Reportable Infectious Diseases

1. Reportable Infectious Diseases Chp. 153. 1/19/06 Dr. Batizy Bogdan Irimies PGY-3

2. Introduction • CDC in Atlanta publishes a list of notifiable infectious diseases. • Requirement to report these diseases is mandated by state or territory laws and regulations. Therefore, the list differs from state to state • The following case definitions establish uniform criteria.

3. AIDS • For patients 13 years or older reporting is required if the patient demonstrates: • 1. CD4 T-cell count <200 • 2. CD4 T-cell percentage of total lymphocyte <14% • 3. Any of the following: pulmonary TB, recurrent pneumonia, cervical cancer or the 23 other AIDS defining conditions.

4. Anthrax • Caused by Bacillus anthracis • Cutaneous form is characterized by a skin lesion evolving over 2-6 days from papule to vesicle to depressed black eschar. • Inhalation form characterized by brief URI, hypoxia, dyspnea, mediastinal widening from adenopathy on CXR.

5. Anthrax • Intestinal form is characterized by fever, sepsis, crampy abdominal pain. • Oropharyngeal form characterized by mucosal lesion in oral cavity, cervical adenopathy, edema, fever. • Lab diagnosis (Dx:) • 1. Isolation of B. anthracis from clinical specimen • 2. anthrax electrophoresis/immunoflurescence

6. Botulism: 3 forms • Foodborne: acute illness manifested by diplopia, blurred vision, bulbar weakness or symmetric paralysis of rapid onset. • Infant: constellation of symptoms in infant under 1 y/o including constipation, poor feeding, failure to thrive, progressive weakness, impaired respirations and death

7. Botulism • Wound: symptoms similar as for food borne. • Lab Dx: • botulinum toxin in serum, stool, food. • Positive culture for C. botulinum from stool

8. Brucellosis • Infection w/Brucella characterized by fever, night sweats, fatigue, anorexia, weight loss, headache (HA), arthralgias. • Lab Dx: • Culture positive from specimen • Increase in Brucella agglutination titers • Positive immunofluorescence of Brucella in clinical specimen

9. Chancroid • STD caused by Haemophilus ducreyi • Painful genital ulcer w/inflamed inguinal lymph nodes. • Isolation from clinical specimen confirms Dx.

10. Chlamydia Trachomatis • Causes urethritis, epididymitis, cervicitis, salpingitis, conjunctivitis, pneumonia, or maybe asymptomatic. • Lab Dx: • Positive culture • Detection of the antigen or nucleic acid on immunofluorescence.

11. Cholera • Manifested by diarrhea and vomiting • Lab dx: • Isolation of toxigenic Vibrio cholerae O1 or O139 from stool or emesis

12. Coccidioidomycosis • Caused by fungus Coccidioides immitis, endemic to SW U.S. • Causes influenza like respiratory illness: -Fever, cough, chest pain, myalgias, arthralgias, HA, pneumonia on CXR, erythema nodosum or erythema multiforme rash, meningitis, or involvement of bones, joints, viscera or lymph nodes.

13. Coccidioidomycosis • Lab Dx: • Culture, histopathology, or molecular evidence of C. immitis • Serologic tests such as IgM by immunodiffusion, ELISA, latex agglutination • Coccidiodal skin test conversion after onset of symptoms

14. Cryptosporidiosis • Caused by protozoa Cryptosporidium parvum • Signs & Symptoms (S/Sx:) • Fever, nausea, vomiting, abdominal cramps, loss of appetite • Lab Dx: • Detection of oocysts in stool • demonstration of organism in intestinal fluid or small bowel biopsy • detection of Cryptosporidium antigen in stool

15. Cyclosporaisis • Intestinal illness caused by protozoa Cyclospora cayetanensis • S/Sx: • watery diarrhea, weight loss, flatus, nausea, fatigue, vomiting, anorexia, abdominal cramping and fever

16. Cyclosporaisis • Lab Dx: • Detection of oocysts in stool • Detection of Cyclospora in intestinal fluid or small bowel biopsy • Demonstration of sporulation • Detection of DNA by PCR

17. Diptheria • Caused by Cornynebacterium diptheriae • S/Sx: URI like, sore throat, fever, adherent membrane to tonsils, pharynx or nose. • Lab dx: • Isolation of organism from specimen or histopathologic diagnosis

18. Ehrlichiosis • Tick borne illness presents as flu-like illness w/fever, HA, myalgias, malaise, nausea, vomiting or rash. • May see thrombocytopenia, leukopenia, elevated LFTs • Three categories need to be reported: • 1. HME caused by Ehrlichia chaffeensis 2. HGE caused by E. phagocytophila 3. Ehrlichiosis, Human

19. Arboviral Encephalitis/Meningitis • S/Sx: • Arboviral meningitis: fever, HA, stiff neck, pleocytosis. • Arboviral encephalitis: febrile illness assoc w/neurologic s/sx’s such as HA, mental status change, confusion, nausea/vomiting, meningismus, CN palsy, paresis or paralysis, sensory deficit, seizures, or coma.

20. Arboviral Encephalitis/Meningitis • Lab Dx: • Fourfold rise in antibody titer • Isolation of virus or viral antigen from tissue, serum or CSF • IgM antibody detection

21. Enterohemorrhagic E. Coli • S/Sx: caused by E. Coli 0157:H7 in foodborne outbreaks • Enterohemorrhagic illness w/bloody diarrhea, abdominal cramping and may have HUS or TTP • Lab Dx: isolation of E. coli 0157:H7 or a shiga toxin producing E. coli

22. Giardiasis • Caused by protozoan Giardia lamblia • S/Sx’s: diarrhea, abdominal cramps, weight loss, malabsorption • Lab Dx: G. lamblia cysts or trophozoites in stool or antigen in stool by specific immunodiagnostic test

23. Gonorrhea Caused urethritis, cervicitis, salpingitis, disseminated disease or maybe asymptomatic Observation of gram neg. intracellular diplococci

24. Haemophilus Influenzae Invasive Disease • Invasive diseases are: meningitis, bacteremia, epiglottitis, or pneumonia • Lab Dx: isolation of H. Flu from blood CSF or joint fluid

25. Hansen Disease(Leprosy) • Caused by organism Mycobacterium leprae • Four clinical forms of disease: • Tuberculoid leprosy: one or few well demarcated, hypopigmented and anesthetic skin lesions • Lepromatous form: number of erythematous papules & nodules that affect the face, hands and feet in a symmetric pattern

26. Hansen Disease(Leprosy) • Dimorphous form: skin lesions characteristic of the tuberculoid and lepromatous forms • Indeterminate form: hypopigmented macules that do not have characteristics of tuberculoid or lepromatous forms • Lab Dx: demonstration of acid fast bacilli in skin or dermal nerves requiring a skin biopsy.

27. Hantavirus Pulmonary Syndrome • S/Sx’s: prodrome of fever, chills, myalgias, HA, and GI symptoms that progress to bilateral pulmonary infiltrates, respiratory compromise, ARDS. May see hemoconcentration, WBC count w/left shift, neutrophilic leukocytosis & thrombocytopenia • Lab Dx: Hantavirus specific IgM or rising titers of IgG, PCR, or Hanta virus antigen

28. HUS, Postdiarrheal • HUS present as acute onset of microangiopathic hemolytic anemia, renal injury and thrombocytopenia usually w/in 3 weeks of diarrheal illness. • TTP w/similar features but also fever and CNS involvement • Lab Dx: anemia of microangiopathic changes(schistocytes, burr cells, helmet cells) and renal failure.

29. Legionella Causes 2 diseases: Legionaires’ disease and Pontiac fever. Fever,myalgias, cough, pneumonia. Lab dx: Isolation of Legionella from respiratory secretions, lung tissue, pleural fluid or sterile bodily tissue Demonstration of rising antibody titer Detection of L. pneumophilia serotype 1 in body fluids Detection of L. pneumophilia serotype 1 antigen in urine

30. Listeriosis • Listeria monocytogenes caused meningitis and/or bacteremia • Lab Dx: • Isolation of L. monocytogenes from sterile body fluids, fetal tissue or placenta

31. Lyme Disease • Tick borne illness caused by Borrelia burgdorferi • S/Sx: fever, fatigue, HA, stiff neck, arthralgias/myalgias, erythema migrans, high degree heart block, myocarditis, meningitis/encephalitis • Lab Dx: isolation of organism or identification of antibody(IgM or IgG) in serum or CSF

32. Malaria • Caused by Plasmodium species, present w/fever, HA, chills, myalgias, nausea/vomiting, diarrhea, cough, renal failure, pulmonary edema and coma/death • Malaria parasites can be seen on blood smear.

33. Measles(Rubeola) • S/Sx: Generalized rash >3 days, temp. >38.3, cough, coryza, conjunctivitis • Lab Dx: • Positive serology for IgM • Rise in measles antibody titer • Isolation of measles virus from specimen

34. Meningococcal Disease • S/Sx’s: meningitis, meningococcemia, purpura fulminans, shock, death • Lab Dx: • Isolation of Neisseria meningitidis from blood or CSF

35. Mumps • S/Sx: unilateral or bilateral tender, self-limited swelling of parotid or other salivary gland for > 2 days w/out other cause. • Lab Dx: • Isolation of mumps virus from specimen • Rise in serum IgG or IgM

36. Pertussis • S/Sx: 2 week history of paroxysmal cough, inspiratory whoop or posttussive vomiting. • Lab Dx: • Isolation of Bordetella pertussis from clinical specimen • Positive PCR for B. pertussis

37. Plague • S/Sx: fever, chills, HA, malaise, prostration , leukocytosis. • Different forms: • Bubonic plague: regional lymphadenitis • Septicemic plague: sepsis • Pneumonic plague: pneumonia from inhaled droplets • Pharyngeal plague: pharyngitis and cervical lymphadenitis

38. Plague • Lab Dx: • Increase in serum antibody titers to Yersinia pestis fraction 1 antigen • Detection of fraction 1 antigen by fluorescent assay • Confirmation w/isolation of Y. pestis in clinical specimen

39. Paralytic Poliomyelitis • S/Sx: illness of acute onset characterized by flaccid paralysis of one or more limbs, DTR’s are absent, no sensory abnormalities, and no other apparent cause for above. • Clinical case definition is sufficient for reporting

40. Psittacosis • S/Sx: disease of birdhandlers, fever, chills, HA, photophobia, cough, myalgia • Lab dx: • Isolation of Chlamydia psittaci from respiratory secretions • 4 fold rise in serum antibody titers • Detection of serum IgM to C. psittacci

41. Q Fever • S/Sx’s: acute infection with Coxiella burnetti, fever, myalgias, malaise, retrobulbar HA, hepatitis, pneumonia, meningoencephalitis • Lab Dx: • fourfold rise in antibody titer • Isolation of C. burnetti from specimen • Demonstration of C. burnetti by antigen or nulceic acid testing

42. Rabies • S/Sx: acute encephalomyelitis, coma, death w/in first 10 days of first symptom • Lab Dx: • Direct fluorescent antibody of viral antigen • Isolation in cell culture or lab animal of rabies virus from saliva, CSF, or CNS tissue • Identification of rabies neutralizing antibody titer in serum or CSF in a previous unvaccinated person

43. Rocky Mountain Spotted Fever • S/Sx: tick born disease characterized by HA, myalgia, fever, petechial rash on palms and soles • Lab Dx: • Rise in antibody titer to Rickettsia rickettsii antigen • Positive PCR • Positive immunoflourescence of skin lesion biopsy or organ tissue biopsy • Isolation of R. rickettsii from clinical specimen

44. Rubella • S/Sx: acute onset of generalized maculopapular rash, temp.>37.2, arthralgias, arthritis, lymphadenopathy, conjunctivitis. • Lab Dx: • Isolation of rubella virus • Rise in serum IgG titers • Positive IgM

45. Salmonellosis • S/Sx: Salmonella causes nausea, vomiting, abdominal pain and diarrhea • Lab Dx: • Isolation of Salmonella from specimen

46. Shigellosis • S/Sx: same as Salmonella • Lab Dx: • Isolation of Shigella from specimen

47. Invasive Group A Streptococcal Disease • Diseases include: pneumonia, bactermia assoc. with cutaneous infection(cellulitis, wound infection), myositis/necrotizing fasciitis, meningitis, peritonitis, osteomyelitis, septic arthritis, postpartum sepsis, neonatal sepsis • Lab Dx: • Isolation of Group AStreptococci (Strep. Pyogenes)

48. Streptococcal Toxic Shock Syndrome • S/Sx: Group A strep infection associated w/a cutaneous lesion • All of following must be present w/in 48 hrs.: hypotension, two or more multiorgan involvement such as renal failure, coagulopathy/DIC, LFT’s 2 x normal, ARDS, generalized maculopapular rash/desqumation, necrotizing fasciitis or gangrene • Lab Dx: isolate Group A Strep from sterile site

49. Syphilis • S/Sx: primary (genital chancres), secondary mucocutaneous lesions, tertiary neurosyphilis, skin, bone and cardiovascular • Lab Dx: • Primary or secondary syphilis: demonstrate Treponema pallidum on dark field microscopy or direct fluorescent antibody(DFA-TP)

50. Syphilis • Latent or Tertiary syphilis lab Dx: • Reactive VDRL or RPR • Reactive treponemal test(FTA-ABS or MHA-TP) • History of syphilis therapy w/a fourfold rise in antibody titer