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Chapter 12

Plagues Chapter1 2.docx

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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 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 dise
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