Infectious Disease 2018: "Housekeeping" (03:01)
Barbara Bancroft welcomes participants. She presents quiz questions about the amount of fecal matter deposited on underwear over 24 hours and the most contaminated stalls in public bathrooms.
Handwashing is the most important aspect of infectious disease prevention and control. Hand sanitizers must be 60% alcohol. Using soap and water is just as effective, and more effective for Norovirus and C. difficile. Single patient rooms reduce hospital acquired infection risk.
Pathogen Lifespan (08:48)
See how long viruses and bacteria can live on inanimate objects. Learn about managing Legionnaire's disease and C. diff, including using robots to disinfect hospital rooms.
Herpes Simplex Virus (04:47)
Herpes lives 45 minutes on a toilet seat. Bancroft tells a humorous story from nursing school about deciphering a patient's North Carolina accent.
Toilet Aerosolization (02:36)
Flushing sprays droplets throughout bathrooms. SARS, Adenovirus, Norovirus, flu, C. diff, cholera, shigella, salmonella, E. coli, Hepatitis A and B, and coxsackie virus are transmitted via feces.
Bancroft discusses the importance of immunizing against preventable childhood diseases. Learn about the history of immunizations, including eradicating smallpox.
TB cases have increased since the 1980s due to immunodeficiency in HIV patients. Learn about transmission routes and risk factors.
TNF-alpha Inhibitors (04:23)
Hear why patients with autoimmune diseases must be tested for TB before going on monoclonal antibodies that inhibit tumor necrosis factor alpha.
Diagnosing TB (03:56)
Learn about tuberculosis symptoms. Sputum exams are only 50% accurate. The Mantoux test is for immunocompromised patients. The IGRA is for BCG-vaccinated patients.
Vaccine Success Stories (03:21)
Invasive H. flu meningitis cases have reduced. Children receive 49 doses of 14 vaccines by age six. In the future, immunizations may be administered via shampoo or nano needles in Band Aids.
Vaccine Myths and Recommendations (07:08)
Bancroft cites statistics of parents that believe the MMR vaccine causes autism and relates a toddler death from measles. Adults should receive tetanus and diphtheria boosters every ten years. Pregnant women should receive the Tdap to protect infants against pertussis.
Meningococcal Disease (07:03)
Learn about epidemiology, risk factors, vaccines, and treatment options for meningococcal meningitis exposure. See examples of meningococcemia complications, including DIC.
Travel Vaccine Recommendations (01:19)
Bancroft recommends checking with the health department for immunizations six weeks before traveling to developing countries.
Shingles and Shingrix (06:06)
Learn about herpes zoster risk factors and symptoms. The old vaccine, Zostavax, is 51% effective and cannot be given to immunocompromised patients. Shingrix is 97% effective and is administered in two shots.
Flu Vaccine (12:02)
Children are highly contagious and should be vaccinated before elderly people. Hear why most flu viruses come from China. The CDC develops new vaccines annually; a universal flu vaccine is under development. Learn about viral cell function and mutation.
Shifts and Pandemics (04:21)
There have been six flu pandemics in 300 years. Learn about the Spanish flu, Avian flu, and Swine flu, including public health interventions.
Gardasil-9 Vaccine (12:27)
Learn about a new vaccine against HPV types causing genital warts and cancer. Adolescents should be vaccinated before becoming sexually active. Oral HPV cancers are rising faster than cervical cancer. Bancroft discusses sexual practices relating to HPV risk.
Emerging Pathogens (03:41)
We are increasingly exposed to existing pathogens through environmental changes. Health changes include aging, immunosuppression, and antibiotic use. Bacterial mutations with deleted genes and pathogens exchanging genetic information are more toxic.
Parvovirus B19 (01:23)
The virus known as "fifth disease" or "slapped cheek" in children can cause migratory arthritis in older adults and aplastic crisis in patients with hemolytic anemia.
Legionnaire's Disease (04:42)
The bacteria causing respiratory symptoms are spread via plumbing, water, and air conditioning systems. Bancroft recommends cleaning shower heads and humidifiers regularly. Learn about unusual pneumonia symptoms.
Lyme Disease (10:20)
Over 300,000 Americans contract tick-borne illnesses annually. Learn about the spirochete bacteria, transmission route, risk factors, geographic area, symptoms, and treatment options.
Human Immunodeficiency Virus (16:06)
Thirty-seven million people live with AIDS globally; 17 million are undiagnosed. Hear how the disease developed and spread from Africa to the U.S. via Haiti. Bancroft discusses risk factors, prevention and treatment programs, and a gene mutation protecting Scandinavians from HIV.
Helicobacter pylori and PUD (03:57)
H. pylori is transmitted via contaminated water systems and is a major cause of gastric cancer. Bancroft discusses past and current peptic ulcer disease treatments.
GABHS Mutations (05:00)
Group A beta hemolytic strep complications include acute post-streptococcal glomerulonephritis, rheumatic heart disease, necrotizing fasciitis, STSS, and PANS. Learn about PANS symptoms mimicking autism in children. The condition is curable with Intravenous immunoglobulin.
Necrotizing Fasciitis (03:12)
Fournier's gangrene can develop in IV drug users injecting into the dorsal vein of the penis or in diabetic patients on SGLT2 inhibitors like canagliflozin/Invokana.
Staphylococcal TSS vs. Streptococcal TSS (05:36)
Bancroft discusses the "tampon wars" and cases of toxic shock syndrome due to staphylococcal bacteria in the early 1980s. She distinguishes this from streptococcal toxic shock.
Cat Bites (01:16)
Cats carry Pasteurella multocida that can lead to necrotizing fasciitis; deep puncture wounds should be treated with antibiotics.
Hepatitis C (11:42)
The most common chronic blood-borne infection worldwide accounts for nearly 50% of chronic liver disease cases. Bancroft's brother was diagnosed after forty years and cured with Harvoni. She discusses transmission routes, CDC testing guidelines, and treatment options.
West Nile Virus (02:30)
The mosquito-borne illness also affects birds and horses. After a two week incubation period, flu-like symptoms develop and can lead to encephalitis.
Severe Acute Respiratory Syndrome (04:52)
The corona virus mutation originated among bats in the Guangdong Province. Learn about airborne outbreaks in Hong Kong and Toronto. Bancroft relates a humorous story about an advertisement campaign for Hong Kong's tourist industry.
Ebola Viral Disease (02:14)
Learn about outbreaks in 2014 and 2018, including transmission routes. The virus triggers an immune response damaging the vascular system, resulting in hypovolemic shock and hemorrhaging.
Zika Virus (04:07)
Bancroft discusses the disease's epidemiology, microcephaly complications, transmission routes, and prevention measures. The same properties that affect fetal development may be used to treat glioblastoma multiforme stem cell brain tumors.
Seven Trends in Infectious Disease (01:50)
Bancroft will discuss increased global warming, food-borne illnesses, zoonoses, immunocompromised patient populations, STIs, overuse of antibiotics, and bioterrorism threats.
Global Warming and Mosquitoes (07:25)
Mosquitoes are traveling farther from the equator. Hear an overview of malaria, dengue fever, and chikungunya. A West Nile Virus outbreak occurred in an Illinois cemetery; larvae bred in flower vases. Hear tips for avoiding being bitten.
Global Travel and Infectious Disease (06:11)
See top Canadian and U.S. airports for disease transmission. Traveler's diarrhea is usually caused by coliform bacteria or salmonella typhi; prophylactic antibiotics are only recommended for immunocompromised patients. Bancroft advises against drinking water in airplane bathrooms.
Global Economics and Infectious Disease (01:10)
Asian tiger mosquitoes hiding in a shipment of used tires from Southeast Asia caused a dengue fever outbreak in Texas in 1985.
Food-borne Illnesses (09:02)
Pathogen sources include imported produce, food handlers using improper handwashing techniques, "factory farms," and food processing plants. See how many pathogens it takes to become sick from common food-borne diseases. Hear about passengers contracting cholera on a long-haul flight.
Top Five Food-Borne Pathogens (04:58)
Norovirus, Salmonella, Clostridium perfringens, Campylobacter spp, and Staphylococcus aureus account for 91% of food-borne illness. Salmonella from unpasteurized eggs is the leading cause of food borne death. Bancroft discusses a bioterrorism case in an Oregon salad bar.
The food-borne pathogen is common among cruise ships, nursing homes, and restaurants. Food handlers and healthcare workers should stay home four days after symptoms subside.
E. Coli 0157:H7 (05:46)
Shiga-toxin producing E. coli is the third most deadly pathogen and can cause acute renal failure in children. Bancroft discusses a 1993 Jack-in-the-Box outbreak and cautions against prescribing Imodium before determining the cause of diarrhea. Spinach, sprouts, and lettuce are carriers.
Listeria Monocytogenes (02:37)
Bancroft references "The Jungle" that led to meat processing regulations. Listeria thrives in anaerobic environments, including shrink-wrapped deli items and blue cheese. Pregnant women, young children and the elderly are at high risk.
Pets and Zoonoses (05:26)
Puppies can carry Campylobacter jejuni, which causes diarrhea in humans. Hear why not to let dogs lick your mouth.
Toxoplasmosis Gondii (04:03)
The parasite reproduces in the feline gastrointestinal tract and relies on its host to eat infected mice. It can cause birth defects and cognitive disability; pregnant women should avoid contact with litter boxes. However, contaminated meat is the primarily transmission source.
Pets and Salmonella (05:02)
Exotic pets, including iguanas, frogs, turtles, lizards, hamsters, snakes, can cause Salmonella sepsis in children under age five. Bancroft relates a case where a family put an iguana in a baby's crib; the baby died.
Increased Population of Immunocompromised Patients (01:14)
Bancroft outlines increased rates of diabetes, HIV, cancer, and transplants; increased corticosteroid use; and an increased elderly population.
Historic Sexually Transmitted Infections (04:23)
One fifth of France had syphilis in the 17th century. Bancroft discusses medieval mercury treatments and Gabriel Fallopius' attempt to make a condom.
Sexually Transmitted Infections Today (04:01)
See a list of current STIs; healthcare providers use contact tracing and expedited partner therapy. "Natural feel" condoms only prevent pregnancy; latex condoms protect against disease. Circumcision reduces HPV, HSV-2 and HIV acquisition rates.
STI Incidence in Baby Boomers (02:53)
Syphilis and chlamydia are increasing among retirement communities due to Viagra use. The Sexual Revolution started when penicillin became available to treat syphilis, fifteen years prior to the birth control pill.
Hospital-Acquired Infections (03:08)
One in twenty-five patients acquire antibiotic-resistant "superbugs," including MRSA, C. difficile, VRE and CRE. Risks of blood transfusion-related infections are very low.
C. Difficile (09:56)
Fluoroquinolones are commonly associated with C. diff, but any antibiotics can trigger it. Other risk factors include exposure to CD patients and taking proton-pump inhibitors. Learn about vancomycin and fecal transplant treatment modes. Bancroft discusses her mother’s C. diff experience.
Methicillin Resistant Staphylococcus Aureus (02:28)
MRSA primarily infects the skin, lungs, bloodstream, urinary tract, and surgical sites. Bancroft discusses risk factors and intervention measures.
Antibiotic Stewardship (03:10)
Healthcare professionals should avoid using antibiotics when appropriate and use strategies optimizing which antibiotic to use, how much to give, and appropriate route. See optimal antibiotic duration in common infections and ways to minimize antibiotic need.
Healthcare professionals should be suspicious of common disease "clusterings" or of a few cases of an uncommon disease. Public health departments should have a plan in case of attack.
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