AIDS

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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

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AIDS Spectrum

• Infected individuals that appear healthy
• No signs of infection
• Chronic Illness
• Terminal Stage Disease

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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

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Transmission of AIDS

• Transmitted through body fluids
• Tears
• Saliva
• Blood
• Sexual Intercourse
• Mothers Breast Milk
• Homosexuals, IV drug users/infected needles
• Sex with multiple partners
• Blood transfusions
• Organ transplants

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Protection Against AIDS

• UNIVERSAL/STANDARD PRECAUTIONS!!
• Gown, Gloves, Goggles
• Protection from needle sticks
• Never recap needles

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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

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Opportunistic Infections

• Kaposis Sarcoma
• Cancer of skin spreading to other sites (lungs
  GI)
• Tuberculosis
• Fungal Infections
• Mucosal tongue Candidiasis
• Fungal Pneumonias (Pneumocystis Carinii)
• Eye infections
• Cervical Cancers

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Treatment

• Supportive Care
• Oxygen
• Psychological counseling
• Anti-viral agents
• AZT
• Retrovir
• Videx
• Treat individual infections

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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

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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.

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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.

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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.

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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.

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Chest Assessment

• Increased tactile and vocal fremitus
• Dull percussion note
• Crackles/rhonchi
• Pleural friction rub
• Bronchial breath sounds
• Whispered Pectoriloquy
• Bronchophony or Egophony

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Clinical Assessment

• Nonproductive, barking or hacking cough.
• Later, cough becomes productive.
• Hemoptysis
• Purulent
• Painful respirations.
• Pleural is involved.
• Fever sweats
• Weight loss
• Periodontal disease

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Chest X-ray

• Consolidation with single cavity containing an
  air-fluid level.
• Air bronchograms
• Pleural effusions
• Silhouette sign

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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
• Mendelsons Syndrome

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Lipoid Pneumonitis

• Aspiration of oil
• Mineral Oils
• Oils from animal fat

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Avian Flu
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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.

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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)

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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

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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/

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Symptoms of Avian Flu

• Non-specific complaints of fever.
• Cough
• Dyspnea
• Conjunctivitis
• CXR Diffuse infiltrates rare pleural effusions.
• Lab Leukopenia

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Treatment for Avian Flu

• Supportive
• Antiviral drugs
• amantadine, rimantadine, oseltamivir, and
  zanamivir
• Vaccine
• Flu vaccine not effective

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Swine Flu

• http//www.cdc.gov/h1n1flu/key_facts.htm

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Severe Acute Respiratory Syndrome (SARS)
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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

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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.

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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.

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Diagnostic Testing

• CXR Usually normal initially
• Pulmonary infiltrates as disease progresses
• Lab WBC normal or low

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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