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Zoonosi respiratoria

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aproximación y puntos clave de enfermedades infecciosas trasmitidas por animales

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Zoonosi respiratoria

  1. 1. Zoonosi respiratoria DR. JORDI ROIG Pneumologia
  2. 2. Time present & time past are both perhaps present in time future. And time future is contained in time past. T. S. Eliot The Four Quartets 1936
  3. 3. HIV / AIDS ES UNA ZOONOSI: malaltia transmisible d’animals a l’home en condicions naturals
  4. 4. HEMORRAGIA ALVEOLAR: PERLS
  5. 5. Història dels Virus de la Grip “mutants” Spanish Flu - 1918-19; pigs – influenza A - 20-50 million deaths - WWI Asian Flu - 1957-58; ducks/pigs China – influenza A - 1 million deaths Swine flu - 1976 - pigs – influenza A, 40 million vaccinated, 1 death Avian Flu - 1997-99 - chickens Hong Kong – killed 6 (H5N1); 1.5 million chickens killed
  6. 6. Altres Virus “mutants” Ebola - 1976 – monos a l’ Africa – 900 morts per sagnat HIV - 1980-81- African chimps & monos – 40 million infectats; 25 million morts Nipah virus - 1998-’99 – ratpenats a porcs - Asia – 100 morts en treballadors del porc – no transmissió de persona a persona SARS virus – 2003 – font animal ?
  7. 7. Forma de Transmissió: Associada directament amb Aviram i Animals - China - Time
  8. 8. Contacte Directe amb Animals Infectats Caça & carnisseries
  9. 9. Influenza Epidemics Antigenic drift Neurominidase Hemagglutinin New strains each yr Animal reservoirs New vaccines formulated Highly contagious
  10. 10. Epidèmia de Grip Espanyola “Soldiers returning from the Great War haven’t come back alone. They have brought back a horror that will surpass the battlefields of Europe with its deadliness.” “Rather than threaten the very young and the very old, this flu singles out those between the ages of 15 and 35.”
  11. 11. Epidèmia de Grip Espanyola “Spanish flu kills quickly & inexplicably, sometime within hours. Healthy young go to bed & never wake up…..” “Panic sets in. Services began to falter as employees succumbed to the virus or refuse to come to work. Doctors and nurses are helpless to stem the tide….”
  12. 12. Epidèmia de Grip Espanyola “In October of 1918 in NYC, a steam shovel is used to dig trenches to temporarily bury the bodies of the Spanish Flu victims.” “By the spring of 1919, it is a fading nightmare that has left almost 50 million dead worldwide, more than all of the casualties of the Great War.”
  13. 13. Transmissió Animals a Humans Reservoris Animal Virus Grip Asiàtica Anecs - Porcs ‘57-’58 Ebola Micos ‘76 Grip porcina Porcs ‘76 HIV Micos ‘80-’81 Grip Aviar Pollastres ‘97-’99 Nipah Porcs ‘98-’99 SARS ?? 2003 Grip Espanyola Porcs ’18-’19
  14. 14. Armes Biològiques Anthrax* – spores Smallpox* – virus & vaccine Plague* – bacterial aerosol Viruses: – Hemorrhagic fevers – Ebola virus Q fever Bacteria: – Tularemia – Botulinum toxin
  15. 15. Key Points For all of the biological agents known to have potential for use in bioterrorism: – occur as natural infections – management involves procedures similar to those already used to manage other critically ill patients – most are not transmitted person to person – for the exceptions, established hospital precaution procedures can prevent transmission: smallpox (contact + droplet or airborne precautions) plague pneumonia (droplet precautions) hemorrhagic fever viruses (contact + airborne)
  16. 16. Anthrax Spore outside host & bacillus in host Spores may survive for years in soil Organism present worldwide in soil Host: herbivores - cattle, goats, buffalo Disease in cattle prevented by vaccine Not spread person to person
  17. 17. Anthrax Presentations Cutaneous Gastrointestinal Inhalation
  18. 18. Anthrax Toxin = Virulence Spores on skin, ingested or inhaled Spores germinate to bacilli; capsule Bacilli produce toxin (3 proteins): – PA = protective antigen - binds host cells (ATR) – EF = edema factor inhibits phagocytosis – LF = lethal factor kill macrophages, TNF Vaccine (PA): induces antibodies to PA
  19. 19. Dixon, NEJM, 1999:341:815
  20. 20. Inhaled B. anthracis Disease requires 8,000 - 50,000 spores Incubation period = 1 - 5 days Sx: fever, malaise, dry cough, SOB, sepsis Dx: blood: Gram-stain, Ag & AB Rx cipro, doxy, Pen G + streptomycin Prophylaxis: cipro or doxy x 4 wks Vaccine: 0, 2, 4 wks, 6, 12 &18 mo
  21. 21. Anthrax in Tissue
  22. 22. Lessons from Anthrax: USA Difficult to produce small spores Need to improve diagnostic tests Better vaccines are needed New antitoxin treatments of interest Clinicians should be vigilant Public health improvement
  23. 23. TABLE 1. Symptoms and signs of inhalational anthrax, laboratory-confirmed influenza, and influenza-like illness (ILI) from other causes Inhalational Laboratory-confirmed ILI from Symptom/Sign anthrax (n=10) influenza other causes _____________________________________________________________________ Fever or chills 100% 83%-90% 75%-89% Fatigue/malaise 100% 75%-94% 62%-94% Cough 90% 84%-93% 72%-80% Shortness of breath 80% 6% 6% Chest discomfort or pleuritic chest pain 60% 35% 23% Headache 50% 84%-91% 74%-89% Myalgias 50% 67%-94% 73%-94% Sore throat 20% 64%-84% 64%-84% Rhinorrhea 10% 79% 68% Nausea or vomiting 80% 12% 12% _____________________________________________________________________ Modified from MMWR November 9, 2001
  24. 24. Pneumonic Plague: Yersinia pestis Pneumonia Bacterial Aerosols in Subways, Buildings, or Airplanes
  25. 25. Plague - Y. pestis ID/IP: 100-500 orgs; 2-3 days Sx: fever, bloody sputum, pn, sepsis Dx: blood, sputum GS, Ag, culture, AB Rx: Gent + doxy Prophylaxis: doxy, Tetracyclines Vaccine: inactivated 0, 1 & 6 mo Precautions: droplet
  26. 26. History of Bacterial Plague AD 54 - 1st plague: Egypt, Europe, Asia, 50-60% of the population died 1346 - 2nd plague: Black Death – 20-30 million deaths - 1/3 of Europeans 1855 - 3rd plague: China & India 12 million deaths
  27. 27. Types of Plague: Y. pestis Enzooic infection of rodents: flea vector Bubonic - skin lesion (bubo) with spread to bloodstream or flea bite with Y. pestis Pneumonic - inhaled bacterial aerosol or infected respiratory droplet secretions
  28. 28. Prairie Dog - Y. pestis Reservoir
  29. 29. Plague as a Biological Weapon Perhaps the most serious BW Capacity for mass production Aerosol = pneumonic plague High fatality rate Secondary spread from secretions
  30. 30. Signs: Plague Pneumonia IP = 2-4 days; acute onset of “flu” Signs & symptoms: The Patient – fever >101o F, cough, bloody/watery sputum – breathing rapidly – nausea, vomiting & diarrhea Pneumonia & shock Rapidly progressive
  31. 31. Viral Hemorrhagic Fevers Hemorrhagic fevers & Ebola, Marburg Intestinal hemorrhage, MOF IP = 7d; fever, N&V, malaise & headache with raised rash over entire body Ebola: person-to-person contact Similar Hantavirus No Rx: mortality = 80%-90%
  32. 32. Brucellosis - Brucella spp. 10-100 organisms, IP 5->60 days Sx: fever, pn, jt, cardiac or respiratory sx Dx: blood, BM, serology & culture Rx: doxy + rifampin or TMP-SMX Prophylaxis: doxy + rif x 3 wks Vaccine: none Precautions: standand or contact
  33. 33. Tularemia - F. tularensis ID/IP: 10-50 orgs: 2-10 days Sx: ulceroglandular, typhoidal, pneumonia Dx: blood, sputum, culture, serology Rx: gentam. Prophylaxis: doxy or Tetracyclines Vaccine: inactivated single dose Precautions: standard
  34. 34. Q Fever - Coxiella burnetii ID/IP: 1-10 orgs: 10-40 days Sx: fever, headache, myalgia, chest pains, neurologic, skin, LFTs, FUO Dx: EIA or serology Rx: Tetrac., macrolides, or quinolones Prophylaxis: doxy or Tetrac. Vaccine: investigational in USA
  35. 35. - Produced by ingestion or inhalation of one of seven serologically distinct types of botulinum toxin, groups A-G - Clinical illness characterized by symmetrical cranial neuropathies and (often) dilated pupils, followed by symmetric descending flaccid paralysis - No fever or sensory abnormalities - DTRs reduced or absent - Differential Dx includes Guillain-Barre syndrome, myasthenia gravis, tick paralysis BOTULISM
  36. 36. - Incubation period 1-5 days - Not transmitted person-to-person - standard precautions in hospitalized patients - Supportive care, possible mechanical ventilation (2-3 months) - Prompt administration of trivalent equine botulinum antitoxin (types A, B and E) - Antitoxin not known to be effective after exposure but before symptoms BOTULISM
  37. 37. Claus anamnesi Psitacosi: ocells, esplenomegàlia FQ: boví, citolisi hepàtica Leptospira: rosegadors + aigüa, conjuntivitis hemorr., ictericia
  38. 38. Claus anamnesi Febre botonosa: garrapates, taca negra, rash palmoplantar, gossos Tularèmia: caça, conills, lesió pell Brucella: febre sudoral àlgica, llet ovelles i cabres no controlada
  39. 39. MENJADOR DE CARGOLS CRUS
  40. 40. MISSATGES El que no sap el que busca no entén el que troba Globalització: viatges, immigrants Història epidemiològica es bàsica –Animals, laboral, hobbies

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