This document discusses communicable diseases that commonly affect the elderly population. It summarizes that geriatrics refers to healthcare for elderly people, noting that the elderly population is growing rapidly. Some common communicable diseases that impact the elderly include pneumonia, influenza, herpes zoster, urinary tract infections, and gastrointestinal infections such as H. pylori and C. difficile infections. Prevention strategies include vaccination, hygiene practices, and early treatment of infections to prevent worsening and spread.

2. It is the specialty of medicine that
focuses on health care of elderly
people.
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3. 6 million (7.3% from total population)
At 2030, expected to reach 12% from total population
Male: 3 million Females: 3 million.
Life expectancy: 71 year
Death rate = 58.8% (male: 70y – female: 72y)
Smokers: 10%
Working: 1.1 million (19% of all geriatrics)
Illiterate: 64%
Low socio-economic state: 19.2%
Central Agency for public mobilization and statistics
2014 report
‫واإلحصاء‬ ‫العامة‬ ‫للتعبئة‬ ‫المركزي‬ ‫الجهاز‬
2014

4. Communicable diseases refer to infectious diseases
that can be transmitted and make people ill.
They may be caused by infective agents (pathogens),
e.g. bacteria and viruses, which invade the body and
multiply or release toxins to cause damages to normal
body cells and their functions. In severe cases, they
may lead to death.

5.  Pneumonia.
 Influenza .
 Herpes zoster .
 Urinary Tract Infection .
 GIT infections ( H.Pylori – C.Difficile)
Also there are other diseases like:
 Subcutaneous tissue infections
 Acute infectious conjunctivitis

6. 1- Personal hygiene
2- Hand hygiene in situations.
3- Respiratory hygiene and cough manners
4- Skin care
5- Environmental hygiene
6- Food safety and hygiene
7- Vaccination of residents and staff
Key in management of CD is:
• Medical surveillance,
• Early treatment,
• Good prevention of spread.
So,

7. Mode of Infection: Air born infection
IP: 1- 3 days
Age : older adults mostly in winter and spring
Suscebility :
1. Weakened immune system
2. Living conditions : as elderly not move to much they are more
likely to develop influenza.
3. Chronic illnesses : i.e: asthma, increase risk of complications.
4. Genetic risk factors
5. Obesity: increased complications risk in BMI ≤ 40

8. Clinical picture :
1. Headache
2. Cough
3. Sudden onset of fever
4. Generalized body aches
5. Sore throat,
6. nasal congestion
7. possibly runny nose
Influenza

9. Investigations : -
1. Nasopharyngeal or nasal swab
2. Viral culture
3. Serology
4. Rapid antigen testing
5. Reverse transcription polymerase chain reaction
6. (RT-PCR)
Influenza

10. Prevalence and Mortality :
 The traditional method for assessing the severity of
influenza seasons is to estimate the associated
increase in pneumonia and influenza (P&I)
mortality.
In a study conducted from 1970 till end of 1995:
Persons aged <65 years had:
 57% of all influenza-related hospitalizations:
 90% of influenza- deaths
Influenza

11. Prevention and control :
In addition to the general measures there are:
Immunoprophylaxis with vaccine:
 - Inactivated (i.e., killed virus) influenza vaccine and
 - live attenuated influenza vaccine.
Chemoprophylaxis (antiviral agents):
 Oseltamivir and Zanamivir
 Amantadine ( CNS side effects)
 Rimantadineare
Daily dose of should not exceed 100mg
Influenza

12. What is pneumonia?
 Pneumonia is an infection that inflames the air sacs
in one or both lungs. The air sacs may fill with fluid
or pus, causing cough with phlegm or pus, fever,
chills, and difficulty breathing.
Etiology
The most common pathogen is Streptococcus
pneumoniae, although atypical and Gram-negative
bacilli play an important role.

13. Incidence:
 Globally: 25–44 cases per 1000 persons. (WHO)
 In the United States:
 600,000 are hospitalized every year.
Mortality rates
 ranging from 10 to 30% in those aged 65 years or older.
CAP
Epidemiology

14.  Community-acquired pneumonia:
 Bacteria – viral- fungi .
 Hospital-acquired pneumonia
 Health care pneumonia
 Aspiration pneumonia
CAP
Mode of Infection

15. People older than age 65:
lower normal body temperature.
sudden changes in mental awareness.
CAP
Clinical Picture:

16. Treatment of CAP
 Antibiotics are the main line
 as beta-lactam , fluoroquinolones and macrolides.
Prevention :
1. Vaccination : pneumococcal polysaccharides vaccine
2. Chemoprophylaxis: for those who are at high risk for
influenza
CAP
Prevention & Control

17. Mode Of Infection & IP
The virus is spread through direct contact with fluid
from the rash blisters caused by shingles.
A person with active shingles can spread the virus
when the rash is in the blister-phase

18. :Susceptibility
 Once the illness resolves, the virus remains latent in
the dorsal root ganglia.
 VZV can reactive later in a person’s life and cause a
painful, maculopapular rash called Herpes.
 Most people typically have only one episode of
herpes zoster in their lifetime. However, second and
even third episodes are possible.
HZ

19. Rash :
 Trunk (most common site)
 Painful and itchy
 It develops into clusters of clear vesicles, then these
vesicles continue to form over three to five days and
progressively dry and crust over. They usually heal in
two to four weeks.
Some people may also have:
Headache
Photophobia
HZ
Clinical Picture

20.  Direct fluorescent antibody staining of varicella-
zoster virus (VZV)-infected cells in a scraping of cells
from the base of a lesion is rapid, specific, and
sensitive
 PCR more sensetive
 Serologic methods: IgM.. IgG
 Tzanck smears of lesion specimens are inexpensive
and can be performed at bedside, although they do
not distinguish between VZV and herpes simplex
HZ
Diagnosis

21. Vaccination
• in 1974 a live attenuated varicella-zoster vaccine is
developed by isolating VZV from a child with varicella
and passing the isolate in human embryonic lung
fibroblasts and guinea pig embryo cells.
• Vaccine efficacy :∼85%–90% protection
• Many countries have licensed the vaccine for the
prevention of varicella. beside 25 states in the US.
• In the United States, >20 million doses have been
administered, and VZV epidemic curves have been
reduced in regions where the vaccine is accepted
HZ
Prevention & Control

22. live attenuated varicella virus
 It’s given in two doses 4-8 weeks apart. SC injection.
 The antibodies persist for 9 years , booster doses are
effective.
Varicella zoster immunoglobulins (VZIG)
 prepared from plasma of normal donors are
effective in modifying or preventing the disease if
given within 72 hours to 96 hours after exposure
HZ

23. It occurs when bacteria in the bladder or kidney multiplies in
the urine. It gets more serious if left un-treated.
 UTIs can lead to acute or chronic kidney infections, which
could permanently damage the kidneys and even lead to
renal failure.
Prevalence: About 8.3 million doctor visits each year.

24. Infection of the bladder (cystitis).
 This type of UTI is usually caused by Escherichia coli
(E. coli), which come from the GIT.
Infection of the urethra (urethritis):
 Which may come from the skin.
UTIs are thought to be much more common in women
because the urethra is shorter in women than in men,
giving bacteria-which live in the rectal area and also on
a person's skin-an easier route into the body.
Causes and Symptoms
UTI

25.  Change in behavior
 Urinary incontinence
 Half of all women will develop a urinary tract
infection in their lifetimes
Warning Signs!
UTI

26. UTIs are easy to cure. But,
if left untreated can cause
sepsis, a potentially life-
threatening infection of the
bloodstream.
UTI

27.  "A bladder infection places stress on the body,"
That stress can result in confusion and abrupt
changes in behavior in older adults with an elderly
urinary tract infection. And for people suffering
from Parkinson's disease, Alzheimer's disease, or
other dementia, "any kind of stress, physical or
emotional, will often make dementia temporarily
worse
UTI

28.  Home Test: A dipstick is held in the urine stream.
 Ultrasound Exam - Ultrasoudns can help evaluate
bladder and kidney problems
 X-ray
 CAT Scan: A CAT scan provides a detailed three-
dimensional picture of the urinary tract.
 Simple urine alysis can confirm the infection.
 Culture
Diagnosis
UTI

29. Antibiotics are the first choice of treatment.
for mild cases:
 Ciprofloxacin (Cipro),Levofloxacin (Levaquin)
 Cephalexin (Keflex) ,Ceftriaxone (Rocephin)
 Azithromycin, Doxycycline
Severe infection
 For a severe UTI, you may need treatment with
intravenous antibiotics in a hospital.
Treatment
UTI

30.  Hormone replacement therapy (HRT for women
after menopause due to less estrogen that protect
them from rising UTI.
 must drink plenty of fluids to flush the bacteria from
their systems. Proper fluid intake makes it harder
for bacteria to live and multiply in the urinary tract.
 Drink cranberry juice.
Prevention & Control
UTI

31. Age-related changes to digestion and gastrointestinal flora
put elderly at increased risk of developing gastrointestinal
infections.
Two of the most common are:-
 Helicobacter pylori.
 Clostridium difficile
Susceptibility:
 Epidemiological elements,
 immunosenescence,
 malnutrition,
 Ageing

32. H. pylori infection Is the major risk factor for developing
 Chronic gastritis and Peptic ulcer
 Gastric mucosa-associated lymphoid tissue lymphoma and GC.
 Moreover, interesting there is a clinical association between H.
pylori infection and extra-digestive disorders which are
particularly frequent in older people.

C. difficile infection can cause a spectrum of manifestations
 C. difficile–associated diarrhea (CDAD): Watery diarrhea Colitis
 Other manifestations include: lower abdominal pain, cramping,
low-grade fever, nausea, anorexia, leukocytosis
Clinical picture:
GIT Infec

33. H. pylori infection:
 can be achieved with invasive or noninvasive techniques.
 Invasive tests (histology, culture, and rapid urease test) need
upper gastrointestinal endoscopy and biopsy material for tests
 noninvasive techniques [C-urea breath test (UBT), stool
antigen test, and serological blood test] use other methods.

C. difficile infection:
 It is suspected in patients with clinically significant diarrhea
 The diagnosis is established via a positive laboratory stool
test for C. difficile toxins or C. difficile toxin gene.
Diagnosis:
GIT Infec

34. H. pylori :
The triple therapy regimens including:
 PPI, Clarithromycin and Amoxicillin or Metronidazole for H. pylori infection
In older people, this regimen has also been reported as effective and safe for
the treatment of H. pylori infection, AS:
 Reduces symptomatology, ulcer recurrences ,activity of chronic gastritis
and prevent progression of pathological changes of the gastric mucosa as
well as NSAID-related gastroduodenal damage.
 PPI-based triple therapy regimens are highly effective and well tolerated in
old age, especially if a short duration (one-week) and low dosages of the
drugs are used.
 ‘Do elderly people need to have their H. pylori treated?‘
Evidence Based Medicine says : “YES”
Treatment:
GIT Infec

35. C.Difficle:
Doctors typically prescribe a 10- to 14-day course of one of the
following oral antibiotics: Metronidazole, Dificid, Vancocin
 Flagyl is usually tried first. Improvement usually happens within 72
hours after starting antibiotics, but the diarrhea may return
temporarily.
 Another round of antibiotics is needed in about 25% of cases.
In addition to prescribed medications, treatment may include:
 Pro-biotics: available over the counter. Simply, it’s made of useful
gut bacteria to avoid C. diff. infection recurrence.
 Fluids. IV or fluids to avoid dehydration.
Treatment:
GIT Infec

36. Rehydration – oral and sometimes intravenous
 For many cases of bacterial gastroenteritis, only symptomatic treatment
(for fever, diarrhea…) is required.
Antibiotics
 may be recommended in particularly severe cases of gastroenteritis, or if a
specific bacteria has been identified as the cause.

Relation to NSAID.s:
 Relationship exists between HP infection and NSAID use in elderly patients
with upper gastrointestinal bleeding as they are associated with a high
incidence of upper gastrointestinal tract bleeding in the elderly with
higher incidence of ulcer complication.
Treatment for GIT infections
GIT Infec