Communicable Diseases in Elderly people

Geriatrics?It is the specialty of medicine that focuses on health care of elderly

people.

,,,,

Elderly people in Egypt6 million (7.3% from total population)

At 2030, expected to reach 12% from total population

Male: 3 million Females: 3 million.Life expectancy: 71 yearDeath rate = 58.8% (male: 70y – female: 72y)Smokers: 10%Working: 1.1 million (19% of all geriatrics)Illiterate: 64%Low socio-economic state: 19.2%

Central Agency for public mobilization and statistics

2014 reportواإلحصاء العامة للتعبئة المركزي الجهاز

2014

What are Communicable

diseases?Communicable diseases refer to infectious diseases that can be transmitted and make people ill .

They may be caused by infective agents (pathogens), e.g. bacteria and viruses, which invade the body and

multiply or release toxins to cause damages to normal body cells and their functions. In severe cases, they

may lead to death.

Here are some of the diseases-: Pneumonia. Influenza . Herpes zoster . Urinary Tract Infection . GIT infections ( H.Pylori – C.Difficile)

Also there are other diseases like: Subcutaneous tissue infections Acute infectious conjunctivitis

General measures in prevention of communicable diseases :

1 -Personal hygiene2 -Hand hygiene in situations.

3 -Respiratory hygiene and cough manners4 -Skin care

5 -Environmental hygiene6 -Food safety and hygiene

7 -Vaccination of residents and staff

Key in management of CD is: • Medical surveillance, • Early treatment, • Good prevention of spread.

So,

InfluenzaMode of Infection: Air born infectionIP: 1- 3 daysAge : older adults mostly in winter and spring

Suscebility :1. Weakened immune system2. Living conditions : as elderly not move to much they are more

likely to develop influenza. 3. Chronic illnesses : i.e: asthma, increase risk of complications.4. Genetic risk factors 5. Obesity: increased complications risk in BMI ≤ 40

Clinical picture :1. Headache 2. Cough3. Sudden onset of fever4. Generalized body aches5. Sore throat, 6. nasal congestion7. possibly runny nose

Influenza

Investigations : -1. Nasopharyngeal or nasal swab2. Viral culture3. Serology4. Rapid antigen testing5. Reverse transcription polymerase chain reaction 6. (RT-PCR)

Influenza

Prevalence and Mortality : The traditional method for assessing the severity of

influenza seasons is to estimate the associated increase in pneumonia and influenza (P&I) mortality.

In a study conducted from 1970 till end of 1995: Persons aged <65 years had: 57% of all influenza-related hospitalizations: 90% of influenza- deaths

Influenza

Prevention and control :

In addition to the general measures there are:Immunoprophylaxis with vaccine: - Inactivated (i.e., killed virus) influenza vaccine and - live attenuated influenza vaccine.Chemoprophylaxis (antiviral agents): Oseltamivir and Zanamivir Amantadine ( CNS side effects) Rimantadineare Daily dose of should not exceed 100mg

Influenza

Community acquired Pneumonia in elderly patients

What is pneumonia? Pneumonia is an infection that inflames the air sacs

in one or both lungs. The air sacs may fill with fluid or pus, causing cough with phlegm or pus, fever, chills, and difficulty breathing.

EtiologyThe most common pathogen is Streptococcus

pneumoniae, although atypical and Gram-negative bacilli play an important role.

Incidence: Globally: 25–44 cases per 1000 persons. (WHO) In the United States: 600,000 are hospitalized every year.Mortality rates ranging from 10 to 30% in those aged 65 years or older.

CAP

Epidemiology

Community-acquired pneumonia: Bacteria – viral- fungi . Hospital-acquired pneumonia Health care pneumonia Aspiration pneumonia

CAP

Mode of Infection

People older than age 65:lower normal body temperature.

sudden changes in mental awareness.

CAPClinical Picture:

Treatment of CAP Antibiotics are the main line as beta-lactam , fluoroquinolones and macrolides.Prevention :1. Vaccination : pneumococcal polysaccharides vaccine2. Chemoprophylaxis: for those who are at high risk for

influenza

CAPPrevention & Control

Herpes ZosterMode Of Infection & IP

The virus is spread through direct contact with fluid from the rash blisters caused by shingles.

A person with active shingles can spread the virus when the rash is in the blister-phase

:Susceptibility Once the illness resolves, the virus remains latent in

the dorsal root ganglia. VZV can reactive later in a person’s life and cause a

painful, maculopapular rash called Herpes. Most people typically have only one episode of

herpes zoster in their lifetime. However, second and even third episodes are possible.

HZ

Rash: Trunk (most common site) Painful and itchy It develops into clusters of clear vesicles, then these

vesicles continue to form over three to five days and progressively dry and crust over. They usually heal in two to four weeks.

Some people may also have:HeadachePhotophobia

HZClinical Picture

Direct fluorescent antibody staining of varicella-zoster virus (VZV)-infected cells in a scraping of cells from the base of a lesion is rapid, specific, and sensitive

PCR more sensetive Serologic methods: IgM.. IgG Tzanck smears of lesion specimens are inexpensive

and can be performed at bedside, although they do not distinguish between VZV and herpes simplex

HZDiagnosis

Vaccination• in 1974 a live attenuated varicella-zoster vaccine is

developed by isolating VZV from a child with varicella and passing the isolate in human embryonic lung fibroblasts and guinea pig embryo cells.

• Vaccine efficacy : 85%–90% protection∼• Many countries have licensed the vaccine for the

prevention of varicella. beside 25 states in the US. • In the United States, >20 million doses have been

administered, and VZV epidemic curves have been reduced in regions where the vaccine is accepted

HZPrevention & Control

live attenuated varicella virus It’s given in two doses 4-8 weeks apart. SC injection. The antibodies persist for 9 years , booster doses are

effective.Varicella zoster immunoglobulins (VZIG)

prepared from plasma of normal donors are effective in modifying or preventing the disease if given within 72 hours to 96 hours after exposure

 

HZ

Urinary Tract Infections It occurs when bacteria in the bladder or kidney multiplies in the urine. It gets more serious if left un-treated. UTIs can lead to acute or chronic kidney infections, which

could permanently damage the kidneys and even lead to renal failure.

Prevalence: About 8.3 million doctor visits each year.

Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli

(E. coli), which come from the GIT.Infection of the urethra (urethritis): Which may come from the skin.UTIs are thought to be much more common in women because the urethra is shorter in women than in men, giving bacteria-which live in the rectal area and also on a person's skin-an easier route into the body.

Causes and SymptomsUTI

Change in behavior Urinary incontinence Half of all women will develop a urinary tract

infection in their lifetimes

Warning Signs!

UTI

UTIs are easy to cure. But, if left untreated can cause sepsis, a potentially life-threatening infection of the bloodstream.

UTI

"A bladder infection places stress on the body," That stress can result in confusion and abrupt changes in behavior in older adults with an elderly urinary tract infection. And for people suffering from Parkinson's disease, Alzheimer's disease, or other dementia, "any kind of stress, physical or emotional, will often make dementia temporarily worse

UTI

Home Test: A dipstick is held in the urine stream. Ultrasound Exam - Ultrasoudns can help evaluate

bladder and kidney problems X-ray CAT Scan: A CAT scan provides a detailed three-

dimensional picture of the urinary tract. Simple urine alysis can confirm the infection. Culture

DiagnosisUTI

Antibiotics are the first choice of treatment. for mild cases: Ciprofloxacin (Cipro),Levofloxacin (Levaquin) Cephalexin (Keflex) ,Ceftriaxone (Rocephin) Azithromycin, Doxycycline Severe infection For a severe UTI, you may need treatment with

intravenous antibiotics in a hospital.

TreatmentUTI

Hormone replacement therapy (HRT for women after menopause due to less estrogen that protect them from rising UTI.

must drink plenty of fluids to flush the bacteria from their systems. Proper fluid intake makes it harder for bacteria to live and multiply in the urinary tract.

Drink cranberry juice.

Prevention & Control

UTI

GIT Infections Age-related changes to digestion and gastrointestinal flora put elderly at increased risk of developing gastrointestinal infections.Two of the most common are:- Helicobacter pylori. Clostridium difficile

Susceptibility: Epidemiological elements, immunosenescence, malnutrition,  

Ageing

H. pylori infection Is the major risk factor for developing Chronic gastritis and Peptic ulcer Gastric mucosa-associated lymphoid tissue lymphoma and GC. Moreover, interesting there is a clinical association between H.

pylori infection and extra-digestive disorders which are particularly frequent in older people.

C. difficile infection can cause a spectrum of manifestations C. difficile–associated diarrhea (CDAD): Watery diarrhea Colitis Other manifestations include: lower abdominal pain, cramping,

low-grade fever, nausea, anorexia, leukocytosis

Clinical picture:

GIT Infec

H. pylori infection: can be achieved with invasive or noninvasive techniques. Invasive tests (histology, culture, and rapid urease test) need

upper gastrointestinal endoscopy and biopsy material for tests

noninvasive techniques [C-urea breath test (UBT), stool antigen test, and serological blood test] use other methods.

C. difficile infection: It is suspected in patients with clinically significant diarrhea The diagnosis is established via a positive laboratory stool

test for C. difficile toxins or C. difficile toxin gene.

Diagnosis:GIT Infec

H. pylori :The triple therapy regimens including: PPI, Clarithromycin and Amoxicillin or Metronidazole for H. pylori infectionIn older people, this regimen has also been reported as effective and safe for the treatment of H. pylori infection, AS: Reduces symptomatology, ulcer recurrences ,activity of chronic gastritis

and prevent progression of pathological changes of the gastric mucosa as well as NSAID-related gastroduodenal damage.

PPI-based triple therapy regimens are highly effective and well tolerated in old age, especially if a short duration (one-week) and low dosages of the drugs are used.

‘Do elderly people need to have their H. pylori treated?‘ Evidence Based Medicine says : “YES”

Treatment:GIT Infec

C.Difficle: Doctors typically prescribe a 10- to 14-day course of one of the following oral antibiotics: Metronidazole, Dificid, Vancocin Flagyl is usually tried first. Improvement usually happens within

72 hours after starting antibiotics, but the diarrhea may return temporarily.

Another round of antibiotics is needed in about 25% of cases.

In addition to prescribed medications, treatment may include: Pro-biotics: available over the counter. Simply, it’s made of useful

gut bacteria to avoid C. diff. infection recurrence. Fluids. IV or fluids to avoid dehydration.

Treatment:GIT Infec

Rehydration – oral and sometimes intravenous For many cases of bacterial gastroenteritis, only symptomatic treatment

(for fever, diarrhea…) is required.Antibiotics may be recommended in particularly severe cases of gastroenteritis, or if a

specific bacteria has been identified as the cause. Relation to NSAID.s: Relationship exists between HP infection and NSAID use in elderly patients

with upper gastrointestinal bleeding as they are associated with a high incidence of upper gastrointestinal tract bleeding in the elderly with higher incidence of ulcer complication.

Treatment for GIT infectionsGIT Infec

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