ify'>Q fever is caused by the bacteria Coxiella burnetii and is carried by dairy animals such as sheep and cattle.  Risk factors include working on farms or meat packing plants, or drinking unpasteurized milk.  Disease can be asymptomatic or present with flu-like illness that can lead to high fever, sore throat, cough, sweats, vomiting, diarrhea, and generalized pain.  Chronic cases are similar to chronic fatigue syndrome.  Diagnosis is made by antibody tests.  Treatment is with tetracycline type drugs. 

 

Congenital rubella

Rubella infection in a pregnant woman during the first trimester may have devastating effects on the fetus in utero and after delivery.  The incidence of stillbirths and spontaneous abortions is increased.  Infants born with rubella may have any of the following: cataracts or glaucoma, congenital heart defects, hearing loss, purpura (purple bruises), jaundice, a large spleen, a small head, mental retardation, meningitis, and bone disease.  Diagnosis is by isolating the virus or by antibody tests.  There is no therapy for the disease.  Infants can remain infectious for up to a year and should be isolated for that long unless they have repeated negative cultures any time after 3 months of age. 

 

Salmonellosis

Infection by any of the Salmonella species of bacteria is termed salmonellosis.  The bacteria infect humans and animals, usually causing a diarrheal illness.  It is passed by the fecal oral route or through ingesting infected animal products such as meat and dairy.  It is also commonly carried by reptiles, so having pets such as lizards and turtles is a risk factor.  It is a common cause of food poisoning.  Illness usually consists of fever, abdominal cramps, and diarrhea 12-72 hours after consuming the infectious agent.  Most people recover without treatment in less than a week.  In some cases the infection spreads into the bloodstream, which can be fatal if untreated.  Some patients later on develop painful joints, irritated eyes, and painful urination, known as Reiter’s syndrome.  Diagnosis is by stool culture or by blood culture in invasive disease.  Invasive disease can be treated with a multitude of antibiotics such as ampicillin and gentamycin.  Prevention is through good hygiene and cooking food thoroughly. 

 

Shigellosis

This is caused by bacteria of the genus Shigella, the most common of which are Shigella sonnei, S flexneri, and S dysenteriae, which causes dysentery.  It is passed by the fecal-oral route and is a common cause of food poisoning.  Symptoms include diarrhea that is usually bloody, fever, and stomach cramps starting within 2 days of exposure.  Children less than 2 years can also develop seizures with infection.  Diagnosis depends on stool culture.  Treatment is with a variety of antibiotics.  Antidiarrheal agents generally make the illness worse.  A small proportion of those infected with S flexneri will develop Reiter’s syndrome (painful joints and eyes, and painful urination).  Prevention is good hygiene. 

 

Resistant Staph aureus

The bacteria Staphylococcus aureus used to be highly susceptible to antibiotics such as penicillin and methcillin.  Resistance has now developed to these and other drugs, posing a greater threat to those infected with the bacteria.  Invasive infections with staph include septicemia (infection in the blood), osteomyelitis (infection in the bone), arthritis, endocarditis (infection of the heart valves), and pneumonia.  Staph can also cause food poisoning and toxic shock syndrome (discussed elsewhere).  The most well known resistant strain is methicillin resistant Staph aureus (MRSA), which requires treatment with vancomycin.  A very few cases of vancomycin resistant disease (VRSA) have been described.  The only drug shown to be affective against these cases is a new drug called linezolid.  Patients with resistant disease must be isolated. 

 

Syphilis

Syphilis is caused by the bacteria Treponema pallidum and is transmitted sexually.  Disease is divided up into several stages.  Primary syphilis is characterized by a painless chancre (ulcer type lesion) at the site of infection, usually the genitalia.  Secondary syphilis usually manifests as a diffuse rash and swollen lymph nodes.  Syphilis can present with a wide range of symptoms and is easily mistaken for other diseases.  It used to be termed ‘the great imitator’.  The disease can also remain latent for many years.  Tertiary syphilis can present as neurosyphilis when the central nervous system is infected.  Other manifestations of late syphilis are lesions in the heart, skin (known as gummas), and bone.  A diagnosis can be made by several methods.  The bacteria from the original lesion can be seen on darkfield microscopy or by antibody tests.  Several blood tests for Treponema proteins or antibodies are available.  Treatment is with penicillin G.  All sexual contacts of cases should be referred for care.  Prevention is safe sexual practices. 

 

Tetanus (lockjaw)

Tetanus is caused by the bacteria Clostridium tetani.  Spores of the bacteria are found in the soil.  They can then be introduced into a puncture wound.  The bacteria do not need oxygen to grow.  Symptoms include excitability and generalized muscle spasms particularly of the neck.  Symptoms are due to a neurotoxin released by the bacteria.  Diagnosis can be made by culture but is usually clinical.  Treatment is with tetanus immune globulin or with an equine variety to counter the toxin.  Penicillin G or tetracycline is also given to kill the bacteria.  Prevention involves getting a booster tetanus shot every 10 years. 

 

Tuberculosis

TB is caused by the bacteria Mycobacterium tuberculosis that is spread through the air.  Many people are infected with TB, as seen by a positive PPD test on the skin but no bacteria in the sputum, but a far smaller number actually develop disease.  Those with weakened immune systems are much more likely to develop active disease.  Symptoms are fever, night sweats, weight loss, and cough.  Diagnosis is made by seeing the bacteria on sputum smear and by characteristic lesions on chest X-ray.  Several drugs are used to treat TB although resistance is developing.  The most common drugs are isoniazid, rifampin, ethambutol, and streptomycin.  Drugs must be taken for several months.  Those with evidence of disease even if it is not active should take several months of isoniazid.  Prevention involves using respiratory precautions among infected individuals. 

 

Tularemia

Tularemia is caused by the bacteria Francisella tularensis and is found in a wide variety of animals as well as humans.  It can be transmitted by handling tissues of infected animals, bites of deer flies or ticks, or eating undercooked meat of an infected animal.  It cannot be spread person-to-person.  The most common mode of transmission in this country involves rabbits.  Those at risk are hunters and others who spend a lot of time outdoors or who handle wild animals.  Symptoms start with a skin lesion and swollen lymph nodes.  People may also have GI upset or a pneumonia-like illness.  Treatment is with gentamycin.  To prevent infection, gloves should be worn when handling animals like rabbits.  Protective clothing outdoors is also recommended. 

 

Typhoid fever

Typhoid is caused by the bacteria Salmonella typhi and occurs only in humans.  It is passed by the fecal-oral route.  Some people are carriers of the bacteria but do not suffer disease.  Symptoms include a high fever, loss of appetite, abdominal pain, and rash.  Severe cases can cause bowel obstruction.  Diagnosis is by stool culture.  Therapy includes ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin.  There is a vaccine available for those traveling to endemic countries.  Prevention involves hygienic food preparation. 

 

Waterborne outbreaks

These outbreaks can be caused by many different kinds of organism.  Some of the common causes are giardia, shigella, hepatitis A, and Norwalk-like viruses.  The criteria for this kind of outbreak is 2 or more people must have similar illness after ingestion or exposure to the same water where the evidence points to water as the source of illness[5]. 

 

Class A3

 

Amebiasis

Amebiasis is an intestinal illness caused by Entamoeba histolytica, a parasite found worldwide.  It is mainly found in tropical areas and unsanitary conditions.  It is spread mainly by the fecal-oral route, so through contaminated food or water.  It can be present for weeks to years, and can progress to amebic dysentery, which is characterized by abdominal pain, bloody stools, and fever.  It can be cured with antibiotics. 

 

Botulism (infant or wound)

Botulism is summarized above in Class A1.  Wound botulism is seen most often among IV drug users.  Medical care often involves surgical excision.  Infant botulism is usually caused by the infant ingesting honey.  Infants less than 1 year should not be fed honey.  Infant botulism accounts for 72% of the cases of C botulinum infection. 

 

Brucellosis (undulant fever)

Brucellosis is a bacterial disease, caused by Brucella species, usually spread by contact with livestock or products such as unpasteurized dairy products.  It is not usually passed from person to person.  Symptoms include fever/chills, headache, weakness, swollen lymph nodes, and weight loss.  It is treated with doxycycline and streptomycin or rifampin.  Early treatment can prevent chronic infection. 

 

Campylobacteriosis

This is a disease of any bacteria in the Campylobacter genus, usually C jejuni, and is the most common bacterial cause of diarrhea in the US.  It usually causes intestinal symptoms such as diarrhea, cramping, and fever.  It is especially dangerous to those with compromised immune systems.  Diagnosis is through stool culture.  Most people recover without treatment.  Most outbreaks are due to eating undercooked poultry or drinking contaminated water or milk.  More than half of the raw chicken in this country is contaminated with Campylobacter.  Disease can be prevented with kitchen hygiene. 

 

Chlamydia

Chlamydia trachomatis causes many types of infections.  These include genital infections of the urethra, epididymis, cervix, and fallopian tube, and conjunctivitis and pneumonia in newborns.  It is the most prevalent of all STDs in the US.  Genital infections may be asymptomatic, but may cause irritation and discharge.  They can also progress to pelvic inflammatory disease (PID) with fever/chills and systemic infection.  Neonatal conjunctivitis occurs within 3 weeks of delivery while pneumonia from Chlamydia can occur up to 16 weeks from birth.  Diagnosis is usually made from tissue culture or antibody tests.  DNA amplification tests are also available.  Antibiotic treatment with tetracycline drugs is curative, but reinfection is common.  

 

Creutzfeldt-Jakob disease

CJD is a rare neurological disease usually found in older people.  A new variant of CJD thought to be linked to bovine spongiform encephalopathy (BSE), commonly known as mad cow disease, afflicts younger people and from eating contaminated beef.  Transmission is thought to occur through brain, eye, and spinal cord tissue of affected animals.  The disease is thought to be caused by prions (protease resistant proteins) and not from an infectious etiology.  Person to person transmission has not been seen.  Symptoms include lethargy, decreased concentration, unsteadiness, agitation, dementia, and muscle spasms.  Disease progresses to worsening dementia and ensuing death.  There is not treatment. 

 

Cryptosporidiosis

This is a diarrheal disease caused by Cryptosporidum parvum, a one celled parasite.  The eggs are shed in the stool and are the infectious agent.  Risk includes drinking unfiltered water from rivers, lakes, or streams, and associating with infected persons.   Illness is usually self-limited and includes watery diarrhea, fever, headache, and loss of appetite for 1-2 weeks.  Immunocompromised individuals such as those with HIV or receiving chemotherapy can develop life-threatening illness from Cryptosporidium.  Diagnosis is made from detecting the eggs in stool.  Treatment is usually just supportive.  Prevention includes proper cooking of food and good hygiene.  Only bottled water that is distilled by reverse osmosis is considered free of the eggs. 

 

Congenital cytomegalovirus

Cytomegalovirus (CMV), also known as human (beta) herpesvirus 5, is a very common infection among adults, but can be devastating for a fetus.  Intrauterine infection occurs in 0.5-2% of all births when the mother is infected during pregnancy, and is usually asymptomatic.  Severe disease occurs in 5% of those infants infected in utero.  Symptoms and signs include, lethargy, seizures, jaundice, petechiae, hepatosplenomegaly, intracerebral calcifications, and pulmonary edema.  Infants that survive often have mental retardation, motor dysfunction, hearing loss, and liver disease.  Diagnosis is made from viral culture or serology.  It is usually transmitted in secretions such as saliva, urine, breast milk, and semen.  The efficacy of antiviral therapy is debatable.  Screening pregnant mothers for the virus has not been shown to be beneficial given the virus is shed intermittently, is extremely common, and lab tests are expensive.  There is no vaccine. 

 

Ehrlichiosis

This disease is caused by 2 species of Ehrlichia bacteria transmitted by ticks.  People that spend a lot of time outdoors are at greatest risk.  The disease caused by these bacteria are human monocytic ehrlichiosis (HME) caused by Ehrlichia chaffeensis, and human granulocytic ehrlichiosis (HE) cause by an unnamed Ehrlichia species.  Symptoms include headache, fever/chills, aches, sweating, vomiting, and sometimes a rash.  These occur 7-11 days after a tick bite.  Diagnosis is by antibody assay.  Treatment is tetracycline. 

 

Giardiasis

This is caused by the one celled parasite Giardia lamblia.  It is passed by the fecal-oral route and is commonly contracted from contaminated water sources such as lakes and streams.  Symptoms usually include diarrhea, nausea, and abdominal cramping, although many individuals are asymptomatic.  Therapy is metronidazole.  Prevention includes good hygiene, washing and peeling raw fruit and vegetables, and drinking bottled water when traveling.  If a water source is suspected to be contaminated, it should first be checked for coliform bacteria since specific tests for Giardia are quite expensive. 

 

Gonococcal infection

Commonly known as gonorrhea, this is a sexually transmitted infection caused by the bacteria Neisseria gonorrheae.  Patients may be asymptomatic or may experience pain on urination and/or a thick discharge.  In women the disease can progress to pelvic inflammatory disease and cause pain in the lower abdomen.  Untreated, PID can lead to infertility by scarring of the fallopian tubes.  Diagnosis is made by culture or DNA based tests of the urethral or vaginal discharge.  It can be treated with one injection of the antibiotic ceftriaxone, or with other drugs.  All sexual contacts of the patient within the previous month should be tested and treated.  Prevention involves safe sexual practices. 

 

Hepatitis B

Hepatitis B virus affects the liver.  Many cases resolve on their own, but some persist and cause lifelong infection, cirrhosis (scarring of the liver), liver cancer, all of which can lead to liver failure and death.  Most people do not have acute disease when infected.  Acute infections are similar to hepatitis A (see above).  HBV is spread by blood and body fluids.  Risk factors include unsafe sexual practices, IV drug abuse, and working with blood products.  Diagnosis is made by antibody tests from the blood.  There is no cure for hep B.  There is a vaccine available that all children and adults at risk should receive.  Prevention involves vaccination as well as safe sexual practices and not sharing needles. 

 

Hepatitis C

Hepatitis C virus affects the liver and is spread by contact with an infected person’s blood.  Risk factors include working with blood products, IV drug use, and having received blood transfusions.  It is seldom transmitted sexually.  HCV rarely manifests as an acute illness and most people are unaware they are infected.  HCV is much more likely to cause long term liver damage than HBV.  Of those infected, 70% develop chronic liver disease, 15% develop cirrhosis, and 5% die from complications of the infection.  Diagnosis is by antibody tests.  Treatment is with antiviral drugs such as interferon and ribavirin, although these drugs only provide a cure in 30-40% of patients. 

 

Hepatitis D, Hepatitis E

These are other rare forms of hepatitis.  Not much is known about them.  Hep D exists conjointly with hep B and is spread the same way.  Hep E is spread by the fecal-oral route.  It resembles hep A and has a predilection for pregnant women. 

 

Congenital herpes

Congenital herpes is caused by Herpes simplex virus types I and II, and manifests as several different symptom complexes: 1) disseminated disease involving the liver and other organs, 80% have skin lesions, 2) encephalitis, 60% have skin lesions, and 3) skin and mucosa involvement, 90% have skin lesions.  The virus is isolted from skin lesions, mucous membranes, or spinal fluid.  Transmission to the newborn usually occurs during the birthing process where the mother has active genital lesions.  Thus, Caesarean section is recommended for these women.  There is no cure for HSV.  Infected infants should be placed in isolation and followed closely for a month. 

 

Kawasaki disease (mucocutaneous lymph node syndrome)

This syndrome has no known etiology and is unresponsive to antibiotics.  It consists of fever for more than 5 days, red eyes, redness around the lips and throat, swelling and redness of the extremities, rash, and large lymph nodes in the neck.  Long term complications are coronary artery aneurysm with thrombosis.  Diagnosis is purely clinical.  It is most common in children less than 4 years of age.  It cannot be transmitted person-to-person.  Treatment consists of intravenous immune globulin and aspirin. 

 

Leprosy (Hansen disease)

Leprosy is caused by the bacteria Mycobacterium leprae.  It is a chronic infection that affects the skin and nerves.  There are several manifestations of the disease: 1) tuberculoid, characterized by a few, light colored, anesthetic lesions, 2) lepromatous, characterized by many red nodules mainly on the face, hands, and feet in a symmetrical distribution, 3) borderline, and 4) indeterminate.  Diagnosis is made from identifying the bacteria from skin biopsy.  The disease is only found in humans.  It is not very contagious, and usually is spread by a lot of skin contact or by fomites (inanimate objects).  The disease has a very long incubation period: a person may not develop disease until many years after the exposure.  It is quite rare in the US, and most cases are imported.  Patients with the lepromatous type should be isolated.  Treatment consists of sulfa based drugs. 

 

Leptospirosis

This disease is caused by the bacteria of the genus Leptospira.  It is found worldwide and is caused by ingesting water contaminated with an infected animal’s urine.  Many kinds of animals carry the infection, and it is not passed from person-to-person.  Infection can be asymptomatic or cause a multitude of symptoms such as fever/chills, headache, muscle aches, vomiting, diarrhea, jaundice, and rash.  If left untreated, complications such as kidney or liver failure and meningitis can occur, usually in a relapse episode.  Diagnosis is by blood or urine sample.  Treatment is doxycycline or penicillin.  Prevention involves avoiding possibly contaminated water sources such as lakes and streams. 

 

Lyme disease

Lyme disease is caused by the bacteria Borrelia burgdorferi and is transmitted by the black-legged tick, Ixodes scapularis.  Risk factors include being outdoors, especially in the summer/fall months and in wooded areas.  The illness starts as a circular, red rash around the tick bite that expands in size.  This is accompanied by flu-like symptoms and joint pain and swelling.  If untreated, nerve palsies and heart problems can occur.  Diagnosis is by antibody tests in the blood or spinal fluid.  Treatment is with tetracycline.  Prevention includes wearing protective clothing and insect repellant when outdoors in tall grass or wooded areas.  When removing ticks from the body, it is important to remove the mouthparts attached to the skin.  Removed ticks can be checked for lyme disease by the Ohio dept of health. 

 

Meningitis (other bacterial)

Meningitis can be caused by a multitude of bacteria.  The most dangerous and of greatest public health concern is that caused by Neisseria meningitides, as discussed above.  Cases caused by other kinds of bacteria are also reportable.  The most common of these are Streptococcus pneumoniae and Haemophilus influenzae type B.  See the section on meningococcal disease for symptoms and treatment.  Vaccines are available for H flu type B and for some strains of Strep pneumo. 

 

Other mycobacterial disease

Other types of mycobacteria also cause disease.  The most common is Mycobacterium avium intracellulare (MAI) which causes disease in immunocompromised patients such as those with AIDS.  Disease is similar to MTB.  It is treated with clarithromycin. 

 

Pelvic inflammatory disease (PID)

PID is caused by several different organisms.  The two most common are Neisseria gonorrheae and Chlamydia trachomatis.  The disease results from the organisms spreading from the vagina to the pelvic organs (uterus, fallopian tubes).  Criteria of PID are lower abdominal tenderness, cervical motion tenderness (pain on moving the cervix), and tenderness of the adnexa (ligaments surrounding the fallopian tubes).  Additional signs of PID are high temperature, high white blood count, pus in the lower abdomen, and pelvic abscess.  See gonococcal infection and chlamydia infection for diagnosis, treatment, and prevention.   

 

Reye syndrome

The cause of Reye syndrome is not known.  It usually follows a viral infection such as influenza or varicella (chicken pox).  There is a link between taking aspirin during the viral illness and the development of Reye syndrome.  The syndrome involves vomiting and encephalopathy presenting as an alteration in consciousness that can lead to coma and death.  Liver damage is also present with increases in liver enzymes.  It is a diagnosis of exclusion.  Therapy is directed toward lowering intracranial pressure to decrease brain swelling.  Prevention involves taking antipyretics other than aspirin during viral illnesses. 

 

Rheumatic fever

This is an inflammatory illness that sometimes occurs as a delayed reaction to inadequately treated group A streptococcal infection (strep throat).  It is not communicable.  Major criteria for disease are: carditis, polyarthritis (arthritis in several joints), chorea (uncoordinated movements), subcutaneous nodules, and a rash called erythema marginatum.  Minor criteria that can be seen in rheumatic fever are: joint pain, fever, elevated erythrocyte sedimentation rate (ESR), positive C-reactive protein, or white count, and a prolonged PR interval (and EKG abnormality).  Diagnosis is made clinically.  Treatment is aimed at controlling inflammation and cardiac failure.  This is usually done with aspirin and steroids.  Some patients require prophylaxis with penicillin over the long term. 

 

Rocky mountain spotted fever

This disease is caused by the bacteria Rickettsia rickettsii and is transmitted by the American dog tick, Dermacentor variabilis.  Most cases are in the southern US.  Symptoms start with headache, myalgias, and fever.  A rash then develops, starting on the wrists and ankles spreading to the palms, soles, and trunk.  Diagnosis is by antibody tests in the blood or DNA amplification.  Treatment is tetracycline.  Prevention includes controlling the tick population on dogs and wearing protective clothing outdoors. 

 

Invasive Group A Strep

Group A Strep refers to Streptococcus pyogenes, bacteria commonly found in the mouth and on the skin.  The bacteria become dangerous when they invade other areas of the body such as blood, lungs, spinal fluid, or muscle.  People with chronic illness such as diabetes, lung, or heart problems are at greater risk of developing invasive disease.  Diagnosis is with Gram stain and culture.  Treatment is with penicillin based antibiotics and sometimes surgery.

 

Neonatal Group B Strep

Group B Streptococci are the most common cause of sepsis and meningitis in the newborn population.  It is also a common cause of newborn pneumonia.  One in 20 infected newborns die from the infection.  The infection is usually acquired during childbirth from the mother’s birth canal since many women are asymptomatic carriers of the bacteria.  Diagnosis is made by culture of blood or spinal fluid.  Treatment is IV antibiotics of the penicillin family.  Prevention includes culturing pregnant women at 35-37 weeks gestation.  Infected women should be given intrapartem antibiotics to prevent infection of the newborn. 

 

Invasive Streptococcus pneumoniae

This bacteria causes a multitude of infections: pneumonia, sepsis, ear infections, meningitis, peritonitis (infection in the abdominal cavity), and arthritis.  Invasive disease has a 14% mortality rate.  A vaccine (Pneumovax) has been developed that is effective against 89% of the serotypes causing invasive disease.  It is not effective in infants. 

 

Toxic shock syndrome

TSS can be caused by either group A Streptococci or Staph aureus.  It can occur with any kind of infection but is usually associated with a skin lesion.  In the past it has been associated with use of certain types of tampons.  Disease is characterized by shock and multi-system organ failure.  Early symptoms are high fever, rash, peeling skin on the palms and soles, and hypotension.  Disease is toxin mediated and an organism is not usually found in the blood or spinal fluid.  It is not communicable.  Treatment consists of antibiotics as well as supportive therapy. 

 

Congenital toxoplasmosis

Mothers infected with Toxoplasma gondii early in pregnancy may pass the infection to the fetus.  This can result in a variety of symptoms including encephalitis, chorioretinitis (inflammation of the retina), malformed organs, jaundice, and calcifications in the brain. 

 

Trichinosis

This disease is caused by the larvae of the nematode (type of worm) Trichinella spiralis.  Many types of animals carry the parasite.  Most human infections are from eating undercooked pork.  Most cases are asymptomatic.  Symptomatic cases manifest with gastroenteritis, eyelid swelling, muscle aches, fever/chills, and many eosinophils on a blood smear.  The larvae enter through the digestive tract and then migrate to the muscles.  Diagnosis is confirmed by a muscle biopsy or serologic tests.  There is no treatment.  Steroids may be helpful in severe cases.  Disease is prevented by thoroughly cooking pork. 

 

Typhus (murine typhus, squirrel associated epidemic typhus)

This disease is caused by either Rickettsia prowazekii or Rickettsia typhi transmitted by lice or fleas on mammals such as rats or flying squirrels.  Symptoms include headache, fever, myalgias, and rash that starts on the trunk and spreads outward.  Diagnosis is with serologic blood tests.  Treatment is tetracycline.  Prevention includes avoiding contact with squirrels. 

 

Vancomycin resistant enterococcus

Enterococci are normal inhabitants of the gut.  The drug vancomycin was developed to treat resistant strains of Staphylococcus.  As a result, some strains of enterococcus have become resistant to vancomycin.  Only some patients with VRE actually suffer disease from it.  Patients at risk are those in intensive care settings and those who are immunocompromised.  VRE is also frequently transmitted to health care workers who don’t use contact precautions in the hospital.  The concern is that the vancomycin resistance gene will somehow find its way to Staphylococcus.  This has been shown to happen in the laboratory, and a handful of cases have been described.  The spread of VRE can be contained by improved infection control measures in healthcare facilities. 

 

Varicella (deaths only)

Varicella is better known as chicken pox (discussed later).  Only deaths due to varicella are classified as A3. 

 

Vibriosis

Two kinds of bacteria cause disease in this category: Vibrio parahaemolyticus and Vibrio vulnificus.  V para causes a self-limited gastrointestinal illness.  The bacteria is found in brackish waters in the US and Canada.  Most people are infected by eating raw shellfish, or through an open wound when they are in salt water.  Cultures can be taken from stool, blood, or a wound infected with the organism.  Usually treatment is not necessary.  V vulnificus is very similar to V para except that it occasionally infects the bloodstream and becomes a much more serious disease with 50% mortality.  Treatment is with doxycycline or ceftazidime.  Prevention for both types of disease is thoroughly cooking shellfish. 

 

Yersiniosis

This disease is caused by bacteria from the genus Yersinia.  It is spread by the fecal-oral route and is found among many domestic animals as well as humans.  It causes gastrointestinal symptoms that are usually self limited.  Diagnosis can be made by stool culture.  Antibiotics are usually not used.  Prevention includes good hygiene, especially after handling animals. 

 

Class B diseases

 

Chicken pox

Chicken pox are caused by varicella-zoster virus (VZV).  Humans are the only host.  Transmission is either airborne or through direct contact.  It is usually a disease of children.  Symptoms are a skin eruption of vesicles that are quite itchy.  Fever and malaise may also be present.   Complications include Reye syndrome, pneumonia, arthritis, and aseptic meningitis.  Those infected as older children or adults are more likely to develop complications.  Diagnosis can be made by isolating the virus from the lesions or by antibody tests.  Treatment is symptomatic.  Aspirin should not be used.  Immunity is conferred after one infection.  Cases should be isolated until the 6th day after the rash started or until all the lesions are dry.  There is now a vaccine available. 

 

Genital herpes

Genital herpes is also caused by Herpes simplex virus types I and II and is transmitted sexually.  The virus causes painful genital or anal ulcers.  Primary infections may cause constitutional symptoms and painful lymph nodes.  Diagnosis is made by isolating the virus from the lesion or showing the characteristic cell pattern (multinucleated giant cells) on a smear of the lesion.  The antiviral drug acyclovir is given to control recurrences but is not curative.  Prevention is safe sexual practices. 

 

Influenza

There are 3 influenza viruses: A, B, and C.  It is spread through droplets from secretions.   Cases can vary from asymptomatic to severe.  Usually it causes a respiratory infection with fever/chills, headache, fatigue, and runny nose.  Complications include pneumonia, myositis (muscle inflammation) and Reye syndrome (a post-viral encephalopathy).  Diagnosis is through detection of viral antigen in the nose or through serological tests from the blood.  Treatment is to alleviate symptoms.  Aspirin should not be used since it increases the risk of developing Reye syndrome. 

 

Class C diseases

 

Blastomycosis

This is caused by the fungus Blastomyces dermatitidis that is found in soil in much of the northeastern US.  Infection occurs through the respiratory tract.  It can cause a mild respiratory disease as well as granulomas in skin and bone.  Diagnosis is by tissue biopsy.  Treatment is with itraconazole or amphotericin B.  There are no means of prevention. 

 

Acute Conjunctivitis

Conjunctivitis is inflammation of the mucosa surrounding the eye, often resulting in irritation and discharge.  It is commonly known as pink eye.  It can be caused by a variety of organisms such as viruses, bacteria, fungi, or environmental allergens.  Treatment depends on the causative agent. 

 

Histoplasmosis (reticuloendothelial cytomycosis, cavern disease, Darling’s disease)

Histoplasma capsulatum is a fungus that grows in the soil as well as animals and humans.  It is commonly found in caves or areas of bat and bird excreta, mainly in the Mississippi  and Ohio river valleys.  Most infections are asymptomatic.  If symptoms occur, they resemble the flu.  A chronic pulmonary form can develop which is similar to tuberculosis.  In people with compromised immunity a disseminated form can develop.  This is characterized by an enlarged liver and spleen, pneumonia, and fever, among other things.  Diagnosis is either through culture of the organism or through antibody tests.  Antifungal drugs are effective against the chronic cases.  Prevention is difficult since it is so pervasive in endemic areas. 

 

Nosocomial infections

Nosocomial infections are infections acquired while a patient is admitted to the hospital or a healthcare facility.  The rate of nosocomial infections can reflect an institution’s effectiveness at infection control.  Common infections include pneumonia, urinary tract infections, and gastroenteritis. 

 

Pediculosis (lice)

There are several kinds of lice that affect humans. Pediculus humanus capitis is the head louse, Pediculus humanus corporis is the body louse, and Pthirus pubis is the pubic or crab louse.  Head lice cause itching of the scalp and are found mainly among young school children.  Head lice do not transmit diseases.  Body lice are found only in populations with very poor hygiene.  They cause a rash of itchy, red bumps in the affected area and have been known to transmit other diseases such as typhus and relapsing fever.  Pubic lice or “crabs” infest coarsely haired parts of the body, and may cause bluish lesions on the trunk and limbs.  They are usually spread by sexual contact and are not known to transmit diseases.  Diagnosis is made by finding the nits or eggs in the hair.  The infected individual can be treated with one of several products: lindane preparations, synergized natural pyrethrins, and synthetic pyrethrins.  All contacts of the infested person should be examined.  The last step is to achieve environmental control by cleaning all clothes, bedding, and other objects contacted by the patient in the last 48 hours.  In Ohio, a person with lice is excluded from school or child care until they have begun treatment with a pediculicide. 

 

Scabies

Scabies is a skin disease caused by mites that burrow into the skin.  This causes itchy, pimple-like lesions and burrows, usually occurring in the finger web spaces, armpits, genitalia, and buttocks.  The mites are transmitted from skin-to-skin contact or through infected clothing or bedding.  Diagnosis is by microscopic analysis of skin scrapings.  Treatment is with prescription creams containing lindane, permethrin, pyrethrin, or crotamiton.  Infected clothing and bedding should be washed in hot water and/or sealed in a container for over a week.  Fumigating the home is not necessary.  Prevention involves wearing latex gloves whenever coming into contact with an infected person or their belongings. 

 

Sporotrichosis

Sporothrix schenckii is a fungus that lives on plants.  When it enters the skin, usually from a thorn, it causes a pustule or ulcer and regional swollen lymph nodes.  Diagnosis is from clinical history or tissue specimens.  Treatment is itraconazole.  It is commonly known as rose gardener’s disease.  It can be prevented by wearing gloves while handling plants. 

 

Staph skin infection

Staphylococcus aureus is a major cause of skin infections.  These include furuncles (pimples and boils), impetigo (crusty lesions on the face), cellulitis, and wound infections.  The bacteria is commonly found on the skin, and thus any break in the skin predisposes to infection.  Diagnosis is by Gram stain or culture.  Treatment is with a variety of antibiotics. 

 

Toxoplasmosis

This disease is caused by the one-celled parasite, Toxoplasma gondii.  Many people are infected, but most are asymptomatic.  Illness develops mainly in those who are immunocompromised.  Toxoplasmosis can be transmitted by any contact with cat feces, by eating infected meat, or by organ transplantation.  Pregnant women who are newly infected with Toxoplasma can pass the infection to the fetus, which may result in mental retardation and other physical problems.  Symptoms in adults usually resemble the flu.  In the immunocompromised, toxo can cause serious damage to the eyes and brain.  Several types of tests are available for diagnosis.  Treatment is with antibiotics.  Immunocompromised people and pregnant women should limit contact with cats to prevent infection. 

 

Other outbreaks not categorized in A, B, or C. 

Self-explanatory.  Unrecognized diseases would fall into this category. 

 

Conclusion

There are many, many diseases that are reportable in Ohio.  This provides a summary of how the reporting system works, the reasoning behind it, and brief information about each of the reportable diseases. 

 

References:

Recommendations and Reports: Mandatory Reporting of Infectious Diseases by Clinicians,  Morbidity and Mortality Weekly Report, June 22, 1990 / 39(RR-9):1-11, 16-17.

 

Centers for Disease Control and Prevention.  Summary of notifiable diseases, United States, 2001.  MMWR 2001; 50(no,53), pp. 2-3.

 

Surveillance for foodborne-disease outbreaks – U.S., 1988-1992, Oct. 25, 1996. MMWR 1996; 45[SS-5]

 

“Surveillance for waterborne-disease outbreaks – US, 1995-1996”, MMWR Dec. 11, 1998; 47(SS-5).

 

Levinson W, Jawetz E,  Medical Microbiology and Immunology 6th ed, Lange Medical Books/McGraw-Hill, New York, 2000. 

 

www.odh.state.oh.us/resources/publications

            Infectious Disease Control Manual (IDCM)

 

www.odh.state.oh.us/data/inf_dis/idann/idsum02/02idsum1.htm

            2002 Annual Summary of Infectious Diseases, Ohio

 

www.who.int/csr  -  Communicable Disease Surveillance and Response, WHO

 

http://www.cdc.gov/ncidod/osr/index.htm

National center for infectious disease: infectious disease surveillance

http://www.cdc.gov/mmwr//index.html

Morbidity and Mortality Weekly report

             



[1] Centers for Disease Control and Prevention.  Summary of notifiable diseases, United States, 2001.  MMWR 2001; 50(no,53), pp. 2-3.

[2] Information on international reporting is from www.who.int/csr

[3] Information for disease summaries is from Levison and Jawetz 2000 and ODH’s Infectious Disease Control Manual (IDCM)

 

[4] Surveillance for foodborne-disease outbreaks – U.S., 1988-1992, Oct. 25, 1996. MMWR 1996; 45[SS-5]

[5] “Surveillance for waterborne-disease outbreaks – US, 1995-1996”, MMWR Dec. 11, 1998; 47(SS-5).