Corona Virus Infection

Assess your symptoms

The response of humans to COVID-19 infections varies. It’s is a respiratory disease and most infected people will develop mild to moderate symptoms and recover without requiring special treatment. 

People who have underlying medical conditions and those over 60 years old have a higher risk of developing severe disease and death.

People with mild symptoms who are otherwise healthy should self-isolate and contact their medical provider

Transmission:

AS the COVID-19 is a new virus, we still learn about it every day. It’s a highly transmitted infectious disease.

It could be transmitted from person to person or even from infected surfaces.

Corona virus Family

  • The coronavirus – enveloped RNA viruses – are a big family of viruses which may cause illness in animals (birds and mammals) and human. 
  • Several coronaviruses are known to cause respiratory infections ranging from mild illnesses like common cold to serious illnesses like pneumonia or bronchitis, such as Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS) and Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19).
  • COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.

References:

  1. World Helath Organization
  2. World Helath Organization Situation Report (PDF)
  3. World Helath Organization “Origin /Transmission”
  4. World Helath Organization “About MERS”
  5. Centers for Disease Control and Prevention (CDC) “Virus types”
  6. Centers for Disease Control and Prevention (CDC) “About MERS”
  7. National Institute of Allergy and Infectious Diseases

Meningitis

Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling. However, injuries, cancer, certain drugs, and other types of infections also

can cause meningitis. It is important to know the specific cause of meningitis because the treatment differs depending on the cause.

  1. Bacterial meningitis
  2. Viral Meningitis

Bacterial Meningitis

Bacterial meningitis is very serious and can be deadly. Death can occur in as little as a few hours. Most people recover from meningitis. However, permanent disabilities (such as brain damage, hearing loss, and learning disabilities) can result from the infection.

  • Causes

Common causes of bacterial meningitis vary by age group:

    • Newborns: Group B Streptococcus, S. pneumoniae, L. monocytogenes, E. coli
    • Babies and children: S. pneumoniae, N. meningitidis, H. influenzae type b (Hib), group B Streptococcus
    • Teens and young adults: N. meningitidis, S. pneumoniae
    • Older adults: S. pneumoniae, N. meningitidis, Hib, group B Streptococcus, L. monocytogenes.
  • How It Spreads

Generally, the germs that cause bacterial meningitis spread from one person to another. Certain germs, such as L. monocytogenes, can spread through food.

How people spread the germs often depends on the type of bacteria. It is also important to know that people can have these bacteria in or on their bodies without being sick. These people are “carriers.” Most carriers never become sick, but can still spread the bacteria to others.

Here are some of the most common examples of how people spread each type of bacteria to each other:

    • Group B Streptococcus and E. coli: Mothers can pass these bacteria to their babies during birth.
    • Hib and S. pneumoniae: People spread these bacteria by coughing or sneezing while in close contact with others, who breathe in the bacteria.
    • N. meningitidis: People spread these bacteria by sharing respiratory or throat secretions (saliva or spit). This typically occurs during close (coughing or kissing) or lengthy (living together) contact.
    • E. coli: People can get these bacteria by eating food prepared by people who did not wash their hands well after using the toilet.
  • Signs and Symptoms

Meningitis symptoms include sudden onset of

    • Fever
    • Headache
    • Stiff neck

There are often other symptoms, such as

    • Nausea
    • Vomiting
    • Photophobia (eyes being more sensitive to light)
    • Altered mental status (confusion)

Newborns and babies may not have or it may be difficult to notice the classic symptoms listed above. Instead, babies may

    • Be slow or inactive
    • Be irritable
    • Vomit
    • Feed poorly

In young babies, doctors may also look for a bulging fontanelle (soft spot on infant’s head) or abnormal reflexes. If you think your baby or child has any of these symptoms, call the doctor right away.

Symptoms of bacterial meningitis can appear quickly or over several days. Typically they develop within 3 to 7 days after exposure.

Later symptoms of bacterial meningitis can be very serious (e.g., seizures, coma). For this reason, anyone who thinks they may have meningitis should see a doctor as soon as possible.

  • Diagnosis

If a doctor suspects meningitis, they will collect samples of blood or cerebrospinal fluid (fluid near the spinal cord). A laboratory will test the samples to see what is causing the infection. It is important to know the specific cause of meningitis so the doctors know how to treat it.

  • Treatment

Doctors treat bacterial meningitis with a number of antibiotics. It is important to start treatment as soon as possible.

  • Prevention

Vaccines are the most effective way to protect against certain types of bacterial meningitis. There are vaccines for 3 types of bacteria that can cause meningitis:

  • Meningococcal vaccines help protect against N. meningitidis
  • Pneumococcal vaccines help protect against S. pneumoniae
  • Hib vaccines help protect against Hib

Viral Meningitis

Viral meningitis is the most common type of meningitis, an inflammation of the lining of the brain and spinal cord. It is often less severe than bacterial meningitis, and most people get better on their own (without treatment). However, anyone with symptoms of meningitis should see a doctor right away because some types of meningitis can be very serious. Only a doctor can determine if someone has meningitis, what is causing it, and the best treatment. Babies younger than 1 month old and people with weakened immune systems are more likely to have severe illness from viral meningitis.

  • Causes
    • Non-polio enteroviruses are the most common cause of viral meningitis in the United States, especially from late spring to fall. That is when these viruses spread most often. However, only a small number of people infected with enteroviruses will actually develop meningitis.
      Other viruses that can cause meningitis are
    • Mumps virus
    • Herpesviruses, including Epstein-Barr virus, herpes simplex viruses, and varicella-zoster virus (which causes chickenpox and shingles)
    • Measles virus
    • Influenza virus
    • Arboviruses, such as West Nile virus
    • Lymphocytic choriomeningitis virus
  • Symptoms
    Common symptoms in babies
    • Fever
    • Irritability
    • Poor eating
    • Sleepiness or trouble waking up from sleep
    • Lethargy (a lack of energy)

Common symptoms in children and adults

    • Fever
    • Headache
    • Stiff neck
    • Eyes being more sensitive to light
    • Sleepiness or trouble waking up from sleep
    • Nausea
    • Irritability
    • Vomiting
    • Lack of appetite
    • Lethargy (a lack of energy)

Most people with mild viral meningitis usually get better on their own within 7 to 10 days.

  • Prevention

There are no vaccines to protect against non-polio enteroviruses, which are the most common cause of viral meningitis.  The best way to help protect yourself and others from non-polio enterovirus infections is to

    • Wash your hands often with soap and water for at least 20 seconds, especially after changing diapers or using the toilet
    • Avoid close contact, such as touching and shaking hands, with people who are sick
    • Clean and disinfect frequently touched surfaces
    • Stay home when you are sick and keep sick children out of school

Vaccines can protect against some diseases, such as measles, mumps, chickenpox, and influenza, which can lead to viral meningitis. Make sure you and your child are vaccinated

References:

  1. wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/poliomyelitis
  2. https://www.cdc.gov/meningitis/viral.html

Poliomyelitis is a very contagious febrile viral infection, which causes an inflammatory reaction in the central nervous system, producing in a variable proportion of cases acute flaccid paralysis of irregular distribution, extent and permanence. The virus lives in an infected person’s throat and intestines. It enters the body through the mouth and spreads through contact with the feces of an infected person and, though less common, through droplets from a sneeze or cough.

Poliomyelitis

Clinical features

Clinical features have been classified according to the severity of symptoms. The majority of exposed patients (around 95%) are asymptomatic. During this period, there is shedding of the virus in stool and it can be isolated from throat swabs also. The ratio of asymptomatic to paralytic cases ranges from 50:1 to 1000:1. Abortive poliomyelitis, which is a mild viremic form, accounts for around 4% to 8% of infections. There may be gastroenteritis, influenza-like illness, and mild respiratory tract infections, which usually subside within 1 week. Around 1% of the clinical cases present as aseptic meningitis. There can be severe muscle spasm of the neck, back, and lower limbs, which follows a brief prodrome like the one in abortive poliomyelitis. Complete recovery usually takes place within 10 days. The most severe form, paralytic poliomyelitis, which is seen in less than 1% of patients, presents as excruciating episodes of pain in back and lower limbs. In children, the disease may present in biphasic form—a period of prodrome followed by a brief symptom-free period of 7 to 10 days and then appearance of asymmetrical paralysis of limbs. Flaccid paralysis is the hallmark with loss of deep tendon reflexes eventually.

Recovery may be complete in some patients but if loss of motor functions persists beyond 12 months, lifelong disability ensues. The 3 forms of paralytic poliomyelitis are spinal poliomyelitis, which is most common, bulbar poliomyelitis (2%), and a combination of above 2, bulbospinal poliomyelitis (around 19%)4 Bulbar poliomyelitis has the maximum fatality as the brain stem neurons are involved. In PPS, there is progressive muscular weakness, joint deterioration, and increasing skeletal deformities. Fatigue, following even minimal physical activity may lead to severe handicap of the day-to-day functioning.

Prevention:

Sanitary conditions and hygiene markedly reduce the risk of acquiring the polio virus. But still, the best way to ensure safety is vaccination. Almost all children (99 children out of 100) who get all the recommended doses of vaccine will be protected from polio.

  • Comparison of Oral Polio Vaccine (OPV) and Inactivated Polio Vaccine (IPV).

Property of Vaccine

Oral Polio Vaccine

Inactivated Polio Vaccine

Preparation

Live attenuated poliovirus serotypes (Sabin types 1, 2, and 3), in a 10:1:3 ratio, respectively.

Strain of each of the 3 serotypes that have been inactivated (killed) with formalin, adsorbed onto adjuvants. The final vaccine mixture contains 40, 8, and 32 d-antigen units of serotypes 1, 2, and 3, respectively.

Valency

Trivalent OPV (tOPV) and monovalent, against type 1 (mOPV1) and against type 3 (mOPV3) bivalent (type 1 and type 3) OPVs (bOPVs)

Only 1-type trivalent

Storage

+2°C to +8°C. Should be protected from light. Any vaccine showing particulate matter, turbidity, or change in color should be discarded

+2°C to +8°C. Should be protected from light. Any vaccine showing particulate matter, turbidity, or change in color should be discarded

Pathogenesis

Produce a local immune response in the intestines. Mucosal immunity decreases the replication and shedding of the virus

Antibodies are produced against the polio virus which provide humoral immunity, thus decreasing the replication of the virus.

Administration

Through mouth as drops

Intramuscularly into the upper arm or anterolateral thigh, can be administered alone or in combination with other vaccines

Recommended dosage

No longer in use in polio-free countries like United States and United Kingdom. Used routinely only in polio campaigns in high risk and endemic areas

A total of 5 doses of vaccine at the appropriate intervals

Vaccine efficacy

Immunity from oral poliovirus vaccine is probably lifelong. OPV produces excellent gut immunity

The duration of immunity with IPV is not known with certainty. Highly effective in producing immunity to poliovirus and protection from paralytic poliomyelitis. No gut immunity

Adverse effects

Vaccine-associated paralytic poliomyelitis (VAPP) outbreaks due to circulating vaccine-derived poliovirus (cVDPV)

Adverse events following administration of IPV are very mild and transient

References:

  1. wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/poliomyelitis
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212416/

Tuberculosis (TB):

Tuberculosis (TB) is a bacterial disease which usually attacks the lungs, but it can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. TB is a serious condition and latent TB could develop into an active TB disease, particularly in people who have a weak immune system, but it can be cured if it’s treated with the right antibiotics. If not, TB disease can be fatal. TB is usually transmitted from one person to another by coughing or sneezing or when spending a lot of time near one another where you share breathing space.

Prevention:

Avoid close contact or prolonged time with known TB patients in crowded, enclosed environments. There are several treatment options for latent TB infection for those at high risk for developing TB disease. Though treatment for latent TB infection is much easier than treatment for TB disease, TB disease is still curable.

References:

www.who.int/en/news-room/fact-sheets/detail/tuberculosis

Hepatitis B:Hepatitis-B

Hepatitis B is one of the most commonly reported communicable diseases in Egypt and accounts for a substantial burden of disease and medical costs. Hepatitis B is a viral liver infection is transmitted when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth. For some people, hepatitis B is an acute, or short-term, illness but for others, it can become a long-term, chronic infection. Chronic Hepatitis B can lead to serious health issues, like cirrhosis or liver cancer.

Prevention:

The best way to prevent Hepatitis B is by getting vaccinated.

References:

www.who.int/en/news-room/fact-sheets/detail/hepatitis-b

Rabies:

Rabies

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The incubation period may vary from days to years but usually falls between 30 and 90 days.

Symptoms:

The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms.

Prevention:

Rabies in humans is 100% preventable through prompt appropriate medical care and ensuring adequate animal vaccination and control. For people who have never been vaccinated against rabies previously, postexposure anti-rabies vaccination should always include administration of both passive antibody and vaccine. Wound cleansing (immediate gentle irrigation with water or a dilute water povidone-iodine solution) alone without other postexposure prophylaxis has been shown to markedly reduce the likelihood of rabies and the risk of bacterial infection.

  • Preexposure Vaccinations

Consists of 3 doses of rabies vaccine given on days 0,7  and 21 or 28

  • Postexposure prophylaxis

Consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14. For people who have never been vaccinated against rabies previously

References:

  1. www.who.int/rabies/en/
  2. www.cdc.gov/rabies/index.html
 
 

Diphtheria:Diphtheria

Diphtheria is an infection caused by the Corynebacterium diphtheriaebacterium.

diphtheria spreads (transmits) from person to person, usually through respiratory droplets, like from coughing or sneezing. Rarely, people can get sick from touching open sores (skin lesions) or clothes that touched open sores of someone sick with diphtheria. A person also can get diphtheria by coming in contact with an object, like a toy, that has the bacteria that cause diphtheria on it.

Symptoms:

Bacteria that cause diphtheria can get into and attach to the lining of the respiratory system, which includes parts of the body that help you breathe. When this happens, the bacteria can produce a poison (toxin) that can cause:

  • Weakness
  • Sore throat
  • Fever
  • Swollen glands in the neck

Prevention:

In the United States, there are four kinds of vaccines used to prevent diphtheria: DTaP, Tdap, DT, and Td. Each of these vaccines prevents diphtheria and tetanus; DTaP and Tdap also help prevent pertussis (whooping cough). Babies and children younger than 7 years old receive DTaP or DT, while older children and adults receive Tdap and Td

References:
www.cdc.gov/diphtheria/about/index.html

Tetanus:

Tetanus is an infection caused by a bacterium called Clostridium tetani. Spores of tetanus bacteria are everywhere in the environment, including soil, dust, and manure. The spores develop into bacteria when they enter the body.

Symptoms:

  • Jaw cramping
  • Sudden, involuntary muscle tightening (muscle spasms) — often in the stomach
  • Painful muscle stiffness all over the body
  • Trouble swallowing
  • Jerking or staring (seizures)
  • Headache
  • Fever and sweating
  • Changes in blood pressure and heart rate

Vaccination:

Being up to date with your tetanus vaccine is the best tool to prevent tetanus. Protection from vaccines, as well as a prior infection, do not last a lifetime. This means that if you had tetanus or got the vaccine before, you still need to get the vaccine regularly to keep a high level of protection against this serious disease. CDC recommends tetanus vaccines for people of all ages, with booster shots throughout life.

References:

www.who.int/immunization/diseases/tetanus/en/

www.cdc.gov/tetanus/about/index.html

Pertussis (Whooping Cough):Pertussis

Pertussis, a respiratory illness commonly known as whooping cough, is a very contagious disease caused by a type of bacteria called Bordetella pertussis. These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper respiratory system. The bacteria release toxins (poisons), which damage the cilia and cause airways to swell.

Symptoms:

Early symptoms can last for 1 to 2 weeks and usually include:

  • Runny nose
  • Low-grade fever (generally minimal throughout the course of the disease)
  • Mild, occasional cough
  • Apnea – a pause in breathing (in babies)
  •  
  • After 1 to 2 weeks and as the disease progresses, the traditional symptoms of pertussis may appear and include:
    • Paroxysms (fits) of many, rapid coughs followed by a high-pitched “whoop” sound
    • Vomiting (throwing up) during or after coughing fits
    • Exhaustion (very tired) after coughing fits

Prevention:

Most people who get a whooping cough vaccine do not have any serious problems with it. However, side effects can occur. Most side effects are mild, meaning they do not affect daily activities. See the DTaP and Tdap vaccine information statements to learn more about the most common side effects

References:

www.who.int/immunization/diseases/pertussis/en/

Measles:

illustration: person coughing on another person

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours in an airspacewhere the infected person coughed or sneezed.

Infected people can spread measles to others from four days before through four days after the rash appears.

Measles

Measles is an acute viral respiratory illness. It is characterized by fever and malaise, cough, coryza (catarrhal inflammation of the mucous membrane in the nose), and conjunctivitis -the three “C”s -, followed by a maculopapular rash. The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities. Of note, sometimes immunocompromised patients do not develop the rash. Measles is one of the most contagious of all infectious diseases. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area.

Prevention:

Measles can be prevented with measles-containing vaccine, which is primarily
administered as the combination measles-mumps-rubella (MMR) vaccine.

 

First dose

Second dose

Children

Age 12-15 months

Age 4-6 years

Teenagers and adults with no evidence of immunity

As soon as possible

N/A

References:

www.cdc.gov/measles/index.html

Mumps:Mumps

Mumps is a contagious disease caused by a virus. It usually involves pain, tenderness, and swelling in one or both parotid salivary glands (cheek and jaw area). Mumps spreads through saliva or mucus from the mouth, nose, or throat. An infected person can spread the virus by coughing, sneezing, or talking, sharing cups or eating utensils with others. When a person is ill with mumps, he or she should avoid contact with others from the time of diagnosis until at least 5 days after the onset of parotitis.

Prevention:

Vaccination is the best way to prevent mumps. This vaccine is included in the combination measles-mumps-rubella (MMR) and measles-mumps-rubella-varicella (MMRV) vaccines.

References:

www.who.int/immunization/diseases/mumps/en/

Rubella (German Measles):Rubella

Rubella is a contagious disease caused by a virus. Most people who get rubella usually have a mild illness, with symptoms that can include a low-grade fever, sore throat, and a rash that starts on the face and spreads to the rest of the body. Rubella can cause a miscarriage or serious birth defects in a developing baby if a woman is infected while she is pregnant. Rubella spreads when an infected person coughs or sneezes. Also, if a woman is infected with rubella while she is pregnant, she can pass it to her developing baby and cause serious harm.

Prevention:

The best protection against rubella is MMR (measles-mumps-rubella) vaccine.

References:

www.cdc.gov/rubella/about/index.html

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