EMERGING ILLNESSES http://www.irgc.org/IMG/pdf/Emerging_Infectious_Diseases_Fineberg_and_Wilson-2.

pdf An emerging infection is one that is newly recognized as occurring in humans newly appearing in a different population than previously affected, (though previously recognized) is newly affecting many more individuals, or has evolved new attributes. Perhaps it would be more precise to describe these as emerging, reemerging, and recrudescing infections. From the risk point of view, all are relevant. Emerging infections in humans tend to be caused by microbes that are established in vertebrate animals and have crossed the species barrier to infect humans. Such animal to human transmission is termed a zoonotic infection or zoonosis. Wildlife (e.g., bats, nonhuman primates) and food animals (e.g., poultry, swine, and cattle) have been sources of zoonoses. Infections described as emerging recently are caused by many classes of agents (bacteria, fungi, protozoa, helminths, prions, viruses) and have many different routes of transmission. The most prominent emerging pathogens globally have been viruses that spread from person to person, typically by inhalation, sexual exposure, or direct contact to mucous membranes (e.g., HIV/AIDS, SARS, influenza viruses. Infectious disease deaths globally by mode of transmission include: person to person 65%; food/water/soil 22%; insect/vector 13%; directly from animal <1%. Once an infection has occurred in a human, in order for the infection to be maintained or to spread in the population, the infectious organism must reproduce (in new hosts) faster than it dies out (in already infected hosts). Epidemiologists characterize this basic reproductive rate (R0) in numerical terms, where R0 must exceed a value of 1.0 for an infectious outbreak to spread. In general, four features influence the value of R0: (1) The intrinsic infectiousness of the organism; (2) The duration of the infectious period in an infected individual; (3) The number in the population who are susceptible to infection; (4) The extent of mixing between those infected and those susceptible. These elements are useful in that they help characterize what has changed to produce an emerging infection and point to opportunities to interdict the spread of disease, i.e., to prevent or mitigate the risk. A key feature that determines how controllable an infection will be is the duration of infectivity in the absence of overt symptoms (e.g., HIV-infected persons often have long periods without symptoms when they can transmit the virus).

The emergence of infectious diseases: human, animal, environmental dimension Human factors that contribute to emerging infection include such elements as behavior and lifestyle, mobility (travel and immigration), and economic and technologic conditions of living. The size of the human population and density of habitation also affect emerging infections. Environmental factors range from soil and vegetation, weather and season, longer-term climate change, and local conditions such as altitude, temperature, humidity that influence animal and vector populations. Animal factors include geographic range, legal and illegal trade in domesticated animals and wildlife, biodiversity, predator/prey balance, habitat, and animal health. Particularly telling are the drivers that occur at the intersections of the three core dimensions: at the human-animal interface, for example, factors such as industrial food production [see Pew Commission, 2008] wildlife management, animal husbandry practices, live animal markets, food preferences (bush meat), and human encroachment on animal habitat. At the human-environment interface appear such factors as urbanization and crowding, the nature of the built environment (window screens), water and waste management, and non-animal farming practices. At the animal environment interface are such factors as conditions for reproduction and survival of disease vectors, and expansion or loss of species range

SARS - Severe acute respiratory syndrome Severe acute respiratory syndrome (SARS) is an emerging, viral respiratory illness that seems to be transmitted primarily through close human-to-human contact, such as through coughing and sneezing. In general, SARS begins with a high fever. Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the onset and may develop a dry cough and most patients develop pneumonia. Currently, there is no definitive test to identify SARS during the early phase of the illness, which complicates diagnosis. Furthermore, there is no specific treatment for SARS. SARS was first reported in Asia in February 2003. PATHOPHYSIOLOGY OF SARSPredisposingFacto http://www.scribd.com/doc/54575438/SARS-Pathophysio#download Pathophysiology http://bestpractice.bmj.com/best-practice/monograph/904/basics/pathophysiology.html SARS coronavirus (SARS-CoV) is transmitted primarily through droplets, entering the human body via the respiratory tract mucosa and causing viraemia. Angiotensin-converting enzyme 2 (ACE2) has been identified as a functional receptor for SARS-CoV. The incubation period is 2 to 10 days and the risk of transmission is greater during the second week of illness, which correlates with the timing of peak viral load. The possibility of fomite transmission and airborne transmission cannot be excluded, although the role of faecal-oral or faecal-respiratory spread seems to be of minor importance. Although each SARS case is expected to infect 2 to 4 people, it is thought that, in the pandemic of 2002-2003, a small number of infected individuals were responsible for a disproportionate number of transmissions in socalled 'superspreading events', and that it was through this mechanism that the SARS outbreak disseminated globally. There are 3 phases in the course of the disease: viral replication, inflammatory pneumonitis, and pulmonary fibrosis. Pathological findings of the lungs include diffuse alveolar damage, desquamation of pneumocytes, hyaline membrane formation, and inflammatory infiltrates. The longer the course of the disease, the more extensive the fibrous organisation of the lung tissue.

Clinical deterioration in some patients during the third week of illness, despite a fall in viral load, suggests that immune dysregulation may play a role. Furthermore, the HLA-B*4601 haplotype has been associated with the severity of SARS infection, suggesting the existence of a genetic predisposition.

Avian Influenza (Bird Flu) http://www.cdc.gov/flu/avian/gen-info/facts.htm Avian influenza is an infection caused by avian (bird) influenza (flu) A viruses. This influenza A viruses occur naturally among birds.Most avian influenza viruses do not cause disease in humans. However, some are zoonotic, meaning that they can infect humans and cause disease. The most well known example is the avian influenza subtype H5N1 viruses currently circulating in poultry in parts of Asia and northeast Africa, which have caused human disease and deaths since 1997. Most of these cases have resulted from people having direct or close contact with H5N1-infected poultry or H5N1contaminated surfaces. Of the few avian influenza viruses that have crossed the species barrier to infect humans, HPAI H5N1 has caused the largest number of detected cases of severe disease and death in humans. The HPAI H5N1 virus does not infect humans easily, and if a person is infected, it is very difficult for the virus to spread to another person. Pathophysiology of Avian Flu http://emedicine.medscape.com/article/219557-overview#a0104 Pathophysiology HPAI H5N1 virus binds to receptors with sialic acids bound to galactose by alpha-2,3 linkages, which are primarily, but not entirely, distributed in the human lower-respiratory tract. Such receptors have also been reported in the human gastrointestinal tract. Furthermore, specific structural conformation, not just receptor binding affinity, may be important in binding to receptors in the upperrespiratory tract. H5N1 virus obtained from human clinical samples with the ability to bind upperrespiratory tract tissue has also been reported. High and prolonged HPAI H5N1 viral replication in the lower respiratory tract induces pro-inflammatory cytokines and chemokines, resulting in pulmonary capillary leak, diffuse alveolar damage, and acute lung injury, and can lead to development of ARDS. HPAI H5N1 viraemia has been reported in fatal cases, and dissemination of HPAI H5N1 virus to infect brain tissue, isolation from cerebrospinal fluid, gastrointestinal infection, and vertical transmission to infect placenta and fetal lung cells have been documented. Reactive haemophagocytosis has also been reported. Avian influenza A viruses, including HPAI H5N1 virus, can potentially be transmitted to humans through different modalities.

Direct or close exposure to infected sick or dead poultry or poultry products is thought to be the major risk for transmission of avian influenza A viruses to humans. Inhalation of aerosolised material (e.g., poultry faeces) containing infectious HPAI H5N1 virus is a likely route of transmission from poultry to humans.

Self-inoculation of the mucous membranes after direct contact with material containing HPAI H5N1 virus (touching or cleaning infected birds) or indirect (fomite) contact transmission from surfaces contaminated with poultry faeces or products containing HPAI H5N1 virus to mucous membranes has also been hypothesised.

Consumption of uncooked poultry products, including blood from infected birds, has been identified as a potential risk factor in field investigations, but whether transmission can occur by primary HPAI H5N1 virus infection of the human gastrointestinal tract is unknown.

Multiple Injuries http://www.scribd.com/doc/64956488/Multiple-Injuries Description - Is a physical injury or wound thats inflicted by an external or violent act; it may be intentional or unintentional; involve injuriesto more than one body area or organ Etiology Weapons Automobile collision Physical confrontation Falls Unnatural occurrence to the body *Type of trauma which determines the extent of injury Blunt trauma leaves the body intact Penetrating trauma disrupts the body surface Perforating trauma leaves entrance and exit Pathophysiology - A physical injury can create tissue damage caused by stressand strain on surrounding tissue which results to infection, pain ,swelling and potential compartment syndrome or it can be lifethreatening if it affects a highly vascular or vital organ