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Objectives

Understand pathophysiology and management of pulmonary TB and AIDS Understand how common infectious disease are transmitted Discuss the appropriate measures to prevent cross infection

Dr. Shamay Ng (18 Oct 2012)

Form 2 groups Each group discuss about (30 minutes):

y Pathophysiology y Clinical picture y Transmission of disease y Prevention P ti of f disease di

On both Tuberculosis and AIDS Write down the answer (in point form) onto the board

Pathophysiology of TB

Inhalation of aerosolized droplets from coughing and sneezing of TB patients Once droplet (containing tubercle bacillus) reaches the alveoli, it start to multiply Within 2 t Withi to 10 weeks, k th the t tubercle b l b bacilli illi are walled ll d off ff by macrophages Latent TB infection developed Tubercle bacillus break free from the wall and reproduce quickly if the bodys immune system is weakened, and becomes Active TB disease

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Clinical Pictures of TB

Transmission of TB

Coughing lasting more than 3 weeks Weight loss and loss of appetite Fever and chills Sputum with blood-stained Fatigue Chest pain, occasionally Swollen lymph node

Droplets from infected patient through talking, laughing, coughing, sneezing, and singing Air-borne in nature TB are NOT spread by:
y y y y

Sharing dishes and utensils Using towels and linens Handling food Toilet seat

Diagnosis of TB

Tuberculin Skin Test

Tuberculin skin test (TST): +ve reaction CXR: cavities Sputum culture: 3 specimen on 3 different days Acid-fast bacilli (AFB) sputum smear

Injection of tuberculin or purified protein derivative (from M. Tuberculosis bacterium) under the skin Measure delayed-type hypersensitivity reactions Degree of reaction is observed 42-78 hours after injection
patient status HIV+ +ve result > 5mm

Healthy individuals >10mm with exposure history Healthy individuals with no exposure history >15mm

TB is caused by germs called bacteria.

Quiz - Question 1
TB

is caused by germs called bacteria.

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

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TB is caused by germs called bacteria.

Quiz - Question 1
TB

Quiz - Question 2
TB

is caused by germs called bacteria. TRUE

is spread from one person to another through the air.

Answer:

y TB is caused by bacteria called Mycobacterium

tuberculosis.

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

Information from: State Hygiene Laboratory at the university of Iowa

Quiz - Question 2
TB

Quiz - Question 3
Everyone

is spread from one person to another through the air. Answer: TRUE
TB bac bacteria e aa are e pu put into o the ea air when e a pe person so with

should get tested for TB.

active TB disease of the lungs or throat coughs, laughs, sings, or sneezes. People nearby may breathe in these bacteria and become infected.

TRUE

FALSE

You

cannot get TB from:

Sharing foods and drinks, smoking, kissing, sharing

toothbrushes, shaking hands, touching bed linens or toilet seats.

Information from: State Hygiene Laboratory at the university of Iowa Information from: State Hygiene Laboratory at the university of Iowa

Quiz - Question 3
Everyone

Quiz - Question 4
Everyone

should get tested for TB. Answer: FALSE

y Not all people need a TB test. You should get a

who gets infected with TB bacteria will get sick.

TB test t t if you are at t increased i d risk. i k

y Conditions with higher risks: You have spent time with a person known to have active TB disease or suspected to have active TB disease (Clinical Placement) You have HIV You have signs and symptoms of active TB disease
Information from: State Hygiene Laboratory at the university of Iowa

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

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Quiz - Question 4
Everyone

Quiz - Question 5
Some

who gets infected with TB bacteria will get sick. Answer: FALSE
y People who become infected infected, but are not sick

people can get TB easier than others.

have what is called latent TB infection. People who have latent TB infection do not have any symptoms, and cannot spread TB to others. But, some people with latent TB infection go on to get TB disease.
Information from: State Hygiene Laboratory at the university of Iowa

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

Quiz - Question 5
Some

Quiz - Question 6
TB

people can get TB easier than others. Answer: TRUE

Anyone can get TB disease, but some people who get infected with TB germs are more likely to get sick. You have a higher chance of getting TB disease if you:
Have HIV infection. Have been infected with TB germs in the last 2 years. Have other health problems, like diabetes.

disease can be cured.

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

Information from: State Hygiene Laboratory at the university of Iowa

Quiz - Question 6
TB

Quiz - Question 7
TB

disease can be cured. TRUE

can affect other parts of the body aside from the lungs.

Answer:

TB disease can almost always be cured with medicine. But the medicine must be taken as the doctor or nurse tells you.

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

Information from: State Hygiene Laboratory at the university of Iowa

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Quiz - Question 7
TB

Quiz - Question 8
TB

can affect other parts of the body aside from the lungs. TRUE

infection and TB disease are the same.

Answer: A

y TB usually affects the lungs but it can spread

to other body parts like the kidneys, spine, and brain. TB living in other parts of the body usually cannot be spread to other persons.

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

Information from: State Hygiene Laboratory at the university of Iowa

Quiz - Question 8
TB Answer:

Quiz - Question 9
TB

infection and TB disease are the same. FALSE

y TB infection and TB disease are not the same. TB infection is a condition in which TB bacteria are alive, but inactive in the body. People with latent TB infection have no symptoms, cannot spread TB germs to others, and usually have a positive TB test. TB disease is an illness in which TB bacteria are growing and attacking the body. People with TB disease have symptoms and feel sick. A person with TB disease can spread TB germs to others, and usually has a positive TB test.
Information from: State Hygiene Laboratory at the university of Iowa

bacteria have a difficult time living in fresh air and sunlight.

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

Quiz - Question 9
TB

Quiz - Question 10
If

bacteria have a difficult time living in fresh air and sunlight. TRUE

you have a TB infection, you may have to take medicine even if you dont feel sick.

Answer: A

y Fresh air and sunlight make it harder for TB

bacteria to stay alive. Fresh air scatters the bacteria and sunlight kills them.

TRUE

FALSE

Information from: State Hygiene Laboratory at the university of Iowa

Information from: State Hygiene Laboratory at the university of Iowa

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Quiz - Question 10
If

you have a TB infection, you may have to take medicine even if you dont feel sick. TRUE

Answer: A

y If you have TB infection you may have to take

medicine even if you feel fine to make sure that you do not get TB disease.

Information from: State Hygiene Laboratory at the university of Iowa

Pathophysiology of AIDS

Mode of Transmission

Retrovirus bind to CD4 molecule of T-lymphocytes Virus penetrates the cell wall and initiates a cycle of viral replication within the cell

Sexual contact y Oral, vaginal and anal sex Blood y Via blood transfusion or needle sharing Mother to child y Pregnant woman to fetus y Via breast milk

Seversity of immune system damage is measured by absolute CD4 lymphocyte count

If a person infected with HIV has a CD4 count less than 200, they are said to have AIDS

Prevention of AIDS

Summary Table on the HIV/AIDS Situation

The Quarter (Apr to Jun 2010) HIV 1. Sex Male Female 2. Ethnicity Chinese 66 39 12 4 3088 1561 886 255 Non-Chinese 74 31 13 3 3724 925 975 166 AIDS Cumulative HIV AIDS

Safe Sex Do not use intravenous drugs HIV +ve test persons should not donate blood, plasma, body organs Mother having HIV +ve test should not breastfeed her baby

Information from: Visual AIDS Office, Hong Kong Department of Heath, The Government, Hong Kong (SAR), 2007

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Cont
The Quarter (Apr to Jun 2010) HIV 3. Route of Transmission Heterosexual Contacts Homosexual Contacts Bisexual Contacts Injecting Drug Use Blood/ Blood Product Recipants Perinatal Undetermined Total: 33 31 7 4 0 1 29 105 8 5 1 0 0 0 2 16 2054 1217 188 288 79 25 798 4649 700 239 45 46 24 7 80 1141 AIDS Cumulative HIV AIDS

The Meaning of Red Ribbon

The Red Ribbon:

y The international symbol of HIV and AIDS

awareness.

Creation:
y in New York,1991. y by the Visual AIDS Artist Caucus. The group was inspired by the yellow ribbons honoring soldiers serving in the war. The color red was chosen as it represents the color of blood, passion, anger and love.

Information from: Visual AIDS Office, Hong Kong Department of Heath, The Government, Hong Kong (SAR), 2007

Quiz - Question 1
Q: A:

What is HIV?

Human Immunodeficiency Virus (HIV) is the virus that causes AIDS.

Information from: Hong Kong AIDS Information Network

Quiz - Question 2

Quiz - Question 3
Q:

Q: What is AIDS? A: Acquired Immune Deficiency

Do people with HIV have AIDS?

A: NO! However, HIV can remain

Syndrome S d i is a t terminal i l ill illness caused d by HIV in which the virus destroys a persons ability to fight disease leaving him or her vulnerable to a wide range of infections and cancers.
Information from: Hong Kong AIDS Information Network

dormant in the body for several years before some unknown factors trigger the infections associated with AIDS.

Information from: Hong Kong AIDS Information Network

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Quiz - Question 4
Q:

Quiz - Question 5
Q:

Do people with HIV always look sick?

How is HIV spread?

A: NO! The median incubation period

for adult can be as long as 10 years. During this period, most of those infected feel fit and well without obvious symptoms.

A: HIV is mostly transmitted through the

exchange of semen and blood blood. The most common ways of transmission are: Sexual Intercourse, sharing of contaminated needles, passing HIV from Infected mother to her infant.
Information from: Hong Kong AIDS Information Network

Information from: Hong Kong AIDS Information Network

Quiz - Question 6
Q: A:

Quiz - Question 7
Q:

Is HIV spread by mosquitoes?

Is donating blood safe?

NO! They will digest the blood that they took from their victims, not to inject it into another human being.

A: YES! In Hong Kong all blood

donating equipment is sterile and used once only, so there is no risk to the donor of infection with HIV.

Information from: Hong Kong AIDS Information Network

Information from: Hong Kong AIDS Information Network

Quiz - Question 8
Q:

Quiz - Question 9
Q:

Do animals have AIDS?

A: Not exactly. Animals might have

Is there a vaccination against HIV infection?

A: NO! Currently there is no vaccine

viruses similar to HIV which cause diseases comparable to AIDS among those animals. However, none of these viruses can be transmitted to human beings.

available for HIV/AIDS.

Information from: Hong Kong AIDS Information Network

Information from: Hong Kong AIDS Information Network

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Quiz - Question 10
Q:

Quiz - Question 11
Q:

What is Window Period?

Is condom effective in preventing AIDS?

A: For people with infection of HIV, the

A: YES! Currently condom, when

antibodies will be generated only after 3 weeks to 6 months of infection. During this window period, people will test negative no matter which his/her status should be.

used properly, is an effective mean of prevention against sexual transmission of HIV.

Information from: Hong Kong AIDS Information Network

Information from: Hong Kong AIDS Information Network

Quiz - Question 12
Q:

What are high risk sexual behaviors?

A: Anal, vaginal or even oral sex without

condom (active or passive) and Blood contact of any kind can be considered as high risk sexual behaviors.

Click the link below for further information: http://hkaids.med.cuhk.edu.hk/edu/

Information from: Hong Kong AIDS Information Network

1. How would you minimize the risks of cross infection?

2. Personal Protective Equipment

Having knowledge of infectivity of disease Taking appropriate precautions for all patients Following guidelines setting by hospitals Patients education Washing hands after treating every patient Being fit and healthy

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3. Mode of Transmission of TB:

4. Do HIV / AIDS patients need to be nursed in isolation?

Which substances are known to transmit HIV? Blood Vaginal ag a sec secretion e o Breast milk

Inhalation of aerosolized droplets from coughing and sneezing of TB patients Only patients with AFB +ve in sputum smear is highly infectious Prolonged exposure to infectious environment is necessary for infection to occur Patients with AFB +ve in sputum smear is considered as non-infectious after having completed 2 weeks of chemotherapy includes rifampicin.

Which substances are known to be potentially risky in transmitting HIV?

Which substances are known to be low risky in transmitting HIV?

Cerebrospinal fluid Synovial fluid Peritoneal fluid Pleural fluid Pericardial fluid HIV patients may need Reverse-Isolation because of low body resistance

Sputum sweat Faeces Nasal secretion Tears Urine Vomitus

If they do not carry visible blood

5. Specific precautions to minimize the risk of HIV cross infection?

Video 1
Video

Personal Protective Equipment

y y y y y y y y

Surgical Mask (or N95) Protective glasses Face shield (optional) Gown Hair cover Shoe cover Gloves Proper dressing if having any open wound

showing the appropriate sequence in putting on/off of Personal Protective Equipment (PPE)

Source:

http://www.youtube.com/watch?v=iHB bWLYpCuU&feature=related

Follow guidelines set by hospitals Washing hands properly

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Video 2
Video

: Patient education on tuberculosis

Source:

http://www.youtube.com/watch?v=Jty X694ubio

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