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Medical Education Division |
Operational Medicine 2001
Field Medical Service School
Student Handbook
DISEASES OF OPERATIONAL IMPORTANCEFMST 0605 17
Dec 99
TERMINAL LEARNING OBJECTIVE 1. Given a combat environment (day and night) and individual combat equipment, demonstrate knowledge of diseases of operational importance, per the references. (FMST 06.05) ENABLING LEARNING OBJECTIVES 1.
Without the aid of reference materials, determine the factors effecting
infectious diseases, per the student handbook.
(FMST 06.05a) 2.
Without
the aid of reference materials and given a list of diseases, select the category
of infectious diseases of military importance that may compromise a military
mission, per the student handbook. (FMST
06.05b) 3.
Without
the aid of reference materials and given a list of diseases, select the mode of transmission for each disease, per the student
handbook. (FMST 06.05c) 4.
Without
the aid of reference materials and given a list of diseases, select the personal
protection measures for each disease, per the student
handbook. (FMST 06.05d) 5.
Without
the aid of reference materials, determine the correct purpose of disease surveillance, per the student handbook.
(FMST 06.05e) 6.
Without
the aid of reference materials, determine the correct purpose of vector surveillance, per the student handbook.
(FMST 06.05f) 7.
Without
the aid of reference materials and given a list of diseases, select the symptoms
for each disease, per the student handbook. (FMST 06.05g) 8.
Without
the aid of reference materials and given a list, identify the appropriate vector 9.
Without
the aid of reference materials and given a list, identify the appropriate preventive measures for selected vector borne
diseases, per the student handbook.(FMST 06.05I) OUTLINE A. Background – Throughout history, the United States Armed Forces have traveled to regions both for training and actual combat. A disturbing fact is that Disease Non-battle Injuries (DNBI), such as malaria, Dengue Fever, and Yellow Fever historically have killed more Americans than combat wounds killed in action or died of wounds (KIA/DOW). B. Infectious Disease
plants, animals, minerals, and humans. Infectious
disease ranks fifth in causes of death in the United States.
a.
Contamination
– the presence of an infectious agent on a body surface or object b.
Infection
– implantation and successful reproduction of an infectious agent n a living
host c.
Subclinical
infection – no clinical symptoms present
d.
Infectious
disease – tissue injury or physiologic reponse produces clinical symptoms C.
Chain of
Transmission
a.
Person
b. Animal
c.
Arthropod
d.
Plant
e.
Water
f.
Food
g.
Soil
a. Genitourinary
tract - Gonorrhea
b.
Intestinal tract - Hepatitis
c.
Oral cavity - Tuberculosis
d.
Open lesion - Syphilis
a. Direct:
Physical contact between source and victim (sexually, orally, fecal
contamination, airborne droplets)
b. Indirect transmission: Requires pathogen to survive on an
inanimate vehicle
without the host (air, water, food, soil, fomite)
a. Ingestion
b.
Inhalation
c.
Mucous membrane
d.
Placenta
a.
Age
b. Sex
c.
Ethnic group
d.
Cultural behaviors regarding eating and personal hygiene
e.
Health status
f.
Presence of concurrent disease D.
Breaking
the Chain of Transmission
E.
Types of
Infectious Agents
a.
Considered
parasitic in nature b.
Is
dependent on host cell for metabolic and reproductive needs c.
Consists
of either DNA or RNA material d.
Has a
protein capsid (capsule) instead of a true cell wall
a.
A genius
of microorganism that are between viruses and bacteria b.
Considered
parasitic in nature c.
Is
dependent on host cell for metabolic and reproductive needs d.
Usually
transmitted by arthropods
a.
Unicellular
microorganism that multiple by cell division, b.
Has a
cell wall c.
Can be
aerobic or anaerobic d.
Can be
motile or non-motile e.
9
different forms (diplococci, bacilli, vibrios, etc).
a.
Plant-like
organisms that include yeasts and molds b.
May be
single celled (yeast) or multicellular (molds). c.
No
chlorophyll, therefore is: 1)
saprophytic
(eat dead tissue) 2)
parasitic
(live inside cells)
a.
A
worm-like animal b.
May be
either free-living or parasitic F.
Factors
Effecting Infectious Disease
disposal
diseases transmitted from person to person
infectious diseases
isoniazid (INH) therapy for tuberculosis and
Primaquine or Mefloquine for
Malaria G.
Categories
of Infectious Diseases
a.
Influenza 1. Types
a) A is associated with epidemics and pandemics
b) B is associated with regional and widespread epidemics
c) C is associated with sporadic cases and localized outbreaks Note:
Types A and B are the viruses responsible for the frequent epidemics.
These viruses undergo antigenic changes which necessitates the annual flu
vaccine.
2. Signs / Symptoms: a)
Headache b)
Fever c)
Myalgia d)
Cough e)
Sore
throat
3. Mode of transmission: a)
Person to
person contact b)
Airborne
droplet spray infects people c)
Contaminates
with viruses that can transmit infection. 4.Prevention
and control: a)
Immunization
– annual flu shot given before flu season b)
Handwashing
– assists in breaking the chain of infection from person to person c)
Isolate
patients – use respiratory precautions d)
Avoid
overcrowding – berth only the recommended numbers in tents or other berthing spaces e)
Educate
population – explain modes of transmission and prevention to your personnel b.
Pneumococcal
Pneumonia 1.
Infectious
Agent – Streptococcus pneumoniae 2.
Signs /
Symptoms – Acute bacterial infection a)
Sudden
onset with shaking chill b)
Fever c)
Pleural
pain d)
Productive
cough of “rusty” sputum 3.
Mode of
transmission: a)
Direct -
droplets spread by oral contact b)
Indirect
- through articles freshly soiled with respiratory discharge. 4.
Prevention
and control: a)
Immunization b)
Avoid
overcrowding c)
Universal
precautions d)
Education c.
Tuberculosis 1.
Infectious
Agent – Mycobacterium tuberculosis, M.
africanum, M. bovis 2.
Signs /
Symptoms: a)
Pulmonary-
infection in the lungs 1) Often asymptomatic - just “not feeling well” 2) Fever 3) Night sweats 4) Weight loss 5) Productive cough 6) Hemoptysis b)
Extrapulmonary
- infection of the lymph nodes, bones, abdominal organs
1) Lesions on that site 2) Swelling of lymph nodes 3) Collapsed vertebrate 3.
Mode of
transmission: a)
Inhalation
of droplet nuclei as in coughing,
singing, sneezing b)
Ingestion
of unpasteurized milk or diary products 4.
Prevention
and control: a) Annual
tuberculin skin testing using purified protein derivative (PPD) b)
Avoid exposure in crowded environments such as prisons, homeless
shelters c) Chemoprophylaxis
for convertors using Isoniazid therapy d) Isolate
active cases of TB e) Do
not consume unpasteurized dairy products d.
Anthrax 1.
Infectious
Agent – Bacillus anthracis, a gram
positive, encapsulated, spore forming, non-motile rod. 2.
Signs /
Symptoms: a)
Inhalation
1)
Onset is
gradual and nonspecific with fever, malaise, and fatigue 2)
Nonproductive
cough and mild chest discomfort 3)
After 2-3
days there is an abrupt development of severe respiratory distress with dyspnea,
diaphoresis, stridor (loud harsh breathing), and cyanosis 4) X-rays reveal widened mediastinum (space beneath
the sternum containing
the heart, aorta, and trachea) often with pleural effusions 5) Shock and death occurs within 24-36 hours of
respiratory distress b)
Cutaneous
1)
Itching
of skin that was exposed, followed by a lesion that
becomes papular, then vesicular 2)
In 2-6
days the lesion develops into a depressed blackened eschar (a hard crust over a raw surface) 3.
Mode of
Transmission: a)
Direct
contact with tissues of affected carcasses or inhalation of spores 4. Prevention
and Control: a)
Educate
personnel on the handling of potentially contaminated
carcasses or materials b) Immunization with purified B. anthracis protective antigen. Intervals are: initial, 2, 4, 6, 12, and 18 months. This interval of vaccination has been shown to be effective in preventing or significantly reducing the incident of inhalation anthrax.
a. Malaria
1. Infectious agent: Plasmodium falciparum, P. vivax, P. malariae, P.
ovale
2. Sign / Symptoms: a)
Fever b)
Headache c)
Chills d)
Sweats e)
Cough f)
Diarrhea
3. Mode of transmission: a)
The bite
of an infected female Anopheles mosquito 4. Prevention
and Control: a)
Education
about individual personal protective measures
(PPM)
b)
Proper
use of DEET on the skin c)
Permethrin
on uniforms and bednetting d)
Control
of breeding sites e)
Chemical
vector control f)
Chemoprophylaxis/terminal
prophylaxis such as mefloquine, doxycycline and
primaquine
b.
Dengue Fever 1.
Infectious
agent: Aedes aegypti, A. albopictus 2.
Signs /
Symptoms a)
Sudden
onset of fever b)
Intense
headache c)
Myalgia
(tenderness or pain of the muscles) d)
Retro
orbital pain (pain in back of the eyes) e)
Anorexia f)
GI
disturbances g)
Rash 3.
Mode of
Transmission: a) The bite of an infected female mosquito 4.
Prevention
and Control: a) Education about individual personal protective
measures (PPM)
b) Proper use of DEET on the skin c) Permethrin on uniforms and bednetting
d)
Control of breeding sites
e)
Chemical vector control
f)
Chemoprophylaxis/terminal prophylaxis such as mefloquine,
c. Japanese Encephalitis 1.
Infectious
agent: Culex tritaeniorhynchus, C. vishnui,
C. geledus 2.
Signs /
Symptoms: a)
Most
infections are asymptomatic b)
Mild
cases often occur as a febrile headache or aseptic meningitis. c)
Symptomatic
infections can be marked by acute onset of headache, high fever, stupor,
disorientation, coma, tremors, occasional convulsions (especially infants) and
spastic (rarely flaccid) paralysis d)
About
25% of cases are fatal 3.
Mode of
Transmission: a)
Bite of
an infected female mosquito 4.
Prevention
and Control: a) Education about individual personal protective
measures (PPM)
b) Proper use of DEET on the skin c) Permethrin on uniforms and bednetting
d)
Control of breeding sites
e)
Chemical vector control
f)
Chemoprophylaxis/terminal prophylaxis such as mefloquine,
3. Food and water-borne: a.
Diarrheal
diseases 1)
Infectious
agent: Bacterial mainly also can be viral a)
Escherechia
coli (E. coli) b)
Shigella c)
Campylobactor d)
Entamoeba
histolytica 2)
Signs /
Symptoms: a) Loose stools b) Diarrhea with presence of blood (dysentary)
c)
Abdominal cramping 3)
Mode of
Transmission: a)
Ingestion
of contaminated food or water 4)
Prevention
and Control: a)
Consume
only approved food and water sources b)
Proper
handwashing c)
Chlorination
of water supply 4.
Sexually Transmitted Diseases (STD)
a. Gonorrhea 1)
Infectious
Agent: Neisseria gonorrhoeae
(bacteria) 2)
Signs /
Symptoms:: a)
Male:
A purulent discharge from the anterior urethra with dysuria, due to the inflammation of the columnar and
transitional epithelium. b)
Female: A
few days after exposure, an initial urethritis or cervicitis Occurs which may be mild enough to go unnoticed 3)
Mode of
Transmission: a)
Contact
with exudates (inflammatory fluid - i.e.
pus) from infected person usually as a result of sexual activity 4)
Prevention
and Control: a)
Mutual
monogamy with an noninfected partner b)
Avoiding
multiple sexual partners or casual sex c)
Consistent
and correct use of condoms with all partners not known to be free of STD’s b.
Chlamydia 1)
Infectious
Agent: Chlamydia trachomatis (bacteria) 2)
Signs /
Symptoms: a)
Males (1)
Urethritis
(2)
Mucopurulent
discharges of a scanty or moderate quantity (3)
Urethral
itching (4)
Burning
upon urination. b)
Females (1)
Mucopurulent
cervicitis (2)
Edema (3)
Erythema (4)
Easily
induced endocervical bleeding (5)
Most with
endocervical or urethral infections are asymptomatic (6)
Complications
include salpingitis (inflammation of fallopian tubes) with risk of infertility,
ectopic pregnancy, or chronic pelvic pain 3)
Mode of
Transmission: a)
Sexual
intercourse 4)
Prevention
and Control: a)
Mutual
monogamy with an noninfected partner b)
Avoiding
multiple sexual partners or casual sex c)
Consistent
and correct use of condoms with all partners not known to be free of STD’s c.
Syphilis 1.
Infectious
Agent: Treponema pallidum (bacteria) 2.
Signs /
Symptoms: a)
Primary: 1)
Single
lesion at the site of initial invasion containing the
Treponema and
appearing 10 – 90 days after infection 2)
Lesion is
hard and firm as a result of the intense cellular infiltration 3)
Lesion
heals within 1-5 weeks and a satellite lesion (bubo) may develop in an inguinal
(groin) lymph node b) Secondary: 1) Begins as the primary lesion is resolving, lasts 2-6 weeks and is characterized by symmetrical maculopapular rash involving the palms and soles and lymphadenopathy (disease of the lymph nodes c)
Latency 1)
Classified
as a patient who within a year preceding evaluation had: a) seroconversion
b) Symptoms of primary or secondary syphilis, or
c) Sex partner who had primary, secondary, or latency syphilis. 2)
There may
be recurrence of secondary stage and progressive
arterial damage. d)
Late
latency 1)
About one
third of infected, untreated patients manifest symptoms which includes
degenerative lesions (gummas) of the cardiovascular and central nervous systems,
skin, and viscera (organs in the chest or abdominal cavity) 2)
These
manifestations shorten life, impair health, and limit occupational efficiency 3.
Mode of
Transmission: a)
By direct
contact with infectious exudates from early lesions of skin and mucous
membranes, body fluids, and secretions (saliva, semen, blood, vaginal
discharges) of infected people during sexual contact, rarely by kissing 4.
Prevention
and Control: a)
Emphasis
on early detection and effective treatment of patients, mutual monogamy with a
noninfected partner b)
Avoiding
multiple sexual partners or casual sex c)
Consistent
and correct use of condoms with all partners not known to be free of STD’s d.
Herpes 1.
Infectious
agent: Herpes simplex virus (HSV), types 1 and 2 2.
Signs /
Symptoms: a)
Type 1 (HSV
1) 1)
Mostly
associated with oral, labial, ocular, or skin lesions (fever
blisters/cold sores) which appear as clear vesicles usually on lips or
face that crust and heal within 2-3 days 2) The
organism continues to be viable in the body 3)
The HSV
travels along sensory nerve pathways to a sensory nerve
ganglion where it remains in a latent stage 4)
Recurrence
of HSV lesions is generally in the area of initial
inoculation. This is triggered by another infectious disease,
menstruation, emotional stress, or immunosuppression b)
Type 2 (HSV
2) 1)
In women
the primary sites of the lesions are cervix and vulva, perineal skin, legs, and
buttocks 2)
In men
lesions appear on the glans penis or prepuce and/or anus and rectum for those
engaging in anal sex 3)
Other
genital or perineal sites as well as the mouth may be involved depending on
sexual practices 3.
Mode of
Transmission: a)
Contact
with HSV 1 virus in the saliva of carriers is the most important mode of spread b)
Transmission
of HSV 2 is usually by sexual contact c)
Both HSV
1 and 2 may be transmitted to sites by oral-genital, oral-anal or anal-genital
contact 4.
Prevention
and Control: a)
Emphasis
on early detection and effective treatment of patients b)
Mutual
monogamy with a noninfected partner c)
Avoiding
multiple sexual partners or casual sex d)
Consistent
and correct use of condoms with all partners not known to be free of STD’s e.
Hepatitis
1. Infectious
Agents and Mode of Transmission:
2. Signs / Symptoms:
a)
HAV – Abrupt fever, malaise, anorexia, nausea and abdominal
discomfort followed by jaundice
b) HBV – Anorexia, vague abdominal discomfort, nausea and vomiting,
sometimes arthralgia and rash, and often progressing to jaundice
c) HCV - Anorexia, vague abdominal discomfort, nausea and vomiting,
progressing to jaundice less frequently than Hepatitis B
d) HDV-
Onset is abrupt with sx resembling Hepatitis B, may be severe and
is always associated with Hepatitis B virus
e) HEV- Clinical course is similar to Hepatitis A, no evidence of a
chronic
form. 3. Prevention
and Control: a)
HAV 1)
Good
sanitation and personal hygiene with emphasis on careful handwashing 2)
Proper
disposal of feces, proper water treatment and sewage disposal 3)
Vaccinate
with Hepatitis A vaccine b)
HBV 1)
Provide
routine Hepatitis B vaccine 2)
Testing
of donated blood 3)
Use
disposable syringes and needles only c)
HCV 1)
Testing
of donated blood 2)
Use
disposable syringes and needles only d)
HDV 1)
Prevention
of HBV infection with Hepatitis B vaccine prevents infection e)
HEV 1)
Sanitary
disposal of feces and handwashing after defecation and before handling food 2)
Basic
measures to prevent fecal-oral transmission H.
Disease
Surveillance 1. Purpose:
To determine disease rates and identify abnormally high rates at any
given time whether in garrision or on deployment. Suveillance acts as a “early
warning system” enabling medical and command personnel to focus efforts on
corrective action. 2. Methods:
Use of patient logs to monitor the rates of new patients complaints on at
least a weekly basis and report these results to the medical officer, commanding
officer, and Preventive Medicine advisors for corrective action as necessary to
reduce disease and injury. The
surveillance records should be maintained to provide a basis for historical
comparison of disease non-battle injuries (DNBI) rates in that unit in various
scenarios. I.
Vector
Surveillance 1. Purpose:
Identifies the number and type of disease causing vectors in an area.
This information provides the basis for evaluating the need and effectiveness of
vector control measures such as use of aerial pesticide spraying, larvicides,
rodent trapping, or fly control. 2. Methods:
a)
Mosquito
larvae - use a dipper to sample
water at breeding site and b)
Mosquito
adults – Use of CO2 and Light traps to capture and count mosquitoes (females
in particular) c)
Flies –
Use baited flytraps with an attractants such as vegetables, fruit, or meat. May
also use sticky trap d)
Rodents
– Sticky or snap traps, observe for rub markings or detection of urine from a
fluorescent lamp along walls, corners, or piping. REFERENCE (S): 1.
Control
of Communicable Diseases Manual, (NAVMED
P-5038, FM 8-33) 2.
Hunter’s
Tropical Medicine 3.
Medical
Environmental Disease Intelligence & Countermeasures
Field Medical Service School
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