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Chapter 12

HLTB21H3 Chapter Notes - Chapter 12: African Trypanosomiasis, Iceberg, Lyme Disease


Department
Health Studies
Course Code
HLTB21H3
Professor
C.Barkat
Chapter
12

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HLTA01: Plagues and People- Chapter 1+2 Notes
Legionnaires Disease
Peter Turner, WW2 veteran, 65 years old he attended an American legion convention in Philadelphia
He stayed 2 days at the Bellevue-Stratford hotel and 2 days later fell ill. He had: high fever, chills,
headache, muscle aches and pains and thought it was just a summer cold. Few days later his symptoms
got worse: dry cough, chest pains shortness of breath, diareahha. Within a week his lungs filled with
fluid and pus and he died of pneumonia. 221 Legionnaires became ill and turner and 33 other died of
pneumonia. The disease quickly gained public attention, because nobody really knew the cause of it.
Few people attended the funerals of those who died of it because there was a fear they would contract
it.
Studies showed that all who became ill spent more time in the lobby of the Bellevue Stratford hotel. Air
was the probable pathway of spread of the disease. The infection resulted from the aspiration of
bacteria called Legionella in air conditioners. Infections caused by aspiration are produced by choking.
Secretions in mouth gets past choking reflex and instead of going into the esophagus and stomach
mistakenly enter the lungs. Mechanisms that normally prevent aspiration are defective in old people,
smokers and people with lung disease: legionnaires were perfect candidates. There have been many
reports of the disease since the Philadelphia outbreak. Fatality rate is 15% and it can be linked to water
heaters. Whirlpool baths, respiratory therapy equipment and ultra sonic misters used in grocery stores.
Toxic Shock Syndrome (TSS)
Mary Benton, grad student and TA at UCLA, 24 years old
Found herself doubling over in pain every time she went to the bathroom, but she was healthy and
active and thought it was just and infection from overeating. Her symptoms became worse; she had a
headache, nausea, chills, vomiting. Her temperature was very high indicating a fever and her blood
pressure had dropped to 84/50. Her heart rate also went up to 178 beats a minute. She also had
conjunctivitis in both eyes and a red rash on her thighs that spread to her face abdomen and arms. Her
chest x-ray was normal but she had a discharge coming from her vagina.
Oxygen, IV and antibiotics were of no help and Mary died of multiorgan failure- hepatitis, renal
insufficiency, low BP, internal blood clots. Cultures from blood, urine and stools, were negative but the
tests for the vaginal sample contained the bacterium; staphylococcus aureus.
People thought TSS could be transmitted as an STD. The disease continued to affect previously healthy
young women in the US. TSS is a gender specific disease, from 1979-1996 it affected 5296 women,
median age 22, with a peak death rate of 4%. But it was found out not to be an STD. It was actually
linked to the used of certain tampons, especially those super absorbent ones containing cross linked
carboxymethyl cellulose with polyester foam. High vaginal temperature and neutral pH, both of which
occur during menses were enhanced by the super absorbent tampons and provided a favourable
environment for the toxin producing, S. Aureus. Tampons also obstruct flow of blood and may cause
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reflux of blood and bacteria back into the vagina. By the late 1980’s these tampons were taken off the
market and the number of deaths from TSS dropped dramatically.
Severe Acute Respiratory Syndrome (SARS)
2003 outbreak began in February, when a 64 year old Chinese physician was working in a hospital in
Guangdong province in southern china. He travelled to Hong Kong to attend a wedding and became ill.
He had a fever, dry cough, sore throat and a headache. Unconcerned he went to sightsee and shop with
his brother in-law in Hong Kong but during that day his condition worsened, he was taken to intensive
care and put on antibiotics anti-inflammatory and oxygen. The tests came back negative for
Legionnaires, tuberculosis and influenza. Nothing could help and he suffered respiratory failure and
died.
Three days later the brother in-law who was with him for only 10 hours suffered the same symptoms
and was hospitalized. All measures failed and he died 3 weeks later. Later more cases of SARS continued
to come up. With the nurse who had seen the physician, and a 72 year old Chinese Canadian business
man who had returned to Hong Kong for a family reunion. He stayed in the same hotel as the physician
and on the same floor as the physician and ultimately carried SARS back to Canada. The next was the
nurse of the physicians’ brother in law and the rest were visitors or nurses in the hospital. Total of 10
cases, 4 died, 6 survived
Over the next 4 months the survivors of SARS sowed the seeds of the infection that led to more than
8000 cases and 800 deaths in 27 countries across all continents.
Typhoid Fever
Mary Mallon, Irish immigrant to the United States, called Typhoid Mary. In 1906 she worked as a cook
for a wealthy New York banker, Charles Henry Warren and his family. The family rented a house in
Oyster Bay, Long Island from Mr. George Thompson. That summer 6 of 11 people in the house came
down with typhoid fever cause by the germ- Salmonella enteric server Typhi. Mrs. Warren, 2 daughters,
2 maids and a gardener.
Mr. Thompson was worried he wouldn’t be able to rent his house out sp he hired George Soper a
sanitary engineer to find the source of the epidemic. His search led him to Mary Mallon. Mary was a
healthy carrier of the typhoid germs. Although she was unaffected by the disease which causes
headache, diarrhea loss of energy fever and in 10% of cases death, she could still spread it to others.
When Soper tried to confront Mary to tell her what she was doing, she tried to attack him with a carving
knife. Mary was a threat to public health and when the test from her feces came back it was positive for
typhoid bacteria. Mary was held at the Riverside Hospital for 3 years and then allowed to go free as long
as she remained in contact with the health department and did not engage in food prep. She
disappeared and she took employment at the Sloane Maternity Hospital as a cook under the name Mrs.
Brown. She spread the typhoid to 25 others (doctors and nurses etc.) and then was taken back to the
hospital where she lived for the rest of her life.
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