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