosing syphilis and other spirochetal infections2. Detecting Helicobacter pylori in gastric biopsies3. Identifying fungal infections4. Guiding treatment decisionsWould you like more information on these staining techniques or their applications?

16. Trichrome stain gomori Wheatly stain and iron haematoxylin stain Here's an overview of the Trichrome stain, Gomori Wheatley stain, and Iron Hematoxylin stain:Trichrome StainPurpose : Differentiate collagen, keratin, and other connective tissue fibersProcedure:1. Section preparation2. Staining with Biebrich scarlet, phosphotungstic acid, and aniline blueInterpretation :- Collagen: blue- Keratin: red- Nuclei: black- Cytoplasm: pinkApplications:1. Connective tissue disorders (e.g., fibrosis)2. Tumor diagnosis (e.g., carcinomas)3. Skin and hair analysisGomori Wheatley Trichrome StainModification of Trichrome stainPurpose : Enhance collagen stainingProcedure:1. Section preparation2. Staining with chrome alum, Biebrich scarlet, and aniline blueInterpretation :- Collagen: intense blue- Keratin: red- Nuclei: black- Cytoplasm: pinkApplications:1. Liver disease diagnosis (e.g., cirrhosis)2. Fibrotic disorders3. Tissue repair studiesIron Hematoxylin StainPurpose : Stain nuclei, nucleoli, and cytoplasmic inclusionsProcedure:1. Section preparation2. Staining with iron hematoxylin , followed by differentiation and bluingInterpretation :- Nuclei: black- Nucleoli: dark blue- Cytoplasmic inclusions: blue-black- Cytoplasm: pale blueApplications:1. Tumor diagnosis (e.g., cancer)2. Infection diagnosis (e.g., viral inclusions)3. Neurological disorders (e.g., Alzheimer's)Comparison:| Stain | Purpose | Collagen | Keratin | Nuclei || --- | --- | --- | --- | --- || Trichrome | Connective tissue | Blue | Red | Black || Gomori Wheatley | Collagen enhancement | Intense blue | Red | Black || Iron Hematoxylin | Nuclear staining | - | - | Black |These stains are essential in histology and cytology laboratories for diagnosing various diseases and understanding tissue structure.Would you like more information on these staining techniques or their applications

17. Trichrome stain gomori Wheatley stain and iron hemat

18. Culture and susceptibility testing Cultures Susceptibility testing

19. Taste the detective antibodies to microorganisms (immunological tests) Agglutination tests Complement fixation Enzyme immunoassay Precipitation tests Western blot test

20. Western blot test

21. Complement fixation

22. Enzyme immunoassay

23. Precipitation tests

24. Non nucleic acid base identification method for infectious diseases Chromatographic methods Mass spectroscopy

25. nucleic acid base identification method for infectious diseases Amplification

26. Immunizations Prevention of any illness is always better than treatment Vaccines are the single best technique for prevention Vaccines are the safer choice to getting the disease

27. Immunization Schedule By 24 Months children should have: 4 Dtap , Hib , PCV 3 Hep B, IVP 1 MMR, varicella

28. Immunizations Are either inactivated or activated Inactivated include Dtap , Hib , Hep Activated (live) multiplies for days-weeks in body MMR, Varicella

29. Reactions Vaccines are very safe and have little chance for side effects Side effects are minor and occur with in days of administration Reactions to live vaccines can occur 30-60 days post vaccine (usually in older children)

30. Reaction to Vaccines local tenderness erythema swelling at site low grade fever (possibly high with activated) behavior changes, irritability

31. Adverse Events National Law to provide care for those affected by a vaccine’s adverse event Law requires nurses to Obtain consent prior to vaccine record lot #, manufacturer, exp. date of vaccine after administration

32. Barriers to Immunization Complexity of the health care system Expense Inaccurate recordkeeping Reluctance of health care workers to give more than two vaccines at a time Lack of public awareness of vaccines Parental misconceptions

33. Parental Misconceptions Parents may understand the dangers inherent in some of these diseases suffering, permanent disability, death Unimmunized children are at a greater risk of getting the disease and of spreading it to pregnant women and to infants and children with serious medical conditions.

34. Parental Misconceptions Misconception: Vaccine-preventable diseases have been eliminated Correct Information Travelers may reintroduce the disease Recent outbreaks of measles, mumps, and pertussis have been linked to groups of children not immunized

35. Parental Misconceptions Misconception: Immunization weakens the immune system. Fear of giving multiple vaccines. Correct Information Child’s immune system is capable of several immunizations at once No effect on immune system

36. Parental Misconceptions Misconception: Vaccines may cause serious conditions, such as autism Correct Information Numerous studies have confirmed the lack of association between the measles vaccine and autism, as well as thimerosal in vaccines and autism

37. True contraindications and precautions Moderate-severe illness with or without fever Immunocompromised Prior serious reaction (fever 105, seizure, anaphylatic)

38. Administration Nursing Consideration Proper storage Reconstitution Expiration date Consent Documentation (immunization record)

39. Atraumatic care Select needle of adequate length Select proper site VL infants Deltoid > 18 months Minimize pain EMLA cream Distraction Atraumatic care is a therapeutic care philosophy that aims to minimize the physical and psychological distress of children and their families while in healthcare settings. It's based on the principle that actions taken to help children should be therapeutic in nature and not cause harm. 

40. Nursing Responsibilities Assessment : Identify recent exposure Identify prodromal symptoms s/s occur early in disease Locate immunization history Confirm history of having the disease

41. Nursing Responsibilities Implementation : prevent spread-isolation reduce risk of cross contamination prevent complications provide comfort

42. Management Isolation at home until vesicles dry (2-3 weeks) and 1 week after lesions are gone Very young and immunocompromised may need isolation in hospital Relief of itching Antiviral agents Treat secondary complications (bacterial infections from scratching)

43. Diagnosis and Management Diagnosis by symptoms, serology available 1 month after infection Treatment Antipyretics Comfort measures **Pregnant people must avoid infected child=fetal death

44. Rubella (German measles) Viral Infection Vaccine Available “R” in MMR Transmitted by direct contact of nasopharyngeal secretions, feces, urine, or articles freshly contaminated Communicable 7 days before to 5 days after rash

45. Symptoms Rash on face which rapidly spreads downward to neck, arms, trunk and legs by end of first day body is covered with pinkish-red maculopapules Rash disappears in same order as it appeared Rash gone by 3 rd day also low grade fever, HA, Malise, cough, sore throat

46. Diagnosis and Management Diagnosis made on symptoms, serology 1 month later Management: Isolation until rash disappears Bed rest Antipyretics Fluids and vaporizer for cough Skin care (itchy rash) Decrease lighting-photophobia may cause eye rubbing and corneal abrasion

47. Mumps Viral infection Vaccine available 2 nd “M” in MMR Transmitted by direct contact of saliva and respiratory droplet Communicable immediately before swelling begins

48. Symptoms Fever, HA, M, Anorexia, x 24 hours, earache aggravated by chewing On 3 rd day: parotitis (enlarged parotid gland), unilateral or bilateral, pain, tenderness

49. Diagnosis and Management Diagnosis by classic presentation, serum antibody testing 1 month after infection Treatment: analgesics for pain antipyretics Isolation Bed rest Soft diet Cold compress to neck

50. Chikungunya

51. dengue fever

52. SWINE FLU

53. Roseola Viral infection No vaccine available Transmitted most likely by contact with saliva Disease of younger children, rarely affects children >3 years Communicability unknown, but believed NOT to be communicable once rash appears

54. Symptoms Persistent high fever for 3-4 days in a child who appears well Then drop in fever to normal => rash appears rose-pink macules first on trunk, spread to neck, face, extremities, not itchy, lasts 1-2 days

55. Roseola

56. Diagnosis and Management Diagnosis is made based on classis rash and symptoms, serum testing available antipyretics, analgesics, isolation not necessary May result in fetal death if woman is infected during pregnancy. Since fever is very high can have febrile seizures

57. A common viral infection in young children that may cause high fever and a rash. Roseola is a generally mild infection caused by two strains of herpes virus. It's common, usually affecting children by age two. It occasionally affects adults. Symptoms include several days of high fever, followed by a rash. The rash may appear as many small, pink spots. Treatment includes bed rest, fluids and medication to reduce fever.

58. Bacterial Infections

59. Diphteria Bacterial infection Vaccine available “D” in Dtap Transmitted by direct contact with respiratory secretions,droplet, contaminated objects Communicable 2-4 weeks=highly contagious

60. Symptoms yellow nasal discharge may have epitaxis sore throat hoarseness with cough enlarged lymph nodes low grade fever increase pulse malaise laryngeal involvement: potential airway obstruction=serious for the very young

61. Diagnosis and Management Diagnosed by culture of discharge strict isolation abx (PCN) complete BR trach if obstructed airway suctioning

62. Pertussis (whooping cough) Bacterial infection Vaccine available “P” in Dtap Transmitted by direct contact, droplet Communicable for up to 4 weeks

63. Symptoms Begins with URI symptoms: dry, hacking cough that becomes severe, worse at night ** short, rapid coughs followed by sudden inspiration and whooping** Cheeks flush, eyes bulge, tongue protrudes Thick secretions, often vomits Sick for 4-6 weeks www.whoopingcough.net for sound and video

64. Diagnosis and Management Diagnosed by classic presentation Treatment: hospitalization for infants or children who are dehydrated BR increase fluids abx Suctioning Humidifier Observe for airway obstruction (restlessness, retractions, cyanosis)

65. Scarlet fever Bacterial infection (strep), often sequela to strep throat No vaccine available Transmission by direct contact, droplet Communicable for 10 days to 2 weeks

66. Scarlet fever

67. Symptoms Abrupt high fever Very high pulse, Vomit, HA, Maliase, chills, abd. Pain tonsils enlarged: (edematous, red, covered with patches of white exudate). First 1-2 days tongue is coated with papules, is also red & swollen = “white strawberry tongue”

68. By 4 th or 5 th day white coat sloughs off leaving prominent papillae = “red strawberry tongue” Rash: red, pin head sized lesions, rash is intense in folds and joints, flushed cheeks

69. Diagnosis and Management Diagnosis + TC, ASO titer Management: respiratory isolation x 24 hours full course of PCN/EES analgesics for sore throat

70. Fifth’s Disease Parvovirus (HPV B19) No vaccine available Transmitted by probable respiratory secretions Easily Communicable up to 14 days after infection

71. Fifth’s Disease

72. Symptoms Classic rash of erythema on face (cheeks), “slapped face appearance” High fever, lethargy, n/v, abd. Pain, cervical lympadnopathy

73. Symptoms Followed with maculopapular red spots appear in 1 week, symmetrically on upper and lower extremities has a lace-like appearance rash subsides, but reappears if skin is irritated (sun, heat, cold)

74. Management Explain the stages of rash development to parents. The immune-competent child can return to school or daycare once the body rash has appeared

75. Lets Play a Game….

76. Practice Questions!

77. ? Which of the following statements indicates that a parent understands the treatment for his/her child who has fifth? (Select All That Apply) 1. “I will give antibiotic for the full 10 days ” 2. “No antibiotic is needed, as this is a viral infection.” 3. “I will apply antibiotic cream to her rash twice a day.” 4. “My child can go back to school when the body rash appears”. 5. “If my child had the vaccine, she wouldn’t have go gotten sick”

78. Fill in the Blank The nurse is explaining the vaccine schedule to a parent of a newborn. The nurse evaluates parental understanding if the parent states the child will need _____ DPT vaccines by age 24 months.

79. A mother brings her infant to the pediatrician because the baby has had a high fever for 3 days and then developed a rash. The nurse examines the baby to find light pink macules on trunk, neck, face, and extremities. The nurse suspects the baby has: 1. Rubeola 2. Rubella 3. Roseola 4. Scarlet Fever

80. If a 2 year old child was fully immunized or “up to date”, the child has a very low chance of getting which infection: (Select All that Apply) Diptheria Varicella Roseola Pertussis Rubella